A new report warns that physicians should not prescribe cognitive enhancers to healthy individuals — those who don’t have a psychiatric disorder.
Researchers from the Institut de recherches cliniques de Montréal (IRCM) led by Dr. Eric Racine base their recommendation on the professional integrity of physicians, the drugs’ uncertain benefits and harms, and limited health care resources.
The study report is found in the Canadian Medical Association Journal (CMAJ).
Currently, prescription stimulants and other pharmaceuticals are often used by healthy people to enhance concentration, memory, alertness and mood, a phenomenon described as cognitive enhancement. However, they are generally only approved for use to treat actual mental illnesses and psychiatric disorders, like attention deficit hyperactivity disorder (ADHD).
“Individuals take prescription stimulants to perform better in school or at work,” said Racine, a Montréal neuroethics specialist.
“However, because these drugs are available in Canada by prescription only, people must request them from their doctors. Physicians are thus important stakeholders in this debate, given the risks and regulations of prescription drugs and the potential for requests from patients for such cognitive enhancers.”
Experts say the prevalence of cognitive enhancers used by students on university campuses ranges from 1 per cent to 11 per cent. Authorities warn that taking such stimulants is associated with risks of dependence, cardiovascular problems, and psychosis.
“Current evidence has not shown that the desired benefits of enhanced mental performance are achieved with these substances,” explains Cynthia Forlini, first author of the study and doctoral student in Racine’s research unit. “With uncertain benefits and clear harms, it is difficult to support the notion that physicians should prescribe a medication to a healthy individual for enhancement purposes.”
“Physicians in Canada provide prescriptions through a publicly-funded health care system with expanding demands for care,” Forlini said.
“Prescribing cognitive enhancers may therefore not be an appropriate use of resources,” when a specific psychiatric disorder isn’t present or hasn’t been diagnosed.
“The concern is that those who need the medication for health reasons,” such as a psychiatric disorder like ADHD, “but cannot afford it will be at a disadvantage.”
“An international bioethics discussion has surfaced on the ethics of cognitive enhancement and the role of physicians in prescribing stimulants to healthy people,” Racine said. “We hope that our analysis prompts reflection in the Canadian medical community about these cognitive enhancers.”