​The use of cognitive enhancers in students, doctors and the military

Our report gives more information on cognitive enhancement, the prescribed use of pharmacological cognitive enhancers, use by healthy individuals and the legal aspects.
Location: UK
Audience: GPs Occupational health doctors
Updated: Tuesday 22 October 2019
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​Cognitive enhancement or neuro enhancement is the use by individuals of traditional or modern technologies to strengthen cognitive abilities. Education and physical exercise are two well-established cognition enhancers and there is growing interest in other factors such as diet, sleep and social interaction.

 

Pharmacological cognitive enhancers

Pharmacological cognitive enhancers are available and licensed to improve cognitive functioning in those suffering from specific medical disorders such as ADHD, dementia and narcolepsy.

Usage in healthy individuals

There is growing evidence that healthy individuals use pharmacological cognitive enhancers without a prescription for non-medical purposes.

Media reports claim that they are used widely by students in the USA to aid memory and concentration. They can be readily accessed from fellow students who are prescribed it or can be purchased online easily without a prescription, often from overseas.

In healthy individuals and in many patient groups, the overall effects of pharmacological cognitive enhancers seem to be modest. However, there is evidence that there might be significant effects in subgroups, such as those whose baseline performance is poorest or in individuals with a particular genotype.

Current research suggests that they may impair people who are already at the optimum level of cognitive function (healthy people). There may be unwanted side effects from taking these drugs which may be tolerated less well by healthy individuals compared to their use for treating illness.

​Healthy individuals who wish to protect or enhance their cognitive powers are advised to avoid pharmacological cognitive enhancers and instead focus on leading a healthy lifestyle. This includes being physically, mentally and socially active, eating a healthy diet, drinking alcohol only in moderation and maintaining good sleeping habits.

 

Practice-based recommendations

At first glance the issues arising from the use of pharmacological cognitive enhancers by those in work seem relevant to just a few practising occupational physicians. However, this guidance describes the use of cognitive enhancers in students, doctors and the military.

Their dubious benefits might also seem attractive to others working shifts or in safety critical roles such as transport, healthcare, emergency services and utilities to improve focus, wakefulness and performance when fatigued.

Graduate recruits may have a history of use through their student years or at exam time and may continue use when entering the world of work and, possibly, recommend them to others.

In England prescriptions for stimulants nearly doubled from 1998 – 2004. Therefore it is likely that physicians who prescribe pharmacological cognitive enhancers will be called upon to provide information and guidance on workplace implications. 

Occupational physicians and others who care for patients at work should:

  1. Be aware that a proportion of the workforce may be prescribed pharmacological cognitive enhancers for specific medical conditions, such as ADHD and narcolepsy. They may require informed occupational health guidance and assessment of fitness to work.
  2. Understand the law and regulations relating to human medicines in order to advise employees and employers accordingly.
  3. Be aware of the licensed indications for pharmacological cognitive enhancers, their benefits, potential side effects, drug interactions and their impact on the ability of patients to work safely.
  4. Be aware that pharmacological cognitive enhancers are increasingly being used by healthy people and can be bought (illegally) over the internet.
  5. Consider routinely asking about the use of pharmacological cognitive enhancers in patients who are students or in social groups likely to use such drugs.
  6. Be able to advise employees and managers of the risks of misuse and ensure employees have easy access to information about the advantages and dangers of using pharmacological cognitive enhancers.
  7. Be able to advise employees and managers of other risk-free methods of enhancing performance eg education, exercise, diet, stress management techniques and the avoidance of excessive amounts of alcohol.
  8. Be able to advise on designing shift work schedules to minimise circadian disruption, sleepiness and fatigue.
  9. Explore with employees who request information about pharmacological cognitive enhancers the reason for their request and discuss the indicated medical uses for employee or patients, including:
  • The specific indications for use, such as ADHD, dementia and narcolepsy.
  • The legal position on using the drugs without clinical indication by healthy individuals.
  • The uncertain long-term risks to healthy individuals.
  • The fact that the known benefits are not necessarily long-lasting.
  • That high cognitively performing individuals, and those with higher IQs, are unlikely to derive any benefit.
  • Usage may be associated with a negative effect on self-control and may induce overconfidence.
  • Purchase of any drugs over the internet can result in substances of dubious quality.