Modafinil & Company: The Promises & Perils of Mind-Altering, World-Changing Drugs Like Modafinil
by www.SixWise.com

Millions of Americans down mug after mug of coffee to stay alert and get through the day with perhaps a bit of an edge. Some go so far as to pop caffeine pills to pull all-nighters while studying for exams or finishing a top-priority report. Others awaken bleary-eyed at 4 a.m. to get their days started, while the rest of us typically just wish we had more hours in a day.

But if there were a pill you could take that would keep you wide-awake for 40 hours at a time -- with no side effects, no risk of addiction, and no crash afterward -- would you take it?

This tempting question is now a reality as mind-altering drugs like modafinil are already on the market. Modafinil, a drug originally developed to treat narcolepsy, is being prescribed off-label to a host of people who need to stay awake, including those with other sleeping disorders, depression and ADHD, people in the military and even those with jet lag.

"People ask me about it almost daily," says William C. Dement, director of the Stanford University Sleep Center. "Everybody would like to be able to have more time to do whatever they want to do. I could stand in front of a roomful of Stanford undergrads right now and say, 'If you feel tired, raise your hand,' and every hand would go up."

To put it simply, modafinil shuts off the urge to sleep. Meanwhile, it allows you to stay just as alert as you would normally feel. In trials conducted on Army helicopter pilots, for instance, modafinil allowed the pilots to stay awake for nearly two days with nearly the same focus and ability to deal with complex problems as those who had slept. What's more, after just one eight-hour respite, the pilots were able to stay awake for another 40 hours straight.

"This could replace caffeine," says Joyce Walsleben, director of the New York University Sleep Disorders Center.

A 24-Hour World?

Clearly there are circumstances when a drug like modafinil would be warranted. Combat missions in which soldiers have no choice but to stay awake, or emergency situations during which medical and rescue workers must work around the clock to save lives are two obvious ones.

But the controversy arises when the very fine line between "need" and "want" is crossed. Our society is already functioning on a 24-hour timeframe, with everything from restaurants to grocery stores to health clubs staying open around the clock. So who would qualify as "needing" modafinil or a similar drug to stay awake with almost superhuman finesse?

"Sleepiness is everywhere," says Neil Feldman, medical director of the St. Petersburg, Florida-based Sleep Disorder Center. "We're a 24-hour society. We no longer live by the night/day cycle. We live by whatever our occupation demands. Physicians on call at night. Nuclear power plant operators. Police, firemen. Plus the world is becoming a smaller place. Trans-meridian travel, commonly known as jet lag. There are economic demands -- more than one job -- plus raising children."

There are truck drivers, airline pilots, CEOs, politicians, night-shift workers, and countless others, all who must stay awake for long periods. Then there are those who simply want to.

"The young professional who wants to work and play and do everything, and doesn't want to spend time sleeping?" asks University of Pennsylvania sleep researcher David Dinges. "That's another matter."

Still, while modafinil is promoted as not having the side effects of other stimulants like cocaine or even caffeine, no one really knows what the effects of sleep deprivation will be on the human body.

"Emphasize the idea that we may be playing with fire here," says Helene Emsellem, director of the Center for Sleep and Wake Disorders. "Who knows why we get cancer? Chronic sleep deprivation may be a risk factor for long-term disease. I would love to get by on five hours of sleep because I don't like to lie in bed, leashed by a sleep requirement. I would love to be unleashed. But at the same time, prove that it is safe. I don't need another round of winter flu, thank you very much. Getting sick, being constitutionally exhausted ... Your grandmother was right. If you don't get enough sleep, you're going to get sick."

Taking Pills to Keep up With the Joneses

At the heart of the ethical dilemma facing not only modafinil but also other mind-altering drugs is whether people will one day be forced to take them just to keep up.

If everyone at the office is taking modafinil and is able to meet deadlines 24-7, for instance, could you afford not to? Meanwhile, the drugs could create different classes of humans, separated by who could afford the drugs and who could not.

Some A-students are already using study drugs to enhance their performance in school, and it may not be long before parents are actually encouraging their kids to do so.

Believe it or not, already "some schools require kids -- not diagnosed with ADHD by doctors -- to take Ritalin to attend school," says Richard Glen Boire, senior fellow on law and policy at the Center for Cognitive Liberty & Ethics in Davis, California.

A Medicated, Superhuman Society

Looking into the future, mind-altering drugs are set to become even more precise, targeting specific brain areas with incredible results and few side effects, says Martha Farah, a neuroscientist at the University of Pennsylvania.

Still, she says, "Is there a trade-off between focusing attention and reducing creativity? And if more workers use it [modafinil] to excel, will we have a workforce of narrow, rigid thinkers?"

Along with the possibility of creating a superhuman population with, perhaps, almost programmed, albeit unprecedented, abilities, is the scary prospect of what will happen if mind-altering drugs are taken too far.

People are already forced to take drugs in criminal situations, such as sex offenders who are forced to take libido-dampening drugs. But, says Farah, a "neuro-correctional system" may one day exist in which drugs could turn all sorts of criminals into non-criminals by dampening violent impulses and the like.

Drugs are also in the works to help enhance learning, combat shyness and slow down mental decline as we age. There may at one point be a drug for just about anything, which completely blurs the line between what are characteristics of a normal human being and what are not.

For now, however, just answering the question of whether you would take a drug to avoid sleep is hard enough.

"When you have debate on this topic," says sleep researcher Dale M. Edgar, "on one side, people say: 'Just sleep more. Do what you have to do and the economy be damned. Get the sleep that you need and that's that.' On the other side, people are saying: 'But wait a minute. This is a 24-hour world. Those services have to be performed at the highest level they can. People make mistakes.' "

But the even more far-out question, says Dinges, is, "What if we eventually had something that was absolutely safe that could substitute for sleep? Is that the direction we want to go? Many would say yes. I don't know what the implications are for our species. Probably not bad. This is pure speculation. Should humans try to live without sleep? I don't know. We're already trying to do that."

Recommended Reading

Study Drugs -- Use of These Dangerous New Drugs is Skyrocketing Among the A+ Student Crowd

Drugs with Potentially Psychotic Side Effects: Which Ones are They (& Who Deserves to Know)?

Sources

Time.com January 18, 2007

WashingtonPost.com