Healthy patients without attention deficit disorder (ADD) should not be prescribed cognitive enhancement medications, according to an article published in CMAJ.
People are sometimes prescribed stimulants (such as methylphenidate and dextroamphetamine) for cognitive enhancement, which is essentially using them to only improve memory or concentration.
As a prescription is necessary for these drugs, doctors must make sure that they are prescribing them to people who actually need them and not to healthy individuals without ADD. The American Academy of Neurology does not impose any restriction on who can be prescribed ADD medication, in fact, it even allows doctors to prescribe the medications to people without ADD.
Dr. Eric Racine, from the Institut de recherches cliniques de Montréal and Université de Montréal, said: "Physicians are important stakeholders in this debate, given the risks and regulations of prescription drugs and the potential for requests from patients for cognitive enhancers."
Most people who take the drugs for cognitive enhancement think that by using it to they will perform better at school or work.
It is predicted that up to 11% of university students use stimulants to improve concentration. A previous editorial published in CMAJ highlighted the extent of stimulant abuse in universities and colleges, pointing out the many harmful side effects it can have and how questionable the benefits are.
Many university students without ADHD take ADHD medications
However, recent studies have indicated that these stimulants are not associated with any benefits in mental performance. In fact, they often induce psychosis, cause cardiovascular harm and even dependence.
Dr. Racine with Cynthia Forlini, two coauthors of the paper, add: "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,"
Prescribing people cognitive enhancers may not always be in the best interest of the patient or the Canadian publicly funded health care system. It can end up becoming a waste of money, and also put the patient at risk of side effects.
Doctors have to make sure that they are allocating health-care resources in a careful and responsible way. It can create drug shortages and may prevent those who really do need to take the drugs from having them.
The authors concluded:
"Given the current state of limited evidence on medical, scientific, social and ethical aspects of cognitive enhancement, we call for greater attention to its appropriateness within existing Canadian health care systems."
Commonly prescribed ADHD medications include:
- Methylphenidate (Ritalin, Concerta, Metadate, Daytrana)
- Dexmethylphenidate (Focalin)
- Amphetamine-Dextroamphetamine (Adderall)
- Dextroamphetamine (Dextrostat, Dexedrine)
- Lisdexamfetamine (Vyvanse)