Cognitive enhancement and recreational drugs

In a commentary published yesterday in the journal Nature“Towards responsible use of cognitive-enhancing drugs by the healthy” – Stanford University law scholar Hank Greely and colleagues working in ethics, medicine and neuroscience argue that the use of certain stimulants by healthy people is of benefit to them as individuals, and to society. The authors say that new thinking by physicians, teachers and others can maximise the benefits and minimise the harm caused by these so-called ‘smart drugs’.

The drugs in question include the prescription medicines Adderall, a mixed amphetamine compound, Ritalin and Modafinil. Adderall and Ritalin are used to treat attention deficit hyperactivity disorder in children, and Modafinil is an approved treatment for various sleep disorders.

There is evidence to show that college students are using these drugs illicitly to improve concentration and focus attention in academic activity. One survey has estimated that nearly 7% of students in US universities have used such prescription-only stimulants, and that on certain campuses up to 25% had taken them in the past year.

There is considerable interest in the physiological effects of smart drugs, and rightly so given the poor reputation of amphetamines among health professionals and former abusers. Of all the widely-used controlled drugs, amphetamines are seen by many as having the most damaging physical effects. Yet in the UK amphetamines have a lower legal classification than heroin, which illustrates the irrationality of current drug policy.

Can cognitive-enhancing stimulants really improve mental faculty? Yes, according to a growing body of evidence. Can they do so without harm? The evidence says that they can be used safely, though there are a number of caveats attached to this. One of the more serious criticisms of smart drugs is that their use will lead to a social divide in which academic success depends on the ability to procure expensive pharmaceuticals in an open market.

Greely and his co-authors note that human ingenuity has given us the ability to enhance our brains through technologies such as written language, printing and the Internet. Smart drugs should, they say, be viewed in the same general category as education, healthy living and information technology – i.e., as ways of self-improvement.

One must question the degree of personal effort involved in any self-improvement technique in relation to the reward. For example, following a healthy diet can require a considerable effort for some, while popping pills does not. But, say the Nature commentary authors, “cognitive-enhancing drugs seem morally equivalent to other, more familiar, enhancements.”.

As someone who feels strongly that the state has no business proscribing the possession and use of recreational drugs, I am sympathetic to the argument presented by Greely and his colleagues, even if I do have a few concerns about the wisdom of using smart drugs on a long-term basis to improve intellectual ability. What strikes me is that their argument can also be applied to narcotic and psychedelic drugs. Especially the latter, among which I include cannabis.

Use does not necessarily imply abuse, and it should be for the individual, together with family, friends and GP, to judge whether the use of certain substances is beneficial or harmful. One cannot legitimately differentiate on a moral level between smart drugs, narcotics and psychedelics based on the lack of ‘high’ associated with cognitive-enhancing stimulants. After all, the sense of personal reward is a subjective thing. We do not ban jogging on the grounds that it stimulates the body’s production of opiate-like endorphins, and the responsible use of alcohol is positively encouraged in many communities.

The Nature article is a valuable contribution to the debate. What we should be discussing next is community regulation of non-medical drugs of all kinds, ‘smart’ ones included.