Medical Journal of Australia

Are students popping pills to boost performance?

RESEARCH is needed to determine whether significant numbers of Australian students are trying to improve their academic performance by taking diverted prescription stimulants, according to academics from three Australian universities and a Canadian research institute.
Dr Jayne Lucke, principal research fellow at the University of Queensland’s Centre for Clinical Research, said there were anecdotal reports of students taking methylphenidate and dexamphetamine, to improve concentration and memory.
These reports suggested students were obtaining the drugs from family or friends who had been prescribed them for attention deficit hyperactivity disorder (ADHD).
In a letter to the Medical Journal of Australia, Dr Lucke and Professor Wayne Hall, also from the Centre for Clinical Research, said there were good reasons to be concerned about non-medical use of prescription stimulants, yet there was “surprisingly little empirical data on the extent of non-medical use of prescription stimulants in Australia”. (1)
They have teamed with the National Drug and Alcohol Research Centre at the University of NSW, Deakin University in Victoria and the Clinical Research Institute of Montreal to apply for grant research funding from the Australian Research Council to explore the issue.
Dr Lucke told MJA InSight it was important to determine whether non-medical use of stimulants might partly explain the 87% increase in stimulant dispensing in Australia from 2002 to 2009.
Dr Sharlene Kaye, research fellow at the National Drug and Alcohol Research Centre at the University of NSW, said the increase might reflect increased recognition of ADHD, but her recent research suggested diversion was an issue.
She found that 31% of 269 illicit drug users had used diverted prescription stimulants, while only 7% had been prescribed them.
“The implication is that these drugs are getting out to a lot more people than they’re being prescribed for”, she said. “It’s not only happening among university students, but among the illicit drug population as well.”
Dr Kaye said United States studies showed that 23%–84% of college students who had been prescribed stimulants had experienced people asking for them or offering to buy them.
Dr Lucke said there was a great deal of hype in the US about using medication to boost brain power, with research suggesting 7% of US college students had taken methylphenidate and dexamphetamine as study aids.
“Often you find it’s male students not getting great grades, who have higher levels of alcohol and other recreational drug use”, she said.
Dr Lucke said increased financial and academic pressure may be influencing students’ non-medical use of prescription stimulants, but recreational use also had to be considered.
Ms Jade Tyrrell, president of the Students Association of the University of Technology in Sydney, said she had heard of a couple of students taking the drugs but she wasn’t aware that it was a widespread issue.
“I’m sure it goes on with the higher pressure subjects. Some students pull out all stops to try and balance the financial and academic pressures they face”, she said.
“No-Doz [caffeine] is pretty standard in exam time for cram sessions towards the end of semester and energy drinks are standard for sure”, she said.
Ms Tyrrell said the high cost of living in Sydney placed a lot of pressure on students, particularly when they had to combine work and study.
Dr Lucke said despite the toxic side effects of stimulant misuse and dependence, clinicians seemed more concerned about non-medical use of opioids prescribed for chronic pain.
“Is that because we haven’t got the proper studies to show the extent of non-medical use of stimulants by students in Australia?” she said.

MJA Careers: Medical mentor – Associate Professor John Kelly

Associate Professor John Kelly reflects on his career in dermatology

Melbourne dermatologist Associate Professor John Kelly is Director of the Victorian Melanoma Service at the Alfred Hospital, a leading force in multidisciplinary cancer care. He also runs a specialist practice in Armadale.
“When I left school in 1970 I knew I wanted to study medicine, but I set out specifically to avoid becoming a dermatologist. I had strong medical role models in both grandfathers and my father. My paternal grandfather and father were both dermatologists. I was concerned that I might work forever in their shadow if I pursued dermatology.
There was no expectation that I should study medicine, but I admired the commitment that my role models gave to their vocation and their readiness to spend long hours with patients. After working as a medical registrar in various specialties I found myself drawn to dermatology. I liked the way in which an experienced eye could cut through to the diagnosis by recognising the pattern of presentation.
I also found appealing the mix of consulting and procedural work that dermatology offered. As a trainee in dermatology I looked for things that were likely to be important in years to come.
In the early 1980s, I spent time as a registrar with Professor Robin Marks, head of dermatology at the Alfred Hospital. He saw that skin cancer was an increasingly important area in Australia and focused on non-melanoma skin cancer.
Dermatologists in the US were focusing on melanoma and contributing new understanding. I could see a place for myself in melanoma work.
I was then fortunate to work in the melanoma clinic at the University of California in San Francisco, where I did my doctorate. They had a multidisciplinary approach, with pathologists, dermatologists, surgeons, oncologists and psychologists all working together in the clinic.
It became my ambition to establish something similar in Melbourne. The concept was initially met with some resistance; the idea of multidisciplinary cancer care was a new one. The sharing of decision making was a challenge to the way practice was conducted at the time.
Over several years, when I was running the dermatology unit at the Alfred, I got to know John Anstee (plastic surgery), Max Schwarz (oncology), Bill Johnson (general surgery) and John Dowling (pathology) who shared my enthusiasm for a multidisciplinary approach to melanoma. Together we started the Victorian Melanoma Service in 1994.
The most important role of the service is to give people who have been diagnosed recently with melanoma a full understanding of their particular situation. A lack of information and understanding frequently makes a diagnosis with cancer much more frightening than it need be. We aim to expose patients to all the specialists they need to hear from, so they can participate in decision making regarding their therapy.
Our patients are largely cared for in the community. They only come to us when management issues arise; for the most part they see their specialist or general practitioner in the community setting.
At the clinic I see patients. I also chair the multidisciplinary panel meetings. At the meetings, senior consultants in pathology, dermatology, plastic surgery, general surgery, medical oncology, radiation oncology, medical imaging and oncology nursing are present, along with registrars and residents.
After histopathology review and clinical assessment, our fellows present each case to the panel. Each case is discussed and a management plan agreed upon. I enjoy clinical research, identifying problems found in everyday practice. One can find a clinical question and design a study to shed light on it. Our extensive database of more than 6000 cases enables many of these studies.
Initially I did research myself, but more recently I’ve been mentoring others. Mentoring bright young people who want to engage with us in furthering their careers has been a highlight. We have students doing masters or PhD projects who keep me interested and enthusiastic about what I do.
I also have a private practice outside of the Alfred. I still enjoy the very visual, pattern recognition skills that dermatology requires. I enjoy the interaction with people in addressing a problem they care about.”
MJA 195 (7) • 3 October 2011 C5