By Bredann Dubsky

With the controversy of this summer’s Olympic Games still fresh in mind, most people will be aware of the intense discussion surrounding the use of banned performance-enhancing drugs among athletes. The severity with which the sports community looks upon these issues is understandable given the huge impact substances like anabolic steroids can have on physical performance. The far more inconspicuous twin of this issue, however, is that of nootropics: compounds intended to enhance cognitive performance in healthy individuals. As their use increases, it is likely that soon nootropics will constitute an increasing legislative challenge for officiating bodies around the world.

A varied class of compounds
While it is may be tempting to draw parallels to physically enhancing drugs, it should be emphasized that the nootropics available today are generally much less powerful. Indeed, the world’s most widely used nootropic, caffeine, is considered by most to be entirely harmless if used in moderation. Other long-used de facto nootropics include L-theanine (a compound found in green tea), nicotine, and even, according to certain definitions, some ordinary B vitamins.

It is in this light that the proponents of nootropics also wish us to view the more recently discovered compounds: as little more than dietary supplements, only even better at enhancing cognition than traditional counterparts, and possibly also with beneficial long term health effects. The ‘grandfather’ of modern nootropics, piracetam, has, along with its family of racetams, been studied for its pharmacological properties since the 1950s, and has been approved as safe for at least short term use. However, although the internet offers ample anecdotal support for its ability to mildly increase mental clarity, most research done on its cognitive effects has been done on elderly or intellectually impaired people, and even there the results have been inconclusive at best.

Out of the plethora of purported nootropics now available, it is instead with the narcolepsy drug Modafinil, used since the 1990s, that the nootropics seemingly have started to truly live up to their promise. By promoting wakefulness and focus by inhibiting dopamine reuptake, Modafinil has been confirmed in a 2015 meta-study to improve attention, executive function and learning in healthy humans, not suffering from sleep deprivation – with only mild short term side effects. Researchers compare the effect to that of ten shots of espresso, but without the tremors and palpitation.

Who uses them?
It is difficult to properly quantify the use of nootropics in the world given their widespread availability. Surveys suggest that about 3-16 percent of American students use prescription stimulants for the purposes of cognitive enhancement. Nootropics often have the most dramatic effects when used by sleep-deprived individuals, so they are unsurprisingly overrepresented in professions where long shifts are common, such as among surgeons and military personnel. Another segment of the population where nootropics evidently are widespread is the one of overachievers in the technology sector, as epitomized by the Silicon Valley startups. Entrepreneurs with a background in this sector are also among the first to try to harness the commercial potential of these substances via companies such as Nootrobox and Bulletproof.

A legislative challenge
The legal aspect of nootropics use is less black and white than that concerning doping in sports. In the less overtly competitive areas of education and work, health concerns are the primary reason for regulation, and with substances ranging from traditional herbal supplements to amphetamine derivatives, coherent blanket legislation is clearly too much to hope for.

In the United States, the Food and Drug Administration (FDA) is responsible for the classification of substances intended for human consumption. Substances are broadly classified as either medication used to treat specific conditions, or as harmless dietary supplements. Some nootropics, such as Modafinil, fall neatly into the latter category. Many, however, do not. Piracetam has a potency comparable to pharmaceutical drugs and therefore is not approved as as a supplement. On the other hand, it is used for cognitive enhancement in healthy individuals and therefore is not considered medication. It is in the no man’s land of the sale of ‘research chemicals not intended for human consumption’ that much of the commercial activity pertaining to nootropics takes place. EU regulations are generally far stricter, although this varies between countries. For example, in Sweden, both Piracetam and Modafinil are considered a prescription drugs.

The common and clear message sent is that potent drugs should be used to treat illnesses, not to improve performance in those who are already healthy. But as evidence for the effectiveness and relative safety of nootropics – either of currently available or of newly discovered ones – is likely to mount over the coming years, there may be an accompanying demand from the public that a more flexible stance is adopted.

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