To the Editor:
Nonmedical use of prescription stimulants (NMUPS) is a cause for concern in any population, but particularly in the next generation of physicians. While legitimate prescription stimulant use by medical students with attention deficit hyperactivity disorder (ADHD) improves daily function, NMUPS has been reported for recreational or cognitive-enhancement purposes. Anecdotally, students feeling pressure to succeed in the highly competitive medical school environment sometimes turn to NMUPS to enhance their focus and endurance, rationalizing the practice for the sake of academics and their future careers.
Currently, only a handful of studies have evaluated NMUPS within the medical school setting, with reports ranging up to 15%.1,2 As such, it is difficult to gauge the extent of the problem nationwide. Additionally, less is known about the risk factors, motivations, and long-term implications of NMUPS. This significant gap in the literature on medical student well-being may result from stigma surrounding the issue. Medical schools may be reluctant to conduct research in this area and/or to share their results publicly for fear of potential damage to their institutions’ reputations. However, failure to act (1) exposes medical students who engage in NMUPS to inherent risks and side effects of off-label use, (2) fosters resentment among students who do not engage in NMUPS towards colleagues who they suspect are gaining an unfair academic advantage through such use, (3) may stigmatize legitimate use of prescription stimulants by students who need them for diagnosed health conditions, and (4) erodes professionalism by tacitly condoning the practice of illegal acquisition and use of prescription drugs.
We advocate more research in this area to expose the extent of the problem and begin to explore potential solutions, such as addressing the competitive environment in medical schools and promoting holistic well-being through educating students on better coping mechanisms, study habits, and lifestyle choices. Additionally, schools should provide supportive diagnostic testing environments to meet the needs of students who struggle with ADHD.
In conclusion, for the sake of medical student well-being and the culture of their learning environment, we urge all medical schools to take a bold step and critically examine the issue of NMUPS by medical students.
Joshua L. Cohen
Seventh-year MD/PhD student, Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, Alabama; [email protected]; ORCID: http://orcid.org/0000-0002-0270-1068.
Seventh-year MD/PhD student, Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, Alabama; ORCID: http://orcid.org/0000-0003-4350-1641.
Anna Joy Rogers, MA
MD–DrPH candidate, Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, Alabama; ORCID: http://orcid.org/0000-0002-9907-8806.
1. Wasserman JA, Fitzgerald JE, Sunny MA, Cole M, Suminski RR, Dougherty JJ. Nonmedical use of stimulants among medical students. J Am Osteopath Assoc. 2014;114:643653.
2. Emanuel RM, Frellsen SL, Kashima KJ, Sanguino SM, Sierles FS, Lazarus CJ. Cognitive enhancement drug use among future physicians: Findings from a multi-institutional census of medical students. J Gen Intern Med. 2013;28:10281034.