Is residents' use of cognitive enhancers a cause for concern?

By Anastasia Climan, RDN, CD-N | Fact-checked by Barbara Bekiesz
Published May 8, 2023

Key Takeaways

  • The fast-paced, competitive, and high pressure nature of residency leads some individuals to seek cognitive enhancement.

  • “Nootropics” is an umbrella term referring to cognitive-enhancing supplements and medications that can increase energy and mental alertness, improve memory, and help you stay awake longer.

  • Use of all types of nootropics, including herbal products, caffeine, and stimulants, can have negative consequences—HCPs should assess these risks before seeking cognitive enhancers.

“Smart drugs,” or nootropics, are substances that aim to boost brainpower. These cognitive enhancers can range from over-the-counter herbal supplements to prescription amphetamine salts. 

Multiple studies have reported that university students and medical residents are using nootropics to gain a competitive edge, even going as far as taking controlled medications prescribed for someone else.[] Here are the nootropics that individuals most often turn to, and the potential risks at stake.

The appeal of cognitive enhancers

Look no further than your local Starbucks drive-thru to see the popularity of brain boosters. Everyone likes a head start, and a morning jog or yoga session isn’t the most accessible way to get a morning boost. Cognitive enhancers promise to help you think more clearly and be more productive. Many are also stimulants, enabling longer wake times. For medical residents working around the clock, the draw of nootropics can be hard to resist.

With results published in BMC Medical Education, an anonymous survey of about 300 resident physicians at the University of Utah gathered data on the use of cognitive-enhancing medications and supplements.

The results showed that males in surgical specialties who were unmarried and did not have children were the most likely to seek cognitive enhancement. 

Perhaps unsurprisingly, caffeine was the most commonly used substance, reported by over 78% of respondents. The prevalence of amphetamine use was 19.2%, with modafinil at 11.1%. (Modafinil is a non-amphetamine central nervous system stimulant that boosts energy and wakefulness.) About 5% of participants said they used the dietary supplement lion’s mane mushroom. 

The biggest motivators for substance use were to increase memory, alertness, and concentration for work and studying. 

Another study, on residents in Israel, evaluated the misuse of methylphenidate (MPH), or Ritalin, a stimulant drug approved by the FDA for ADHD and narcolepsy.[] Among the 342 respondents to the survey questionnaire, 51.5% used MPH. Of these, 35.1% had no associated diagnosis to warrant its use. The vast majority (87.5%) used MPH when studying for their final residency exam, and 18.7% used the drug to stay alert during night shifts. Adderall (a combination of amphetamine and dextroamphetamine) is another popular prescription stimulant that is often misused. 

Related: Many young people are misusing Adderall—what can clinicians do about it?

Dangers of smart drugs

Although residents may feel a temporary advantage from smart drugs, they should be discouraged from making unhealthy and dangerous choices in an effort to stay ahead. Residency is demanding, and sleep is hard to come by, but many cognitive enhancers have cumulative stimulant effects and other potential consequences.

Amphetamines are addictive, producing a temporary high accompanied by a physical and mental performance boost. They can have diverse and serious adverse effects, including aggression, hallucinations, fast heart rate and heart attack, higher risk of suicide, hypertension, insomnia, memory loss, skin sores, stroke, and tremors.[]

Without a doubt, medical residents are under intense pressure, and many need additional support. 

However, misuse of stimulants presents a significant risk to the individuals using them and the people under their care. 

Residents must be medically supervised when taking prescribed medicine and should understand the consequences of abusing medication for temporary, perceived advantages.

Risks from “natural” nootropics

Residents who shy away from controlled substances may still be putting themselves in harm’s way with seemingly innocuous dietary supplements.[]

For instance, guarana extract usually provides 9 milligrams of caffeine per 75-milligram dose. It is contraindicated for people with chronic headaches, cardiovascular disease, stomach ulcers, diabetes, insomnia, and mental disorders, and during pregnancy and breastfeeding, according to an article published in Nutrients. 

Guarana should be avoided by those taking the respiratory drug theophylline, and people with hypertension should avoid ginseng and the herb eleuthero.

Many other “natural” nootropics are problematic for people with psychiatric issues; rhodiola and dihydroergotoxine are two examples, according to the article in Nutrients

Unfortunately, underlying mental problems often go undetected until triggered by stress and substance use. And given the supplement industry’s lack of regulation and quality control, it’s not always possible to verify the contents of nootropics, regardless of a resident’s medical knowledge.

What this means for you

If you’re currently in residency or work with residents, it’s important to know that many of your colleagues may use cognitive enhancers. While many of these substances are benign, some come with serious risks. Learning to manage the challenges of residency in a healthy way should be encouraged and considered a necessary component of medical training.

Related: Can ‘smart drugs’ benefit your patients?

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