Use of Methylphenidate Analogues as Cognitive Enhancers: The Prelude to Cosmetic Neurology and an Ethical Issue

Zaami, Simona; Tagliabracci, Adriano; Berretta, Paolo; Busardò, Francesco Paolo; Marinelli, Enrico

doi:10.3389/fpsyt.2019.01006

Cited by 10 publications

(6 citation statements)

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“…Ethical issues raised by cognitive enhancement have been debated for over a decade ( 98 ), and many experts have identified multiple ethical concerns including risks to mental and health safety ( 99 ). While CEs hold significant benefits in improving cognitive impairments in several neuropsychiatric disorders such as Alzheimer’s disease ( 7 – 9 ) and schizophrenia ( 100 ), the use of nootropics by healthy individuals clearly poses ethical, clinical, and legal issues, as well as the need to develop a practical policy framework.…”

Section: Discussionmentioning

confidence: 99%

The Psychonauts’ World of Cognitive Enhancers

et al. 2020

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Background: There is growing availability of novel psychoactive substances (NPS), including cognitive enhancers (CEs) which can be used in the treatment of certain mental health disorders. While treating cognitive deficit symptoms in neuropsychiatric or neurodegenerative disorders using CEs might have significant benefits for patients, the increasing recreational use of these substances by healthy individuals raises many clinical, medico-legal, and ethical issues. Moreover, it has become very challenging for clinicians to keep up-to-date with CEs currently available as comprehensive official lists do not exist. Methods: Using a web crawler (NPSfinder ®), the present study aimed at assessing psychonaut fora/platforms to better understand the online situation regarding CEs. We compared NPSfinder ® entries with those from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and from the United Nations Office on Drugs and Crime (UNODC) NPS databases up to spring 2019. Any substance that was identified by NPSfinder ® was considered a CE if it was either described as having nootropic abilities by psychonauts or if it was listed among the known CEs by Froestl and colleagues. Results: A total of 142 unique CEs were identified by NPSfinder ®. They were divided into 10 categories, including plants/herbs/products (29%), prescribed drugs (17%), image and performance enhancing drugs (IPEDs) (15%), psychostimulants (15%), miscellaneous (8%), Phenethylamines (6%), GABAergic drugs (5%), cannabimimetic (4%), tryptamines derivatives (0.5%), and piperazine derivatives (0.5%). A total of 105 chemically different substances were uniquely identified by NPSfinder ®. Only one CE was uniquely identified by the EMCDDA; no CE was uniquely identified by the UNODC. Conclusions: These results show that NPSfinder ® is helpful as part of an Early Warning System, which could update clinicians with the growing numbers and types of nootropics in the increasingly difficult-to-follow internet world. Improving clinicians' knowledge of NPS could promote more effective prevention and harm reduction measures in clinical settings.

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Section: Discussionmentioning

confidence: 99%

The Psychonauts’ World of Cognitive Enhancers

et al. 2020

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“…Based on the findings from a recent systematic review [ 6 ], 9 drugs/substances (modafinil, amphetamines mixtures, methylphenidate, pyridoxine/vitamin B6, super strength caffeine pills, guarana, piracetam, vinpocetine, cobalamin/vitamin B12) were included in the study. These drugs/substances have proved to be most popular among university students and frequently mentioned on the web as well [ 30 ].…”

Section: Methodsmentioning

confidence: 99%

Assessing prevalence, knowledge and use of cognitive enhancers among university students in the United Arab Emirates: A quantitative study

et al. 2022

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Background Cognitive enhancers (CE) are often used to improve memory, alertness and cognitive capacity. These products are commercially and pharmaceutically available. Due to high academic pressure, university students are at risk of CE misuse. However, data regarding this issue are limited, especially in the United Arab Emirates (UAE). Aims To assess the prevalence of CE intake; evaluate students’ knowledge of these substances; and identify student characteristics associated with CE usage. Method A cross sectional study based on a validated online survey that was distributed using university-licensed software (Qualtrics) as a direct web link via email and social media to all Medical, Pharmacy, Dentistry, Nursing and Engineering students enrolled in six UAE universities. Associations between student characteristics and CE use were investigated using the chi-squared test and multiple logistic regression. Reasons for CE use, temporal patterns of use, details regarding purchase and types of CE used were compared by gender. Results One quarter of students had used CEs. There was a clear difference between users and non-users in terms of gender (p<0.001). CE users were disproportionately represented by students from either UAE or other Arab countries (p<0.001), and by students of Medicine, followed by Pharmacy, Dentistry, and Engineering (p<0.001). CE use increased with year of study, reaching the highest level in the fourth year (p<0.001), which for most programmes is the final year. Modafinil was self-administered, especially in males, for concentration and alertness; B12 was typically taken by female students for academic performance and concentration; and high-dosage caffeine compounds were ingested to improve alertness levels. Use of the internet for both obtaining information and purchasing CEs was frequently reported. Multiple logistic regression analysis showed that gender, nationality, and year of study were associated with CE use among UAE university students. Conclusions Universities need to address the prevalence of CE use amongst their students by providing effective support programs.

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“…Medical debate [ 21 , 132 ] has largely focused on the CEs’ potential to help those who are cognitively impaired. Hence, it is here suggested that CEs’ use by university students, seems to raise the issue of “cosmetic” neuropsychopharmacology [ 133 , 134 ].…”

Section: Discussionmentioning

confidence: 99%

The Use and Impact of Cognitive Enhancers among University Students: A Systematic Review

et al. 2021

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Introduction: Cognitive enhancers (CEs), also known as “smart drugs”, “study aids” or “nootropics” are a cause of concern. Recent research studies investigated the use of CEs being taken as study aids by university students. This manuscript provides an overview of popular CEs, focusing on a range of drugs/substances (e.g., prescription CEs including amphetamine salt mixtures, methylphenidate, modafinil and piracetam; and non-prescription CEs including caffeine, cobalamin (vitamin B12), guarana, pyridoxine (vitamin B6) and vinpocetine) that have emerged as being misused. The diverted non-prescription use of these molecules and the related potential for dependence and/or addiction is being reported. It has been demonstrated that healthy students (i.e., those without any diagnosed mental disorders) are increasingly using drugs such as methylphenidate, a mixture of dextroamphetamine/amphetamine, and modafinil, for the purpose of increasing their alertness, concentration or memory. Aim: To investigate the level of knowledge, perception and impact of the use of a range of CEs within Higher Education Institutions. Methodology: A systematic review was conducted in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Whilst 1400 studies were identified within this study through a variety of electronic databases (e.g., 520 through PubMed, 490 through Science Direct and 390 through Scopus), 48 papers were deemed relevant and were included in this review. Results: The most popular molecules identified here included the stimulant CEs, e.g., methylphenidate, modafinil, amphetamine salt mixtures and caffeine-related compounds; stimulant CEs’ intake was more prevalent among males than females; drugs were largely obtained from friends and family, as well as via the Internet. It is therefore suggested that CEs are increasingly being used among healthy individuals, mainly students without any diagnosed cognitive disorders, to increase their alertness, concentration, or memory, in the belief that these CEs will improve their performance during examinations or when studying. The impact of stimulant CEs may include tolerance, dependence and/or somatic (e.g., cardiovascular; neurological) complications. Discussion: The availability of CEs for non-medical indications in different countries is influenced by a range of factors including legal, social and ethical factors. Considering the risk factors and motivations that encourage university students to use CE drugs, it is essential to raise awareness about CE-related harms, counteract myths regarding “safe” CE use and address cognitive enhancement in an early stage during education as a preventative public health measure.

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Use of Methylphenidate Analogues as Cognitive Enhancers: The Prelude to Cosmetic Neurology and an Ethical Issue

Cited by 10 publications

References 10 publications

The Psychonauts’ World of Cognitive Enhancers

The Psychonauts’ World of Cognitive Enhancers

Assessing prevalence, knowledge and use of cognitive enhancers among university students in the United Arab Emirates: A quantitative study

The Use and Impact of Cognitive Enhancers among University Students: A Systematic Review

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