The fourth wave of the opioid epidemic is characterized by the rise of fentanyl derivatives, psychostimulants, designer benzodiazepines, and other novel psychoactive substances (NPSs). Many of these compounds are uniquely novel, but many are older or repurposed medications that continue as prescription drugs in countries outside of the United States. Nootropics, colloquially known as "smart drugs," are one group of these NPSs. Nootropics are deceptively marketed as cognitive enhancers for improving memory, concentration, and alertness despite having little evidence that they benefit cognition. The most common of these drugs is kratom. And while nootropics are marketed as "dietary supplements," others are prescription medications such as methylphenidate, amphetamines, and modafinil which come with their own risks.
In this 90-minute workshop, we will engage learners to discuss nootropics in order to identify and treat the misuse of these substances in our patient population. We want to familiarize attendees with four specific nootropics: tianeptine, phenibut, kratom, and modafinil. We will review the pharmacological and psychological properties of these substances. We will describe their prevalence, addictive potential, withdrawal symptoms, toxicity presentations, and management, including the potential use of medication-assisted treatment solutions. We will also discuss how manufacturers exploit poor FDA oversight and legal loopholes to market these compounds as "dietary supplements." Lastly, we will discuss the international reaction to these compounds, knowledge gaps, and areas for future research.