Smart drugs – wrong fix for cognitive enhancement?

In 2023, Science Magazine published a study³ relating to three “smart drugs”:⁴ Methylphenidate and dextroamphetamine used for the treatment of attention deficit hyperactivity disorder (ADHD), and Modafinil used for narcolepsy. The drugs were administered to participants together with a placebo for control. The participants had to solve a problem that required cognitive resources like working memory and concentration. The results were counter-intuitive to the drugs’ intended outcomes. There was a decline in the quality of effort on the part of the participants to solve the problem. And when they took the placebo, the participants performed better than when they had taken one of the drugs.

These outcomes raise important questions, particularly in the context of the people likely to use smart drugs. This includes persons who work long hours in high-performance stressful environments, such as surgeons. An overview study published in the UK⁵ found that 8.9% of surgeons had used prescription or illegal substances at least once for cognitive enhancement. The study closes by saying the numbers are likely to rise as smart drug use becomes increasingly popular, including (already) among students. Stressful work environments are not unique to surgeons. Bus drivers, pilots, workers in high-risk environments like chemical plants or the health care sector are just a few examples. Many of these people may consciously or unconsciously combine prescribed and/or smart drugs with food supplements,⁶ which are also becoming more popular. These may potentially bring unintended side effects as some may be contaminated with other drugs or ingredients.⁷

The effect may even be more pronounced if users obtain illegal drugs not yet approved for micro-dosing, such as LSD, ketamine or magic mushrooms,⁸ the use of which is reportedly increasing.⁹ These substances have become more popular in management circles as means to enable new insights and increase productivity.¹⁰ What is often forgotten is that news insight are not necessarily always correct ones, and hence also not helpful for decision making.

Adequate decisions are key in high-risk, high-impact occupations. If many professionals turn to smart drugs to enhance performance and the effect is actually opposite, there could be many negative outcomes. In high-risk environments these outcomes are often events that destroy property, lead to bodily injury or loss of life, and financial losses. In high-impact occupations like management, bad decisions made under the influence of smart drugs could harm company performance, which in turn can lead to losses in professional indemnity and/or D&O lines of business.

Lastly, there may still be currently unknown long-term effects of many substances, especially those where use in the past was mainly illegal and recreational. A study published in 2023 indicated that males who take ADHD medication can encounter issues with testosterone levels later in life.¹¹ Insurers should be on the lookout if claims involving smart drug use are increasing, particularly for jurisdictions, where the legal framework makes access to smart pills relatively easy.¹²