In my previous post, I presented an analysis of different regulatory environments. The economic disincentives model (EDM) proved to be the most efficient option for public policy on cognitive enhancement (CE). As with smoking regulation, the EDM provides a framework in which both CE-users and non-enhancers can follow their personal preferences. The remaining question was whether we should use the EDM for all available CE drugs.
In my paper "Prohibition or Coffee-shops: Regulation of Amphetamine and Methylphenidate for Enhancement Use by Healthy Adults", I returned to the question of side-effects. I analyzed available information on two of the most commonly used CE drugs: Adderall and Ritalin. The question that was left unanswered in the first post (and article) was: is the use of Adderall and Ritalin most like using coffee, cocaine, or tobacco? In previous posts, I argued against their use being similar to coffee use and argued for the EDM, which is similar to and yet more profound than our current regulation of tobacco. To cut a long story short, while the use of Ritalin is more ambiguous, the use of Adderall is more like using illicit drugs such as “speed”, since the substances are more or less the same: Amphetamine.
What is the fuss all about?
Even if we take the danger of Amphetamine at face value, the use of both Adderall (Amphetamine) and Ritalin (Methylphenidate) for CE has to be distinguished from both therapeutic and ordinary illicit uses (i.e. to get high). They work on dopamine levels in the brain, which is the reason why they are prescribed in the first place. To simplify things, people with ADHD don't have enough dopamine, so the drugs help. Healthy people can “boost” their performance as well, especially when they are tired. However, meddling with dopamine can be dangerous, since too much dopamine can cause a lot of bad side-effects, including addiction.
That is why both Ritalin (and all other forms of Methylphenidate) and Amphetamine are currently on controlled substance lists all over the world. In fact, the United Nations 1971 Convention on Psychotropic Substances explicitly lists Methylphenidate as a Schedule II drug (dangerous substance with known medical uses).
So, what is the danger?
Even though they can be useful, the side-effects are dangerous. Apart from nervousness, drowsiness, insomnia, and problems during pregnancy, both Ritalin and Adderall could cause serious heart trouble and addiction. The most immediate effect is the increase in blood pressure, which could be dangerous and may even cause sudden death. They are especially dangerous if they are used in high quantities, injected directly into the bloodstream, or inhaled. Namely, the standard oral use (in moderate quantities) of both these drugs is more or less safe. However, if injected or inhaled, the drug can create a “rush”, euphoria (“high”), and even manic episodes similar to schizophrenia. Not nice.
What to do with them?
Again, we must remember that, even though most people have no idea how dangerous Ritalin and Adderall can be, they are not using them to get high. They use them to be able to work longer. But the danger identified above make it clear that we cannot regulate them like coffee, but, even though the picture may be clear for Amphetamine, which is extremely dangerous, there is a difference between various formulas of Methylphenidate. Time-release technology can make Ritalin safer, so that it can only be used as a pill that would guarantee no rush, no high, and less danger of addiction. Amphetamine is just too dangerous in all forms.
But what about the UN Convention?
States that have signed it can't just ignore the 1971 UN Convention. Even if they did, most countries have made laws that reflect the provisions of the Convention. For example, in the United States, the Psychotropic Substances Act of 1978 explicitly ensures compliance with the convention: “It is the intent of the Congress that the amendments made by this Act, together with existing law, will enable the United States to meet all of its obligations under the Convention and that no further legislation will be necessary for that purpose” (21U.S.C.§801a). So, is that it? Prohibition for all CE drugs?
CE use does not have to be abuse
The UN Convention of 1971 regulates abuse of drugs. It also states that a preparation may be exempted from prohibition if it is compounded so that it presents no, or a negligible, risk of abuse and that it does not give rise to a public health and social problem. Since extended release formulas of Methylphenidate (e.g. Ritalin-SR) might meet this criterion, this might make a “discourage use” type of policy like the EDM more or less appropriate. However, the Convention requires the following measures: a) licenses for manufacture; b) statistical records of quantity, date, supplier and recipient; c) prohibition of and restrictions on its export and import; d) inspection of manufacturers, distributors and users; e) statistical reports of use, abuse and commerce for the UN and f) criminal prosecution of illicit manufacture and sale.
Economic Disincentives Model has all that
The Economic Disincentives Model (EDM) includes all the requirements from the Convention and more because the dangers should not be taken lightly. Recall that EDM envisions a licensing procedure for users including a course about known effects and side effects, passing an exam as proof of knowledge, additional medical insurance, and obligatory annual medical tests. Recall that the issue was the right to use and not to use certain substances. Similarly to smokers, would-be CE users, if they know what they are doing, should have the right to do it. Similarly to non-smokers, no one should be forced to bear the effects of such use unwillingly. EDM guaranties the rights of all.