The diffusion of performance and image-enhancing drugs (PIEDs) on the internet: the abuse of the cognitive enhancer piracetam.
BACKGROUND
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.
1Departments of Postgraduate Medicine & Pharmacy, School of Life and Medical Sciences, University of Hertfordshire , UK.
Ornella
O
Corazza
Francesco Saverio
FS
Bersani
Roberto
R
Brunoro
Giuseppe
G
Valeriani
Giovanni
G
Martinotti
Fabrizio
F
Schifano
D003132:Commerce; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects / Q000600:supply & distribution*; D020407:Internet; D018697:Nootropic Agents / Q000009:adverse effects / Q000600:supply & distribution* / Q000627:therapeutic use; D058573:Performance-Enhancing Substances / Q000009:adverse effects / Q000600:supply & distribution* / Q000627:therapeutic use; D060946:Pharmaceutical Services, Online; D010889:Piracetam / Q000009:adverse effects / Q000600:supply & distribution* / Q000627:therapeutic use; D019966:Substance-Related Disorders
D013287:Illicit Drugs; D018697:Nootropic Agents; D058573:Performance-Enhancing Substances; D010889:Piracetam
addiction; cognitive enhancer; drug abuse; online pharmacies; performance and image-enhancing drugs; piracetam