Australian University Students’ Attitudes Towards the Acceptability and Regulation of Pharmaceuticals to Improve Academic Performance

Public Views on Whether the Use of Pharmaceutical Neuroenhancements Should Be Allowed

BACKGROUND AND OBJECTIVES

Some individuals are using drugs to try to enhance cognitive and social-affective functioning and asking physicians for off-label prescriptions for neuroenhancement (e.g., stimulants). Several medical societies released guidance on prescribing neuroenhancers, some of which refer to potential societal effects of neuroenhancement (e.g., distributive justice), besides risks and benefits to users. Which institutions (e.g., medical societies, government, universities) should make decisions on allowing neuroenhancement and whether they should consider potential societal effects are unclear. We examined whether and how much support for allowing pharmaceutical neuroenhancers was influenced by the institution and potential individual and societal effects of neuroenhancers.

METHODS

We conducted a discrete-choice experiment using a constructed representative sample of the US adult public. Multinomial logit models were used to analyze the data.

RESULTS

Participants (n = 927) demographically resembled the US population. Risks of serious side effects (OR 0.20, CI 0.18-0.22) and a lack of benefits for users (OR 0.31, CI 0.26-0.38) had the largest negative effect on participants' support for allowing neuroenhancers. A risk of mild side effects had a moderate negative effect on participants' support for allowing neuroenhancers (OR 0.67, CI 0.62-0.74) and the prospect of more meaningful, long-lasting benefits for users a moderate positive effect (OR 1.74, CI 1.61-1.87). Positive or negative effects of neuroenhancers on the average well-being of people in society and on equality had moderate effects on participants' support for allowing neuroenhancers. For example, the odds of participants' support for allowing enhancers with a negative effect on societal well-being were around half (OR 0.45, CI 0.40-0.50) and the odds of allowing enhancers that worsen inequality were approximately 40% lower compared with enhancers without such effects (OR 0.62, CI 0.55-0.71). The odds of participants allowing neuroenhancers were slightly (10%) lower if enhancers reduced users' authenticity (OR 0.90, CI 0.84-0.97). The institution regulating neuroenhancers and neuroenhancers providing users with an unfair advantage did not affect participants' decisions.

DISCUSSION

When presented with both individual and societal considerations, the public seems to support medical societies and other institutions making policy decisions about neuroenhancers based on risks and benefits for users, as well as, but to a lesser extent, effects on equality and societal well-being.

A Cross-Sectional Study of Attitudes toward Willingness to Use Enhancement Technologies: Implications for Technology Regulation and Ethics

Neuroenhancement is rapidly re-emerging as a research topic because of the development of minimally invasive brain intervention technologies, including neurofeedback. However, public attitude toward enhancement technologies remains relatively unexplored. To fill this gap in the literature, we conducted an online survey of 1258 people in Japan who were presented with four scenarios depicting minimally and highly invasive enhancement interventions. Approximately 20% of the respondents stated that they were willing to use enhancement technologies, whereas 80% were not. Most respondents were cautious about using enhancement technologies. We used a generalized linear mixed-effects model to study the association between the type of intervention and participants’ willingness to use such technologies. Factors related to willingness to use these technologies included interventions’ degree of invasiveness, as well as participants’ gender, educational attainment, and limit or suppression experiences. We also examined the influence of others’ choices and behaviors, and participants’ tolerance toward others’ use of enhancement technologies. We explored important aspects of policymaking vis à vis enhancement technologies. This study could provide valuable insights for a debate on the ethics and regulation of enhancement technologies.

Parents’ Perceptions on the Debated Parenting Practice of Cognitive Enhancement in Healthy Children and Adolescents

First evidence shows that some parents engage in the health-endangering practice of (mis-)using prescription drugs to boost their children’s school performance. But little is known about parental perspectives on this phenomenon. This study aims to better understand parents’ perspectives on the non-medical use of prescription drugs to improve healthy children’s cognitive functioning. We conducted twelve semi-structured face-to-face interviews with a diverse sample of parents in Germany, and applied qualitative content analysis to explore their perspectives on instrumentalizing prescription drugs for improving the performance of healthy children, including their underlying knowledge (gaps), moral evaluations, evaluations of accompanied risks and benefits, opinions on potential motivators, and wishes regarding policy-making. The results show that parents typically believed themselves knowledgeable about such prescription drug (mis-)use, although they were not aware of anyone in their social environment taking them for enhancement. Parents generally considered such behavior to be morally reprehensible, cheating, and similar to doping in sports, and they typically claimed that no situation or occasion could motivate them to administer prescription drugs to their healthy children. Health risks (including side effects or addiction) were a typical expectation of drug use. That doctors should give such drugs to healthy young people was seen as unjustifiable. The results suggest that morality and risk–benefit evaluations of parents play a major role in their decision-making concerning this potentially risky instrumentalization of non-medical drugs. These insights are of distinct importance, especially for future research and further discussions on this topic, such as an evidence-based public dialog and ethics debates.

Super-Men and Wonder-Women: the Relationship Between the Acceptance of Self-enhancement, Personality, and Values

Due to ongoing technological innovations, self-enhancement methods are publicly discussed, researched from different perspectives, and part of ethical debates. However, only few studies investigated the acceptance of these methods and its relationship with personality traits and values. The present study investigated to what extent people accept different enhancement methods and whether acceptance can be predicted by Big Five and Dark Triad traits, vulnerable narcissism, and values. In an online survey (N = 450), we measured personality traits and values. Additionally, participants read scenarios about enhancement methods and answered questions about their acceptance of these scenarios. Factor analysis indicated a general factor of acceptance across scenarios. Correlation analyses showed that high agreeableness, agreeableness-compassion, conscientiousness, conscientiousness-industriousness, and conservation- and self-transcendence values are related to less acceptance of self-enhancement. Moreover, individuals high on Dark Triad traits, vulnerable narcissism, and self-enhancement values exhibit more acceptance. Hierarchical regression analysis revealed that said values and Big Five traits explained unique variance in the acceptance of self-enhancement. These findings highlight the importance of considering personality and values when investigating self-enhancement—a topic that is receiving increasing attention by the public, politicians, and scientists.

Context-Dependent Risk & Benefit Sensitivity Mediate Judgments About Cognitive Enhancement

Opinions about cognitive enhancement (CE) are context-dependent. Prior research has demonstrated that factors like peer pressure, the influence of authority figures, competition, moral relevance, familiarity with enhancement devices, expertise, and the domain of CE to be enhanced can influence opinions. The variability and malleability of patient, expert, and public attitudes toward CE is important to describe and predict because these attitudes can influence at-home, clinical, research, and regulatory decisions. If individual preferences vary, they could influence opinions about practices and regulations due to disagreements about the desirable levels of risks and benefits. The study of attitudes about CE would benefit from psychological theories that explain judgments. In particular, we suggest that variability in risk and benefit sensitivity could psychologically mediate judgments about CE in many contexts. Drawing from prospect theory, which originated in behavioral economics, it is likely that framing effects, shifted reference points, and the tendency to weigh losses (risks) more heavily than gains (benefits) predict decisions about CE. We suggest that public policy could benefit from a shared conceptual framework, such as prospect theory, that allows us to describe and predict real-world decisions about CE by patients, experts, and the public.

Medical Students' Attitudes Towards Pharmacological Cognitive Enhancement With Methylphenidate

OBJECTIVE

The aim of this study was to assess medical students' perception of pharmacological cognitive enhancement (PCE) with methylphenidate and to determine whether this perception differs between junior and senior medical students.

METHODS

The second and fifth year medical student groups of 2017 at a specific university completed self-administered questionnaires in order to investigate if there were a difference in their attitudes towards methylphenidate use for PCE.

RESULTS

A total of 353 students were included as follows: 135 second year and 218 fifth year students. Fifth year students were more aware of PCE with methylphenidate than second year students (94% versus 87%; p value = 0.02). Many students (second year = 86%; fifth year = 71%; p value = 0.2469) were of the opinion that methylphenidate could enhance academic performance. Sixty-six percent of all the students were concerned about the fairness of PCE; 93% were concerned about the harmfulness of methylphenidate. There were no statistical significant differences in the attitudes towards methylphenidate use for PCE between the two groups of junior and senior students.

CONCLUSION

In both groups, the majority of students were against the use of methylphenidate for PCE in students without attention deficit and hyperactivity disorder. Their attitudes regarding the use of methylphenidate for non-medical purposes did not differ significantly. Addressing the topic of PCE with medical students is essential, and the impact on their practice can be an important direction for future research.

Public Opinion on Cognitive Enhancement Varies across Different Situations

People vary widely in their acceptance of the use of pharmacological cognitive enhancement (CE). We tested the hypothesis that the acceptability of CE is malleable, by varying the context in which CE use takes place, by framing the use of CE with positive and negative metaphors, and by distinguishing between self and other CE use. 2,519 US-based participants completed 2 surveys using Amazon's Mechanical Turk. First, participants responded to vignettes describing a fictional character, which varied by framing metaphor (Pandora's box that releases brain performance vs. key that unlocks brain potential), role/setting (student/educational vs. employee/professional), and activity type (blue vs. white collar). Second, participants viewed personalized vignettes describing their own situations. Across both surveys, participants generally found CE use more acceptable for employees than students, while the effects of framing metaphors were unreliable and smaller than previously reported. People were more accepting of CE use by others than by themselves. Participants also found CE use more acceptable if more peers used CE, the environment was less competitive, and authority figures encouraged CE use. Our findings suggest that opinions about CE are indeed malleable, and concerns that peer pressure, the influence of authority figures, and competition might affect CE use are not unfounded.

Pharmacological cognitive enhancement: Examining the ethical principles guiding college students' abstention

Objectives

To understand the ethical principles guiding college students' abstention from pharmacological cognitive enhancement (PCE), and to determine the correlates associated with endorsing different principles.

Design

One-stage cluster sampling was used to implement a paper-based survey among undergraduate students attending one university in the U.S. Thematic analysis was used to explore the ethical principles guiding PCE abstention. Multivariate logistic regression analyses were used to examine sociodemographic correlates associated with endorsed ethical principles.

Participants

Of the 499 eligible students who completed the survey (student response proportion: 94.7%), 259 students had a negative attitude towards PCE, did not engage in PCE, and provided reasons for abstention.

Results

The thematic analysis resulted in the identification of eight themes, with respondents often endorsing more than one theme per response. The three themes most endorsed were non-malfeasance (i.e., avoiding PCE to prevent harm), disapproval of drugs (i.e., a moral opposition to substance use) and dosage beneficence (i.e., adhering to dosage guidance to promote health). The sociodemographic correlates associated with endorsing each theme varied across themes.

Conclusions

Students abstain from PCE for a multitude of reasons, many of which are guided by ethical principles. These findings may be incorporated into future prevention programming messages.

Nonmedical use of prescription drugs for cognitive enhancement as response to chronic stress especially when social support is lacking

The nonmedical use of prescription drugs to improve cognitive performance has gained attention due to concerns over its social and political implications as well as side effects and long-term health consequences. Some researchers expect a future trend of an instrumental use of drugs for cognitive enhancement (CE). Thus, getting insights about causes of CE-drug consumption is warranted before the prevalence increases. Because perceived stress is ubiquitous in universities and may decrease cognitive performance, one reaction to cope with stress and its consequences might be the instrumental use of drugs for CE, especially if other resources, such as social support, are lacking. With a prospective design, randomly selected students from four German universities were invited to a web-based survey and reinterviewed after 6 months (N = 2,203). Results show a 6-month prevalence rate of self-reported CE-drug use of about 2%. Higher reported chronic stress is positively associated with CE-drug use. Although social support has no main effect, stress-buffering effects were found. In men with low stress, more support is associated with a higher chance of self-reported CE-drug use. These findings can inform intervention and prevention strategies such as changes in drug regulation or sensitizing (potential) users to unwanted health consequences.

Moral Attitudes Toward Pharmacological Cognitive Enhancement (PCE): Differences and Similarities Among Germans With and Without PCE Experience

Pharmacological cognitive enhancement (PCE), the use of illicit and/or prescription drugs to increase cognitive performance, has spurred controversial discussion in bioethics. In a semi-structured interview study with 60 German university students and employees, differences and similarities in moral attitudes toward PCE among 30 experienced participants (EPs) vs. 30 inexperienced participants (IPs) were investigated. Substances EPs used most often are methylphenidate, amphetamines, tetrahydrocannabinol and modafinil. Both EPs and IPs addressed topics such as autonomous decision making or issues related to fairness such as equality in test evaluation and distortion of competition. While most EPs and IPs were convinced that the decision of whether or not to use PCE is part of their individual freedom, their views varied considerably with regard to fairness. IPs considered issues related to fairness as much more critical than EPs. Thus, a person’s moral attitudes toward PCE may not only depend on moral common sense, but also on whether they have used illegal and/or prescription drugs for PCE before. This points to the importance of including the various relevant stakeholder perspectives in debates on the ethical and social implications of PCE.

Attitudes Toward Cognitive Enhancement: The Role of Metaphor and Context

The widespread use of stimulants among healthy individuals to improve cognition has received growing attention; however, public attitudes toward this practice are not well understood. We determined the effect of framing metaphors and context of use on public opinion toward cognitive enhancement. We recruited 3,727 participants from the United States to complete three surveys using Amazon's Mechanical Turk between April and July 2017. Participants read vignettes describing an individual using cognitive enhancement, varying framing metaphors (fuel versus steroid), and context of use (athletes versus students versus employees). The main outcome measure was the difference in respondent-assigned level of acceptability of the use of cognitive enhancement by others and by themselves between the contrasting vignettes. Participants were more likely to support the use of cognitive enhancement by others than by themselves and more when the use of enhancement by others was framed with a fuel metaphor than with a steroid metaphor. Metaphoric framing did not affect participants' attitudes toward their own use. Participants supported the use of enhancement by employees more than by students or athletes. These results are discussed in relation to existing ethical and policy literature.

Non-medical prescription stimulant use to improve academic performance among Australian university students: prevalence and correlates of use

BACKGROUND

Some university students consume pharmaceutical stimulants without a medical prescription with the goal of improving their academic performance. The prevalence of this practice has been well documented in the US, but less so in other countries. The potential harms of using prescription stimulants require a better understanding of the prevalence of this practice within Australian universities.

METHODS

An internet survey of 1136 Australian students was conducted in 2015 in three large Australian universities. Students were asked about their personal use of prescription stimulants, attitudes and experiences with prescription stimulants. They were also asked about their use of caffeine, energy drinks and illicit drugs to enhance their academic performance.

RESULTS

Lifetime self-reported use of stimulant medication to improve academic performance was 6.5, and 4.4% in the past year. Students were far more likely to report using coffee and energy drinks (41.4 and 23.6% respectively, lifetime use) than prescription stimulants to help them study and complete university assessments. Non-medical use of prescription stimulants was strongly associated with a history of illicit drug use.

CONCLUSION

The prevalence of nonmedical prescription stimulant use to improve academic performance is low among university students in Australia, especially when compared with their use of coffee and energy drinks.

Towards a Moral Ecology of Pharmacological Cognitive Enhancement in British Universities

Few empirical studies in the UK have examined the complex social patterns and values behind quantitative estimates of the prevalence of pharmacological cognitive enhancement (PCE). We conducted a qualitative investigation of the social dynamics and moral attitudes that shape PCE practices among university students in two major metropolitan areas in the UK. Our thematic analysis of eight focus groups (n = 66) suggests a moral ecology that operates within the social infrastructure of the university. We find that PCE resilience among UK university students is mediated by normative and cultural judgments disfavoring competitiveness and prescription drug taking. PCE risk can be augmented by social factors such as soft peer pressure and normalization of enhancement within social and institutional networks. We suggest that moral ecological dynamics should be viewed as key mechanisms of PCE risk and resilience in universities. Effective PCE governance within universities should therefore attend to developing further understanding of the moral ecologies of PCE.

"It Was Me on a Good Day": Exploring the Smart Drug Use Phenomenon in England

The non-medical use of prescription medication for the pursuit of increasing cognitive and intellectual capacities (defined neuroenhancement) has received growing attention from the scientific community and policymakers alike. To date, limited qualitative data exist exploring the nature of the phenomenon, especially as a potentially emerging trend among university students in England. Existing American literature suggests that students believe that neuroenhancement helps the individual to maximize his/her time, consenting a suitable balance between work and leisure. Students' motivation to experiment with neuroenhancement appears to be more in line with a need to regulate emotions surrounding study/work settings than to actually improve cognitive abilities beyond normal levels. This study aimed to qualitatively explore representations, motivations, beliefs, and consumption styles of a cohort of university student users residing in England. Through snowball sampling, 13 informants were contacted and interviewed regarding their experience with neuroenhancers. Narrations were analyzed and interpreted using qualitative analysis software and Grounded Theory methodology. Participants belonged to a broad variety of university courses and were predominantly habitual consumers of modafinil. Neuroenhancers were acquired either through friends or via the Internet. Motivations regarded the need to "catch up" and be on par with high achieving students. The entire cohort had previously experimented with other psychotropic substances. Synthetic compounds in particular were believed to be "gateway" drugs to using neuroenhancers. Experimentation with neuroenhancement can be seen as a self-governing strategy aimed at achieving continued focused productivity. Participants acknowledged sustainable benefits in neuroenhancement as it optimized work performance. The majority of the cohort also contemplated the possibility of using these drugs in the future once they entered the workforce. Neuroenhancing drug users expressed "situated morality," differentiating between using these substances for assessments (exams) or during revisions, finding only the former as an immoral conduct. In the present scenario, it appears that neuroenhancement is practiced by small numbers of students. Nonetheless, the instrumental views of psychotropic substances held by many young adults and the globalization of these practices make the normalization of neuroenhancement a plausible possibility of the future.

Associations Between the Big Five Personality Traits and the Non-Medical Use of Prescription Drugs for Cognitive Enhancement

While the number of studies of the non-medical use of prescription drugs to augment cognitive functions is growing steadily, psychological factors that can potentially help explain variance in such pharmaceutical cognitive enhancement (CE) behavior are often neglected in research. This study investigates the association between the Big Five personality traits and a retrospective (prior CE-drug use) as well as a prospective (willingness to use CE drugs) measure of taking prescription drugs with the purpose of augmenting one's cognitive functions (e.g., concentration, memory, or vigilance) without medical necessity. We use data from a large representative survey of German employees (N = 6454, response rate = 29.8%). The Five Factor Model (FFM) of Personality was measured with a short version of the Big Five Personality Traits Inventory (BFI-S), which includes: openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. Together with this, demographic variables such as gender, age, education, and income were used as potential confounders in multiple logistic regression models. Our results show a 2.96% lifetime prevalence of CE-drug use and a 10.45% willingness to (re)use such drugs in the future. We found that less conscientious and more neurotic respondents have a higher probability of prior CE-drug use and a greater willingness to use CE drugs in the future. No significant effects were found for openness, extraversion, or agreeableness. Prior CE-drug use was strongly associated with a greater willingness to take such drugs in the future. This study shows that specific personality traits are not only associated with prior enhancement behavior, but also affect the willingness to (re)use such drugs. It helps increase understanding of the risk factors of CE-drug use, which is a health-related behavior that can entail severe side-effects for consumers. The knowledge gathered can thus help improve interventions aimed at minimizing health problems.

The is and ought of the Ethics of Neuroenhancement: Mind the Gap

Ethical perspectives on the use of stimulants to enhance human cognitive performance (neuroenhancement) are polarized between conservative and liberal theories offering opposing advice on whether individuals have a right to use neuroenhancers and what the social outcomes of neuroenhancement might be. Meanwhile, empirical evidence shows modest prevalence and guarded public attitudes toward the neuroenhancement use of stimulants. In this Perspective, we argue that the dissonance between the prescriptions of ethical theories (what ought to be) and empirical evidence (what is) has impaired our understanding of neuroenhancement practices. This dissonance is a result of three common errors in research on the ethics of neuroenhancement: (1) expecting that public perspectives will conform to a prescriptive ethical framework; (2) ignoring the socio-economic infrastructures that influence individuals' decisions on whether or not to use neuroenhancement; and (3) overlooking conflicts between fundamental ethical values namely, safety of neuroenhancement and autonomy. We argue that in order to understand neuroenhancement practices it is essential to recognize which values affect individual decisions to use or refuse to use neuroenhancement. Future research on the ethics of neuroenhancement should assess the morally significant values for stakeholders. This will fill the gap between what ought to be done and what is done with an improved understanding of what can be done within a particular context. Clarifying conflicts between competing moral values is critical in conducting research on the efficacy of substances putatively used for neuroenhancement and also on neuroenhancement practices within academic, professional and social environments.

Swiss University Students' Attitudes toward Pharmacological Cognitive Enhancement

Pharmacological cognitive enhancement (PCE) refers to the nonmedical use of prescription or recreational drugs to enhance cognitive performance. Several concerns about PCE have been raised in the public. The aim of the present study was to investigate students' attitudes toward PCE. Students at three Swiss universities were invited by e-mail to participate in a web-based survey. Of the 29,282 students who were contacted, 3,056 participated. Of these students, 22% indicated that they had used prescription drugs (12%) or recreational substances including alcohol (14%) at least once for PCE. The use of prescription drugs or recreational substances including alcohol prior to the last exam was reported by 16%. Users of pharmacological cognitive enhancers were more likely to consider PCE fair (24%) compared with nonusers (11%). Only a minority of the participants agreed with the nonmedical use of prescription drugs by fellow students when assuming weak (7%) or hypothetically strong efficacy and availability to everyone (14%). Two-thirds (68%) considered performance that is obtained with PCE less worthy of recognition. Additionally, 80% disagreed that PCE is acceptable in a competitive environment. More than half (64%) agreed that PCE in academia is similar to doping in sports. Nearly half (48%) claimed that unregulated access to pharmacological cognitive enhancers increases the pressure to engage in PCE and educational inequality (55%). In conclusion, Swiss students' main concerns regarding PCE were related to coercion and fairness. As expected, these concerns were more prevalent among nonusers than among users of pharmacological cognitive enhancers. More balanced information on PCE should be shared with students, and future monitoring of PCE is recommended.

Work-related stress and cognitive enhancement among university teachers

BACKGROUND

Working conditions of academic staff have become increasingly complex and occupational exposure has risen. This study investigates whether work-related stress is associated with the use of prescription drugs for cognitive enhancement (CE).

METHODS

The study was designed around three web-based surveys (n1 = 1131; n2 = 936; n3 = 906) to which university teachers at four German universities were asked to respond. It assessed past CE-drug use and the willingness to use CE-drugs as factors influencing future use. Overlap among participants across the surveys allowed for analyses of stability of the results across time.

RESULTS

Our study suggests a currently very low prevalence of CE-drug use as well as a low willingness to use such drugs. The results showed a strong association between perceptions of work-related stress and all measures of CE-drug use (when controlling for potential confounding factors). They also showed that past use of CE-drugs increased participants' willingness to use them again in the future, as did lower levels of social support. Two different measures showed that participants' moral qualms against the use of CE-drugs decreased their probability of using them.

CONCLUSIONS

The results increase our knowledge about the prevalence of CE-drug use and our understanding of what motivates and inhibits the use of CE-drug.

Everyday drug diversions: a qualitative study of the illicit exchange and non-medical use of prescription stimulants on a university campus

This article investigates everyday experiences and practises that are associated with processes of pharmaceuticalization and with practices of 'drug diversion'--that is, the illicit exchange and non-medical use of prescription drugs. It reports results from a qualitative study that was designed to examine the everyday dimensions of non-medical prescription stimulant use among students on an American university campus, which involved 38 semi-structured interviews with individuals who used prescription stimulants as a means of improving academic performance. While discussions of drug diversion are often framed in terms of broad, population-level patterns and demographic trends, the present analysis provides a complementary sociocultural perspective that is attuned to the local and everyday phenomena. Results are reported in relation to the acquisition of supplies of medications intended for nonmedical use. An analysis is provided which identifies four different sources of diverted medications (friends; family members; black-market vendors; deceived clinicians), and describes particular sets of understandings, practices and experiences that arise in relation to each different source. Findings suggest that at the level of everyday experience and practice, the phenomenon of prescription stimulant diversion is characterised by a significant degree of complexity and heterogeneity.

Attitudes toward pharmacological cognitive enhancement-a review

A primary means for the augmentation of cognitive brain functions is “pharmacological cognitive enhancement” (PCE). The term usually refers to the off-label use of medical substances to improve mental performance in healthy individuals. With the final aim to advance the normative debate taking place on that topic, several empirical studies have been conducted to assess the attitudes toward PCE in the public, i.e., in groups outside of the academic debate. In this review, we provide an overview of the 40 empirical studies published so far, reporting both their methodology and results. Overall, we find that several concerns about the use of PCE are prevalent in the public. These concerns largely match those discussed in the normative academic debate. We present our findings structured around the three most common concerns: medical safety, coercion, and fairness. Fairness is divided into three subthemes: equality of opportunity, honesty, and authenticity. Attitudes regarding some concerns are coherent across studies (e.g., coercion), whereas for others we find mixed results (e.g., authenticity). Moreover, we find differences in how specific groups—such as users, nonusers, students, parents, and health care providers—perceive PCE: a coherent finding is that nonusers display more concerns regarding medical safety and fairness than users. We discuss potential psychological explanations for these differences.

To dope or not to dope: neuroenhancement with prescription drugs and drugs of abuse among Swiss university students

Background

Neuroenhancement is the use of substances by healthy subjects to enhance mood or cognitive function. The prevalence of neuroenhancement among Swiss university students is unknown. Investigating the prevalence of neuroenhancement among students is important to monitor problematic use and evaluate the necessity of prevention programs.

Study aim

To describe the prevalence of the use of prescription medications and drugs of abuse for neuroenhancement among Swiss university students.

Method

In this cross-sectional study, students at the University of Zurich, University of Basel, and Swiss Federal Institute of Technology Zurich were invited via e-mail to participate in an online survey.

Results

A total of 28,118 students were contacted, and 6,275 students completed the survey. Across all of the institutions, 13.8% of the respondents indicated that they had used prescription drugs (7.6%) or drugs of abuse including alcohol (7.8%) at least once specifically for neuroenhancement. The most frequently used prescription drugs for neuroenhancement were methylphenidate (4.1%), sedatives (2.7%), and beta-blockers (1.2%). Alcohol was used for this purpose by 5.6% of the participants, followed by cannabis (2.5%), amphetamines (0.4%), and cocaine (0.2%). Arguments for neuroenhancement included increased learning (66.2%), relaxation or sleep improvement (51.2%), reduced nervousness (39.1%), coping with performance pressure (34.9%), increased performance (32.2%), and experimentation (20%). Neuroenhancement was significantly more prevalent among more senior students, students who reported higher levels of stress, and students who had previously used illicit drugs. Although “soft enhancers”, including coffee, energy drinks, vitamins, and tonics, were used daily in the month prior to an exam, prescription drugs or drugs of abuse were used much less frequently.

Conclusions

A significant proportion of Swiss university students across most academic disciplines reported neuroenhancement with prescription drugs and drugs of abuse. However, these substances are rarely used on a daily basis and more sporadically used prior to exams.