‘Smart drug’ not such a bright idea

MODAFINIL is just the latest ‘smart drug’ or ‘nootropic’ to be used illicitly to enhance intellectual performance.

‘Smart drug’ not such a bright idea

Just as athletes have improved performance by doping, so too have students and others engaged in mental labour. But is Modafinil dangerous and does it actually work?

Evidence of Irish use is anecdotal, but British universities are awash with the drug — at least according to press reports. Cambridge’s student newspaper, Varsity, reported in its survey of 1,000 students that a tenth had taken Modafinil, or other prescription stimulants, to aid study. Never mind students: a survey published in the scientific journal, Nature, claims a fifth of British academics used Modafinil and similar drugs — 34% of them obtained online without a prescription.

The Irish College of General Practitioners (ICGP) has issued a statement of concern about the health effects of the drug. Dr Darach O’Ciardha, of the ICGP, said drug use without prescription “can have unintended consequences on individual health, interfere with other medications which may be being taken, for example, medications for epilepsy or contraceptive purposes”.

Several journalists at British newspapers have written about their own experiments with the drug, also called Provigil, claiming results I cannot substantiate.

The claims are breathtaking: improved concentration, clearer thinking, and the ability to read and write all day without suffering any kind of ‘high’, all without impacting the ability to sleep. It is also, reportedly, non-addictive. Little wonder then that people in high-pressure environments are drawn to this apparent miracle drug.

In my experience, the claims are also bunk. In the interest of research, I obtained Modafinil in the UK. The results were unimpressive. It’s true there was no ‘high’, but the positive sides were also notable — mostly by their absence. The increased alertness amounted to little more than a slight feeling of bug-eyedness and I found no improvement in motivation. As I’m faced with press deadlines and a seemingly endless PhD research project, some extra motivation would have been nice, but it never came.

After around eight hours I developed a mild headache and an upset stomach. Nothing serious, but enough to irritate. Sleep came at night, and only when I wanted it; the desire to nap in the afternoon was gone. But that’s what the drug is for. It’s not for cognitive enhancement.

Even if it worked long-term and was consequence-free, would we want a world without sleep?

Ironically, as someone who suffers from sleep apnoea {difficulty breathing}, for which modafinil is indicated for use (though not in Ireland), I don’t think I’d much care to take it.

Different people experience drugs differently, but Dr Mike Scully, an addiction psychiatrist at the College of Psychiatrists in Ireland, says Modafinil’s reputation as a wonder drug is misplaced.

“There is a perception among students that it is particularly effective as a cognitive enhancer and there’s not much evidence for that. Being more alert doesn’t mean better cognition; there’s no good evidence for that,” he says.

The darker side is the potential for long-term neurological or psychiatric harm. A 2008 communication to Irish doctors, from pharma company, Cephalon, warned of potential for “psychosis, mania, delusions, suicidal ideation and aggression”. Of course, every medication comes with a long list of potential side-effects, many of which are terrifying, but drugs that work primarily on brain chemistry naturally have the potential to harm the brain. This is where medical supervision is required.

Dr Niall Crumlish, a psychiatrist at St James’s Hospital in Dublin, says “these are stimulant drugs ... psychosis is a possibility.”

As the drug’s availability is severely restricted in Ireland, I spoke to my own GP to ask if drug-seeking was common. He said it occurs, but people tend to want either sleeping pills, or benzodizapines, as a way of “coming down”. Modafinil would not be easy to obtain from an Irish GP, he says, as its use is only indicated for the relatively rare condition of narcolepsy, and it’s not a drug he has ever seen prescribed.

“Needless to say, we’re never in favour of taking prescription drugs without a prescription,” he says.

Online is a different matter, however. Websites claiming to offer the drug proliferate, mostly in Asia. Unsurprisingly, no-one who had used the drug wanted to speak to me on the record, but the evidence that it is used is there. Boards.ie shut down a discussion on its use, due to a breach of forum rules, but other sites, typically based abroad, contain plenty of anecdotal evidence of Irish consumption.

Customs seizures are common. The Revenue Commissioners declined to comment on their frequency, but a quick trawl online indicates they happen regularly.

The Irish Medicines Board says 670 Modafinil tablets were seized during a single week in May. But should a new approach be taken to the use of drugs that enhance cognition?

Professor Barbara Sahakian, a neuroscientist at Cambridge University, is keen to avoid a drug panic, noting that in the US Modafinil is prescribed to shift workers, including doctors.

“I’m quite keen that the [British] government get together with the drug companies to study its use in healthy people. I would rather have a rational approach to it — people are already doing it, but they’re doing it in an unsafe way,” she says.

Prof Sahakian has been researching the drug’s use in patients who have cognitive disorders and says more research into the effects on healthy people, particularly the young, is required.

Dr Scully says the danger of illicit use of medicine is real.

“Illicit use [of Modafinil] is problematic because there’s no advice and no quality assurance. That’s a concern.”

As for the drug itself, Dr Scully says it is reasonably well-understood: “Any medication that’s been around for a while, and this has been around for about 20 years, we have a reasonable profile for. The pharmaceutical reviews we have all say it has a low dependency profile, [but] it can interact with other drugs and has some rare skin conditions associated with it, which can be fatal.”

There are issues of patient choice. In the US, prescriptions are easier to come by as a result of the privatised medical system, but this also increases medical supervision of the drug’s use.

One thing is for sure, though: anyone who orders drugs from an online supplier simply doesn’t know what they’re getting.

As with most miracle drugs, the claims are frequently exaggerated. But, then again, it was never supposed to do what online posters are claiming it does.

Modafinil is intended to treat a serious sleeping disorder, not to turn users into some kind of super-student.

There’s also a moral question. As my GP said: “If people are using medication to stimulate higher performance, where do we go from there?”

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