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Study drugs for students growing { June 11 2006 }

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A Dose Of Genius
'Smart Pills' Are on The Rise. But Is Taking Them Wise?

By Joel Garreau
Washington Post Staff Writer
Sunday, June 11, 2006; D01

Studying with diligent friends is fine, says Heidi Lessing, a University of Delaware sophomore.

But after a couple of hours, it's time for a break, a little gossip: "I want to talk about somebody walking by in the library."

One of those friends, however, is working too hard for dish -- way too hard.

Instead of joining in the gossip, "She says, 'Be quiet,' " Lessing says, astonishment still registering in her voice.

Her friend's attention is laserlike, totally focused on her texts, even after an evening of study. "We were so bored," Lessing says. But the friend was still "really into it. It's annoying."

The reason for the difference: Her pal is fueled with "smart pills" that increase her concentration, focus, wakefulness and short-term memory.

As university students all over the country emerge from final exam hell this month, the number of healthy people using bootleg pharmaceuticals of this sort seems to be soaring.

Such brand-name prescription drugs "were around in high school, but they really exploded in my third and fourth years" of college, says Katie Garrett, a 2005 University of Virginia graduate.

The bootleg use even in her high school years was erupting, according to a study published in February in an international biomedical and psychosocial journal, Drug and Alcohol Dependence. Mining 2002 data, it noted that even then, more than 7 million Americans used bootleg prescription stimulants, and 1.6 million of those users were of student age. By the time students reach college nowadays, they're already apt to know about these drugs, obtained with or without a prescription.

Comparable accounts are common on other campuses, according to dozens of interviews with university students in Virginia, the District, Maryland and Delaware, as well as reports in student newspapers serving campuses in Massachusetts, Connecticut, Michigan, Indiana and Missouri.

"I'm a varsity athlete in crew," says Katharine Malone, a George Washington University junior. "So we're pretty careful about what we put in our bodies. So among my personal friends, I'd say the use is only like 50 or 60 percent."

Seen by some ambitious students as the winner's edge -- the difference between a 3.8 average and a 4.0, maybe their ticket to Harvard Law -- these "brain steroids" can be purchased on many campuses for as little as $3 to $5 per pill, though they are often obtained free from friends with legitimate prescriptions, students report.

These drugs represent only the first primitive, halting generation of cognitive enhancers. Memory drugs will soon make it to market if human clinical trials continue successfully.

There are lots of the first-generation drugs around. Total sales have increased by more than 300 percent in only four years, topping $3.6 billion last year, according to IMS Health, a pharmaceutical information company. They include Adderall, which was originally aimed at people with attention-deficit disorder, and Provigil, which was aimed at narcoleptics, who fall asleep uncontrollably. In the healthy, this class of drugs variously aids concentration, alertness, focus, short-term memory and wakefulness -- useful qualities in students working on complex term papers and pulling all-nighters before exams. Adderall sales are up 3,135.6 percent over the same period. Provigil is up 359.7 percent.

In May, the Partnership for a Drug-Free America issued its annual attitude-tracking study on drug use. It is a survey of more than 7,300 seventh- through 12th-graders, designed to be representative of the larger U.S. population and with an accuracy of plus or minus 1.5 percent, according to Thomas A. Hedrick Jr., a founding director of the organization. It reported that among kids of middle school and high school age, 2.25 million are using stimulants such as Ritalin without a prescription.

That's about one in 10 of the 22 million students in those grades, as calculated by the U.S. Department of Education. Half the time, the study reported, the students were using these drugs not so much to get high as "to help me with my problems" or "to help me with specific tasks." That motivation was growing rapidly, Hedrick says.

Why should we be surprised? This generation is the one we have pushed to get into the best high schools and colleges, to have the best grades and résumés. Computer nerds are culture heroes, SAT scores are measures of our worth and the Ivy League is Valhalla. Hermione Granger in "Harry Potter" is a heroine despite being such a goody two-shoes that she doubles up her course load with a spell that allows her to be in two places at once. This is the kind of focused overachievement that is addressed by smart pills.

A student Web site for a consortium of tony Philadelphia prep schools makes the point with one of those jokes that's not really a joke: You know you are part of this elite educational set if:

· "You applied to Penn as a backup school."

· "You tend to think anything below a 1400 is a mediocre SAT score."

· "You could get adderall in less than 5 minutes at practically any time of the school day."

Smart-pill use has not been the focus of much data collection. This comes as no surprise to researchers such as Richard Restak, a Washington neurologist and president of the American Neuropsychiatric Association, who has written extensively about smart drugs in his 2003 book, "The New Brain: How the Modern Age Is Rewiring Your Mind," as well as his forthcoming "The Naked Brain: How the Neurosociety Is Changing How We Live, Work and Love."

Contributing to this dearth, he points out, is that these drugs are not famous for being abused recreationally and they are not being used by people with a disease.

This is not "the type of data collected by the FDA," he says. Law-enforcement activity has been sparse. "Who is the complainant?"

Compared with the kind of drug users who get police attention, "This is an entirely different population of people -- from the unmotivated to the super-motivated," Restak says. These "drug users may be at the top of the class, instead of the ones hanging around the corners."

Smart-pill use generally doesn't show up in campus health center reports, he says, because "This is not the kind of stuff that you would overdose on" easily. Amphetamines are associated with addiction and bodily damage, but in use by ambitious students, "if you go a little over you get wired up but it wears off in a couple of hours. And Provigil has a pretty good safety record." Finally, smart-pill use is a relatively recent development that has not yet achieved widespread attention, much less study, although Restak expects that to change.

"We're going to see it not only in schools, but in businesses, especially where mental endurance matters." Restak can easily imagine a boss saying, " 'You've been here 14 hours; could you do another six?' It's a very competitive world out there, and this gives people an edge."

That's why even small surveys conducted by students themselves are suggestive. For a senior project this semester, Christopher Salantrie conducted a random survey of 150 University of Delaware students at the university's Morris Library and Trabant Student Center.

"With rising competition for admissions and classes becoming harder and harder by the day, a hypothesis was made that at least half of students at the university have at one point used/experienced such 'smart drugs,' " Salantrie writes in his report. He found his hunch easy to confirm.

"What was a surprise, though, was the alarming rate of senior business majors who have used" the drugs, he writes. Almost 90 percent reported at least occasional use of "smart pills" at crunch times such as final exams, including Adderall, Ritalin, Strattera and others. Of those, three-quarters did not have a legitimate prescription, obtaining the pills from friends. "We were shocked," Salantrie writes. He says that in his report, he was "attempting to bring to light the secondary market for Adderall" specifically because "most of the university is not aware" of its extent, he says.

When you start asking questions about smart pills, the answers you get divide sharply into two groups.

When you ask the grown-ups -- deans, crisis counselors, health counselors -- they tell you they don't know too much about the subject, but they don't think it is much of a problem at their institutions.

"I'm not sure of the size and scope," says Jonathan Kandell, a psychologist and assistant director at the University of Maryland Counseling Center. "I have heard about it. But I don't get a sense it's a major thing that they come to the center about."

When you ask the students, they look at you like you're from the planet Zircon. They ask why you weren't on this story three years ago. Even if some of these drugs are amphetamines, it's medicine parents give to 8-year-olds, they say. It's brand-name stuff, in precise dosages. How bad can it be? Sure, there are problems with weight loss, sleep loss, jitters and throwing up, they say. But other unintended consequences are not what you might expect. Universities now sport some of the cleanest apartments in the history of undergraduate education. Says one student who asked for anonymity because she has been an off-prescription user of these drugs: "You've done all your work, but you're still focused. So you start with the bathroom, and then move on to the kitchen . . . ."

Warning: Side Effects

In the name of altering mood, energy and thinking patterns, we have been marinating our brains in chemicals for a very long time.

Caffeine is as old as coffee in Arabia, tea in China, and chocolate in the New World. Alcohol, coca leaves, tobacco and peyote go way back.

Even psychopharmaceuticals have been around for generations. Amphetamines -- which are the active ingredient in Adderall and Ritalin -- were first synthesized in Germany in 1887. Students have been using them for generations, in the form of Benzedrine and Dexedrine.

Beta blockers have been the dirty little secret of classical musicians since the 1970s. Originally prescribed to treat high blood pressure, they became the "steroids of the symphony" when it became clear Inderal controlled stage fright. As long ago as 1987, a study of the 51 largest orchestras in the United States found one in four musicians using them to improve their live performances, with 70 percent of those getting their pills illicitly.

What's new is the range, scope, quantity and quality of substances, old and new, aimed at boosting our brains -- as well as the increase in what's in the pipeline. Current psychopharmaceuticals represent only the beginning of cognitive enhancers aimed at improving attention, reasoning, planning and even social skills.

The memory compounds being raced to market by four U.S. companies are initially aimed at the severely impaired, such as early-stage Alzheimer's patients. But researchers expect the market for memory drugs to rapidly extend into the aging population we think of as normal, such as the more than 70 million baby boomers who are tired of forgetting what they meant to buy at the shopping mall and then realizing they've forgotten where they parked their cars, too. Or students who think such drugs could gain them hundreds of points on their SATs.

In research now underway, one such substance, ampakines, boosts the activity of glutamate, a key neurotransmitter that makes it easier to learn and encode memory. How useful they might be in a French or law exam.

But there are side effects with every drug. Strattera -- the ADHD medicine that is not a stimulant and may be taken for weeks before it shows an effect -- comes with a warning that it can result in fatal liver failure. The FDA warns it also may increase thoughts of suicide in young people. For a while last year, Canada pulled a form of Adderall from its markets as a result of sudden unexplained deaths in children with cardiac abnormalities. Provigil can decrease the effectiveness of birth control. All of these drugs come with a raft of side-effect warnings.

Nonetheless, pharmaceutical companies are racing to bring to market new drugs aimed at fundamentally altering our attitudes toward having a healthy brain. The idea is less to treat a specific disease than it is to, in the words of the old Army recruiting commercial, "Be all that you can be."

Of Mice and Men

Is this what smart has come to in the early 21st century? Is Ken Jennings, the "Jeopardy" phenom, our model of smart? Do SATs and grade-point averages measure all of what it means to be intelligent? If so, these drugs have a potent future. But definitions of intelligence may change -- already, some colleges have stopped requiring SAT scores from applicants.

Howard Gardner of Harvard is the godfather of the idea that smart is more than what IQ tests test. In his seminal 1983 book, "Frames of Mind: The Theory of Multiple Intelligences," and later works, he laid out a then-novel model of cognition that included many other kinds of sagacity.

"I feel that what we call 'intelligence' is almost always 'scholastic skill' -- what it takes to do well on a certain kind of short-answer instrument in a certain kind of Western school," he writes in an e-mail. "Other uses of intellect -- musical competence, facility in the use of one's hands, understanding of other people, sensitivity to distinctions in the natural world, alertness to one's own and others' emotional states etc. -- are not included in our definitions of intelligence, though I think that they should be. Unless performances in these other domains were directly tapped, we'd have no idea of whether 'performance enhancing pills' affect these other forms of intelligence as well."

Eric R. Kandel is shocked by the idea that powerful elixirs like the ones he is developing might rapidly trickle down to ambitious college kids. He shared the 2000 Nobel Prize in medicine for his research on the physiological basis of memory storage in neurons. He also founded Memory Pharmaceuticals.

"That's awful! Why should they be taking drugs? They should just study! I think this is absurd. What's so terrible about having a 3.9? The idea that character and functioning and intelligence is to be judged by a small difference on an exam -- that's absurd. This is just like Barry Bonds and steroids. Exactly what you want to discourage. These kids are very sensitive. Their brains are still developing. Who knows what might happen. I went to Harvard. I like Harvard. It ain't worth it."

The mind amplifiers he's working on, he insists, could have major effects on lots of needy people -- those with mental retardation or Down syndrome, or those with memory loss from depression or Alzheimer's or cancer chemotherapy or schizophrenia. "There are lots of populations out there that really, really need help," he says.

Kandel is hugely enthusiastic about taking a memory that has slipped and bringing it back up to reasonable. His compounds are terrific in aging mice, he says.

But ambitious college kids?

Why take the risk?

In normal mice, he says, his stuff improves memory -- only by 20 percent to 50 percent.

© 2006 The Washington Post Company

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