Non-Medical Use of Cognitive Enhancers Among Lebanese Pharmacy Students: A National Cross-Sectional Survey

Non-medical use of cognitive enhancers (CEs) is underexplored in the Middle East and North Africa despite high academic stress and inconsistent drug regulation. Pharmacy students, given their pharmacological training and medication access, may represent a key population for surveillance. This study examined CE misuse prevalence and correlates among Lebanese pharmacy students.

A registry-based, design-weighted cross-sectional survey was conducted from March to May 2025 among undergraduates at Lebanon's three largest pharmacy programs. Of 1,003 eligible students, 438 completed the survey (AAPOR response rate RR1 = 43.7%). Post-stratification weights aligned the analytic sample with university-reported margins for gender, academic year, and sector. Non-medical CE use was defined as unprescribed use of donepezil, memantine, racetams, methylphenidate, or modafinil in the past 12 months. Factors associated with use were assessed using DAG-guided multivariable logistic regression.

Weighted 12-month prevalence of non-medical prescription CE use was 28.1% (95% CI: 23.7-32.9). A secondary composite endpoint encompassing prescription misuse and over-the-counter supplements used with explicit cognitive-enhancement intent reached 54.6%. Most common agents were donepezil (12.6%), racetams (11.3%), and methylphenidate (10.5%). Factors independently associated with use included advanced academic year (aOR = 2.12; 95% CI: 1.41 to 3.18) and lower GPA (<3.2 versus ≥3.6; aOR = 1.83; 95% CI: 1.15 to 2.92). Gender, employment, and university type were non-significant.

Non-medical use of prescription CEs is prevalent among Lebanese pharmacy students, with anti-dementia agents and racetams exceeding classic stimulants. These findings underscore the need for targeted medication governance and ethics-integrated pharmacy education.