In March 2025, the Royal Society hosted a seminar on cognitive enhancing drugs and their increased use amongst both those diagnosed with ADHD and those without a diagnosis. Chaired by the Rt Hon. Lord Justice Underhill, a lively discussion on potential legal implications ensued.
Work and study increasingly rely on the use of technologies requiring individuals to switch attention rapidly between emails, texts and tasks. Problems with attention and concentration are common in both people with attention deficit hyperactivity disorder (ADHD) as well as those without a diagnosis. This has led to difficulties getting into the “flow”, which impedes goal attainment and task completion. Possibly related to this, there is an increasing diagnosis of ADHD and prescriptions of drugs such as methylphenidate.
The science
Professor Barbara Sahakian spoke about cognitive enhancing drugs or ‘smart drugs’ and their use by people without a diagnosis.
According to NHS England, prescribing of central nervous system stimulants, such as methylphenidate, lisdexamfetamine, and other drugs for the treatment of ADHD increased by 32% in adults over 18 and 12% in children aged 17 and under from 2021/2022 to 2022/2023. This was also the first year that more adults were prescribed these drugs than children since records started in 2015.
It is well-known that people who have no diagnoses are using these drugs for cognitive enhancement purposes, including to improve attention and concentration, as well as to reduce fatigue, work for longer, counteract the effects of jetlag and improve task-related motivation. Many surveys have shown an increasing lifestyle use of these cognitive enhancing drugs by students and workers alike, globally. A study examining cognitive enhancing drugs in 15 countries found that the use by people without a diagnosis of central nervous system stimulants was highest in the USA (21.6% of people surveyed), whereas the use of modafinil was highest in the UK (10% of people surveyed) . Modafinil (sold under the brand name Provigil) is a wake promoting drug licenced to treat narcolepsy.
These drugs have been shown to improve cognitive performance in people without a diagnosis with generally small to moderate effects. In addition to the improvements in cognition, these drugs seem to boost motivation and cognitive effort . One important randomised clinical trial from Imperial College London and the University of Cambridge found that modafinil reduced impulsive decision-making and improved cognitive flexibility in sleep deprived doctors . In addition, doctors reported feeling more alert, stronger, more gregarious, more attentive and tended to feel more proficient than the placebo group the following morning. This study lends support to the FDA approval of modafinil for shift work sleep disorder in the USA, where it has been shown to reduce accidents or near accidents.
While we might assume that it is easy to tell the difference between restoration and enhancement of cognition and behaviour, this is not the case. For example, we know that we are at our cognitive peak at our 20s and 30s, so if we were to use a cognitive enhancing drug at work as an older adult, in our 50s or 60s, would that just be restoration or enhancement?
A similar question could be asked of jetlag. If we take a cognitive enhancing drug to reduce fatigue and improve concentration and memory following jetlag is that restoration or enhancement? The same question comes up with shift work, as in the case of the sleep deprived doctors, and others who work shifts. We urgently need a long-term study of safety and efficacy in people without a diagnosis of a cognitive enhancing drug, such as modafinil, which has no clear evidence of addiction potential, or methylphenidate.
There should, of course, be some consideration as to who would have access to cognitive enhancing drugs. For example, would they be allowed in competitive situations, such as exams at university, where some students may regard it as ‘cheating’? We may also restrict their use in children and adolescents without a diagnosis due to the fact that their brains are still in development. However, there are potentially great gains from the use of these cognitive enhancing drugs and may be particularly useful for people involved in shift work or jobs where small mistakes can lead to large consequences, and for helping people get back to work following health conditions.
Legal considerations
Aileen McColgan KC introduced some of the legal issues that might arise in connection with the use of performance enhancing drugs. Leaving aside potential criminal liability related to importing, supplying and/or acquiring prescription medication, legal claims could arise if, for example, children are encouraged or required to use such drugs as a condition of school attendance (eg because of behavioural problems). Legal claims could also arise if adults feel obliged to use these drugs to manage demands imposed by study or work, and/or in order to remain competitive with others.
Even if the use of such drugs does not damage health, its impact on human functioning may amount to an interference with private life as protected by Article 8 of the European Convention on Human Rights and the Human Right Act 1998. Article 8 imposes obligations on public authorities to protect people from threats to privacy. It will also restrict measures to prevent the use of performance enhancing drugs (eg by testing). Such testing is commonplace in elite sports but the trade-off between privacy and access to such sport is not readily applicable to access to education, particularly in a situation in which many and increasing numbers of students would be entitled to use such drugs by reason of conditions such as ADHD.
The high and increasing prevalence of such conditions, and the fact that universities may be required under the Equality Act 2010 to make adjustments even absence of formal diagnoses, makes the legal position more complex.
Closing observations by Chair (Lord Justice Underhill)
Both Professor Barbara Sahakian’s illuminating presentation and the discussion which followed brought home how common the use of cognition-enhancing drugs is becoming in some work and educational contexts. Aileen McColgan’s illustrations of the kind of dispute which this was likely to engender revealed that the law has not yet grappled with this phenomenon: it has the tools to do so, but the answers will depend as much on ethical and societal values as on established legal principle.
