June 21, 2012 | Posted By Bruce D. White, DO, JD

The front page of the Sunday, June 10, 2012, New York Times included an article by Alan Schwarz titled “Risky Rise of the Good-Grade Pill.” The one sentence teaser on the Internet copy read: “At high schools across the United States, pressure over grades and competition for college admissions are encouraging students to abuse stimulants.” The article also used a term that I had not heard or seen in some time: “study drugs.” The story describes how students are using prescription drug stimulants like Adderall XR® (mixed salts of a single entity amphetamine, Shire) so they can “focus” when preparing for examinations and taking tests, in hopes of achieving better scores. Sadly, in the article, one student compared taking stimulants as study drugs was just like taking a vitamin.

Amphetamines are indicated for attention deficit hyperactivity disorder and narcolepsy. They were first synthesized in 1887 as a chemical that was to be a substitute for ephedrine. In the US in the 1930s, the drug manufacturer Smith Kline & French sold a volatile base form of the drug as Benzedrine inhaler for nasal congestion. During World War Two, amphetamines were used extensively to combat fatigue and increase alertness.

Wonder if NoDoz® Alertness Aid (long-acting caffeine, Novartis Consumer Health, Inc.) is a “study drug”? Wonder if there’s any difference in taking a 200mg of caffeine versus drinking two 8-ounce cups of coffee (which contains about 300mg of caffeine)? In characterizing the difference between amphetamine and caffeine, maybe the answer is as simple as “one is a prescription drug, the other is not.” But really is it that simple? Such a distinction does allow for a clear line of demarcation. But a clear line of demarcation for what purpose? Probably a legal one and less an ethical one?

When is performance enhancement inappropriate? How is taking caffeine for increased alertness for an examination different from taking amphetamines for the same purpose? What if it is a large does of caffeine and a small dose of amphetamine? What if the individual’s sensitivity to caffeine is such that a small dose of caffeine is equivalent to a large dose of amphetamine? Or does dose matter, a little is still some, particularly when some is illegal?

Or, should questions of inappropriate use even turn on drug and dose? Perhaps the distinction should turn on intent? Is it permissible to take amphetamine for narcolepsy but not for performance enhancement? But how might one respond to the narcoleptic student who’s taking amphetamines just to scrap by with a “pass” as opposed from trying to take a B-plus grade to an A-minus?

Or, should it turn on “performance enhancement”? How is taking amphetamine to score better grades different from an athlete taking anabolic steroids to increase muscle mass or a senior taking Viagra® (sildenafil, Pfizer Inc.) for erectile dysfunction?

Clearly those interested in the ethical arguments surrounding performance enhancement need different characterizations that the subjective ones that we’ve used to date to condemn “abuse.”

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

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