Non-medical Use of Prescription Psychostimulants and Academic Performance in Medical Students

Abstract

Objective: It is well-known that healthy medical students use psychostimulants to improve their cognitive functions and reduce their need for sleep. The main motivation behind this cognitive enhancement is to increase academic performance. However, the literature is not clear enough to support this situation. Methods: This cross-sectional study was conducted with an online survey and 585 students participated. The grade point average number was used to assess the student' academic performance. Additionally, the scale based on self-evaluations was used to assess levels of pharmaceutical knowledge, study performance, academic success, academic anxiety, and study performance. Results: Out of 585 healthy students, 40 (7.3%) admitted to using psychostimulants to enhance their academic performance. However, there was no significant difference in grade point average scores and perceived academic success levels between users and non-users. Nonetheless, most of the users reported that they benefited from taking psychostimulant drugs. Risk factors for non-medical use of prescription psychostimulants included high levels of pharmacology knowledge, smoking, and poor academic performance. Conclusion: Although non-medical use of prescription psychostimulants did not appear to affect academic performance significantly, most students reported positive subjective experiences, which could have a motivational effect. Therefore, it is crucial to investigate the benefits and side effects of psychostimulants in healthy young individuals in more detail and to provide them with up-to-date information on this issue.

Keywords

• Psychostimulant
• academic performance
• medical student
• methylphenidate

References

1. Boclin KLS, Cecílio FFC, Faé G, Fanti G, Centenaro G, Pellizzari T, Gaviolli E, Mario DN, Rigo L. Academic performance and use of psychoactive drugs among healthcare students at a university in southern Brazil: Cross-sectional study. J Sao Paulo Medical Journal 2020;138:27-32. DOI: 10.1590/1516-3180.2019.0182.R1.21102019.
2. Ragan CI, Bard I, Singh I. What should we do about student use of cognitive enhancers? An analysis of current evidence. Neuropharmacology 2013;64:588-595. DOI: 10.1016/j.neuropharm.2012.06.016.
3. Hildt E. Cognitive Enhancement. A Critical Look at the Recent Debate. Hildt E, Franke AG, editors. Cognitive Enhancement: An Interdisciplinary Perspective. Dordrecht: Springer Netherlands; 2013. p. 1-14.
4. Maier LJ, Liechti ME, Herzig F, Schaub MP. To dope or not to dope: Neuroenhancement with prescription drugs and drugs of abuse among Swiss university students. PLoS One 2013;8(11):e77967. DOI: 10.1371/journal.pone.0077967.
5. Sattler S, Mehlkop G, Graeff P, Sauer C. Evaluating the drivers of and obstacles to the willingness to use cognitive enhancement drugs: the influence of drug characteristics, social environment, and personal characteristics. Subst Abuse Treat Prev Policy 2014;9:8. DOI: 10.1186/1747-597X-9-8.
6. Dietz P, Iberl B, Schuett E, van Poppel M, Ulrich R, Sattler MC. Prevalence estimates for pharmacological neuroenhancement in Austrian university students: Its relation to health-related risk attitude and the framing effect of caffeine tablets. Frontiers in Pharmacology 2018;9: 494. DOI: 10.3389/fphar.2018.00494.
7. Fond G, Gavaret M, Vidal C, Brunel L, Riveline JP, Micoulaud-Franchi JA, Domenech P. (Mis)use of prescribed stimulants in the medical student community: Motives and behaviors: A population-based cross-sectional study. Medicine (Baltimore) 2016;95(16):e3366. DOI: 10.1097/MD.0000000000003366.
8. Bossaer JB, Gray JA, Miller SE, Enck G, Gaddipati VC, Enck RE. The use and misuse of prescription stimulants as "cognitive enhancers" by students at one academic health sciences center. Acad Med. 2013;88(7):967-971. DOI: 10.1097/ACM.0b013e318294fc7b.

9. Tuttle JP, Scheurich NE, Ranseen J. Prevalence of ADHD diagnosis and nonmedical prescription stimulant use in medical students. Acad Psychiatry 2010;34(3):220-223. DOI: 10.1176/appi.ap.34.3.220.
10. Maier LJ, Haug S, Schaub MP. Prevalence of and motives for pharmacological neuroenhancement in Switzerland-results from a national Internet panel. Addiction 2016;111(2):280-295. DOI: 10.1111/add.13059.
11. Kusurkar RA, Croiset G, Galindo-Garré F, Ten Cate O. Motivational profiles of medical students: Association with study effort, academic performance and exhaustion. BMC Medical Education 2013;13(1):87. DOI: 10.1186/1472-6920-13-87.
12. Arria AM, Caldeira KM, Vincent KB, O'Grady KE, Cimini MD, Geisner IM, Fossos-Wong N, Kilmer JR, Larimer ME. Do college students improve their grades by using prescription stimulants nonmedically? Addict Behav. 2017;65:245-249. DOI: 10.1016/j.addbeh.2016.07.016.
13. Abelman DD. Mitigating risks of students use of study drugs through understanding motivations for use and applying harm reduction theory: A literature review. Harm Reduct J. 2017;14(1):68. DOI: 10.1186/s12954-017-0194-6.
14. Hall KM, Irwin MM, Bowman KA, Frankenberger W, Jewett DC. Illicit use of prescribed stimulant medication among college students. J Am Coll Health. 2005;53(4):167-174. DOI: 10.3200/JACH.53.4.167-174.
15. Repantis D, Schlattmann P, Laisney O, Heuser I. Modafinil and methylphenidate for neuroenhancement in healthy individuals: A systematic review. Pharmacol Res. 2010;62(3):187-206. DOI: 10.1016/j.phrs.2010.04.002.
16. Smith ME, Farah MJ. Are prescription stimulants "smart pills"? The epidemiology and cognitive neuroscience of prescription stimulant use by normal healthy individuals. Psychol Bull. 2011;137(5):717-741. DOI: 10.1037/a0023825.
17. Volkow ND, Fowler JS, Wang GJ, Telang F, Logan J, Wong C, Ma J, Pradhan K, Benveniste H, Swanson JM. Methylphenidate decreased the amount of glucose needed by the brain to perform a cognitive task. PLoS One 2008;3(4):e2017. DOI: 10.1371/journal.pone.0002017
18. Ilieva IP, Farah MJ. Enhancement stimulants: Perceived motivational and cognitive advantages. Front Neurosci. 2013;7:198. DOI: 10.3389/fnins.2013.00198.
19. Hildt E, Lieb K, Franke AG. Life context of pharmacological academic performance enhancement among university students-a qualitative approach. BMC Med Ethics2014;15-23. DOI: 10.1186/1472-6939-15-23.
20. Vrecko S. Just How Cognitive Is "Cognitive Enhancement"? On the significance of emotions in university students' experiences with study drugs. AJOB Neurosci. 2013;4(1):4-12. DOI: 10.1080/21507740.2012.740141.
21. Concerta Addiction: Signs, Symptoms, and Treatment [updated 03.02.2020. Available from: https://americanaddictioncenters.org/concerta.
22. Ritalin Abuse, Addiction & Treatment [updated 04.02.2020. Available from: https://americanaddictioncenters.org/ritalin,
23. DeSantis AD, Webb EM, Noar SM. Illicit use of prescription ADHD medications on a college campus: A multimethodological approach. J Am Coll Health 2008;57(3):315-324. DOI: 10.3200/JACH.57.3.315-324.
24. McCabe SE, Knight JR, Teter CJ, Wechsler H. Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Addiction 2005;100(1):96-106. DOI: 10.1111/j.1360-0443.2005.00944.x.
25. Blevins CE, Stephens R, Abrantes AM. Motives for Prescription stimulant misuse in a college sample: Characteristics of users, perception of risk, and consequences of use. Subst Use Misuse 2017;52(5):555-561. DOI: 10.1080/10826084.2016.1245338.