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Assignments accumulating? Exams coming up? Halfway through this semester, you may be wondering how you’ll make it all happen. As a pharmacologist on a large campus, I routinely talk to students about how they grapple with this, and hear their conversations about strategies for success. Maybe your oversize coffee goes everywhere you go. Perhaps your friend has a fancy tea that claims to help with mental performance. Maybe your roommate hit up their ADHD classmate for a dose of Adderall.

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 students 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.

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 brought on unwanted 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.

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 on campus, I hear students saying “narcotic” when they mean “sedative,” or “Tylenol” for any over-the-counter pain treatment.

2.  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.

3.  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.

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.

2.  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.

3.  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. Steve Lux, a former health educator at Northern Illinois University, warns that “using stimulants might help you stay up and get the paper done, but you’ll be depleted the next day.”

You can anticipate those effects. “If you’re going to burn through the nights during your exams, make sure that for one to two weeks beforehand, you are getting good sleep, eating well, and taking care of yourself,” Lux says.

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

  • 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).

Student perspectives
“Constant caffeine provides dramatic highs and lows of spiked energy. This makes a normal routine hard, as well as not feeling awake without it. It makes the day drag on longer and your body work harder because of the different demand in energy levels.”
—Fourth-year undergraduate, University of Wisconsin–Stout

“I don’t really think of drinking yerba mate as ‘using substances,’ but I suppose that’s exactly what it is. I drink yerba mate as an alternative to coffee when I need a pick-me-up.”
—Second-year undergraduate, University of Victoria, Alberta

“Everyone needs coffee or an energy drink sometimes. They aren’t healthy, but one every so often isn’t going to hurt. I suppose you could just get more sleep.”
—Third-year undergraduate, The College of New Jersey

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.

GraphMost students are not misusing stimulants
In a national, anonymous survey of more than 80,000 college 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, while others were concerned about possible long-term consequences.

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?

Open pill bottleAnyone who illegally accesses, uses, or distributes prescription drugs is violating federal law, and likely state law and CU Boulder’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 college sanctions. A criminal record may limit your future employment prospects, damage your reputation, and threaten your college career and scholarships. Colleges can enact sanctions against students for crimes committed on and off campus; these can include academic probation, fines, rescinding scholarships, or expulsion.

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.

Giving away or selling your medication This is called “drug diversion,” and it’s a felony. Giving a drug away is considered the same as selling it for cash. People caught selling (or buying) diverted drugs may face fines or jail, and have to attend mandatory treatment for drug abuse, as these penalties vary by state.

Student perspective
“I had a friend actually go to prison for this. Even though it was a misdemeanor, he had to do six months.”
—Fourth-year student, Ashford University (online)

“Many of my (mostly guy) friends have asked me for some Ritalin, but once they discovered I was unwilling to partake in that illegal activity, they stopped asking.”
—Third-year undergraduate, Gonzaga University, Washington

Ernesto Dominguez

Third-year undergraduate, Concordia University, Oregon

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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.

Jennifer G. Schnellmann, PhD, is an associate professor of pharmacology in the College of Medicine at the University of Arizona, where she teaches toxicology and pharmacology. She is the author of seven books, on topics including cardiovascular pharmacology and strategies for gaining admission to professional school. Jennifer lives in Tucson with her daughter Mary Rose and her husband, Rick.