The diffusion of Performance and Image-Enhancing Drugs (PIEDs) on the Internet: The Abuse of the Cognitive Enhancer Piracetam

Abstract

Introduction: Performance and image-enhancing drugs (PIEDs), also known as “lifestyle drugs,” are increasingly sold on the Internet to enhance cognitive as well as sexual, muscular, attentive, and other natural capacities. Our analysis focuses on the misuse of the cognitive enhancer piracetam. Methods: A literature review was carried out in PsychInfo and Pubmed database. Considering the absence of peer-reviewed data, review of additional sources of unstructured information from the Internet was carried out between February 2012 and July 2013. Additional searches were conducted using the Global Public Health Intelligence Network (GPHIN), a secure Internet-based early warning system developed by Health Canada and the World Health Organization (WHO), which monitors media reports in six languages, Arabic, Chinese, English, French, Russian, and Spanish. Results: Piracetam is sold via illicit online pharmacies with no need of prescription at low prices. Buyers, mainly healthy individuals, purchase the product to enhance study- and work-related performances as well as for recreational purposes. Its nonmedical use is often associated with the occurrence of side effects such as hallucinations, psychomotor agitation, dysphoria, tiredness, dizziness, memory loss, headache, and severe diarrhoea; moreover, several users declared to have neither felt any cognitive improvement nor psychedelic effects. Conclusions: This is a new and fast-growing trend of abuse that needs to be extensively monitored and studied also by using near real-time and unstructured sources of information such as Internet news and online reports in order to acquire rapid knowledge and understanding. Products sold online might be counterfeits and this enhances related health risks.

Keywords :

• piracetam
• performance and image-enhancing drugs
• addiction
• drug abuse
• cognitive enhancer
• online pharmacies

THE AUTHORS

Dr Ornella Corazza leads the academic research at the Department of Postgraduate Medicine at the University of Hertfordshire in the UK. Her research interest is in the field of addictive behaviors, mainly substance abuse. She has managed and was awarded the prestigious 2013 Health Award for ReDNet, a project funded by the European Commission, which developed innovative methodologies for the prompt identification and dissemination of evidence-based information on new drug trends and cultural/lifestyle issues behind risky behaviors. She has contributed to the generation of original data on over 700 new drugs (or “designer drugs”) presented in 60 peer-reviewed publications, 13 monographs, and numerous invited lectures, seminars, and media appearances. As a consequence of working internationally in different academic environments, especially at the University of Tokyo in Japan, she has developed a unique specialism in the combined fields of health, culture, and legislation. The basic theme of her research is to find out new strategies to enhance our lifestyles by bridging science and Oriental traditions.

Francesco Saverio Bersani is a resident physician at the Department of Neurology and Psychiatry of Sapienza University of Rome and visiting research fellow at University of Hertfordshire. Major areas of interest: biological psychiatry, psychopharmacology, brain modulation techniques, substance misuse, and psychoneuroendocrinology.

Roberto Brunoro is a PhD student at University of Padua. Currently, he is studying the THC misuse in adolescence as a risk factor in schizophrenia, in COMT Val transgenic mice. He gained his Pharm.D. in 2013 at the University of Padua and has collaborated with ReDNet project in 2012 as a visiting researcher at the University of Hertfordshire where he studied the abuse of Performance and Image Enhancing Drugs (PIED) among college students under the supervision of Dr. Ornella Corazza and Professor Fabrizio Schifano.

Giuseppe Valeriani is a resident physician at the Department of Neurology and Psychiatry of Sapienza University of Rome and visiting research fellow at University of Hertfordshire. Major areas of interest: biological psychiatry, psychopharmacology, substance misuse, novel psychoactive substances, and behavioral addictions.

Giovanni Martinotti is currently Senior Researcher in Psychiatry and Academic Lead of the Research Unit on Addiction at the Department of Neuroscience and Imaging, University “G.d'Annunzio” of Chieti-Pescara. In his career, he has developed a strong clinic and academic expertise in the field of substance abuse, as well as other forms of addiction including pathologic gambling and behavioral addictions. He is author/coauthor of more than 180 papers on peer-reviewed journals with impact factor and he has published 11 books as editor and one monograph. He is also associate editor of different scientific journals. He has recently been elected president of the Young Section of the Italian Society of Psychiatry.

Professor Fabrizio Schifano is one of the very few physicians with training and specialist qualifications in both psychiatry and clinical pharmacology and has contributed to the biomedical science as well as the clinical science of addiction. He has also made a significant contribution to several areas in addiction psychiatry and general psychiatry, including: stimulant synthetic drugs, mortality studies (Professor Schifano co-supervises and co-leads the National Programme on Substance Abuse Deaths (npSAD)), the Internet and drugs. This is a new area of research and Professor Schifano is the Principal Investigator of the third consecutive EU Commission-funded, multi-centre Psychonaut/ReDNet research programme. Results from these studies have provided the only comprehensive and multilingual analysis of the information available online on psychoactive compounds to date.