Pop Culture

It's 10:30 on a Friday night, and Amanda*, a magazine editor in New York City, is the last one in the office. Again. Not that she's complaining. Fact is, the 30-year-old has ridden successive waves of promotions in her brief career, largely because she possesses a blend of talent, smarts, and stamina that's hard to come by. But she has something else in her get-ahead arsenal: a secret stash of little blue-and-white pills.

Amanda got the drugs about a year ago, after those 60-hour workweeks began to leave her mentally unraveled. "I visited my family over the holidays, and they saw I was struggling," she says. By chance, her brother had just been prescribed an amphetamine to treat his attention deficit disorder, and he offered her five pills are dabbling in "cosmetic neurology," an emerging (and controversial) field that deals with mind-and performance-enhancing drugs — sometimes obtained legally, sometimes not. These prescriptions, say advocates, help them outshine coworkers, propel them through their at-home to-do lists, and give them charisma in social situations. But what these women may not realize is that every time they pop a "miracle pill," they're also experimenting with their health.

Why would anyone have such a cavalier attitude toward taking pills? "People who came of age in the past as a stocking stuffer, telling her, "Trust me, they'll give you all the energy you'll need."

Days later at the office, she swallowed one halfway through a brutal afternoon that involved writing two last-minute stories, scheduling appointments with publicists, and arranging an upcoming photo shoot. The result: "My ability to focus was insane," Amanda says. "I cleaned out my inbox, which had been overflowing for weeks, banged out pages of copy, and brainstormed a bunch of ideas. Even deadlines, which usually made me anxious, were no match for my productivity."

Over the next few months, Amanda used up her illicit stash and then bummed a couple dozen more pills from a friend who wasn't using his prescription. She now has one pill left and is trying to draw the line on her use. Still, she's hanging on to the phone number of a friend-of-a-friend who deals in black-market pharmaceuticals. "It's an internal struggle not to call him and place an order," she admits.

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Salvation in a Bottle

It used to be that medicine was for making sick people better. Now, overworked career women and overwhelmed moms decade are so comfortable with prescription drugs for ADHD and pain relief they've been dubbed Generation Rx," says Leonore Tiefer, Ph.D., a clinical associate professor of psychiatry at New York University School of Medicine. In fact, according to data from IMS Health, a health-care research firm, the presence of stimulants alone in American culture has practically tripled since 1998, with about 40 million prescriptions dispensed last year. And the more pills that float around in pockets and medicine cabinets, "the more opportunity there is for them to get into the hands of people they weren't prescribed for," says osteopathic physician Neil Capretto, medical director of the Gateway Rehabilitation Center in Pittsburgh. Today, the attention-deficit drugs methylphenidate and amphetamine/dextroamphetamine are the most abused substances on college campuses. But coeds don't always shake free from their reliance after graduation; 11 to 15 percent of adults in their twenties admit to using prescription drugs for "nonmedical" purposes.

One type that's gaining popularity amongst postgrads is modafinil (better known by its brand name, Provigil), a medication officially approved to "improve wakefulness" in people with certain narrowly defined conditions such as narcolepsy and sleep apnea. The blog chatter among high-octane female execs reads something like this: "Provigil rocks! To-do lists that used to vex me seem to complete themselves!" It bears noting that modafinil sales have more than doubled since 2004 and now approach $1 billion annually.

Sometimes, women turn to drugs not to be more productive, but to calm down. That's where popular antianxiety meds like lorazepam, alprazolam, and clonazepam come in. Carrie, a former member of the Cornell University swim team, started taking clonazepam after a panicky moment before the start of an important meet. Her doctor prescribed drugs even though she was never diagnosed with any clinical anxiety disorder. Now 23 years old and working for a sportswear company in New Jersey, she still digs a pill out of her purse whenever panic starts to well up inside her. "When you have a lot going on and you want to do everything perfectly," she says, "it's hard not to seek help."

Scoring the Goods

And help is often as close as the nearest doctor's office. In one study, actors who posed as patients and requested specific prescriptions were successful more than half the time. Physicians are sometimes so quick to pull out the white pad, you don't even have to go to the trouble of asking. Emily, a 40-year-old daycare provider from Traverse City, Michigan, told her doctor she wished she had more energy during the day. "Try this," he told her, passing a prescription for an amphetamine.

Women who can't easily convince an M.D. to issue a prescription often turn to the web. Last year, a third of subscribers to the science journal Nature who admitted to using drugs for "cognitive enhancement" obtained their supply over the Internet. Others, no doubt, scavenged pills from their friends and family. In a study released last year by the Centers for Disease Control and Prevention, 29 percent of women admitted to sharing or borrowing prescription drugs. Sometimes, the lending happens involuntarily: "I treated one woman who regularly dipped into her 8-year-old son's ADHD medication," says Capretto.

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The Lasting Effect of a Quick Fix

If you sit next to an Energizer Bunny like Amanda at work, part of you may wonder if a pill is your ticket to having it all. But as daycare worker Emily discovered, gaining an edge can have scary side effects. A few months after taking an amphetamine, she noticed her heart would race for no reason and she'd break out in drenching sweats. She abandoned the drug and the M.D. who gave it to her. "I'd rather be a little mentally fuzzy than dead," she says.

Experts warn of other dangers too. Drugs like these are designed for specific medical purposes, so if you're healthy, you may be tinkering with neurological wiring that's already working the way it's supposed to. "When drugs are used for reasons besides those that are approved, you're flying blind," says general internist Lisa Schwartz, M.D., a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. "A lot of these drugs are so new, the risk of serious complications isn't yet clear. They should be used only under a doctor's supervision." The proven side effects are alarming enough: Read the warning label for Amanda's ADHD drug and you'll find phrases like heart attack and sudden death in tiny type.

And then, of course, there's the potential for addiction. "If you're healthy, taking these kinds of drugs puts you on thin ice," Capretto says. "If you have a tendency toward addiction, you don't know how thin your ice is." Even some modafinil fans, comforted by the drug's reputation for safety, were taken aback after a report in the Journal of the American Medical Association warned it could become addictive.

Another pitfall: Once you're comfortable taking one drug, it's easy to start justifying popping others. "If one pill gives you a desired effect (say, amps your energy level), you might try another kind to fix a different type of problem (maybe help you sleep). Soon, you're relying on a drug to manipulate every aspect of your life," warns Capretto. "But know this: Each of these drugs brings possible side effects, which in combination can be dangerous. You might wind up with a laundry list of complications--paranoia, hypertension, heart palpitations, to name a few--as more drugs are brought into the mix. Toss in a few after-work cocktails, and things could get even dicier."

Adding to the danger: You may develop a tolerance to your medication. At first, taking a single daily dose of, say, alprazolam may give you peace of mind. But six weeks later, you may need three pills a day to achieve the same effect; a few months later, you may be downing five pills a night to get that warm-and-fuzzy feeling. "The drugs you originally took to get an edge can become something you need just to get back to the way you were functioning before you started on meds," explains Capretto.

A New Normal

Side effects aside, experts have other concerns about popping pills. One such fear is that drugs could redefine the idea of what's "normal" and set a standard of risky, pill-assisted perfection. "Once half your office is pulling chemically assisted all-nighters, your [normal level of] productivity may start to look deficient," says Martha Farah, Ph.D., director of the Center for Neuroscience and Society at the University of Pennsylvania. "Will you feel pressure to start extending your waking hours just to keep up?"

What's more, doctors worry that these meds will become a crutch that keeps you from making important changes in your life. By opting for a quick fix, you may be tempted to put off finding healthier solutions like figuring out how to manage your time better, learning new relaxation techniques, or having that get-it-off-your-chest talk with your guy. "If drugs are something you rely on," says Capretto, "you need to take a close look at your life."

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Even so, he and others predict that the popularity of prescription enhancers will continue. As long as the drugs offer short-term benefits, people will be drawn to them. That's why some experts suggest that instead of saying whether drugs should be used, we should determine how they should be used. Researchers are already conducting experiments involving emergency-room physicians to see whether drugs like modafinil could reduce the risk of fatigue-related errors.

The concern that it's wrong to use a drug just because it's a drug doesn't make sense, according to Farah. If it helps you get more work done or improves the quality or safety of the work you do, she says, "that weighs in the drug's favor. Do we want to be prissy and say, 'Oh, but it's unethical to use performance-enhancing drugs?' " Use among healthy people should depend on the drug and the situation — as long as everyone is clear about the risks.

"Look, a lot of people use these drugs because they work. But you have to exercise caution and really think things through," Capretto says. "Before you even hand your pharmacist a prescription to fill, have a plan in mind. Ask yourself: Where am I going with this? Do I plan to be on these pills for one week? two weeks? a month? There's a saying: 'Don't lift an airplane off the ground unless you know how to land it.' That same cogency should be applied to prescription drug use."

* All names and some identifying details have been changed.



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