People are well used to seeing performance enhancing drugs in the world of sport, but now chemical enhancement is spreading to the world of academia as students go to extreme lengths to get the right grades.
EPO. Nandrolone. THG. Ephedrine. Anybody who follows sport will have heard of these performance enhancing drugs, usually accompanied by the word "cheat".
Now students are taking the same route, using illicit drugs to gain an advantage over their peers in the exams that will shape their lives.
Students have long used plentiful cups of coffee, as well as caffeine in pill form, to stay up revising late into the night. But now some are going a step further and taking "study drugs".
At the top of the list of study drugs are Ritalin, a drug prescribed to children who suffer from Attention Deficit Hyperactive Disorder (ADHD), and Modafinil, a narcolepsy drug. If not prescribed, Ritalin is a class B drug in the UK, meaning possession can lead to a five-year prison sentence and dealing could put you behind bars for 14 years. Modafinil is also not available over the counter.
So why are students taking them? Modafinil and Ritalin are drugs that stimulate the brain. They make people feel more awake and alert, and help control the behaviour and concentration of children with ADHD.
"It helps me stay awake and stimulates my mind," says Linda - not her real name - who graduated from Manchester University in June.
The 22-year-old psychology graduate took Modafinil with a group of friends several times while working on her dissertation. She used the drug to help her "pull all-nighters" and said that it allowed her to focus on her work for hours at a time.
"It's a stimulant, similar to caffeine or Red Bull although I didn't get distracted and feel jumpy like you sometimes do on caffeine. You don't feel wired but I did lose my appetite... I found it dificult to eat afterwards.
"It's easy to buy and very cheap," says Linda, who bought the drug online, for, she claims, 40p per tablet.
A recent study published in the Pharmacotherapy journal shows that Linda is not alone. At the US university surveyed, 18% of 1,253 first year students had used non-prescribed stimulants, primarily to help with their studies. Other studies have found similar results.
After a few clicks the drugs can easily be found for sale on the internet at affordable prices. This is the source of the pills used by many UK students, although some say they buy their tablets from friends who are prescribed them.
Carson, an 18-year-old high school student, takes Ritalin and Adderall, another drug with similar effects, two or three times a week to help him study and socialise. Studying in Utah, US, he buys the pills for $4 (£2.50) each from a friend at college.
"When I take Ritalin, I can stay awake in class, concentrate on the subject matter, and even take notes during class. I have more energy, I am more outgoing, and more sociable," says Carson.
Carson began taking Ritalin - one every other school day - after a run of poor exam marks, and says that his grades improved dramatically as a result.
"By the end of the school year I was passing every class I was taking."
But Carson's reliance on performance-enhancing drugs has spilled over from his study life to his social life.
"I now take it recreationally, to help myself be more outgoing and socially at school. This morning I took two Adderall capsules. Subsequently, I talked with more people than I would have otherwise and I spent about five hours studying mathematics, which is completely out of my nature."
While the drugs are considered simply as another study aid to those who use them, there are hidden and potentially very dangerous health hazards, according to Dr Ros Maycock, a general practitioner in Poole.
"[These drugs] put a rush of adrenalin into the blood. Your pulse rate and blood pressure increase and your pupils dilate," she says.
"There can be potentially very dangerous physical side effects if you have an underlying cardiac disorder. The effects could lead to a heart attack or similar."
When the drugs are prescribed, a doctor usually carries out checks on a patient's blood pressure and susceptibility to side effects and a careful risk verses benefit calculation is made, says Dr Maycock. But for the students, none of these checks are performed and the taker may not know that they are at risk.
Long term effects
"If you had a hidden aneurysm in your brain, it could blow it apart. People never think that they are the ones at risk."
In the short term, Ritalin users can suffer from an array of side effects - anxiety, insomnia, loss of appetite, irritability and headaches and all common. The long-term effects of the drug are largely unknown.
But potential health risks aside, some will feel the use of illegal stimulants gives an unfair advantage in exams and essays.
While caffeinated drinks and other legal stimulants are available to everybody, amphetamines such as Ritalin are not, says Hazel Biggs, professor of medical law at Lancaster University.
"If people need the drug, it levels the playing field, but if they do not, it may give people an unfair advantage," she says.
There is very little that universities can do to police the use of these substances, short of performing a drugs test on every student entering the exam hall. Manchester University, where Linda studies, has no policy about the use of such drugs.
But did Linda, who got a first for her dissertation, not feel she had been dishonest? No. "I didn't feel like I was cheating. If it was that good, everyone would be doing it," she says.
While the practice was not condemned by her university friends, she concedes that her parents probably wouldn't approve.
And of course, whatever the rights and wrongs of Ritalin as a "study drug", students are still going to have to do the work and perform in the exams.
A good night's sleep might not be a bad idea.
Below is a selection of your comments.
Your article has some SERIOUS flaws. As a chemistry graduate who has synthesised Modafinil, I can tell you that the doctor's statement that it is an amphetamine is completely untrue. Modafinil is a acetamide, which's why it is a schedule 4 drug in the UK, unlike amphetamines which are a schedule 2. Simple research into the article you are writing about on Wikipedia would highlight this. I personally used Modafinil throughout university because I had difficulties with the odd hours and strong circadian rhythm meant that I would sometimes fall asleep in class if I didn't take any.
Michael, Toronto, Canada now Luton, UK
1) Modafinil is not an amphetamine, it does not give a rush of adrenaline, Dr Maycock should try reading the Summary of Product Characteristics or the patient information leaflet or even contact the manufacturer or Marketing Authorisation Holder to check.
2) As far as they can tell, modafinil is not addictive, unlike amphetamines.
3) Modafinil is sold in this country to the NHS for £55.80 for 30 100mg tablets. If "Linda" was paying 40p / tablet, the tablet either wasn't modafinil (could have been speed? could have been Ritalin which is a 10th of the price?) or it was stolen.
Anon, London UK
It's no different to athletes using performance-enhancing drugs, just that it's now a mental arena instead of the physical. If it isn't stopped now, people will continue to cheat (yes, "Linda" - even you) just as they would have done in athletics, baseball, etc etc. Aren't Universities under enough threat of litigation from disgruntled students as it is without piling it on with this?
Gareth Pugh, Leeds, UK
It is a puzzle to me how a Ritalin, a stimulant, calms children with ADHD. Caffeine, another stimulant, sends them bananas. Odd.
wonderfulforhisage, Brackley UK
We are often told that the brain is a muscle, this makes "concentration enhancing" drugs equivalent to steroids, in my opinion. They should never be taken casually, and certainly not without consulting a doctor. In a weird way I wish this could extend to the soft drinks market, as the convergence of diet and medicine alarms me.
Sam B, Ulverston, Cumbria
If an exam result is bolstered by drug-enhanced cognition it reduces the value of the exam system overall. It would be appropriate, then, to note whether a result is genuine or drug induced, allowing universities and employers to recruit based on actual ability rather than drug choice. Whether someone chooses to take drugs or not is a matter for them, provided they are open about it, and are capable of judging the benefits against the risks. A lot more worrying is competitive parents who may consider doping their children to produce better educational results.
It's essential that parents are made aware that such behaviour is adjacent to injecting their children with steriois to improve physical performance. I would consider either action to be child abuse, and would immediately report it.
Rod Copeland, Cambridge
The idea of a 'level playing field' for exams is bit false, isn't it? The students aren't actually competing against each other, as people playing sports do. That aside, I think it very sad that these people can't manage their lives to the extent that they can do their work while 'naturally' fresh. Is drug-taking now endemic in our society?
What is the matter with today's students? I was an undergraduate in my mid 30s between 1993-96. I managed to do "all nighters" fuelled by tea and the odd cigarette (which I have since given up). As long as you eat properly and stay healthy you should not have a problem staying awake and keeping focused.
While studying for my professional accountancy exams I took Omega-3 capsules every day for 2 years. I would not take prescription drugs to enhance my levels of concentration.
Robert Waverley, Bristol
If a drug is "performance enhancing" then it should be banned from use, but of course the schools and universities don't want to ban them if their students are getting the grades