The Not-So-Smart Future of Smart Drugs: Ethical Implications of Pharmaceutical Cognitive Enhancement Drugs

The movie Limitless portrays the somewhat bleak future of cognitive enhancement drugs. A man finds himself at rock-bottom when a friend offers him a drug that could “change his life.” He takes the drug and is suddenly the leading man at a top financial firm. However as the supply of the drug dwindles and he battles intense side-effects, he soon finds himself in a state of dependency and his whole world comes crumbling down.

The movie has an important message about drug dependency– that temporary pleasure comes at a long term mental and physical cost. But the more relevant message from the movie is about the potential negative consequences of cognitive enhancement drugs, or Smart Drugs.

Given the capitalistic society in which we live where productivity and performance are highly valued parts of our lives, who wouldn’t choose a Limitless life where you can have enhanced cognitive abilities, greater motivation, no sleep deprivation, and perfect memory? But what Limitless asks is this: at what cost? At what cost, on the individual and societal level, are we willing to incorporate smart drugs into our lives?

Smart drugs, the potential to make ourselves mentally unstoppable with just a tiny pill, may seem like a far-away-enough dystopian concept; but it is already here. This genre of drugs have already made their debut in academic circles and institutions across the globe, from New York University to the National University of Singapore. The following paper aims to first, define and distinguish smart drugs and will then follow by addressing the current ethical dilemmas and potential future implications which may be associated with smart drug consumption and use.

What are Smart Drugs?

Smart Drugs, or more formally known as Pharmaceutical Cognitive Enhancers (PCEs), are essentially regulated medications which offer consumers improvements in cognitive performance, such as concentration, attention, memory, reflexes, mental clarity, alertness, and even the ability to function effectively without sleep. In other words, PCEs promise consumers a better, more mentally agile version of ourselves.

PCEs exist and were initially developed for the consumption of those with certain impairments. The most common PCEs are Adderall, Ritalin, Novigil, Provigil, Piracetam, Donepezil, and Axura. Adderall and Ritalin are central nervous stimulants generally prescribed to those with impulse control issues such as those with Attention Deficit Hyperactivity Disorder (ADHD). Novigil and Provigil increase wakefulness and are prescribed to those diagnosed with Narcolepsy, Sleep Apnea, or even serious Jet Lag. Axura is a drug which improves memory and is prescribed for those struggling with Alzheimer’s Disease. Piracetam and Donepezil are usually prescribed for Myoclonus and Dementia. For individuals clinically diagnosed and prescribed this regulated medication, PCEs are a form of treatment as they reduce the risk of disease, alleviate cognitive impairment, and ease any uncomfortable symptoms.

However the problem today is with the use of PCEs by those who have no medical reason to consume the drug. In the case of healthy people who have no cognitive disorder to be treated, PCEs strengthen the individual’s already “normal” cognitive abilities. Instead of acting as a mitigator for cognitive impairment, PCEs will act as an enhancer for cognitive ability such as strengthening and improving memory, attention, alertness, and more.

Distinguishing Pharmaceutical Cognitive Enhancers

Caffeine is a widely available and a widely used stimulant. Infact, even Nicotine, found in vapes and cigarettes is a widely consumed stimulant. Both Caffeine and Nicotine are freely available, non-prescription, hardly regulated drugs which many individuals might agree they improve focus and productivity. In addition to Caffeine and Nicotine, there also exist “ancient” herbal supplements such as Ginseng, Ginkgo Biloba, Bacopa Monnieri, Rhodiola Rosea, and more, which are marketed as natural cognitive enhancers.

It follows, then, to address the basic question; how might we distinguish between Smart Drugs like Adderall and natural drugs like Caffeine? And why are natural supplements available so freely while smart drugs have to be regulated?

The difference between a natural supplement, like Ginkgo Biloba, and “soft” cognitive enhancers, like caffeine, is in the magnitude of their impact. The magnitude of impact of Adderall, for example, is significantly different to the impact of Caffeine. Unlike Caffeine or Nicotine, Adderall will have you “wired” for at least 6 hours straight, rarely wavering in your focus. Adderall and other pharmaceutical cognitive enhancers are synthetic and made in labs with incredibly concentrated compounds. One may need to take about 2000mg of Ginseng to have a mild cognitive impact, but one only needs around 20mg of Ritalin to have 10x that effect on their cognition.

In this essay, when referring to pharmaceutical cognitive enhancement drugs, I will be referring to synthetic enhancers which have a profound impact on your concertative and attentional abilities.

Current Investigation & Aims

This paper aims to address the ethical issues of the use of PCEs by healthy people in order to improve their cognitive function. I will argue that the potential negative consequences of “smart drugs” outweigh the potential positive consequences and should therefore not be made legal and freely available. There is a lack of research about the efficacy and safety of PCE use in healthy people, yet from past experiences with drugs, we can validly infer that the potential implications of PCEs are more likely to be negative than positive. Even if they are made legal and available for consumption by the public majority, I will argue that over time they will have negative consequences on society and mankind as a whole.

I will start by addressing the current state of PCE consumption by healthy people, with the intention to enhance ‘normal’ cognition, and why it is currently a problem which needs immediate addressing and regulation. I will then discuss the potential future implications of PCE consumption if it is not regulated and made available to the public majority. The paper will be concluded with a recommendation on regulations strategies.

The Present State Of Pharmaceutical Cognitive Enhancers

As mentioned before, PCEs already have widespread use in academic communities, especially amongst students who intend to augment their cognitive ability to improve their performance in school and remain competitive with their peers. The use of PCEs is trending upwards and has only increased in the past few years. Infact, the Substance Abuse and Mental Health Services Administration (SAMHSA) claims that smart drugs are currently the fastest growing drug problem. In 2017, 30% of individuals reported usage of Smart Drugs and today, in 2022, one in four teenagers believe that prescription drugs can be used as a study aid (SAMSHA). These numbers are only rising, and putting more and more youth at risk for addiction.

This is cause for serious concern as numbers are increasing in younger populations and experts do not actually know the long term effects of this. In addition, as students become more and more dependent on smart drugs, it may encourage other students to do the same just to level the “playing field.” The un-regulation of smart drugs will only lead to more competition amongst young students putting them at risk for potentially addiction and severe negative health outcomes. For these reasons, expanded on in the next section, the regulation of smart drugs is imperative and necessary in its present state.

Unknown Side Effects

The opioid crisis, as well as other narcotics, often overshadow the looming effects of PCEs resulting in a severe lack of empirical research on the topic. There is a widespread misperception that smart drugs are not addictive; this is certainly not true with drugs like Adderall and Provigil which can lead to both tolerance and dependency (SAMHSA). Because PCEs are already FDA approved as treatment for certain diseases, it does not seem necessary to investigate the drug further. However the issue is with the “health” population who use PCEs to enhance their already “normal” cognitive abilities. In addition PCEs are not yet as prevalent and saturated through the population as other drugs like cocaine, marijuana, etc. For these reasons, research concerning the long term impact of PCEs is lacking.

Based on the chemical compounds which make up the majority of smart drugs– amphetamines, methylphenidate hydrochloride, diphenylmethyl– we can make an educated estimate about what the side effects may be, however there have been very few studies which have empirically studied the long term effects of PCE consumption in healthy people. With the usage rates rising, especially in youth populations whose cognitive development may be at an especially vulnerable place, it would be more beneficial to regulate PCEs now rather than wait for the very likely negative long term effects to play out, or wait for more people to start consuming PCEs. In the past, such as the case of opioid based painkillers (e.g. Oxycontin), action was only taken once the drug had become a very prominent problem. Instead of waiting for this to happen, PCEs should be regulated earlier rather than later when it becomes a worse problem than it already is.

Encouraging Competition

Like most drugs, addiction and potential health complications in the long term are a common problem with PCEs. However, unique to PCEs is that widespread use of PCEs may indirectly coerce surrounding individuals, such as peers, co-workers, and other non-users, to also use PCEs in order to remain competitive. Competition in school and work may increase and promote pressure to take PCEs to level the playing field. Further down the road, if everybody in a certain industry is consuming these drugs, it may even become a new normal.

A real life example of this are concert musicians who consume beta blockers to calm their nerves before performances. Concert musicians have a strenuous job of not only mastering complex instruments and performing their music in front of huge crowds, but also they have to make sure they are playing the right part in sync with the entire symphony orchestra. Beta Blockers, or Beta-Adrenergic blocking agents, are a type of cardiac medication that reduce blood pressure predominantly used to manage abnormal heart rhythms and prevent secondary heart attacks. When it comes to concert musicians, this type of medication helps individuals feel more calm, by preventing crippling performance anxiety, sweaty palms, racing heart beats, quick and shallow breathing, and lip quickers. This helps some deliver superior performances. This off-label consumption started in 1970 and quickly expanded to a much larger population as more and more musicians felt pressured to use Beta Blockers. Today this medication is a new “normal” in concert musician circles. Even if some do not want to start taking drugs, they may feel pressured to just stay competitive and be on the same level as their peers. Some may feel pressured to never have an “off-day” or take a break due to stress.

If PCE use increases even more in academic institutions such as in university campuses, and other professional institutions, we certainly seem to be going down a similar path to the Beta Blockers. For this additional reason, PCEs should be regulated as soon as possible rather than later.

Present Trends

PCE consumption is currently, as it presently stands a problem in society. Youth consumption puts not only themselves at risk for unknown long-term adverse health outcomes, but also encourages peer consumption by increasing competition and peer pressure. Youth consumption is only growing with more and more individuals trying out PCEs as study aids and cognitive performance enhancers, growing towards a “new normal.”

While these concerns are mainly for pharmaceutical drugs used to treat diseases, newer smart drugs are being developed by well-known and trusted pharmacology laboratories around the world. Drugs like Qualia, Absolute Focus, Thesis, market themselves as “supplements.” These drugs are pharmaceutically developed, albeit not as concentrated as other PCEs such as Adderall and Ritalin, but they do offer modest improvements in cognition. These drugs, dubbed “nootropics” because they claim to not be addictive, are the first step to “normalizing” PCEs. Eventually as these products sell and become more and more popular, stronger compounds and formulas will be developed. Economically speaking, if the demand for PCEs increases, the supply will have to increase as well. The “Nootropics” which exist today are only growing in their development and subsequent usage. As their usage increases and if a customer base is actually found to exist, there is no stopping big pharma companies from creating stronger compounds to market and sell for a large profit and cost to society.

The Future of Of Pharmaceutical Cognitive Enhancers

The previous sections discussed the current problems with PCE use and called for regulation. It is important to discuss and explore the scenario if PCEs were to become legal and if they were not regulated as a thought experiment but also to urge the audience of its necessity to be regulated. The future implications of PCE are bleak and negative. What would happen if “big pharma” were to start mass production of PCEs for the population? What if it becomes legally enforced for certain professions and no longer a personal choice? What happens to the people in a society dependent on drugs for their cognitive abilities?

Professional Use of PCEs

It would not be a far stretch to imagine a world in which PCEs are used in certain fields and professions such as in the military or by doctors. For surgeons especially, performing surgery can be a long and difficult process where the doctor might risk a patients’ life due to fatigue and tiredness which can impair their psychomotor performance. Serious medical errors are a real concern most surgeons face and it is an ongoing problem which institutions have been attempting to solve. Cambridge University recently conducted a randomized placebo controlled study using the PCE Modafinil and found that the drug actually improved cognitive flexibility and reduced impulsivity in sleep deprived doctors. The broader implications of this study suggest that surgeons may be able to perform interventions more effectively when consuming PCEs, if proven to be safe in the long term. Surgeons are not the only job which may be impacted with PCE use, nurses, academics, pilots, police officers, military, drivers, fire fighters are some other examples. What if this enhancement were to become a “new normal” where these professions were no longer just a choice, but an enforced part of the job?

Currently, interest is growing in a new form of treatment; Transcranial Direct Current Stimulation (tDCS) which claims to treat everything from depression to anxiety and improve everything from cognitive to sports performance. Consider this type of treatment becoming a new normal, what happens to those who can’t afford such a machine? Will they try making an at-home DIY machine just to keep up with the world? Will they try to find PCEs on the blackmarket?

Drug Dependence and Addiction

As a thought experiment, imagine a world in which certain professions are to take PCEs in order to maintain their cognitive abilities, productivity, and heightened performance. Will individuals outside of those professional realms not want to also take part in those drugs just to get an especially productive work day in? In fact, who actually decides what professions should use PCEs and which should not? And where will the line be drawn? What drugs will be developed in the future? Drugs for creativity? For artistic ability? For thinking? For love? What happens when drugs infiltrate and saturate our entire society and become a part of every single moment in our lives? What happens in a society which is entirely dependent on drugs? What human aspects will still be valued when every human is attempting to become a superhuman? The limit for drug development is unknown but it is a slippery slope. Once certain drugs are developed and we become accustomed to, as a society, there is no telling when the development stops.

Recommendations and Regulation Strategies

It is a common argument that if these drugs can improve memory or other forms of cognition, why can’t we use them to get in a productive day of work? The rebuttal to this question is another question; when will the line be drawn? Once we start using drugs for productivity, soon we are using them to not sleep. The big and very possibly near problem is with Big Pharma, the global pharmaceutical industry and companies which manufacture the majority of drugs we use everyday. Just as Big Pharma has done in the past with pain medication, when a demand is found, companies will try their best to take advantage of this for the sake or profit.

Perhaps there is no way to actually control or regulate these drugs or to stop its development as it is already taking place. Proper education and harm reduction programs will play a big role in the near future of PCEs use and consumption by the public majority. Boundaries will need to be clearly established. As a society, the best we can do is to learn from our past mistakes and learn to live with these drugs while maintaining the safety of the population as much as possible.

Smart drugs, PCEs, and Nootropics were most probably developed as a way to benefit society and people yet they may take a turn for the worse.

References

Cakic V. (2009). Smart drugs for cognitive enhancement: ethical and pragmatic considerations in the era of cosmetic neurology. Journal of medical ethics, 35(10), 611–615.

The ethics of smart drugs. (2011, October 31). University of Cambridge.

Tomažič T, Čelofiga AK. Ethical aspects of the abuse of pharmaceutical enhancements by healthy people in the context of improving cognitive functions. Philos Ethics Humanity Med. 2019;14(1):7. Published 2019 Apr 25.

Ricci G (2020) Pharmacological Human Enhancement: An Overview of the Looming Bioethical and Regulatory Challenges. Front. Psychiatry 11:53.

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