Turning to the Pharmacopeia in Indian Colleges

By: Ruhi Soni

Bhavika Bhatia was in the last semester of design school three years ago when she first learned that drugs could help her be more productive. Struggling with a plethora of deadlines, including a backlog from the previous semester, the then-23-year-old studying in Pune, a small city in southern India, was barely inching towards the finish line of her college education. During this time, a friend of hers, who was also in a similar situation mentioned a tablet that could help them stay awake all night.

“And I was like, I hit the jackpot!” she recalls. “It was like I’ve been looking for it all my life.”

That night, Bhatia and her friend took 200 mg of the pill — modafinil, a pharmaceutical drug also known by its brand name Modalert in India, or Provigil in the west. Normally, modafinil is prescribed to patients who have been diagnosed with sleep disorders, which make it difficult for them to stay awake. They are prescribed the drug in much lower doses. Bhavika and her friend took the medicine with no prescription or medical advice. She ended up staying awake, alert, and productive for about 30 hours.

Bhavika was part of a group of Indian students who go above and beyond the usual coffee and energy drinks that are typically a staple in student lives, taking a variety of substances that may help improve their brains and their grades. The substances are called by various names such as ‘nootropics’, ‘smart drugs’ or ‘cognitive enhancers’ and purport to help people with concentration, alertness, memory, and other brain functions. But these students might be gambling with their health and the law, given that the off-label use of these chemicals is poorly researched and illegal.

Data and information about drug use in Indian colleges are sparse, let alone specifically about nootropics use. For example, one study of 283 students across India showed that about 18 percent of them reported having tried drugs in college – but the study was only limited to medical and paramedical students.

Vinod Kumar, a consultant psychiatrist at MPower, a mental health clinic in India, tries to estimate its prevalence. In his practice of about two decades, he has encountered about a dozen students who have tried to trick him into prescribing them drugs like modafinil by faking symptoms of out-of-hand poor sleep. Anecdotally, he speculates that nootropics are much less prevalent in Indian campuses than marijuana (Marijuana use in Indian colleges is also poorly researched, but there is a strong ‘weed culture’ consisting of ganja, charas, bhang, and more).

There isn’t even consensus on what a nootropic is, considering it’s a category that might include certain allopathic drugs taken without prescription as well as certain Ayurvedic medicines, which are less stringently regulated than modern drugs.

Defining nootropics is a challenge that Shiv Issar had to grapple with. Issar, currently a 30-year-old doctoral student and lecturer in sociology at the University of Wisconsin-Milwaukee in the United States, first dealt with this question when he was completing his Master’s degree thesis in India on the topic of nootropics used by medical students in his college.

“Some people see caffeine or nicotine as nootropics,” he explained. “It makes you question how does one even define a nootropic? Is the definition more ‘socially constructed’ than pharmaceutical?”

Kumar agrees. “It’s a notion more than anything, a loose term,” he says. That being said, “we haven’t found anything proven to be safe and efficacious so far.”

Legally speaking, modafinil is a Schedule H drug in India – it cannot be sold without a prescription. Schedule H drugs are only one level lower than Schedule X drugs, whose sale requires pharmacists to have even more certifications before they can stock it and sell it. However, that doesn’t stop students from walking up to their nearest local pharmacists and buying a strip of 10 100 mg modafinil tablets for INR120 (US$1.63), no questions asked.

This ease of access is a symptom of a problem that plagues much of Indian regulation, including medical regulation – rules are easy to define but hard to implement. “Most of the pharmacies here are corner shop pharmacies run by non-pharmacists,” Kumar said. “They are mostly concerned with meeting sales targets and paying rent, and the government doesn’t give a rat’s ass.”

The lack of information and regulatory advice are some reasons why students taking these pills find accurate, up-to-date information not in Indian government documents or scientific journals, but on online forums such as Reddit. A quick scroll through such anecdotal sources throws up some names more than others among Indian users. While modafinil appears to be the most popular drug of choice, other options include armodafinil (a milder version of modafinil), a class of drugs called racetams and their variants (which gives students a bit of a mental ‘pick-me-up’) and ashwagandha, a centuries-old Ayurvedic medicine (whose effects are supposedly more long-term than the other options and may help students relax).

Issar himself used modafinil when he was completing his thesis in 2018, partly to immerse himself first-hand in the very topic he was writing about, and partly to break into a tight-lipped community of drug users. He learned more about the types of students who would resort to these drugs.

“Mostly, they wanted to get ahead. They were burned out by the system, the long hours in classes, by long hospital rounds,” he said.

“I’ve bought it three or four times but they [the pharmacists] didn’t seem to care,” said Kovida Mehra, a 21-year-old fresh graduate in communications, who first used modafinil when she was a 17-year-old studying for the final exams of her high school.

However, Mehra had other issues with modafinil – it didn’t work on her. She tried it in isolation, and after combining it with coffee and tea. “My friends who took way lesser doses than me were able to pull two nights in a row with intense focus. For me, I had pretty much no change except a little bit of appetite suppression.”

Instead, her productivity got much better after she was diagnosed with ADHD in October this year and prescribed inspiral – a common Indian counterpart to Adderall and Ritalin in the West. There was an immediate improvement even at low doses. She is less easily distracted when working now and reacts less impulsively to difficult situations.

“It makes me slow down,” she said.”So I can think a little better while working, or catch myself before I react to something in a way I’ll regret.”

ADHD medicines taken with or without prescription seem to be the most popular nootropic of choice among Western students. In India, however, ADHD medication like Mehra’s inspiral often fall under Schedule X drugs – those which are monitored much more stringently than Schedule H drugs like modafinil. Pharmacies selling Schedule X drugs cannot jump through the bureaucratic loopholes and apathetic regulation that is associated with Schedule H drugs.

Mehra’s monthly ritual for getting her ADHD pills involves going to one of the only two government-run pharmacies in India, who take her prescription after providing her the required pills. This pharmacy also cross-checks her name, address and past purchases. Such steps are a far cry from most day-to-day purchases at other pharmacies, where one keeps their prescription, and their personal details and past purchases are never investigated.

In other words, Mehra finds it more difficult and time-consuming to get her hands on prescribed ADHD pills than unprescribed modafinil ones. Interestingly, she wasn’t. Interestingly, She was not the only interviewee who had a run-in with nootropics and was also diagnosed with mental health issues. Bhatia was also diagnosed with ADHD this year.

“When I look back at it, the signs have been there all my life,” she said. After all, her inability to focus on tasks is what drew her to modafinil in college in the first place. “I was never dependent on modafinil. I was addicted to that feeling that, for the first time in my life, I could actually work without being distracted all the time.”

“If someone comes into my clinic trying to dupe me into giving them a [modafinil] prescription, I try to learn more about their mental health. More often than not, I end up discovering they have ADHD or anxiety or such things. They are more productive and healthier if they get the right help for those underlying issues instead.”

His caution is not without good reason – modafinil taken without medical supervision can have its drawbacks. It gave Bhatia the ability to work with intense concentration for long periods of time. But if she didn’t have her work lined up before taking the pill, she could end up intensely focusing on trivial tasks instead.

She had other challenges with modafinil too. During finals week during her college years, she had been taking modafinil repeatedly. During this time, “it’s like my body was asleep but my mind was awake.”

She recounts the last exam of her college career. “I revised for it. I went to the exam hall, got the paper, and completely blanked out. My eyes were open, but my mind was just shut,” she recounts. “The questions were straightforward, but I stared at that paper like I was expected to write high-level theoretical formulas. I knew right there that I was failing it.”

On the other hand, Arushi Tandon, a 24-year-old assistant manager for Ashoka University’s entrepreneurship department, turned to a nootropic to improve her mental state after her prescribed pills couldn’t. She had been prescribed a concoction of psychiatric medicines to manage her mental health. She was a type-A personality since childhood and had burned herself out on academic work so much that her immune system had given up and she had developed lupus in college. She could not continue taking her psychiatric medicines as they caused her lupus symptoms to flare up.

“And that’s when I turned to homeopathic and Ayurvedic medicines, including ashwagandha and brahmi,” she says, referring to two medicines that are frequently taken by nootropics users and praised on online forums. While she hadn’t taken these medicines specifically to seek out their cognitive boost, she felt the improvement anyway.

“It was a slow and gradual process, like over a couple of months,” she says. “But when it kicked in, I felt the most relaxed and in control of my work than I had since high school, since I started taking antidepressants and stuff.”

Bhatia sums it up best. She was diagnosed with ADHD after she moved out of India. Once abroad, she had more awareness and access to psychological resources. “Had I known I had ADHD all along, I could have saved so many situations throughout my life. I might not have turned to modafinil in the first place.”

Looking at her, it is easy to wonder how many other students might be like her, students who turned to poorly understood and illegal ‘smart drugs’ when what they really needed was psychological support.

Ruhi Soni lives in Bangalore, India. She is a recent graduate in journalism at Hong Kong University’s Journalism and Media Studies Center, which made the article available to Asia Sentinel. She also studied biology and is pursuing science journalism. She can be reached through Twitter at @rookarmeremanko.

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Source: Asia Sentinel
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