Medical Examiner

Hypothetically, Would Adderall Turn Joe Biden Into a Debate Whiz?

A pharmacist on President Trump’s bizarre theory.

Rows of adderall pills.
artisteer/iStock/Getty Images Plus

On Sunday, President Donald Trump “strongly demanded” that his Democratic opponent, Joe Biden, be drug tested for Tuesday’s debate. Only drugs could explain why “Sleepy Joe Biden” sometimes wasn’t so sleepy at all, Trump alleged. If it initially sounded like the president may have been referring to another drug that was famously popular in his heyday in 1980s New York, a surrogate, Rudy Giuliani, clarified things on Fox & Friends on Tuesday morning. He claimed that Biden “has dementia. There’s no doubt about it. I’ve talked to doctors”—and then added: “The president’s quite right to say maybe [Biden]’s taken Adderall.”

There’s no evidence to suggest Biden is actually on any drugs, legal or otherwise. But purely hypothetically: Would Adderall really do what Giuliani (and by implication, Trump) claims? What kind of miracle drugs does Trump think Biden would need here? Slate spoke to Michael T. Swanoski, a professor at the University of Minnesota’s College of Pharmacy, to get into what is and isn’t scientifically possible. Our conversation has been condensed and edited for clarity.

Heather Schwedel: How would a drug like Adderall affect someone’s debate performances?

Michael T. Swanoski: Adderall is a stimulant that’s often prescribed for attention deficit disorder. So Adderall potentially could increase your attentiveness if you’re feeling drowsy or if you’re fatigued. But it doesn’t increase cognition per se. It doesn’t improve thinking, but it provides a boost similar to what you’d get from a cup of coffee—a little more pronounced, but not increasing cognition in any way. It wouldn’t have an effect on your acetylcholine, which is the chemical that’s connected with clear thoughts, thinking through a difficult task, and high-level thinking.

What other kind of drugs would take a person from sleepy to wide awake, so to speak?

There’s been a push in marketing nutritional supplements that are touted for improving brain health or memory. They make vague claims of brain enhancer or memory enhancer without really getting too specific, because they’re not allowed to make claims that they can’t back up. But there’ve certainly been cases of students using stimulants to help, maybe if they’ve got a big exam, to make them more alert potentially. People are purchasing these products with the hope that they’ll help them with giving them a competitive edge, perhaps in their job or whatever they need to think about.

Would those show up in a drug test?

Whether a nutritional supplement would show up in the urine is questionable. If you had amphetamine in your urine, that would show up.

Trump seems to be implying that there’s a drug that could magically make someone who was frail and confused into a brilliant debater. Is that possible?

Inherently your talents in debating are not going to suddenly be enhanced because you took a nutritional supplement or you took a prescription stimulant. The best they can do is maybe make you more alert. They’re not going to suddenly increase your intelligence. That’s just not possible.

Trump has been pretty vague, but on Fox News, Rudy Giuliani has gone so far as to say Biden has dementia. There’s a difference between normal cognitive decline and actual dementia, right?

There is a difference. As we age, our mental acuity or intelligence, they’re all still there. Forgetting someone’s name is not unusual, but if you forget where you live or where you’re going, it’s really a more pronounced loss of memory and cognitive function. With normal aging, there’s occasional short-term memory lapses here and there, but it’s not profound enough to really impact us. You look at someone like Judge [Ruth Bader] Ginsburg, who was almost 90 years old. She was highly intellectual and exercised her brain, and maybe she had some symptoms of forgetting where she put her keys, but her high level of cognition was still intact. Not everybody who ages gets dementia.

Giuliani also said “the president’s quite right to say maybe [Biden has] taken Adderall,” implying it would be a treatment for his supposed “sleepiness.”

Dementia is not lack of energy; there’s damage going on in the brain. There’s neural damage that occurs that then impairs the function of these neural transmitters, these chemicals like acetylcholine, which is this chemical that’s really responsible in large part for our normal cognitive function. And so someone with dementia would not be treated with amphetamines to get them more alert. It wouldn’t increase their brain acuity at all. It would make them jittery, more confused, really, because they wouldn’t be able to think clearly. Drugs for dementia are primarily aimed at increasing levels of acetylcholine, like Donepezil, which is used for Alzheimer’s dementia.

So just to be clear, you’re saying that Adderall is not a treatment for dementia?

You are correct.