Students used to take drugs to get high. Now they take them to get higher grades
It’s still more than three months until
finals, but there’s a whiff of panic in the
air of the Edinburgh student flat where I’m
having dinner. “Everybody’s feeling it,”
says Suzy. Feeling what? “The pressure.
There’s just so much pressure.” About
what? Your exams? Or what to do next?
“Everything. I shouldn’t even be here. I
didn’t even want to go to university but
everyone said I should. And the work! It’s
just… there’s so much of it! I feel like I
wouldn’t even have a chance if it wasn’t for
modafinil.”
Modafinil: a prescription-only medication
for narcolepsy that the NHS’s website
describes as “a central nervous system
stimulant” that prevents “excessive
sleepiness during daytime hours”. Or, used
off-label, bought via some off-shore
pharmaceutical retailer, it’s what’s known
as a “smart drug”. I hadn’t even heard of it
a week ago, but it turns out they’re all on
it, the students. They’ve all taken it on at
least a couple of occasions, all five of the
female final-year students who live in this
particular flat, and all five of the male
final-year students they’ve invited over to
dinner.
“It’s not that it makes you more
intelligent,” says Phoebe, a history
student. “It’s just that it helps you work.
You can study for longer. You don’t get
distracted. You’re actually happy to go to
the library and you don’t even want to stop
for lunch. And then it’s like 7pm, and
you’re still, ‘Actually, you know what? I
could do another hour.’”
But isn’t it cheating? Or like doping in
cycling? If lots of people are doing it, it’s
too much of a disadvantage not to join in?
“My ex-girlfriend used to say that to me,”
says Johnny, another history student. “She
was like, ‘I don’t agree with it. It’s unfair.’
And then when the pressure was on, she
was like, ‘Can you give me some?’”
Everyone’s taking it, they say. What do you
mean everyone? “Everyone!” says Phoebe.
“Everyone I know, anyway. It’s rife.”
You do have to be to be careful though,
says Johnny. “It gives you this amazing
concentration but you have to make sure
you’re actually in front of your books. I
spent five hours in my room rearranging
my iTunes library on it once.”
The talk moves on, but later when I ask
them what they’re going to do next year,
they tense up. The ones who do know what
they want to do next year worry about how
they’re going to get there. And the ones
who don’t know just go into a state of mild
panic and ask questions like, “How did you
know what you wanted to do?”
“My parents don’t have a clue what it’s like
these days,” says Daniel. “My dad is really
successful. And he got to where he is today
with a 2:2 from Hull University. You
wouldn’t get a look in the door with most
jobs with that these days.”
Student life has changed. But it’s not that
it’s changed from what it was like when I
was a student a generation ago, it’s that it’s
changed from what it was even five years
ago. Jack Rivlin, who’s the founder and
editor of the Tab, a national network of
student news sites, says it’s obvious from
the traffic stats on his website.
“We can track it from the change in stories
that interest students these days. It’s
stories about CVs, jobs, fees… much more
so than it used to be. We can see it.
Students are much more career-conscious
than they were even five years ago when I
was a student. They’re much more
conscious of getting value out of their
degree. The atmosphere is definitely
careerist and competitive and getting more
so.”
And, this is where modafinil, and the other
smart drugs that have become increasingly
common in universities across Britain –
Ritalin (methylphenidate), Adderall
(mixed amphetamine salts), Dexedrine
(dextroamphetamine), all of which are
attention deficit hyperactivity disorder
(ADHD) medications – start to look like a
symptom rather than a cause.
Because this year’s final students are the
first to graduate into a brave new world of
massive debt. They’re the first cohort to
come through who will experience the full
force of the impact of the coalition’s
decision to introduce tuition fees: they’ll
owe an average of £44,000 a head by the
time they leave in just a few months. This
is at a time when stories about graduate
unemployment and exploited interns are
never far from the news pages – last week a
media group admitted that it was charging
students to write for it, and before that it
was a thinktank making its unpaid interns
pay £300 for a reference.
And in this scenario, if you were offered a
small white pill that held the promise of
enhanced productivity, greater focus, more
hours in the library, and, ultimately, the
potential of a better degree, well… it’s not
hard to see the attraction.
Though, it’s not quite as simple as that.
Everyone’s brain chemistry is different.
Everyone reacts in a different way. There
are no medical checks when you click a
button on the internet. And no controls
over what you’re actually sent. I hear story
after story about essay deadlines achieved
against all odds and then when I’m
leaving, one of the quieter women says to
me: “It’s awful. I just got… very anxious.
Depressed.”There have always been drugs, of course.
Every generation has had its narcotic of
choice. LSD provided the mind-expanding
backdrop to the 60s and the appearance of
ecstasy in the late 80s kickstarted rave
culture and another summer of love. But
this use of drugs to work harder, to gain a
competitive advantage, to produce more –
this is new, at least in Britain. Anjan
Chatterjee, a professor of neurology at the
University of Pennsylvania, who has
published several influential papers on
the ethics of smart drugs, tells me that he
sometimes makes jokes about it. “When I
was young, students would use drugs to
check out. Now they’re using them to check
in.”
He’s witnessed the rise, in the last 10
years, of a generation of American students
doping themselves up on various
medications they believe will give them a
competitive edge. “It’s even in high schools
now, especially in the more affluent
suburbs. Students call them ‘study aids’;
they don’t even think of them as drugs.
There’s an entire grey market on
campuses. But then, the current estimate is
that a third of all students have a
prescription for some sort of psychoactive
medication anyway: antidepressants, or
medication for ADHD, or for anxiety, so the
availability is quite high. Often, they’ll just
sell on the medication in the library.”
He believes that cognitive enhancement –
or cosmetic neurology, as he calls it – is
likely to become viewed as normal over
time, in much the same way as cosmetic
surgery has been. If it’s available, people
will avail themselves of it. And his
intuition “is that this use of drugs is not
the cause of this sense of competition. It’s a
phenomenon of it.” Smart drugs are part of
a “parcel of broader cultural trends” that
tap into something that is already within
our culture. “And this is what does give me
pause. It’s this relentless pursuit of
productivity, and material productivity in
particular that seems to be at the root of
this. Going after drugs is a symptom of that
underlying impulse.”
His account of the pattern of use of these
drugs tallies with what the students in
Edinburgh tell me too. I meet with a
smaller group of them the day after our
dinner: Phoebe and Johnny from the night
before and Annie, who’s studying English,
and they talk me through how and when
they started taking them. What’s
noticeable is that they’re all high
performers, all on target for high 2:1s or
firsts, academically bright but also
articulate and sociable and trying to fit
everything in. They’re all working hard
while maintaining fairly full-on social
lives: a large network of friends, nights out
clubbing, nights in having people around
for dinner.
“I didn’t know anything about it in my first
year,” says Phoebe. “It’s all coming from
the international students. It was the
American students that we discovered it
from. They’re all medicated and they’ve
got prescriptions and they sell them on.”
Johnny describes his first experience with
Adderall, which he bought off an American
student. “It made you feel weird. I
remember sitting in an exam and thinking,
‘This is awful.’ And, ‘Oh my God, I feel like
I’m going to faint.’ But at that same time I
was remembering stuff… I could remember
whole paragraphs, word for word. It was
amazing.”
It enhanced your memory? “It did. But the
whole thing was so unpleasant. And then,
last year someone had a prescription for
modafinil and started selling them and
then we started buying them from a
website in Singapore.”
Annie has only taken it when she’s at what
she calls “crisis point”. “I had two major
essays to deliver within four days of each
other and it was such a huge amount of
work that I just needed something. And it
got me through. I did it. But I have to say
my work wasn’t as good as it could have
been. It was just quite… shallow. It makes
you focus very narrowly and I really zoned
in on something which turned out to be
quite minor.”
Phoebe has taken such drugs
intermittently and lists the plus points:
“You take it on an empty stomach first
thing in the morning and then you work
really hard all day and it kills your
appetite and then if you go to the gym, you
do a really good workout. So you lose
weight, nail your exams, and go hard at the
gym all at once.”
If it sounds too good to be true, it probably
is. Phoebe gave them up because she
didn’t like the side effects. “My stomach,”
she says, holding her waist. “It wasn’t
good.” Johnny describes how he was taking
them every day for several months. “And
then over Christmas I realised I was
definitely dependent on them. And it
wasn’t even that beneficial for my work.
It’s just kind of like a feeling inside that I
need to take some so I can perform.”
He’s cut down but then he reveals that he’s
taken one that morning. “Have you?” asks
Phoebe, surprised. There’s no burning
deadline for any of them today. They’re
happy to sit and chat over lunch. “Just a
half,” he says. “It just… you know how the
first few hours of the day, you struggle to
wake up and get going? You take a
modafinil and you’re singing R&B in the
kitchen half an hour later. You’re just on
it.”
You don’t know what’s actually in those
pills you’re ordering over the internet
from Singapore, though, do you? “No…”
says Johnny slowly. “They’re in blister
packs though. You know, they look real.”
Modafinil, which is prescribed in the UK
and the US as Provigil, was created in a
French laboratory in the late 70s and was
licensed for use in the UK as a narcolepsy
medication in 2002. In the US, that was
extended to include excessive daytime
sleepiness and shift work sleep disorder. It
apes some of the effects of classic
stimulants such as amphetamines but
without the classic stimulant side-effects:
jitters, anxiety and so on. It’s not
considered addictive, but some studies
have shown that it appears to increase
dopamine in the brain’s reward centre,
which has been correlated with addictive
behaviours.
And while the side effects of modafinil are
considered relatively minor – a headache,
most frequently, or stomach upset, or
relatively rare, serious skin reactions have
occurred in a handful of patients – perhaps
the biggest issue is that there simply
haven’t been any long-term studies into its
effects.
Barbara Sahakian is a leading authority on
the effects of smart drugs on the brain and
she’s continually making just this point.
She’s a professor of clinical
neuropsychology at Cambridge University
and she was one of the first people to
realise that the drugs she was studying in
her laboratory, drugs to ameliorate the
effects of Alzheimer’s and Parkinson’s, or
to enhance the cognition of stroke
sufferers, were being used for very
different reasons.
“I was over in Florida where I was due to
speak on my research and I hadn’t been
scheduled until late in the day and I
turned to my colleague and said, ‘It’s such
a shame I’m so jetlagged.’ And he said,
‘Would you like some of my modafinil?’ It
was a drug we used in the lab but I’d never
thought of it in any other context and I was
totally shocked. And then at the break I
started asking other colleagues if they took
any of these drugs and one said, ‘Yes, I use
Adderall.’ And another was using
modafinil and somebody else was taking
Ritalin. I was quite amazed. At least half
the people around the table were using
them.”
She wrote about it for Nature magazine.
“And they conducted an online survey and
out of 1,400 people who responded, one in
five was using something. I mean this is
people who are [choosing] to fill in a
survey on it, but it was still very
surprising.”
There are ways that the drug is useful and
could be even more useful, she believes.
It’s been shown to improve surgeons’
performances. “They’re like shift workers
essentially. They work late into the night
and they mainly use caffeine and you get
serious tremor with that, which is not
ideal. It’s been shown to reduce
impulsivity in the sleep-deprived, to
improve problem-solving ability. If it
reduces accidents in the workplace or bus
drivers who fall asleep at the wheel, this
has to be a good thing.”
What’s more, some of her most recent work
has shown that it increases “task
motivation. It motivates you to do the
things you’ve been putting off. They
become more pleasurable. It makes boring
things more interesting. It’s the tax return
drug.”
But she’s worried about the increasing
number of students who come up to her
after she gives talks. “Some of them are
quite angry – they don’t want to use the
drug but they feel they’ll be at a
disadvantage.” More than that though is
the lack of proper research into the effects
over time.
“We just don’t have any long-term studies.
That’s why it’s so inadvisable to use them
until that’s done and that’s why I’ve been
pushing the government to work with the
pharmaceutical industry to do that. The
other thing with young people is that their
brains are still in development. If you have
severe ADHD then you need a treatment
like Ritalin to be able to function, but if
you are a healthy young person… and you
are putting these drugs into a developing
brain. Well, we just don’t know enough
about what this does.”
In the absence of hard facts, there are
stories. I email back and forth with a young
woman in New York called Kate Miller,
who wrote a gripping account of her life
on, and coming off, Adderall for the New
York Times. Of how she discovered it in her
final year at university and continued to
use it as she started in a junior position at
a law firm doing 60-hour weeks, until she
finally realised she had become dependent
and quit. Her withdrawal was long and
difficult: “I slept through appointments
and was unable to stay up to meet
deadlines. The drug had curbed my
appetite and… without it I was ravenous.”
She found she was “sensitive and
emotional from the new chemical
imbalance” and “gaining weight and
falling behind at work” only exacerbated
it.
But the person I most want to speak to
about his experience of taking smart drugs
won’t talk to me about it: Johann Hari. He
was a prolific and well-regarded columnist
for the Independent until his career was
consumed by a media firestorm in 2011. It
was revealed that he’d written interviews
with people that contained quotes he’d
lifted from other sources and that he’d
made malevolent remarks,
pseudonymously, on other journalists’
Wikipedia pages.
Before that though, in 2008, he’d written
an article about modafinil that extolled its
unique and wondrous properties.
“Normally, one day out of seven I have a
day when I’m working at my best – I’ve
slept really well and everything comes
easily and fast. Provigil makes every day
into that kind of day,” he wrote. It enabled
him to “glide into a state of concentration –
deep, cool, effortless concentration”. And
the upshot is that he “inhales books” and
“exhales articles” effortlessly.
Eventually, though, he concludes that
“taking narcolepsy drugs when you don’t
have narcolepsy is just stupid”. And he
cuts a deal with himself. He’ll put away the
“gorgeous temptress” Provigil and only
take it when “I’m really knackered” and
not “more than two or three a month”.
Except that wasn’t it. He didn’t throw off
the gorgeous temptress. He was still taking
the pills when he lifted the quotes and
when he anonymously took to Wikipedia to
make his feelings known about his fellow
journalists. He gave them up the week his
disgrace came to light (along with the
antidepressants he was also taking) as he
explained to the Guardian in an interview
he gave last month to promote his first
post-scandal work: a book on drugs called
Chasing the Scream.
“I had been swallowing fistfuls of white
narcolepsy pills for years… I had read that
if you take them you can write in long,
manic weeks without pause and without
rest and it worked – I was wired,” he writes
in the foreword to the book. But he found
he had begun to wonder “if I was becoming
an addict myself. My long drugged writing
binges would stop only when I collapsed
with exhaustion and I wouldn’t be able to
wake for days.”
Hari’s special subject is drugs. Chasing the
Scream is the result of extensive research
and has garnered serious critical attention.
But he won’t talk about them with me. “It
was a terribly painful period of my life
and I find it too distressing to discuss in
detail in public,” he emails. And he still
won’t talk to me when I email back and
point out that his article on the joys of
Provigil is still all over the internet and is
quoted on multiple sites by people who
have used it as a reason to try it
themselves, so it might be useful for them
to know what he thinks of it now. And
anyway, I’m interested in the cultural
landscape in which these drugs exist, but
he won’t be drawn.
He’s made it clear in various interviews
that he doesn’t want to blame his
behaviour on drugs or to invite sympathy
for himself. And correlation is not
causation and he, more than anyone,
perhaps, is aware of the politics that make
any discussion of drugs so fraught and
open to misinterpretation. But still. In the
absence of proper studies, personal
experience, stories, are all that anyone has
to go on and he obviously has an
interesting one about modafinil that he’s
simply not telling.
In the US, surveys have shown the highest
levels of usage are at elite universities in
the north-east, where academic pressure is
at its most acute; where students are most
competitive; where intelligence, and all
the things that supposedly come from it,
jobs, money, success, are perhaps most
highly valued, most highly desired.
Sahakian also makes a comparison with
cosmetic surgery. “We are already
enhancing ourselves in all sorts of ways. I
was shocked when those problems with
those French breast implants came to light
and the number of women who had to have
them removed by the NHS. But it just all
depends what you’re valuing. And if you
go to a good university and expect a high
salary, it’s likely you are going to be
valuing certain things and if you can
enhance these things that’s going to be
attractive.”
And in Britain, informal surveys, such as
one carried out by student website the
Tab, have suggested the highest levels of
usage are in the more academic
universities – Oxford came top of its poll –
and students of subjects with the highest
workloads tended to show the highest
usage. Rivlin, the editor of the Tab, was
studying at Cambridge in 2010 when he
first heard about modafinil and started
using it. “It was my third year and it
suddenly appeared and people were like,
‘It’s amazing. It allows you to concentrate.’
And, you know, there’s a lot of pressure to
perform and it was very useful for
mechanical academic work when you’re
just trying to do a lot of notes or something.
“It probably says a lot about Oxbridge that
it seemed to take off there. I remember my
friends at other unis hadn’t really heard
about it at the time but it’s now certainly
bigger everywhere.”
Not that any university I get in touch with
wishes to acknowledge this. It’s partly
because there is a danger that articles like
this, even with all the caveats, might
encourage more people to try these drugs.
Partly because there’s no good research
being done into the numbers of students
taking them, though there are all sorts of
indices. In October, a record haul of smart
drugs being traded over the internet was
seized by the UK’s Medicines and
Healthcare Products Regulatory Authority.
And Sahakian points to the increasing
lifestyle use of cognitive enhancing drugs,
or smart drugs, by healthy people.
Published figures suggest a large
discrepancy between the number of
diagnosed narcoleptics and the amount of
anti-narcoleptic drugs sold (Cephalon,
makers of Provigil, made $1.2bn in
worldwide sales in 2012), and the ever
increasing amounts of ADHD medications
being prescribed (Dexamphetamine is the
second most privately prescribed drug in
Britain).
But, more than this, it’s a can of worms.
Duke University in North Carolina has
amended its academic honesty policy to
include “unauthorised use of a
prescription medication” and Sue
Wasiolek, the dean of students, tells me
that it was students themselves who
lobbied for this. They “wanted it noted for
the student community that using drugs to
enhance academic performance constitutes
cheating”. It’s only gone as far as noting it,
though. Without drug testing, it’s hard to
see how it could be enforced, though
several academics have started calling for
that too.
In Britain, the official policy of most
universities seems to be to pretend it isn’t
happening. When I email Oxford
University in search of somebody in
student services to talk to about whether
they’d encountered any students
struggling with these drugs, I get varying
sorts of brush-offs before an official
statement is issued. But then, it is a
tangled, morally difficult subject with no
easy answers. Even if you ban it in exams,
what’s to stop students using it for
revision? And there are cognitive
enhancers that have been around for
hundreds of years that no one considers
“cheating”. Caffeine is one; nicotine
another.
But we may all have to consider these
ethical questions one day. Because
cognitive enhancement isn’t going away.
Which is good news for Alzheimer’s and
Parkinson’s sufferers. And possibly for the
rest of us too. “We live in a global society
that is very competitive and where there’s
a lot of pressure and stress,” says Sahakian.
“And there are lots of difficult questions. If
you’re older and your pension is not
performing and you have to compete
against younger colleagues, what’s the
pressure there? If you take one of these
drugs, are you enhancing yourself? Or
restoring yourself to what you were?”
The Future of Humanity Institute at Oxford
University was set up to consider just this
sort of question and Anders Sandberg, a
computational neuroscientist there, tells
me how they look at the biggest threats
humanity is facing, as well as
opportunities; what emergent technologies
may offer us as humans.
And cognitive enhancement, whether it’s a
drug, or an electric current across the
brain, or a form of brain training on
computers, is absolutely part of our future,
he says. The difficulty is doing research.
“Ethics committees shy away from it. They
get nervous. Part of the problem is the
word ‘pill’. If you said it was a herb that
gave you a better memory, rather than
little white pills, people wouldn’t be so
scared.”
But, he’s upbeat about their democratising
potential. “University is a cognitive
enhancement but it’s rather an expensive
one. Smart drugs are relatively
inexpensive and if they help people
increase their opportunities then I think
this is a good outcome. The smart people
get more competition but a cognitively
enhanced society would help us all.”
When I talk to Sandberg, he’s at a
conference in Florida, due to deliver the
keynote lecture the next day. “So I will take
a modafinil after breakfast just to give me
that extra edge.” He started taking it about
10 years ago and mostly uses it when “I am
trying to solve really hard problems. I
think it helps. Though quite often I find
I’m not working on the right problem and I
would actually probably really benefit
from a good time-management course.”
He finds it suppresses divergent thinking,
which is one part of intelligence, “but I
think I’m too divergent. I never finish stuff.
This helps me focus.” Mostly, though, he
compares it to a “really good cup of coffee
that lasts all day”.
What interests him too is what people say
they want to enhance. People take smart
drugs to get ahead in their career, or
there’s enough of a placebo effect to make
them believe that they are. Silicon Valley
thrums with it. And Richard Kingdon, who
runs a rehab clinic, City Beacon, in
London’s Square Mile, tells me that people
who come to him with addictions to
cocaine and alcohol are often on it too.
“But we could be thinking about
enhancements that make our lives happier
and more fulfilled,” says Sandberg. “We
asked people if they’d take a supplement
that enhanced their kindness and empathy
and only 9% wanted that.”
It isn’t the drugs. It’s us. We’re medicating
ourselves against what used to be
considered the problems of everyday life.
Sadness, anxiety, overwork. “We really
have to look at ourselves as a society,” says
Sahakian. “We used to have a childhood.
What is causing such stress? And it’s a
problem with all types of drugs. If you look
at the use of painkillers, it’s enormous. We
all believe in the power of the little white
pill.”
Danny Lee-Forest, head of operations in
the enforcement division of the Medicines
and Healthcare Products Regulatory
Agency, tells me that smart drugs are just
one part of a huge online business. His
team seized £11m worth of drugs last year
“and it’s mostly stuff that either people
don’t want to go to their doctor about or
they do, and he tells them something they
don’t want to hear, like go on a diet, or do
some exercise. It’s slimming pills or
erectile dysfunction pills or hair loss.” Or,
increasingly, pills to block out the
competing distractions of everyday life.
Pills to get ahead.
Mike Power, the author of Drugs 2.0: The
Online Revolution That’s Changing How the
World Gets High , points out that ADHD
drugs are amphetamines. “That’s what
Adderall and Ritalin are. Those American
students are all just speeding off their
heads.” And while, it isn’t quite yet that
bad here, we are living in a “more
narcotised society generally. From the idea
of celebrities ‘partying’ or people talking
about ‘a big night out’, there is an
unacknowledged ubiquity to drugs from
the boardroom to the street, but we just
don’t have the political or intellectual
maturity to discuss it rationally. We just
get various moral panics. For better or
worse, the internet has opened up access to
any number of drugs and we’re just not
dealing with it.”
And it’s young people who are caught in
the frame. “We have a generation of young
people leaving university with mortgage-
sized debts and the growth in prescription
drugs and appetite for enhancement drugs
mirrors that almost exactly.”
In the 60s, tranquillisers were known as
mother’s little helpers. Smart drugs are
capitalism’s little helpers. Just another
symptom of the aching gap in equality
that’s opened up: a product of scarcity, of
the ever-increasing competition for
resources, of a world in which everyone’s
looking for an edge.
There’s something that I’ve so far failed to
mention. And that is that I researched and
wrote most of this article on modafinil. I
ordered it from a UK website and received
it the next day by Royal Mail special
delivery, disguised inside a pouch for
“rosehip supplements”. It’s not illegal to
buy, only to sell on to others, and I took it
in decreasing amounts over three days.
It was only going to be two, but I felt so out
of sorts by the third day – dehydrated,
headachy, poorly rested, a bit panicked –
that I took some to feel halfway normal
again. Which is pretty much the definition
of dependency. I got a lot of work done. But
I would have without modafinil: that’s why
deadlines were invented.
And I can’t help thinking about Johann
Hari. We’ve all done stupid things, made
poor judgments. My suspicion, and it’s only
a suspicion since he won’t talk to me about
it, is that he doesn’t know what role
modafinil played in his own cautionary
tale. Did the small white pills have an
effect on his behaviour? Did the gorgeous
temptress play a role in his downfall? Or
was it an accessory after the fact? It’s
impossible to know. But I’m not tempted to
continue my own experiment.
Young people, students, take it from the
expert. Sahakian points out that one of the
most effective, best documented and
certainly safest cognitive enhancers is
entirely free: exercise. Go for a walk, lift
some weights, dance. The drugs may work.
But they’re not the answer. It’s the world
that needs changing, not your brain
chemistry.
