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Calendars colliding? Deadline approaching for a project at work? Responsibilities increasing? Still have a way to go with your degree? You may be wondering how you’ll make it all happen. As a pharmacologist who works with students, I routinely talk with them about how they grapple with this, and hear their conversations about strategies for success. Maybe your oversize coffee goes everywhere you go. Perhaps your colleague bought some funky herbal product that claims to help with mental performance.

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 people tell me that they wanted to be more alert and took something that instead gave them 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

These products are not regulated and may be misleadingly labeled. The “natural” claim is often dubious, and products labeled this way can be risky. As a rule, I see the “non-drug” label that is required by law (a statement that the product has not been evaluated by the FDA and is not intended to treat a disease) as an admission that the product carries little, if any, benefit.

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.

Drug classification is not a reliable measure of risk to you

Drugs are classified (“scheduled”) by the government according to how accepted they are for medical use and how liable 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.

For example, acetaminophen (the active ingredient in Tylenol and some other over-the-counter pain relief medications) is unscheduled and “low-risk,” yet it kills hundreds of people every year, owing to liver failure.

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 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.

Three questions to ask yourself if you consider using

  1. 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 at a higher-ed institution, I hear students saying “narcotic” when they mean “sedative,” or “Tylenol” for any over-the-counter pain treatment.
  1. 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.
  1. What effect could this drug or substance have on me? A drug may be right for a specific problem, but wrong for you. “Do not rely on what your friends or acquaintances are saying. Everybody is different and has different reactions; these are very hard to predict,” says Lux. 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.

Three simple keys to understanding drug dose

  1. 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.
  1. 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.
  1. 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. “There is no free lunch. You can steal from Peter to pay Paul only so far,” says Steve Lux, a former health educator at Northern Illinois University. “Using stimulants might help you stay up and get the paper done, but you’ll be depleted the next day.”

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

Caffeine/energy drinks/yerba mate

Caffeine/energy drinks/yerba mate

  • Main takeaway Caffeine in the form of coffee, tea, soda, 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).

 

“Wakefulness” medications

“Wakefulness” medications

  • 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 college disciplinary sanctions.
    • Online purchases are not monitored by US government agencies; buyers cannot be sure the drug contains the active ingredient they seek at the correct strength, or that other unwanted or dangerous substances (“adulterants”) are not included.

Nicotine

Nicotine

  • 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
    • Age restrictions apply to people seeking to purchase tobacco and/or nicotine gum in some states.
    • Tobacco (smoking and chewable) contains nicotine; this damages the DNA in our cells, and may lead to the growth of new cancerous tumors in the mouth and lungs, and activate or accelerate cancers that are already present or dormant.
    • Smoking nicotine is becoming less socially acceptable. Nicotine users may face higher health insurance premiums. Some employers will not hire smokers.

“Nootropics” or “smart drugs”

“Nootropics” or “smart drugs”

  • Main takeaway Compounds that are sold to consumers as “smart drugs” (e.g., piracetam, aniracetam, oxiracetam) may do nothing more than generate expensive urine.
  • Effectiveness Studies confirm that these drugs offer little to zero cognitive enhancement. The FDA 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).
  • 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
    • These medications have not been approved by the FDA for legitimate medical uses.
    • Piracetam (previously sold online) cannot legally be sold as a dietary supplement in the US.
    • The FDA monitors the websites of vendors who sell these products and make false claims.
    • Studies have shown no cognitive benefit to the general population of using other prescription drugs designed to treat Alzheimer’s, which also have significant side effects.

Prescription stimulants

Prescription stimulants

  • 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 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 school disciplinary sanctions.

Who’s using what in college?

Caffeine use is common among students, and sizable minorities of students have used energy drinks and other high-dose caffeinated substances, surveys show. The vast majority of students have not used prescription “study drugs” that were not prescribed for them.

Substance

Who used (percent)

High school
College
Other
Nonprescription “stimulant” (e.g., caffeine powder, yerba mate, “energy drink”)

21

38

19

Prescription stimulant or “study drug” not prescribed for them (e.g., Ritalin, Adderall, Provigil)

5

10

3

“Nootropic” or “cognitive enhancer” (e.g., piracetam. aniracetam)

1

2

1

Most students are not misusing stimulants

In a national, anonymous survey of more than 80,000 students, 88 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, 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, 1,000+ respondents (not representative of students nationally)

What are the legal, professional, and academic implications of misusing prescription drugs?

Anyone who illegally accesses, uses, or distributes prescription drugs is violating federal law, and likely state law and your school’s code of conduct. Unauthorized possession of scheduled, non-narcotic substances (such as stimulant medications) is at minimum a misdemeanor. Possession of scheduled narcotics (such as methadone or Percocet) is more serious. You may be subject to federal and state charges and penalties, and/or school sanctions. A criminal record may limit your future employment prospects, damage your reputation, and threaten your academic career and scholarships.

“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.

  • The laws vary by state, but you will likely be red flagged by the Drug Enforcement Administration.
  • If this happens, your name will be entered into a database and shared with all physicians and pharmacies, preventing you from obtaining and filling more than one prescription for certain medications.
  • You may end up reliant on one source for prescribing and dispensing drugs.
  • Your access to drugs you need when you need them may be reduced long-term; for example, when a “doctor shopper” is injured in a car accident, it may be harder for them to get prescribed pain relief medications.

Falsifying symptoms Pretending you have certain symptoms can get you barred from seeing some physicians.

Tampering with prescription forms Doing this with the intention to get drugs is a felony, 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 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. Possession is often charged as a misdemeanor. Having large amounts of a substance implies that you intend to distribute it, resulting in heavier charges and penalties.

Colten McMillan

Second-year student, Nova Scotia Community College, Waterfront Campus

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Article sources

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.