Smart Drugs: What's the deal?

07 November 2017

Interview with

Professor Barbara Sahakian, University of Cambridge

There are many lengths that people go to in order to improve their performance in the workplace, and increasingly there amongst them are reports of ‘smart drugs’ being taken at work, but what are they and who is taking them? Chris Smith heard from Barbara Sahakian from the University of Cambridge where she studies these agents and how they work...

Barbara -  They’re cognitive enhancing drugs, so they improve the focusing of your attention and concentration, or maybe your memory, or maybe your planning problem solving. All the different forms of cognitive function that we have. In America, people frequently use adderall (amphetamine salts). In the UK and Europe, it tends to be more methylphenidate which is Ritalin or Modafinil.

Georgia - We actually put a call out for people’s experiences with smart drugs and were surprised by the number of responses we got. This one came to us from someone who works in a tech startup in London and this is what she wrote to us…

My current regime is that I will take half a tablet of Modafinil at around 8am once every two or three weeks as needed, and then I will go through phases of taking twelve micrograms of LSD every three days.
For me, Modafinil lowers my activation threshold, which means all those jobs I’ve been putting off because of doubt or anxiety become much easier.
The night before a planned Modafinil day I will write
ato do list of these kind of tasks, along with any menial work I just need to plough through. It will start to work after about 20 minutes and I will feel an active focus and interest in what I am doing, without the slightest desire to procrastinate. I find myself irritated by needing to go to the bathroom and break my flow.
Sometimes I might accidentally get sent down the wrong path and find myself spending an hour tidying my desktop and document files, which is why
theto do list is so important to keep on track. By early afternoon I’ll noticeably begin to run out of steam and develop a minor headache in the front of my skull. Focus will fade, and by around 3pm I’ll find it difficult to work. It  makes the day shorter and more intense, often achieving a huge bundle of things that have been mounting in a pile of procrastination.
However, you definitely feel like you’ve been on a drug, like a supercharged coffee followed by a daytime hangover. That feeling,
ofI’ve been ‘on’ a substance and made a trade-off for the instant problem fix, means that Modafinil isn’t something I do often or view in a particularly positive light.
Microdosing LSD is different. I’ll feel a general sense of positivity towards my colleagues and begin to see problems from their perspective, even when we’ve disagreed in the past. I’ll be focused on my work, and again feel less anxiety about difficult issues, but without that adrenalised focus of modafinil.

Chris - Barbara, am I alone in feeling mildly alarmed by hearing that?

Barbara - Well it is surprising that so many people are using these drugs but, actually, the two reports accord quite well. In our studies where we’ve looked at cognitive enhancing effects, we’ve found that the 200mg dose is most successful and that’s what one of the people commented on using. They also commented on using it “to get into the flow” to actually get focused and also with tasks often that they’re trying to avoid, or they don’t find very enjoyable, or they’ve been putting off.

We’ve shown in our studies that are double-blind placebo controlled that when we ask people to rate say how interesting they found doing a test, that under placebo the test is okay, but under modafinil they rated it as really pleasurable or enjoyable. So, somehow, it makes these tasks seem a lot easier to get through that you’ve been putting off for some reason.

Chris - You’ve been doing these studies for a long time where you put people in brain scanners, put them on these chemicals, and see what changes in their brains when they’re on the chemical and doing a task compared with when they’re not. So what does happen when you take a drug like ritalin or modafinil?

Barbara - For ritalin, what we found was that if they’re doing a working memory task, which is the type of thing we use all the time for what we call higher cognitive function. So planning, problem solving, all of that will have a component which is what we call “working memory” where you’ve got some things in your memory space and then you get rid of them when you don’t need them any more. What we found was that not only on ritalin, in healthy people, do they have a better performance than those people on placebo, but also the brain doesn’t need to act as strongly so there’s more efficacy in the brain activation, but they have a better performance. It seems that your brain doesn’t have to work as hard, but you have a better performance.

I did a study with Lord Ara Darzi at Imperial College, because he was concerned about his surgeons taking too much coffee (caffeine) at night to stay awake and alert. Of course then, you can get hand tremor which is a common side effect of taking caffeine and so he wanted to know whether the surgeons would do better under modafinil. So we sleep deprived doctors and then we gave them modafinil, a placebo in a double-blind placebo controlled study. And we find that the doctors on modafinil who were sleep deprived actually had better cognitive function in terms of their ability to be cognitively flexible when solving problems, so they could switch between problem solving very quickly. We also found that they were less impulsive, so it seems to have these benefits as well.

But it is worrying, as you say, because we don’t know the long term consequences of using these drugs, so there are not long term safety and efficacy studies in healthy people with these drugs. Also, a lot of people are buying it over the internet and you don’t really know what you’re getting.

Chris - I know you’ve said that we don’t actually know what the long term effects are yet. But could one envisage a situation where if you take these chemicals and they enable you to “burn the candle at both ends,” we know that robbing yourself of good restful sleep is is a risk factor for say Alzheimer's disease, do you think that we might encourage people to put themselves at increased risk of things like Alzheimer’s because they adopt a higher risk lifestyle?

Barbara - That’s a very interesting point that you make. And I often worry about students who are taking these drugs and they’re usually cramming for exams because they haven’t done the work consistently. What they do sometimes with ritalin, they might take a tablet and then, as it’s wearing off, take another tablet and then, of course, they don’t sleep at night. We consolidate our memories in our sleep and also we need  that obviously for rest as well. So it’s counterproductive really because you’re not consolidating what your were trying to learn during the day.

I think we do need to put this into perspective and I often say will people in the future use these drugs to have a better work/life balance and to get their work done, and enjoy themselves and go out and exercise and things like that. Or will they just work longer because they can work longer so they just get into a 24/7 cycle.

Chris - Is it habit forming because the initial contributor we heard from said “I did it a certain way because I didn’t want to become dependent”  -are all these drugs habit forming?

Barbara - So far, for modafinil, nobody's demonstrated any abuse potential. But we do know that classic stimulants like amphetamine and the methylphenidate do have potential for abuse, and so there could be a physical aspect to it. But with modafinil, it might be that you become psychologically wanting to use it all the time because it worked for you on one occasion so now you want to try it on another, but it doesn’t seem to have abuse potential.

Chris - You’ve surveyed this, how many people in your surveys in circles like silicon valley and academics are using these agents?

Barbara - We don’t really know about the silicon valley, but what we do know is the surveys they’ve done in the United States they often find some place between 13 and 20% of students using them at colleges. There was a Varsity survey in Cambridge some time ago and they found about 10% of students. In Germany, they’ve done surveys and they’ve found about - and these are insurance surveys so they’re looking at people in the workplace - they’ve found about 7% of people in the workplace were using these drugs because they felt they couldn’t do their jobs otherwise.

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