The Use of Prescription Drugs and Drugs of Abuse for Neuroenhancement in Europe
Not Widespread But a Reality
Abstract
Abstract. Pharmacological neuroenhancement, defined as the misuse of prescription drugs, illicit drugs, or alcohol for the purpose of enhancing cognition, mood, or prosocial behavior, is not widespread in Europe – nevertheless, it does occur. Thus far, no drug has been proven as safe and effective for cognitive enhancement in otherwise healthy individuals. European studies have investigated the misuse of prescription and illicit stimulants to increase cognitive performance as well as the use of tranquilizers, alcohol, and cannabis to cope with stress related to work or education. Young people in educational settings report pharmacological neuroenhancement more frequently than those in other settings. Although the regular use of drugs for neuroenhancement is not common in Europe, the irregular and low-dose usage of neuroenhancers might cause adverse reactions. Previous studies have revealed that obtaining adequate amounts of sleep and using successful learning techniques effectively improve mental performance, whereas pharmacological neuroenhancement is associated with ambiguous effects. Therefore, non-substance-related alternatives should be promoted to cope with stressful situations. This paper reviews the recent research on pharmacological neuroenhancement in Europe, develops a clear definition of the substances used, and formulates recommendations for practitioners regarding how to react to requests for neuroenhancement drug prescriptions. We conclude that monitoring the future development of pharmacological neuroenhancement in Europe is important to provide effective preventive measures when required. Furthermore, substance use to cope with stress related to work or education should be studied in depth because it is likely more prevalent and dangerous than direct neuroenhancement.
References
2010). Pharmaceuticalization of society in context: Theoretical, empirical and health dimensions. Sociology, 44, 603–622. doi: 10.1177/0038038510369368
(2008). Licit and illicit use of medications for attention-deficit hyperactivity disorder in undergraduate college students. Journal of American College Health: J of ACH, 56, 601–606. doi: 10.3200/JACH.56.6.601-606
(2013). Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers. Frontiers in Neuroscience, 7, 82. doi: 10.3389/fnins.2013.00082
(2008). Nonmedical use of prescription stimulants among college students: Associations with ADHD and polydrug use. Pharmacotherapy, 28, 156–169. doi: 10.1592/phco.28.2.156.Nonmedical
(2013). Dispelling the myth of “smart drugs”: Cannabis and alcohol use problems predict nonmedical use of prescription stimulants for studying. Addictive Behaviors, 38, 1643–1650. doi: 10.1016/j.addbeh.2012.10.002
(2012). When more equals less: Overtraining inhibits perceptual learning owing to lack of wakeful consolidation. Proceedings of the Royal Society/Biological Sciences, 279, 4143–4147. doi: 10.1098/rspb.2012.1423
(2013). Illicit use of prescription stimulants in a college student sample: A theory-guided analysis. Drug and Alcohol Dependence, 132, 665–673. doi: 10.1016/j.drugalcdep. 2013.04.024
(2008). Enhancing concentration, mood and memory in healthy individuals: An empirical study of attitudes among general practitioners and the general population. Scandinavian Journal of Public Health, 36, 532–537. doi: 10.1177/1403494807087558
(2009). Illicit methylphenidate use: A review of prevalence, availability, pharmacology, and consequences. Current Drug Abuse Reviews, 2, 157–176. Retrieved from http://europepmc.org/abstract/MED/19630746
(2012). Better evidence for safety and efficacy is needed before neurologists prescribe drugs for neuroenhancement to healthy people. Neurocase, 18, 181–184. doi: 10.1080/13554794.2011.588174
(2009). Cognitive enhancement: Methods, ethics, regulatory challenges. Science and Engineering Ethics, 15, 311–341. doi: 10.1007/s11948-009-9142-5
(2004). Methylphenidate does not improve cognitive function in healthy sleep-deprived young adults. Journal of Investigative Medicine: The Official Publication of the American Federation for Clinical Research, 52, 192–201.
(2007). Neuropsychiatric effects of prescription drug abuse. Neuropsychology Review, 17, 363–380. doi: 10.1007/s11065-007-9037-7
(2012). Use of cognitive enhancement medication among northern Italian university students. Journal of Addiction Medicine, 6, 112–117. doi: 10.1097/ADM.0b013e3182479584
(2010). Achievement, attributions, self-efficacy, and goal setting by accounting undergraduates. Psychological Reports, 106, 1–11. doi: 10.2466/PR0.106.1
(2014). Battery powered thought: Enhancement of attention, learning, and memory in healthy adults using transcranial direct current stimulation. NeuroImage, 85, 895–908. doi: 10.1016/j.neuroimage.2013.07.083
(2014). Effects of methylphenidate on cognitive functions in children and adolescents with attention-deficit/hyperactivity disorder: Evidence from a systematic review and a meta-analysis. Biological Psychiatry, 76, 603–615. doi: 10.1016/j.biopsych.2013.10.005
(2009). Gesundheitsreport 2009: Analyse der Arbeitsunfähigkeitsdaten. Schwerpunktthema Doping am Arbeitsplatz
([Health Report 2009: Analysis of data on employee absence due to illness. Focus on work place doping] . Hamburg, Germany: DAK. Retrieved from http://www.dnbgf.de/fileadmin/texte/Downloads/uploads/dokumente/2009/DAK_Gesundheitsreport_2009.pdf2008). Botox for the brain: Enhancement of cognition, mood and pro-social behavior and blunting of unwanted memories. Neuroscience and Biobehavioral Reviews, 32, 760–776. doi: 10.1016/j.neubiorev.2007.12.001
(2014). Use of neuroenhancement drugs: Prevalence, frequency and use expectations in Switzerland. International Journal of Environmental Research and Public Health, 11, 3032–3045. doi: 10.3390/ijerph110303032
(2013). Randomized response estimates for the 12-month prevalence of cognitive-enhancing drug use in university students. Pharmacotherapy, 33, 44–50. doi: 10.1002/phar.1166
(2012). Judging cheaters: Is substance misuse viewed similarly in the athletic and academic domains?. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors, 26, 678–682. doi: 10.1037/a0027872
(2013). Improving students’ learning with effective learning techniques: Promising directions from cognitive and educational psychology. Psychological Science in the Public Interest, 14, 4–58. doi: 10.1177/1529100612453266
(2012). Neuroenhancement among German university students: Motives, expectations, and relationship with psychoactive lifestyle drugs. Journal of Psychoactive Drugs, 44, 418–427. doi: 10.1080/02791072.2012.736845
(2013). Caffeine as an attention enhancer: Reviewing existing assumptions. Psychopharmacology, 225, 251–274. doi: 10.1007/s00213-012-2917-4
(2013). The indirect psychological costs of cognitive enhancement. The American Journal of Bioethics: AJOB, 13, 45–47. doi: 10.1080/15265161.2013.794880
(2013). Should physicians prescribe cognitive enhancers to healthy individuals?. Canadian Medical Association Journal, 185, 1047–1050. doi: 10.1503/cmaj.121508
(2011). Non-medical use of prescription stimulants and illicit use of stimulants for cognitive enhancement in pupils and students in Germany. Pharmacopsychiatry, 44, 60–66. doi: 10.1055/s-0030-1268417
(2011). Muster des Missbrauchs von (Psycho-)Stimulanzien zum pharmakologischen Neuroenhancement bei Studierenden
([Patterns of (psycho)stimulant misuse for pharmacological neuroenhancement in students] . Suchttherapie, 12, 167–172. doi: 10.1055/s-0031-12843892010). Pharmacological neuroenhancement and brain doping: Chances and risks. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 53, 853–859. doi: 10.1007/s00103-010-1105-0
(2012). Charakteristika von Studierenden, die pharmakologisches Neuroenhancement mit Stimulanzien betreiben: Eine Pilotstudie
([Characteristics of university students using stimulants for cognitive enhancement: A pilot study] . Psychiatrische Praxis, 39, 174–180. doi: 10.1055/s-0031-12989002013). State mindfulness during meditation predicts enhanced cognitive reappraisal. Mindfulness, Advance online publication. doi: 10.1007/s12671-013-0250-6
(2014). Modafinil combined with cognitive training is associated with improved learning in healthy volunteers – a randomised controlled trial. European Neuropsychopharmacology: The Journal of the European College of Neuropsychopharmacology, 24, 529–539. doi: 10.1016/j.euroneuro.2014.01.001
(2013). The influence of exercise on cognitive abilities. Comprehensive Physiology, 3, 403–428. doi: 10.1002/cphy.c110063
(2013). Pediatric neuroenhancement: Ethical, legal, social, and neurodevelopmental implications. Neurology, 80, 1251–1260. doi: 10.1212/WNL.0b013e318289703b
(2014). Life context of pharmacological academic performance enhancement among university students – a qualitative approach. BMC Medical Ethics, 15, 23. doi: 10.1186/1472-6939-15-23
(2011). “Doctor, would you prescribe a pill to help me …?” A national survey of physicians on using medicine for human enhancement. The American Journal of Bioethics: AJOB, 11, 3–13. doi: 10.1080/15265161.2011.534957
(2014). Pharmacokinetic and pharmacodynamic effects of methylphenidate and MDMA administered alone or in combination. International Journal of Neuropsychopharmacology, 17, 371–381. doi: 10.1017/S1461145713001132
(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
(2013). Enhancement stimulants: Perceived motivational and cognitive advantages. Frontiers in Neuroscience, 7, 198. doi: 10.3389/fnins.2013.00198
(2012). Rest is not idleness: Implications of the brain’s default mode for human development and education. Perspectives on Psychological Science, 7, 352–364. doi: 10.1177/1745691612447308
(2008). Age-dependent and age-independent human memory persistence is enhanced by delayed posttraining methylphenidate administration. Proceedings of the National Academy of Sciences of the United States of America, 105, 19504–19507. doi: 10.1073/pnas.0810650105
(1998).
(What does enhancement mean? . In E. ParensEd.. Enhancing human traits: Ethical and social implications (pp. 29–48) Washington, DC: Georgetown University Press.2011). Der Bezug von Methylphenidat in der Schweiz: Nicht alarmierend – Fragen stellen sich dennoch
([Acquisition of methylphenidate in Switzerland: Not alarming – but questions must be raised] . Schweizerische Ärztezeitung, 92, 1295–1299.2008). Cognition enhancers between treating and doping the mind. Pharmacological Research, 57, 196–213. doi: 10.1016/j.phrs.2008.02.004
(2012). Methylphenidate produces selective enhancement of declarative memory consolidation in healthy volunteers. Psychopharmacology, 221, 611–619. doi: 10.1007/s00213-011-2605-9
(2010). Psychometric evaluation of a Prescription Stimulant Expectancy Questionnaire. Experimental and Clinical Psychopharmacology, 18, 375–383. doi: 10.1037/a0019347
(2011). Academic doping or Viagra for the brain? The history of recreational drug use and pharmacological enhancement can provide insight into these uses of neuropharmaceuticals. EMBO Reports, 12, 197–201. doi: 10.1038/embor.2011.15
(2012). Cognitive-enhancing substance use at German universities: Frequency, reasons and gender differences. Wiener Medizinische Wochenschrift, 162, 262–271. doi: 10.1007/s10354-012-0115-y
(2013). To dope or not to dope: Neuroenhancement with prescription drugs and drugs of abuse among Swiss university students. PLoS One, 8, e77967. doi: 10.1371/journal.pone.0077967
(2013). Neuroenhancement in Switzerland: Relevance for public health?. European Journal of Public Health, 23 Suppl. 1, 285–286. doi: 10.1093/eurpub/ckt124.120
(2014). Trends in medical use, diversion, and nonmedical use of prescription medications among college students from 2003 to 2013: Connecting the dots. Addictive Behaviors, 39, 1176–1182. doi: 10.1016/j.addbeh.2014.03.008
(2003). Sleep-dependent learning: A nap is as good as a night. Nature Neuroscience, 6, 697–698. doi: 10.1038/nn1078
(2012). Formen der Stresskompensation und Leistungssteigerung bei Studierenden
([Forms of stress compensation and performance enhancement in students] . Hannover, Germany: HIS.2013). Influence of methylphenidate treatment assumptions on cognitive function in healthy young adults in a double-blind, placebo-controlled trial. Psychology Research and Behavior Management, 6, 65–74. doi: 10.2147/PRBM.S47526
(2007). The nonmedical use of prescription ADHD medications: Results from a national Internet panel. Substance Abuse Treatment, Prevention, and Policy, 2, 32. doi: 10.1186/1747-597X-2-32
(2013). Neuroenhancement among Swiss students – a comparison of users and non-users. Pharmacopsychiatry, 47(1), 22–28. doi: 10.1055/s-0033-1358682
(2012). Neuroenhancement – perspectives of Swiss psychiatrists and general practitioners. Swiss Medical Weekly, 142, w13707. doi: 10.4414/smw.2012.13707
(2011). Smart drugs “as common as coffee”: Media hype about neuroenhancement. PLOS One, 6, e28416. doi: 10.1371/journal.pone.0028416
(2013). Australian university students’ attitudes towards the use of prescription stimulants as cognitive enhancers: Perceived patterns of use, efficacy and safety. Drug and Alcohol Review, 32, 295–302. doi: 10.1111/dar.12005
(2014). Determinants of physicians’ prescribing behaviour of methylphenidate for cognitive enhancement. Psychology, Health & Medicine, 19, 286–295. doi: 10.1080/13548506.2013.802361
(2010). Ethics of neuroenhancement: A phantom debate. BioSocieties, 5, 153–156.
(2010). Predictors of nonmedical ADHD medication use by college students. Journal of Attention Disorders, 13, 640–648. doi: 10.1177/1087054709334505
(2008). Cognitive enhancement, lifestyle choice or misuse of prescription drugs? Neuroethics, 3, 1–4. doi: 10.1007/s12152-008-9023-7
(2010). Modafinil and methylphenidate for neuroenhancement in healthy individuals: A systematic review. Pharmacological Research, 62, 187–206. doi: 10.1016/j.phrs.2010.04.002
(2010). Stimulant medication use among Flemish students: Results from an exploring secondary data analysis 1965–2005. Archives of Public Health, 67, 169–178. doi: 10.1186/0778-7367-67-4-169
(2007). Professor’s little helper. Nature, 450, 1157–1159. doi: 10.1038/4501157a
(2011). Neuroethical issues in cognitive enhancement. Journal of Psychopharmacology (Oxford, England), 25, 197–204. doi: 10.1177/0269881109106926
(2014). Evaluating the drivers of and obstacles to the willingness to use cognitive enhancement drugs: The influence of drug characteristics, social environment, and personal characteristics. Substance Abuse Treatment, Prevention, and Policy, 9, 8. doi: 10.1186/1747-597X-9-8
(2013). Cognitive test anxiety and cognitive enhancement: The influence of students’ worries on their use of performance-enhancing drugs. Substance Use & Misuse, 48, 220–232. doi: 10.3109/10826084.2012.751426
(2011). Neuroenhancement in a medicated generation: Overlooked uses of cognitive stimulants. AJOB Neuroscience, 2, 28–30. doi: 10.1080/21507740.2011.620069
(2013). Prevalence and association of perceived stress, substance use and behavioral addictions: A cross-sectional study among university students in France, 2009–2011. BMC Public Health, 13, 724. doi: 10.1186/1471-2458-13-724
(2012). Pills for the Psyche. Neuro-enhancement among psychiatrists, trainees and other doctors in the Netherlands – an explanatory study. Tijdschrift Voor Psychiatrie, 54, 371–376.
(2012). Mood-Enhancement mittels Antidepressiva. Ethische Aspekte zu Authentizität und Gerechtigkeit
([Mood enhancement by means of antidepressants. Ethical aspects of authenticity and justice] . Bioethica Forum, 5, 158–163.2013). Popping smart pills: Prescription stimulant misuse by university and college students in Flanders. European Journal of Public Health, 23 (Suppl. 1), 122. doi: 10.1093/eurpub/ckt126.300
(2013). Just how cognitive is “Cognitive Enhancement”? On the significance of emotions in university students’ experiences with study drugs. AJOB Neuroscience, 4, 4–12. doi: 10.1080/21507740.2012.740141
(2014). Generating genius: How an Alzheimer’s drug became considered a “cognitive enhancer” for healthy individuals. BMC Medical Ethics, 15, 37. doi: 10.1186/1472-6939-15-37
(2009). Nonmedical prescription stimulant use among a sample of college students: Relationship with psychological variables. Journal of Attention Disorders, 13, 284–296. doi: 10.1177/1087054709342212
(2008). Misuse and diversion of stimulants prescribed for ADHD: A systematic review of the literature. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 21–31. doi: 10.1097/chi.0b013e31815a56f1
(2013). Subjective stressors in school and their relation to neuroenhancement: A behavioral perspective on students’ everyday life “doping”. Substance Abuse Treatment, Prevention, and Policy, 8, 23. doi: 10.1186/1747-597X-8-23
(