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Assignments accumulating? Exams coming up? Halfway through this semester, you may be wondering how you’ll get it all done. As a pharmacologist on a large campus, I routinely talk to students about how they grapple with this, and listen to their strategies for success. Maybe your oversized coffee goes everywhere you go. Perhaps your friend bought some funky herbal product that claims to help with mental performance. Maybe your roommate hit up their ADHD classmate for a dose of Ritalin.
It’s possible that certain products may help you stay alert, think straight, and meet a deadline. Trying these substances may or may not work out as planned. Sometimes students tell me that they took something because they wanted to be more alert and instead, they got a tremor, dry mouth, and insomnia. What went wrong? Did they waste their money? Could they have harmed their health? Good questions. If you consider using anything—even large amounts of caffeine—you need to know how that substance may affect you and how to manage or minimize the risks.
Using substances to enhance your focus or brainpower:
No drug makes you smarter
No medication, treatment, herbal product, street drug, or other substance has been shown to improve intelligence or enhance cognition in people with healthy brains.
ADHD medications don’t provide an intellectual advantage
Drugs prescribed for students with attention or learning issues help level the playing field, addressing the factors that could hold those students back. They may temporarily improve alertness. They do not boost intelligence or grades.
Energy drinks are no more effective than coffee
Energy and related products derive their “oomph” from the added caffeine (and, in many products, lots of added sugar).
Most herbal supplements offer little or no benefit
While manufacturers must apply for a license from Health Canada prior to selling their products, they don’t have to provide sufficient evidence to support the health benefits they’re claiming. “Health Canada routinely grants approval to substances that have no medicinal benefit whatsoever,” says Dr. David Juurlink, scientist with Sunnybrook Health Sciences Centre in Toronto. This may be changing, as Health Canada is creating tougher regulations to prevent manufacturers from making claims they can’t substantiate, or require them to include a disclaimer stating that the benefits have not been authenticated by the government. Until those regulations go into effect, be skeptical about the so-called benefits you see advertised on natural and herbal products.
If you choose to use: Four things you need to know
1 Using any substance means accepting some risk
All drug use carries some risk. This is true whether the substance is legal or illegal, whether it is prescribed or available over-the-counter, and whether it is socially acceptable or socially stigmatized. When medical providers recommend a course of treatment, they consider your state of health and balance the possible risks of the drug against its possible benefits. If you self-medicate, you may not be aware of those risks or adequately factor them in.
Drugs are classified (“scheduled”) by the government according to how accepted they are for medical use and how likely they are to being abused. This scheduling is based on historical problems with drugs; it can be changed depending on new evidence. Scheduling does not fully inform users about the risks of a substance.
“Drug classification is a controversial issue,” says Dr. David Juurlink, scientist with Sunnybrook Health Sciences Centre in Toronto. “They’re classified in relation to their abuse liability. You can go to a store and buy caffeine tablets, but you can’t just go to a store and buy amphetamine. The abuse liability in amphetamine is so much higher, and the potential harms of amphetamine—at least when abused—are quite serious.”
Why drugs are classified differently:
- Some drugs have no accepted medical use and high abuse potential (e.g., heroin, LSD, ecstasy, and “bath salts,” a synthetic stimulant).
- Some drugs have accepted medical uses and low abuse potential (e.g., cough syrups that contain codeine).
- Some drugs have accepted medical uses and high abuse potential (e.g., buprenorphine, an analgesic).
2 It’s on you to know exactly what the substance is and whether it can potentially generate the effect you want
Ever known someone to take a drug and then wonder why it did the opposite of what they desired, or why it produced icky side effects? Maybe they took the wrong dose or were given the wrong drug. Maybe this was not the right drug for that user’s individual biology (even though it seemed to work for their friend). Or maybe the drug wasn’t even designed to improve alertness—which would be like taking Valium for pain (Valium has no pain-relieving properties). Even well-intentioned friends are unlikely to be reliable sources of info.
- What exactly is this drug or substance? “The risks are greater if you don’t know what exactly this is, who made it, did they make it well, and so on,” says Steve Lux, a former senior health educator at Northern Illinois University. Don’t count on your friends for the correct information. People without relevant professional qualifications tend to be vague about brand names versus generic names, drug classifications, and what drugs actually do. As a pharmacologist on campus, I hear students saying “narcotic” when they mean “sedative,” or “Tylenol” for any over-the-counter pain treatment.
- What is the active ingredient in this drug or substance? Some people misuse “fixed dose” products; these are combination drugs containing one or more medications. The chances are that one of the two is a drug you don’t want or need. It’s important to read all drug labels carefully, check the active ingredients, and make sure you’re not doubling up. For example, it’s possible to accidentally overdose on acetaminophen by using Nyquil for its sleep-inducing properties. It’s the diphenhydramine that makes people drowsy, but that comes with a sizable dose of acetaminophen, which can harm the liver.
- What effect could this drug or substance have on me? A drug may be right for a specific problem, but wrong for you. “Taking a medication that’s not prescribed for you has inherent risk, because you may not be the right person for the medication,” says Dr. Smith. “For example, stimulant medications significantly increase both heart rate and blood pressure. For most people, that’s OK; for some people that can lead to very bad outcomes. It has to do with how the individual responds to the medication.” Even health care providers make mistakes, in spite of their many years of training.
How your body and mind respond to a substance is largely determined by your genes. Being sick, or using any other substances, can also change the way a drug works for you (or doesn’t). For example, a sleep aid may be masked by the use of other substances, such as caffeine or stimulants, and actually make you restless. This is why some drugs are available only by prescription; in untrained hands, the risks may multiply.
3 It’s on you to be careful about dosing
It is not true that if a little bit of a drug is good, more must be better. That’s a dangerous approach to any medication.
- The dose makes the poison For example, 20 micrograms of fentanyl, a potent analgesic, can relieve pain. But as little as 2 milligrams of the same drug (an amount equal to two grains of sugar!) can be fatal, especially for someone who may be trying it for the first time and has no tolerance. When there isn’t much wiggle room between a therapeutic and a toxic dose, there’s a high risk of overdosing. Other examples include blood-thinning drugs, such as warfarin (also used as rat poison), and heart rhythm medications.
- Appropriate dosing depends on several factors The right dose of any substance also depends on your health, age, and genetics. The same dose of the same substance may be ineffective, therapeutic, or toxic to different people.
- Even the right dose can have side effects Even appropriate doses of prescribed medications can have negative effects. Talking with your medical provider about how you’re feeling on a drug is important; that’s how you and your provider monitor whether or not it’s the right treatment and dose for you.
4 It’s on you to anticipate any negative effects on your functioning and figure out how to manage and minimize those
Using drugs or substances can affect how you feel and function in the next few days.“You’re risking a whole array of side effects if you take these medications either in doses that are too high or in doses that are taken too frequently throughout the day,” says Dr. Derryck H. Smith, Clinical Professor Emeritus of the Department of Psychiatry at the University of British Columbia.
You can anticipate those effects. If you’re planning on being awake for long hours during exams, try to focus on your well-being in the weeks prior. “Balance things such as sleep, exercise, and study,” says Dr. Smith.
Note: No amount of rest or self-care can mitigate the side effects of drugs.
Considering using any of these?
What they do, how they work, and what you need to know
- Main takeaway Caffeine in the form of coffee, tea, soft drinks, an over-the-counter tablet, a brewed yerba mate drink, or an energy drink is safe and effective for millions of people, and its use is usually socially acceptable. High doses of caffeinated products can have side effects.
- Effectiveness Caffeine can enhance focus, increase stamina, and decrease the effort required to do physical work.
- How this works Caffeine promotes release of stimulatory substances such as norepinephrine to increase energy and well-being, and it blocks a compound in the body that signals the need for sleep.
- Possible side effects Headache, tremor, insomnia, nausea, tooth enamel erosion due to drink acidity, increased pulse and blood pressure in some people, and gastric distress; these effects depend on dose and individual tolerance, and can sometimes be controlled.
Need to know
- Caffeine-containing products are relatively safe; there is mixed evidence on whether users can become dependent.
- Although roughly 30 percent of students are reported to use energy drinks, they offer no performance benefits over and above coffee (American Journal on Addictions, 2016).
- Consumption of several cups (coffee or yerba mate) or cans (energy drinks) of caffeinated beverages within a few hours may cause temporary side effects in some people (e.g., mild tremors, headaches, rapid heartbeat, irritability), which may discourage repeated misuse (Critical Care and Resuscitation, 2010).
- Your own limits may be different from other people’s. Caffeinated products differ in volume, ingredients, and potency, and their effects depend partly on users’ body types. Use your judgment.
- Additional ingredients, such as taurine and ginseng, are typically in quantities too small to provide any benefit (Nutrition Reviews, 2014). The caffeine and sugar (if included) are responsible for any perceived effects (Physician and Sportsmedicine, 2010).
“I used caffeine and yerba mate in high school to stay energized throughout my day and help me get the stuff done I needed to get done. The caffeine made me have an increased heart rate, which now sometimes I mistake for a panic attack about to happen.”
—Second-year undergraduate, University of Guelph-Humber, Ontario
“I don’t really think of drinking yerba mate as ‘using substances,’ but I suppose that’s exactly what it is. I drink yerba mate as an alternative to coffee when I need a pick-me-up.”
—Second-year undergraduate, University of Victoria, Alberta
“Having too much caffeine makes me shaky and [it’s] actually harder to study.”
—Second-year graduate student, University of Victoria, Alberta
“Coffee is the only stimulant I have used. I don’t drink it regularly, but when I’m feeling drained, it is a good temporary boost of energy.”
—Graduate student, Nova Scotia Community College
- Main takeaway Provigil and similar drugs used to increase wakefulness are specifically formulated for people with narcolepsy, a rare sleep disorder, or for people with shift-work sleep disorder. The side effects are relatively minimal, but obtaining these drugs without a prescription is risky.
- Effectiveness For people without sleep disorders, these drugs seem safe; any toxic effects are transient and mild (Clinical Toxicology, 2009).
- How they work These medications increase the activity of neurotransmitters (dopamine, serotonin, and norepinephrine) in the brain, which are stimulatory and reduce daytime sleepiness.
- Possible side effects Headache, dizziness, anxiety, dry mouth, insomnia, nausea, diarrhea, multiple known drug-drug interactions.
- Need to know
- There are no real risks associated with use other than obtaining these drugs without a prescription through diversion (the illegal distribution of a prescription drug); this carries the risk of arrest, legal penalties, and academic disciplinary sanctions.
- Some internet pharmacies are legitimate, but many offer products and services that are dangerous and have not been approved for use in Canada due to safety concerns.
- All drugs approved for sale in Canada have an eight-digit Drug Identification Number (DIN), which assures you that Health Canada has assessed the drug and considers it safe and effective.
“I have a valid prescription for modafinil and have never been asked to share or sell them.”
—Second-year undergraduate, University of Victoria, Alberta
“I used modafinil because I work full time and go to school full time. Sometimes I have to be up for 18–24 hours and need its effects to help me last through the day.”
—Undergraduate, Lord Fairfax Community College, Virginia
- Main takeaway Nicotine is available in cigarettes (traditional tobacco and some e-cigarettes), cigars, and nicotine gum. Nicotine is the most addictive substance known and has serious (often lethal) side effects.
- Effectiveness Nicotine can enhance focus and alertness. The dosing and the duration of this effect vary from person to person.
- How this works Nicotine releases stimulatory neurotransmitters, such as norepinephrine. Paradoxically, at very high doses nicotine has a sedative-like effect (this dose varies, and depends on individuals’ tolerance).
- Possible side effects Insomnia, nausea, gastric distress, craving and addiction to nicotine in an otherwise non-addicted person, increased irritability, anxiety, and a burning sensation in the mouth.
- Need to know
- Provincial laws guide where and when (at what age) you can purchase and consume tobacco.
- Tobacco (smoking and chewable) contains nicotine; this damages the DNA in our cells, and may lead to the growth of new cancerous tumours in the mouth and lungs, and activate or accelerate cancers that are already present or dormant.
- Smoking nicotine is becoming less socially acceptable. Some employers will not hire smokers.
“I would smoke because it temporarily calmed me down. Afterwards, I tended to feel better, but I knew that it was starting to become an issue when I relied on having a smoke before an exam.”
—Graduate student, O’Sullivan College, Montreal
“Positive effects: felt calmer. Negative: became addicted and needed more and more to feel the effects.”
—Second-year undergraduate, Utah State University
- Main takeaway Compounds that are sold to consumers as “smart drugs” (e.g., donepezil, piracetam, aniracetam, oxiracetam) may do nothing more than generate expensive urine.
- Effectiveness Studies confirm that these drugs offer little to zero cognitive enhancement. The Food and Drug Administration in the US has declared them “unsafe” (FDA Warning Letters, 2010). False expectations about these medications may arise from misunderstandings of studies involving patients with mild cognitive decline or the early stages of dementia (e.g., Alzheimer’s disease) who experienced slight, temporary cognitive improvements. People with advanced dementia and those with normal cognition showed no benefit from these drugs (Current Pharmaceutical Design, 2002). “These medications do not work in people with normal cognitive function,” says Dr. Nathan Herrmann, Head of the Division of Geriatric Psychiatry at Sunnybrook Health Sciences Centre in Toronto.
- How they work These medications resemble GABA, a neurotransmitter in the brain, and stimulate fast transmission of nerve signals; they also increase oxygen and blood flow to the brain. Perhaps counterintuitively, this does not produce a meaningful effect (other than a whopping headache).
- Possible side effects Headache, anxiety, insomnia, agitation, nervousness, hyperkinesia (involuntary jerking movements)
- Need to know
- “There are no drugs approved in Canada for the improvement of cognition in people without underlying disorders, [such as] dementia or even ADHD,” says Dr. Herrmann.
- Health Canada conducts regular inspections of companies that manufacture, import, and/or distribute drugs and investigates complaints related to the sale or use of therapeutic drugs, including the websites that sell them.
“I have taken a ‘nootropic’ in an attempt to help supplement my prescription medication for ADHD. Unfortunately, I found that nootropics actually made the ADHD more [severe] and I discontinued usage.” —Second-year graduate student, Southern Alberta Institute of Technology
“I found out this helped some of my fellow students (I had a lot of respect for their knowledge) so I figured I would give it a whirl. I did not like it. I’ll stick with my mediocre knowledge and drug-free lifestyle.” —Second-year undergraduate, St. Lawrence College, Ontario
“It helps me with word availability and gives me crazy dreams.” —Fourth-year undergraduate, University of California, Los Angeles
- Main takeaway Prescription medications, such as Ritalin, Adderall, and Concerta, are used to treat people diagnosed with ADHD. In people without ADHD, they act as direct stimulants, increasing wakefulness. They do not boost intellect or grades and can have unpredictable side effects.
- Effectiveness In people with ADHD, these medications correct neurological imbalances that diminish concentration and increase distractibility, potentially improving focus and helping people complete a task (Frontiers in Neuroscience, 2013). For those who do not have ADHD, they are simply stimulants and may actually increase distractibility.
- How they work Certain neurotransmitters that send stimulatory signals are normally taken up into the cells; these drugs block that process, allowing more stimulatory effects.
- Possible side effects Increased distractibility, increased pulse and blood pressure, headache, insomnia, and high risk for misuses and/or dependence.
- Need to know
- ADHD medications do not boost intellect; using them when ADHD is not present is associated with lower grades (Addiction, 2005).
- Used without medical supervision, ADHD medication can have unpredictable side effects and may be even more risky in combination with high doses of caffeine or other drugs (such as alcohol).
- Obtaining these drugs without a prescription through diversion (the illegal distribution of a prescription drug) carries the risk of arrest, legal penalties, and academic disciplinary sanctions.
“My ex-boyfriend’s brother was prescribed a particular drug to help him with his ADHD. I struggled with procrastination and poor time management so I asked if I could have some to use for my final exams. My then boyfriend said he couldn’t because his brother’s intake of the drug was being strictly monitored.”
—Recent graduate, Mount Royal University, Alberta
“A lot of people in my program ask two of the ‘popular’ students to sell them Adderall. I believe they are ‘popular’ because of this. Every week I hear new stories about the benefits of Adderall while studying. I believe their behaviour is the reason why there is peer pressure to try it.”
—Fifth-year undergraduate, University of New Brunswick
“Adderall gave me laser-like focus and a kind of calm euphoria or feeling that things would work out. It seriously messed with my sleep, though.”
—Third-year undergraduate, Ridgewater College, Minnesota
Most students are not misusing stimulants
In a national, anonymous survey of more than 43,000 Canadian college and university students, 89 percent said that in the past 12 months they had not used a prescription drug that wasn’t prescribed to them (National College Health Assessment, Canadian reference group executive summary, Spring 2016). Of the minority who had chosen to use medications that weren’t prescribed for them, stimulants were the most common (7 percent had used).
In a recent survey by SH101, here’s what students reported about their lifetime use of substances that they hoped would improve their alertness or performance:
Why some students wouldn’t use again
In each substance category in the chart below, around one in three students who had used this type of substance said they would not use it again. Most students who did not intend to use again cited concerns about how the substance(s) might affect their general well-being. Some said their use was a one-off event (e.g., to help them complete a single assignment). Some did not care for the side effects. Some were concerned about possible long-term consequences: “[Adderall] definitely increased my ability to focus, but I turned away from it because it was obviously habit forming,” said a third-year student at Ridgewater College, Minnesota.
Source: SH101 survey, October 2016, 290+ respondents (not representative of students nationally)
What are the legal, professional, and academic implications of misusing prescription drugs?
If you begin to illegally access, use, or distribute prescription drugs, or associate with someone else who is affiliated with drugs, you risk facing serious legal trouble. The policies and regulations regarding prescription drug fraud vary by province across Canada.
“Governed by the Controlled Drugs and Substances Act, prescription drugs are only legal when prescribed by a doctor,” reports the Royal Canadian Mounted Police website.
You may be subject to federal and provincial charges and penalties, and/or academic sanctions. A criminal record may limit your future employment prospects, damage your reputation, and threaten your post-secondary career and scholarships. Most colleges and universities include substance abuse as a violation of the academic student honour code. As such, there is often discipline and conduct issues to consider such as academic probation, fines, rescinding scholarships, or expulsion.
“Doctor shopping” This means visiting multiple physicians with the goal of obtaining several prescriptions for the same or similar medications, and/or using more than one pharmacy to fill these prescriptions.
Falsifying symptoms Pretending you have certain symptoms can get you barred from seeing some physicians and may be considered prescription drug fraud, which is charged under the Controlled Drugs and Substances Act.
Tampering with prescription forms Doing this with the intention to get drugs is a crime, punishable by fines and jail. It would likely result in fewer physicians and pharmacies being willing to help you in a time of real need.
Use of prescription substances without a prescription It is illegal to possess prescription drugs without a valid prescription. Legal penalties are based on the type of substance, when, and how you were caught (for example, whether you were possessing the drug or using it), and how much of the substance you obtained. Having large amounts of a substance implies that you intend to distribute it, which may result in heavier charges and penalties.
Giving away or selling your medication This is called “drug diversion,” and there are legal implications. People caught selling (or buying) diverted drugs may face fines or jail, depending on the province.
Fifth-year undergraduate, Mount Royal University, Alberta
Looking for a way to increase your productivity without risking side effects? This app makes managing tasks easier and is especially useful for those who tend to have the memory of a goldfish—like me! All you need to do is sign up via the app or the website. The app aims to eliminate hand writing to-do lists on sticky notes…or your hand!
Absolutely. We students are always juggling multiple tasks, from homework assignments to bill payments and everything in between.
Assignments and due dates are never fun, but seeing each task being completed made me so proud of myself! #LoveYourself
I’m way more organized and productive, so I finally have some free time for my fav shows on Netflix.
Steve Lux, MS, former senior health educator, Northern Illinois University.
Advokat, C., & Scheithauer, M. (2013). Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers. Frontiers in Neuroscience, 7, 82. doi:10.3389/fnins.2013.00082
American College Health Association. (2016). National College Health Assessment Undergraduate Student Reference Group. Retrieved from http://www.acha-ncha.org/docs/NCHA-II%20SPRING%202016%20UNDERGRADUATE%20REFERENCE%20GROUP%20EXECUTIVE%20SUMMARY.pdf
Duchan, E., Patel, N. D., & Feucht, C. (2010). Energy drinks: A review of use and safety for athletes. Physician and Sportsmedicine, 38(2), 171–179. doi:10.3810/psm.2010.06.1796
Ernest, D., Chia, M., & Corallo, C. E. (2010). Profound hypokalaemia due to Nurofen Plus and Red Bull misuse. Critical Care and Resuscitation, 12(2), 109–110. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20513219
Food and Drug Administration. (2010). Warning Letters—Unlimited Nutrition. Retrieved from www.fda.gov
Gualtieri, F., Manetti, D., Romanelli, M. N., & Ghelardini, C. (2002). Design and study of piracetam-like nootropics, controversial members of the problematic class of cognition-enhancing drugs. Current Pharmaceutical Design, 8(2), 125–138. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11812254
Housman, J. M., Williams, R. D., Jr., & Woolsey, C. L. (2016). Impact of alcohol and alcohol mixed with energy drinks on non-medical prescription stimulant use in a nationally representative sample of 12th-grade students. American Journal on Addictions, 25(5), 378–384. doi:10.1111/ajad.12390
McCabe, S. E., Knight, J. R., Teter, C. J., & Wechsler, H. (2005). Non-medical use of prescription stimulants among US college students: Prevalence and correlates from a national survey. Addiction, 100(1), 96–106. doi:10.1111/j.1360-0443.2005.00944.x
Mora-Rodriguez, R., & Pallares, J. G. (2014). Performance outcomes and unwanted side effects associated with energy drinks. Nutrition Reviews, 72, Suppl 1, 108–120. doi:10.1111/nure.12132
Spiller, H. A., Borys, D., Griffith, J. R., Klein-Schwartz, W., et al. (2009). Toxicity from modafinil ingestion. Clinical Toxicology, 47(2), 15–156. doi:10.1080/15563650802175595
Student Health 101 surveys, October and November 2016.