For students with ADHD, amphetamine-type drugs are not only permissible, they’re often necessary for academic success. For students without ADHD, using those same drugs is illegal and can artificially boost performance beyond that of their peers. School administrators are stuck policing the balance.
On an early morning in spring, I met with out-going Dean of Students at McGill University, Dr. Jane Everett. In this role, Everett was ultimately responsible for student discipline and academic integrity.
Under her watch, no one has yet been disciplined for off-label study drug use.
“The biggest challenge is having any sign and evidence that a student has been using prescription medication off label…Whereas for something like plagiarism or cheating, or fabrication of data, we have documentary evidence, we have paper trails and sources indicating something has been copied; cheating, we have evidence as well, very often. Where, in this case, all we would have is an enhanced performance and that’s not enough.”
Not only is evidence hard to gather, but a complaint would need to be filed in order for disciplinary action
to begin.
According to Everett, to date, that has never happened, “For the moment, no cases have come forward that I am aware of, but we have started thinking about that and discussing it.”
McGill does have an anti-doping policy – its scope is limited to athletics, and falls outside of the regular student code of conduct. And while there is no specific prohibition against study drug use, as Everett sees it, students using drugs to boost their academic performance could still face sanctions through various sections of the code of student conduct.
But McGill’s disciplinary process was not designed with study drugs in mind. Thus, applying that existing framework to study drug use faces several particular challenges:
- Detection. Whereas the university can employ text-matching software to scan submitted documents for plagiarized content, or software to detect highly correlated answers on multiple-choice tests, pharmaceutically enhanced performance may not be detected, especially given larger classes. Further, a student who pulls an “all-nighter” on a study drug may perform better than without, but still produce mediocre results, making detection unlikely.
- Patterns of use. Study drug use is not limited to exam writing; these drugs can be used to quickly write an essay, or to cram information before a mid-term or examination.
- Civil rights. Requiring personal information, especially in the form of a biological sample, to write exams, could easily be challenged as an unreasonable infringement of civil liberties. The Office of the Privacy Commissioner of Canada found that taking fingerprints for the law school admissions test was unreasonable, compulsory urinalysis at a public institution, one can imagine, might meet a similar fate.
In addition to her administrative duties as Dean, Everett is also a professor of French literature and someone who cares greatly about precision in language. Her demeanor, marked by dangly earrings and kind eyes behind angular red wireframe glasses, says pedagogue not police.
Everett sees the situation as a potential teaching moment and as she articulates her position on study drugs, she measures each of her words carefully.
“I understand the desire, or really interest in ingesting things that do not necessarily have a nutritional value, chocolate and alcohol come to mind, but the idea of taking something to enhance your performance and not test yourself, simply because other people are doing it, to me, there’s a logical fallacy. So, maybe that’s part of the education we have to do, is sort of work on how this is not, for one thing, equitable to others. Cheating because other people are cheating, that doesn’t quite work.”
In trying to understand why study drugs are de rigeur now, Everett looks back at her own early academic life. “When I was a student, people took speed, and I heard from them it was wonderful: you felt like you were the lord of the universe, that you would sit down and you could write for hours. That’s something that scared the hell out of me and I never even was remotely tempted but I know people who did do that… And that was seen as — I don’t think anyone had ethical questions about it — it was doing what you had to do to get through,” she said.
While students then and now feel they have achieved loftier academic heights on amphetamine wings, bioethicists and neuroscientists have questioned whether it is more likely due to the powerful effect of the human mind on itself – a placebo effect. (Click here to read my review of the literature on cognitive enhancement.)
But anecdotally, among those who work daily with student mental health, does that equivocating ring true?
“Are study drugs effective for people who don’t have ADHD?” was a question I asked half-way through a brief interview with Dr. Robert Franck, director of McGill University Mental Health.
His response: “Yes.”
Franck then clarified: the drugs were “not as effective as [for] those who do have ADHD, or ADD, and with a greater cost at times. Don’t forget there are potential side-effects, some of them quite serious, to these medications.” (Learn more about safety here.)
“Doing what you have to” can succeed in the short term, but, according both Everett and Franck, it’s not a sustainable way of flourishing in the long term.
When asked what he would say to a student seeking a study drug, Franck explained the conversation might go
something like this:
“I can’t stop you from taking these things, and you may find them helpful in studying, or getting that term paper out, but down the road, how long are you prepared to continue using that to achieve the success that you’re getting,”
Franck suggested discouraging use through an enforcement regime was neither practical nor realistic. The best way forward, Franck explained, is to appeal further to their sense of competition.
“I think we need to offer them competitive strategies, competitive ways of dealing with what they are trying to accomplish…You’ve got to sell it to them that, I’ve got a better product for you. I have a better way for you to get ahead, that’s the way you’ll get a buy-in, not by saying stop, or by making it even harder to obtain, or by imprisoning them if they’re caught with it, or making it like other types of drugs, criminalizing it’s use.”
But, not everyone shares his views.
In September 2011, Duke University in Durham, North Carolina, amended the definition of cheating in their “Academic Dishonesty” policy. It now includes the line “the unauthorized use of prescription medication to enhance academic performance.”
By the December exam period following the policy change, administrators at Duke had noticed no change in student behaviour.
At McGill, the decision to treat study drug use as a separate offence has not been made, but administrators are paying attention to discussions at neighbouring institutions. Dean Everett said, “I think what we would prefer to do, as in all cases having to do with academic integrity, is do preventive education: talk about the health dangers, as well as the ethical dilemmas posed by the use of prescription medication in off-label ways and that’s something that we will be discussing more going forward.”
While major institutions struggle to devise a policing strategy in tandem with prevention, anxiety abounds on campuses, much as it always has.
Students who come to Dr. Franck’s office and recite verbatim the carefully memorized diagnostic criteria for ADHD from the Diagnostic and Statistical manual will be out of luck if their underlying “life factors” don’t match up. Students with ADHD tend to be distracted in all aspects of their lives (e.g. general forgetfulness, a tendency toward automobile fender-benders) – not just studying. According to Dr. Franck, students are more likely to seek (and get) drugs, with few questions asked, from their family physicians.
What is propelling that seeking behaviour? It may be their parents’ faults.
A factor over which students have little control, their parents’ genes, may be a strong positive indicator of ADHD. “I think [ADHD] is one of the most heritable disorders in medicine — not just in psychiatry. Statistics show it’s even greater than height, in terms of its heritability,” Dr. Franck explained. Students may be seeking solutions to treat a condition with which they have always lived, but never had diagnosed.
Dr. Franck has also witnessed a more worrying trend: parents may be responsible for contributing more than their genetic material.
“Now, families want their kids to get into that law school, and get into that medical school and get into that whatever, so whereas before you’d often have parents saying, ‘Well, I don’t want you on medication, all your life, and no, I don’t think you have ADD,’ they would be discouraging. Now what we’re seeing is much more that there is pressures from, not just from the student themselves, but from their environment.” (Click here to learn more about the pressures students are facing.)
THE SUPPLY CHAIN: supply&demand | a balancing act | preventive tweets
ETHICAL DILEMMAS: “everyone here is an overachiever.” | health risks vs. potential benefits | an unfair advantage? | now entering your Adderall state