Imagine a drug that makes you more awake. This drug, let's say, could keep you going for 24 hours, without feeling the slightest hint of fatigue or giving off the shaky jitters of caffeine. And, what's more, not only would this drug eliminate feelings of drowsiness, it would also make you incredibly focused, hyper-productive, and gloriously clear-minded. Oh, and it might help you keep weight off, too. If such a drug were to exist, would you try it?
It does, and I did.
Though plenty of people are telling their friends about the wonders of Provigil (modafinil), I was introduced to it by the person who should make that sort of introduction: my doctor. I was about to take an overseas trip, so I asked him for advice on battling the nine-hour time-zone difference. Though I was looking for general tips — you know, eat as soon as you land, that sort of thing — he had other ideas. "I have something that'll help with that," he exclaimed, producing a sample packet of Provigil.
Four days later, I landed in Paris and popped half a pill. Despite not being able to snooze on the plane, I sat in the Jardin des Tuileries and felt as though I'd had a full night's rest. Yes, my body felt slightly off-kilter, but my mind was clear, focused, and — most notably — energized. The clarity went beyond my usual waking state; ideas came to me quickly, and I was able to think quickly. Whereas I usually struggle to remember my French vocabulary, le mot juste came to me time and time again. It wasn't just the absence of fatigue that was notable. It was as though a curtain of mental dullness had lifted, revealing a smarter, more level-headed me.
After using Provigil, I wanted to know why it worked — and why nobody I knew had heard about it. To understand that, you have to know the backstory.
It's no accident that Provigil is often called a "smart" drug. It wasn't intended to be one, though — at least, not any smarter than any other prescription drug. Conceived in the late '90s as a treatment for sleep disorders, it's FDA-approved to treat narcolepsy, shift work sleep disorder, and excessive daytime sleepiness. While it does improve symptoms for people with these problems, it didn't take long for people to realize that its benefits could help people who had no trouble staying awake. "Certainly some people with narcolepsy are prescribed this drug for long-term use," says Dr. Jerry Siegel, Ph.D., a sleep researcher at UCLA. "But of course, they start out much sleepier. Many people are basically abusing it."
As for those people? These days, Provigil is used for off-label purposes by students, programmers, jet-setters, and anyone else who wants to maximize their mind with minimal sleep. The fact that long-term use may lead to mild weight loss makes it attractive to some, too. "People ask for Provigil the same way they would ask for Adderall or Ritalin," says Dr. Nancy Simpkins, MD, who does not prescribe the drug for off-label use. "They're looking to treat things like attention-deficit disorder or jet lag or weight loss. There's a huge spectrum of what people want Provigil for. This stuff has been around for a long time, but in the last 10 years, there's been a tenfold increase in use — and 70% of the use is off-label." (Provigil's manufacturer, Teva, turned down our request for an interview.)
Provigil's popularity owes much to its positive effects, but also to its relative lack of side effects. Headache and nausea are the most common, and, as Dr. Simpkins points out, most people can power through such inconveniences. But otherwise, just as there isn't a "high" involved with Provigil, there isn't much of a low, either. "It's been used in Europe for many years, and it seems fairly safe," says. Dr. Siegel. "We don't know if there are any downsides to chronic use."
And, unlike some stimulants, Provigil doesn't create a physiological dependency. "I think you can get addicted to the feeling, but there's not a physical addiction," Dr. Simpkins says. "But people may wonder, 'Why wouldn't I want to feel this way every day?' That becomes more of a psychological dependence than a physiological addiction like you'd have with, say, cocaine." (Which is why this author used Provigil once, and only once.)
At this point, you may be wondering if Provigil has a downside. The answer isn't simple — and that's why Dr. Simpkins doesn't prescribe it. "This is a Schedule IV controlled substance," she says. "It's not like writing a prescription for an antibiotic." While she admits that many people could use Provigil without problems, she points out that in rare cases, it can lead to a potentially fatal syndrome called Stevens-Johnson syndrome. "There is a black-box warning with this drug," she says. "If there is any chance that a patient of mine could develop a fatal reaction just so they can have three days' less jet lag, I would not prescribe it — absolutely not."
For his part, Dr. Siegel says that Provigil seems otherwise safe — but there's still much that we don't know. "Compare it to caffeine," he says. "The overall epidemiology is pretty clear that it is not dangerous to take caffeine in the doses people typically take it, but modafinil hasn't been around long enough to have that kind of data. Unfortunately, by the time that data is available, any damage may already be done."
Of course, the big question is this: Could Provigil, or drugs like it, usher in an era in which sleep becomes optional? Aside from the less-tangible results of sleep — creativity, imagination, eureka moments discovered upon waking — both Dr. Siegel and Dr. Simpkins say that it isn't as simple as just getting rid of our nightly shut-eye. "These drugs are not turning on waking, or turning on sleep, which is the way it's often presented," Dr. Siegel says. "The brain has many kinds of receptors and many different systems, and they're all affected by any psychoactive substance in ways that are incredibly complicated."
Similarly, Dr. Simpkins says that sleep isn't an isolated concept, and it's definitely not optional. "I get the appeal of the drug," she says. "People say, 'I'm clear-headed, I don't feel fatigue, and I can still go to sleep. The problem people don't realize is that if it keeps you awake for three days, the body still does need to sleep. There are processes that happen during sleep that the body needs."
As with so many pharmaceuticals, there's a lot we don't know about why, exactly, Provigil works. And, until more research is done — particularly among people without sleep disorders — we won't know whether that mental clarity is exacting a toll. But that's unlikely to stop people from asking their doctors for prescriptions. "We're going to see a big rise in use, especially among young people," Dr. Simpkins predicts. "Unfortunately, the future of this drug is another designer drug."