Stressful time: These pupils took exams without help, but other school children can be pushed into taking extreme measures
Josh has an exam and, like most of the other boys at his prestigious public school, he’s keen to put his best foot forward. He’s eaten breakfast and dressed smartly, but before he sets off for class, he reaches for a white pill and pops it into his mouth.
He bought 30 of the viagra online for £40 from the U.S., but for all Josh knows they might well have been knocked up in an illegal backstreet ‘pharmacy’ in India.
Still, the drug modafinil - usually used to treat sleeping disorders - has worked before for him and if it works again he is sure to get top marks.
Welcome to the world of ‘smart drugs’, otherwise known as cognitive enhancement pharmaceuticals. This is a world where pupils as young as 15 self-medicate, participate in illegal online drug trafficking and swap notes on the best pill cocktails for good grades.
Concern over smart drugs has been growing for some time among academics, politicians and pharmacologists, but it has been brought
into sharp focus with the announcement that the former health minister, Lord Darzi of Denham, is heading a study at Imperial College, London, into their effects.
This might seem odd because most of these drugs have been around for decades for the treatment of conditions such as Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy, and have been found to be safe.
But no one has monitored their chaotic use in healthy young people taking inappropriate doses to boost their intellectual prowess.
And some experts believe this kind of use in brains that are still developing could cause addiction and permanent damage.
Josh is an intelligent, articulate 17-year-old, so you wonder why he needs extra help to feel smart. He has been taking modafinil (sold as the prescription-only drugs Provigil, Alertec, Modavigil and Modalert) since he was 16, but has friends who began using smart pharmaceuticals at 15. He lives in London and his parents are lawyers.
‘I read about modafinil in a newspaper and then researched it on the internet and spoke to some of my friends about it,’ he says.
‘It appealed to me as an inexpensive method for highly concentrated revision, for which I would otherwise depend on coffee, tea or Red Bull. Modafinil gives you heightened alertness, stamina and productivity. I find it helpful for focus and memory.
‘I find I can memorise a graph after drawing it once instead of several times. I would say it makes me 40 to 50 per cent more productive in a day, but it does not make me any cleverer.
‘While revising for my last set of exams, I was taking 100mg of modafinil a day for six or seven days a week for three weeks.
‘Around half-term, I stepped it up to 150mg to 200mg a day and in the last two or three weeks up to the exams I took 200mg to 300mg a day and worked 18-hour days.
‘I find you can get by on four to six hours of sleep for up to three weeks and then, at the end, the body needs to rest and catch up. I take a whole day off and sleep for 24 hours.
‘Taking it is no different from having other stimulants such as coffee, ProPlus caffeine cialis or Red Bull. It is no different from taking painkillers for a headache.
‘I use it specifically for exams and will carry on at university. I would recommend it to anyone who is informed about it and knows what they are doing.
‘I haven’t told my parents about using modafinil. They wouldn’t know what it is and they wouldn’t approve of me using it.’
Josh’s use of modafinil is not unusual. A quick scan of student web forums uncovers a world where drug advice is swapped.
The benefits of Ritalin and Adderall, which are meant to be used to treat ADHD, are compared with Provigil, Modalert and a group of drugs called ampakines - prescription pharmaceuticals that are showing promise in the treatment of Alzheimer’s and Parkinson’s.
The problem in telling students not to take them is that tests have shown these drugs can help with focus, memory, concentration and alertness by interacting in different ways with neurotransmitters - chemical messengers - in the brain.
the ADHD treatments contain amphetamines, which can result in addiction, and there are suspicions that sleep disorder treatments such as modafinil could be addictive.
Barbara Sahakian, Professor of Clinical Neuropsychology at Cambridge University, says scientists understand how drugs such as Ritalin work by stimulating levels of the neurotransmitters dopamine and noradrenaline in the brain.
These affect mood, cognition and memory. ‘However, there is an optimal dose for ideal performance,’ she says.
‘Levels beyond that could cause problems with addiction. With modafinil, no one really knows how exactly the drug acts in the brain to boost cognition.’
Concern: Lord Darzi is heading a study into the effects of 'smart drugs'
However, evidence is emerging that modafinil - thought not to be addictive - also affects the levels of dopamine. This is significant because dopamine production can lead to addictive behaviour.
Sometimes referred to as the ‘reward’ drug, dopamine is released during experiences such as the enjoyment of sex, food and drugs. We are programmed to repeat rewarding experiences, a cycle that can result in addiction.
A study published in the Journal of the American Medical Association last year looked at ten healthy men taking modafinil and found it did increase levels of dopamine. The research was conducted by the National Institute on Drug Abuse (Nida) in the U.S.
‘[Modafinil] has the signature that it could potentially be addictive,’ says Nida’s director Dr Nora Volkow.
‘Studies have shown consistently that all of the drugs of abuse . . . have a common effect of increasing dopamine in the nucleus accumbens [area of the brain].
‘That is believed to be crucial for their reinforcing effect and ultimately their underlying potential for producing addiction.’
The jury is still out on whether modafinil is addictive. Scientists regard tests on just ten people as being far from definitive.
Sahakian has called on the Government to hold a public debate on the use of smart drugs.
On the one hand, she feels they could be of real benefit to society if proven to be safe.
On the other, she wonders whether in some dystopian future people will be pressured into taking them to work longer and harder.
Already, there is evidence that students feel pressured into taking smart drugs to compete with highachieving classmates who are using them. And some pushy parents appear to be condoning their use.
One third-year student studying computer science at London Metropolitan University told us that taking modafinil is a ‘lifesaver’ in helping him to complete assignments.
‘I am aware of school children who have taken modafinil. They were aged between 16 and 18,’ he says.
‘Their father [a computer programmer], my friend, used to take it occasionally.
‘The parents had extremely high expectations for their children and they were taking exams.
‘My friend’s daughter was advised to take modafinil by her classmates. Unfortunately, this was a terrible decision.
‘She was taken to hospital after five days of sleep deprivation. She had high blood pressure, was anxious and experienced some kind of hallucinations and psychosis.
‘She was taking extremely high doses of modafinil. I was told she had felt some kind of euphoria and kept taking more and more. It is proof that modafinil can be addictive for some people.’
If Nida in the U.S. is correct and all these drugs affect dopamine levels in some way, then concern is likely to focus on students self-medicating inappropriate dosages and using them over a long time.
Dr Daniel Amen, a psychiatrist and Fellow of the American Psychiatric Association, says that while treating young ADHD patients with carefully controlled doses of Ritalin can improve their lives immeasurably, unmonitored doses taken by healthy youngsters could be damaging.
‘A therapeutic dose arrived at by careful monitoring by a physician might be anywhere from 5mg to 60mg a day,’ he says.
‘We know that can enhance brain function in many people by stimulating levels of dopamine.
‘But where you have some of these students taking concentrations of 100mg to 500mg, that could cause some problems.
‘The extra dopamine produced constricts blood flow to the brain and, over the long term, that could cause permanent damage.
‘The adolescent brain, especially the pre-frontal cortex - the most