Imagine having access to a pill that enhances your performance, working memory, and overall cognitive ability. With effects like that, there seems to be a strong appeal in possessing a drug that can provide all of those qualities. Well, you can, if you have a prescription for mixed amphetamine salts (MAS), a drug commonly referred to by the brand name, Adderall. What if you are not prescribed a drug like Adderall but want the effects it could give you? According to the National Institute on Drug Abuse, the use of nonmedical, or not prescribed, drugs have not only increased but also doubled between the years of 2008 and 2013 (“Monitoring the Future”, 2015). In theory, these cognitive enhancing drugs are alluring, but when they are combined with “healthy” individuals that do not need the prescription, it can lead to dangerous outcomes. I am not in favor of nonmedical neurological enhancements as it can be deemed unethical, lead to addiction, and result in long-term health issues. There should be stricter drug policies to avoid abuse of MAS and other cognitive enhancers (CE).
Diagnosing a person with Attention Deficit Hyperactivity Disorder (ADHD) has become more prevalent within the last decade. According to the Center for Disease and Control (CDC), there has been a 5% increase per year between 2003 and 2011 in ADHD diagnosis, resulting in 6.4 million children with ADHD as of 2011 (“Data and Statistics”, 2015). With around 83 million children in 2011, that is 1 in every 7 diagnosed with ADHD (“United States Census”, n.d.). Although this disorder is becoming more common, it still should not be taken lightly. People with ADHD need the proper medications to function without constantly diverting from the task at hand. It is unfair to those affected with this disorder to miss their day’s dose because another person wanted to use it as a study drug and “pass their finals” or “stay up longer to study”.
In an experiment conducted by Musain and Mehta (2011), there are multiple findings when medical and nonmedical usage of CE is compared. People with ADHD have lower spans in working memory (WM) and when given methylphenidate (a drug similar to Adderall), there was a greater effectiveness in WM in comparison to “healthy” individuals with higher spans of WM. There were also some individuals that have such high spans of WM that adverse effects resulted, exhibiting impairment in performance (Musain & Mehta, 2011). Essentially, those that do not have the prescription generally do not need it because the gain in cognitive function is miniscule. If there is no improvement in function in a healthy person, the person could experience a placebo effect and believe that the pill will enhance cognition (Ilieva & Farah, 2013). In a New York Times article by Alan Schwarz (2013), an interviewee said a single pill could range from $5 to $10, depending on dose. As a broke college student, I understand there is temptation to make a quick buck but no drug transaction is ever ethical and paying that much per prescription drug pill does not seem worth it when the neurological benefit is so small. Also, the prescription drugs fall under the category of psychostimulants, drugs that can be addictive. It is not ethical to put a person at risk of drug abuse for a couple dollars just because you have a couple of extra pills in your prescription. Nonmedical use of MAS is unethical, as it manipulates a drug intended for therapy for a greater neurological enhancement.
As mentioned before, psychostimulants can be addictive. Other psychostimulants like cocaine or amphetamines are classified as addictive because they stimulate the reward pathway, known as the mesoaccumbal pathway, through the neurotransmitter called dopamine. Cognitive enhancers work through the same pathway; therefore, medical amphetamine can express the gene for addiction. Steiner and Waes (2013) explain how this was determined about cognitive enhancers by analyzing different experiments. There are certain animal models that can gauge how addictive a substance is. Two models that were used were conditioned place preference (CPP) and self-administration (SA) of the drug. In CPP, the rats chose the side that contained the methylphenidate. With the latter model, the rats would voluntarily self-administer the methylphenidate. Both outcomes are synonymous with behaviors of cocaine addiction, which provide enough evidence that cognitive enhancers are potentially addictive (Steiner & Waes, 2013). If a healthy person that barely profits from a CE is continuously using it to gain that fraction of neurological function, and could develop an addiction to the amphetamine, it seems like a lose-lose situation.
ADHD is a relatively new disorder, first defined in the DSM-IV-TR in 2000 (Lange et al., 2010). There were certainly people with ADHD before 2000 that were not diagnosed but proper guidelines were constituted to classify ADHD as a disorder. Within the last 15 years, not much research has been done on this disorder and when there were results, it was confusing to interpret because there was not enough data or the treatment were too inconsistent amongst subjects. An article regarding a conglomeration of experiments and finding summaries by Smith & Farah (2011) perfectly delineates the lack of knowledge regarding ADHD treatment. 15 years is not a long-enough timeframe to conduct long-term studies in the effects of the drugs. In 50 or 60 years, we might find out that there are no long-term side effects from the amphetamines, or we can discover a link between methylphenidate and brain atrophy. With unknown side effects, I do not favor nonmedical distribution of these study drugs. Also, without medical supervision, the person partaking in nonmedical use could mix different drugs that could be detrimental to his or her health and/or overdose and experience symptoms like anorexia.
A majority of nonmedical use of prescription stimulants takes place in college settings, with reasons to either get ahead to remain competitive or to cram for an exam (Schwarz, 2013). This could imply stressful students looking for a quick way to get more work done in less time. Mixing stimulants with cortisol, a chemical released due to stress, could be quite dangerous. Hamidovic et al. (2010) conducted an experiment to compare the effects of cortisol and effects of a stimulant like amphetamine. The results showed that cortisol effects are similar to that of stimulant drug (Hamidovic et al., 2010). This insinuates that stressful students emitting cortisol taking stimulant drugs like Adderall are amplifying the effects of acute stress, which could be detrimental to long-term health. Unless the person is prescribed the medication, there are too many complications, like patient history or unethical standards, involved to use these drugs.
As a college student, I witness too many students using Adderall or similar substances that are not prescribed that are unaware of the possible problems that could arise when using the psychostimulants. In Attention-Deficit Drugs Face New Campus Rules, college campuses are enforcing stricter rules when using prescription drugs (i.e., signing a contract listing what one can and cannot do) and doctors are making the process to diagnose the disorder and to obtain the drug more difficult efforts (Shwarz, 2013) and I support these efforts being implemented. More campuses should follow suit because the universities are meant to enhance student learning, not medically enhance cognitive function. In Brain Enhancement is Wrong, Right, a New York Times article by Benedict Carey (2008), Carey questions about potential problems with using these drugs. “What happens if you’re in a fast-paced surgical situation and they’re not available?” These are thoughts one should consider when offered these cognitive enhancers. Until more is discovered about these prescription stimulants, there should be more regulation in place as a precaution to our health.
References
Carey, B. (2008, March 08). Brain Enhancement Is Wrong, Right? Retrieved from http://www.nytimes.com/2008/03/09/weekinreview/09carey.html?pagewanted=1&_r=0&em
Data & Statistics. (2015, July 08). Retrieved from http://www.cdc.gov/ncbddd/adhd/data.html
Hamidovic, A., Childs, E., Conrad, M., King, A., & Wit, H. D. (2010). Stress-induced changes in mood and cortisol release predict mood effects of amphetamine. Drug and Alcohol Dependence, 109(1-3), 175-180. doi:10.1016/j.drugalcdep.2009.12.029
Husain, M., & Mehta, M. A. (2011). Cognitive enhancement by drugs in health and disease. Trends in Cognitive Sciences, 15(1), 28-36. doi:10.1016/j.tics.2010.11.002
Ilieva, I., Boland, J., & Farah, M. J. (2013). Objective and subjective cognitive enhancing effects of mixed amphetamine salts in healthy people. Neuropharmacology, 64, 496-505. doi:10.1016/j.neuropharm.2012.07.021
Lange, K. W., Reichl, S., Lange, K. M., Tucha, L., & Tucha, O. (2010). The History of Attention Deficit Disorder. ADHD Attention Deficit and Hyperactivity Disorders, 2(4), 241-255. doi:10.4324/9780203841723
Monitoring the Future 2013 Survey Results: College and Adults. (2015, April). Retrieved from http://www.drugabuse.gov/related-topics/trends-statistics/infographics/monitering-future-2013-survey-results-college-adults
Schwarz, A. (2013, April 30). Attention-Deficit Drugs Face New Campus Rules. Retrieved from http://www.nytimes.com/2013/05/01/us/colleges-tackle-illicit-use-of-adhd-pills.html?_r=0
Smith, M. E., & Farah, M. J. (2011). Are prescription stimulants “smart pills”? The epidemiology and cognitive neuroscience of prescription stimulant use by normal healthy individuals. Psychological Bulletin, 137(5), 717-741. doi:10.1037/a0023825
Steiner, H., & Waes, V. V. (2013). Addiction-related gene regulation: Risks of exposure to cognitive enhancers vs. other psychostimulants. Progress in Neurobiology, 100, 60-80. doi:10.1016/j.pneurobio.2012.10.001
United States Census Bureau. (n.d.). Retrieved from https://www.census.gov/population/age/data/2011comp.html
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