In years gone by many a student has drunk countless cups of coffee and caffeine loaded drinks to pep them up through the night so that they can finish assignments and cram for exams. The days of Pro-Plus, Red Bull and caffeine overload may still be here, but there is a new trend—the ‘smart’ drug.

In many walks of life and many professions, pharmaceutical drugs have been taken to enhance performance. Violinists, pianists and artists may take beta blockers, and snooker players in the past did the same things. We’re all au fait with the trials and tribulations of performance enhancing drugs, which have been taken by athletes across the globe, from anabolic steroids to erythropoietin, to pseudoephedrine. The list is incredibly long. And so it seems that now the ‘POM’ has made it into University and professional life. But what is a smart drug?

Smart drugs come in many forms and start from general food-stuffs, to herbal medicines, to prescription drugs, but can be loosely defined as “chemical substances that enhance cognition and memory or facilitate learning.” And the truth is that many people take lots of different smart drugs, possibly without even thinking that they are taking what can be perceived as a chemical substance. But it is possible to classify them, so they go like this:

Racetams: Includes a bunch of drugs, which can make you think with more clarity and increase verbal learning. Piracetam is probably the leading drug in this class accompanied by various others and is legally available in the U.S. and many other countries but is only available on prescription in the UK where it is used for monoclonus. Interestingly it depletes choline in the brain and is often taken with a choline substitute in order to prevent the headaches that the depletion of choline can cause.

Stimulants: This includes your standard caffeine, nicotine and more recently the new and soon to be discussed Modafinil. They all increase alertness, increase wakefulness and increase functional IQ but without major side effects, which can be felt without agents. This is a strange class of additives as although the likes of caffeine are available in food, Modafinil is a prescription medicine for narcolepsy.

Adaptogens: These are plant-derived substances and effect metabolic processes, and yet are probably not perceived as drugs at all. This class of smart drugs includes Ginseng, Kava Kava, Passion Flower, St. John’s Wort, and Gotu Kola. And although they are all generally available without any restriction there has been much discussion about the safety of these compounds.

Cholinergics: This includes drugs such as Sulbutiamine, which is used within prescriptions for Chronic Fatigue Syndrome but which has been shown to increase concentration and improve memory.

Serotonergics: These compounds affect 5-hydroxy-tryptamine (5-HT) regulation, which is well documented and recognized for affecting mood, memory, sleep and appetite and which the regulation of the neurotransmitter is the mechanism of many anti-depressant drugs. Selective serotonin re-uptake inhibitors (SSRIs) are prescribed routinely for depression and anxiety and some are available OTC depending on country.

Dopaminergics: These drugs affect the presence of dopamine in the brain, which can affect sense of wellbeing, mood, and behavior. L-Tyrosine is an amino acid, which has been shown to increase concentration, delay fatigue, assist in stress management and enhance mood. Yohimbine, an indole alkaloid derived from the bark of the African yohimbe tree also falls into this group. It’s used in traditional medicine and is a peripheral dilator, which has been investigated for use in organic erectile dysfunction.

Metabolic functions smart drugs: These are substances, which enhance the body’s metabolic functions. Probably the best known is creatine, which is one of the banned substances for performing athletes due to its documented enhancing capabilities as well as Ginkgo Biloba traditionally used in Chinese medicine.

So what’s new?
Many of these drugs and substances are taken without any knowledge of side effects and without any evidence of efficacy, but recently researchers at Harvard and Oxford Universities have published the first review on Modafinil in which they imply that this is the first ‘safe’ smart drug. Modafinil is a POM medicine marketed under the trade name Provigil in the U.S. and UK. It’s indicated for narcolepsy and conditions that relate to fatigue such as sleep apnoea.

However, it also seems to now have become the drug of choice within academics and even military institutions whereby it’s used in combat situations and is approved in the U.S. Air force as well as the French Foreign Legion. Modafinil is documented as enhancing alertness, improving problem-solving capability and even making tasks more enjoyable. The researchers in the academic institutions have now stated that long-term use seems to be safe with limited side effects and lack of addictive qualities.

The researchers reviewed 24 recent modafinil studies and drew to the conclusion that the drug has “many positive effects in healthy people.” It improved memory, learning capability and enhanced attention capacity. It is also available to buy on the internet without any great hassle. Albeit at a price! However having limited or no side effects makes this new market player much more attractive compared to the likes of the ADHD drug Ritalin, which has been investigated for performance enhancement but carries lots of undesirable adverse effects.

But what about the ethics associated with these so-called smart drugs? Although published research into the psychological and perceived physical responses to these substances is limited, it is clear that they can have a positive effect on performance and fatigue management. But where does it end? One-in-four Oxbridge wanna-be’s are reported to have taken modafinil, and while it’s not going to change your intelligence level as such, enhancing your concentration capacity in exams and increasing output means that it simply isn’t a level playing field—and now that it’s openly been reported as safe what’s to stop kids taking the pills to better their grades?

The BBC reported recently that a Cambridge-based research study concluded that for each hour Year 10 pupils spent on screen-time over the average 4 hours a day they dropped on average over 9 points in grades at GCSE. For each hour extra teenagers spent either reading or doing homework they achieved substantially better grades, so hard work really does pay off. So is it ethical to just pop a pill and get the grades to get into the University you want?

Is there any difference between the Olympic athlete who wants to be the best in the world and the intern who wants to get to the top of the corporate ladder? And where does it stop? And how do we control it?

Does Pharma have a social responsibility to ethically limit the use of its’ drugs especially when used out of license? And yet government institutions may argue that they need these substances to enhance security and protect their nations, and the work force may say that they simply need a crutch to get the results that are demanded on the ever-moving treadmill of their career. Maybe it will just come down to moral values and the sense of self-achievement and pride, which no drug can ever give—and knowing you did it yourself.