The latest wonder drug to make headlines sounds like a dream for ambitious workers: Modafinil, a narcolepsy pill, has been shown to make you a sharper thinker, a better decision maker, and generally more alert – whether or not you have a sleep disorder. To add to this, a recent meta-study from Oxford and Harvard researchers found few safety concerns or side effects from the drug. But before getting too excited over the world's first "smart drug," scientists are gunning for a little concern and a lot more common sense: Getting ahead by doping — whether you're biking the Tour de France or making deadlines at work — always comes with consequences.
Modafinil's effect on boosting cognition is fairly well-known: In a number of studies over the last decade, Barbara Sahakian, a neuropsychology professor at Cambridge and colleagues found the drug (approved only for narcolepsy in the FDA) could enhance working memory, planning, and task-related motivation (when boring tasks become more pleasurable) in healthy people. Dr. David Dinges, Chief of the Division of Sleep and Chronobiology at the University of Pennsylvania agrees that the drug's effectiveness isn't contested. "Regarding the issue of will [modafinil] improve your cognitive function? Probably, yes — in the domain where your brain works faster," he says.
Its exact mechanisms, however, remain murky: Sahakian says the drug is thought to hit many chemicals in the brain and enhance cognitive function by boosting dopamine, noradrenline, and glutamatergic function — steering the brain into a focused mindset.
The review looked at 24 individual studies in total, and concluded "very few studies reported potentially negative effects, such as increased anxiety and decreased contentedness" — which doesn't translate into the drug being safe, per se. The authors mention the majority of studies looked at small doses, over a short period of time, in controlled environments. "The main problem is that there are no long-term studies of safety and efficacy in healthy people," Sahakian says. Without safety studies, "we do not know that modafinil is safe in the long-term for people to use." High doses could potentially lead to cardiovascular or metabolic risk, or simply over-driving your alertness, which can cause headaches, dizziness, depression, and mania.
Furthermore, the drug will work differently for everyone: "We don't know yet the genetic alleles of who responds well to the drug,” says Dinges, meaning there will likely be different impacts of the drug as well as side effects for people without narcolepsy. More research would help identify who should and should not use modafinil — especially for those obtaining the drug illegally. "Many people are obtaining modafinil over the internet, which is a very unsafe way to obtain prescription only medication," says Sahakian. "You do not know what you are purchasing, as what you purchase could be anything."
Beyond the health risks, Sahakian notes the ethical consequences of work doping are murky. "As a society, we need to consider which forms of cognitive enhancement are acceptable and for which groups (military, doctors) under what conditions (war, shift work), and by what methods we wish to improve," she says, adding that it would help if the government and the pharmaceutical industry conducted studies of the long-term safety and efficacy of modafinil in healthy people. "That way, if it was shown to be safe and effective in healthy people, they could obtain it easily, for example over the counter at a pharmacy following consultation with a doctor," she says. "This would be much safer than the current practice of purchasing modafinil over the internet."
If you don't have a diagnosed disorder for Modafinil, Dinges suggests turning to a cognitive enhancer that's a little more conventional: Sleep. Getting a good night's rest or napping has been found to improve learning and memory in a number of studies, along with a whole host of other benefits for your body. "Stimulants do not replace sleep," Dinges says, "and the drug won't give you what sleep can give you."