Ethics in Action: Cognitive Enhancement Drugs in Sports: A Slippery Slope with Ethical Considerations

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April 6, 2016

By Kimberly S. Peer, EdD, ATC, FNATA

Smart drugs or nootropics are on the rise in academic settings to enhance cognitive performance. Often called cosmetic neurology or academic doping, this evolving issue is becoming rampant in schools and universities across the country. Although demonstrated through the literature to only provide a modest increase in cognitive ability1, these drugs are now infiltrating the sports world as potential performance enhancing agents. Taken primarily to enhance concentration, the appeal of these substances in sport could become a major factor in future years. Despite the ethical issues associated with performance enhancing as a whole, we have seen an increase in their use as well as efforts to control their use in the past decades.

Although full coverage of the ethical issues associated with performance enhancing drugs collectively is beyond the scope of this blog, ethical arguments typically stem around the concepts of fairness and autonomy. If an athlete chooses to use these substances, despite the risks to health and reputation, it should be the autonomous right of the athlete to choose. However, on the justice perspective, performance enhancing substances create an unfair playing field as not everyone will choose to use these substances to enhance their performance. Although superficial in deliberation, performance enhancing drugs have been banned to various degrees at all levels of sport. The constant challenge remains defining exactly what should be included in the list of banned substances and, of course, regulatio

As Athletic Trainers (ATs), we are intimately involved in the athlete’s health history. It is a growing trend to see more athletes and students overall reporting cognitive enhancing drugs. Provided they are prescribed and of the appropriate chemical compound, these drugs can be a therapeutic intervention. However, the dilemma occurs when athletes who are not prescribed these medications find non-therapeutic means of accessing them to use at their discretion. Discerning who truly needs them and who does not is a true challenge and disadvantages those individuals who do genuinely need them medically.2

Cekic1 presents several interesting questions to consider as we begin to face the outcomes of these ever-evolving drugs. Why are we so offended by taking a pill to increase cognitive awareness yet we will gladly consume coffee to increase alertness? Should these drugs be banned in academia as well as athletics? If so, is it even possible to regulate the misuse of these drugs when so many are being prescribed them? Do these drugs differ from other performance enhancing substances? There are many tough challenges ahead as we begin to face these issues in our profession.

As ATs, we need to be aware of this ever-increasing dilemma of illicit use of cognitive enhancing drugs as a potential performance enhancer in sport. We are bound by our Code of Ethics and the BOC Standards of Professional Practice to report any illegal use of any performance enhancing drug, including the consideration of this new generation of performance enhancers. It will be very complicated to address the increasing availability and access of these drugs to our athletes of all ages. Our responsibility as professionals remains to educate and inform our athletes of the risks and to report any suspected illegal use of these substances.


1. Cakic, V. Smart drugs for cognitive enhancement: ethical and pragmatic considerations in an era of cosmetic neurology. J Med Ethics; 2009. 35:611-615.

2. Greely, H. et al. Towards the responsible use of cognitive-enhancing drugs by the healthy. Nature; 2008: 702-705.

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