Public Health

Physicians confront the rise of “smart drugs”

Responding to the safety concerns generated by a growing use of nootropics, physicians at the 2016 AMA Annual Meeting adopted new policy discouraging the nonmedical use of these prescription drugs for cognitive enhancement in healthy individuals.

Nootropics—the so-called “smart drugs”—include a variety of prescription drugs, supplements and other substances that claim to improve cognitive functions of healthy individuals, particularly executive function, memory, learning or intelligence.

Prescription drugs that are FDA-approved to treat attention-deficit hyperactivity disorder or narcolepsy are commonly associated with off-label use by students and others seeking to boost memory, learning or other aspects of cognition. Such use is associated with a variety of adverse mental health conditions and patterns of substance misuse.

“As temptation grows to use prescription drugs for a competitive advantage at work and school, the nonmedical use of these drugs should be discouraged given potential for substance misuse and other adverse consequences,” said AMA Board Member Maya A. Babu, MD, in a news release on nootropics. “The AMA believes physicians can support this goal by not prescribing any drug for the purpose of cognitive enhancement in otherwise healthy individuals.”

Risks versus benefits of smart drugs

While prescription stimulants carry real risks, they do not make people smarter. The available evidence suggests the cognitive effects of prescription stimulants appear to be highly variable among individuals, are dose-dependent, and limited or modest at best in healthy individuals, according to an AMA Council on Science and Public Health Report.

Only a limited amount of information is available on the patterns of use for dietary supplements and herbal products that are marketed for cognitive enhancement. More than 100 substances from amino acids to botanical preparations are advertised on websites as having the ability to improve cognitive performance, and their safety and efficacy have not been systematically examined.

The new AMA policy recognizes there is a gap in available information and calls for more research into the patterns of use, as well as risks and benefits, of dietary supplements and herbal remedies being promoted for cognitive enhancement.

Delegates also agreed to urge the Federal Trade Commission to examine advertisements for dietary supplements and herbal remedies that claim cognitive enhancement to ensure that they are not misleading and are substantiated.