Can modafinil, part of a new generation of neuroenhancers or ‘smart drugs’, really make us fitter, cleverer, more productive? While Charité researchers demystify the drug and warn against its long-term effects, our reporter decides to give it a try herself.
Axel R.* realised a long time ago that he had a tendency towards indolence. Even when he successfully coerced himself into working, he would only gloss over issues, continuously choosing the path of least resistance. “I think people who are really good at what they do love it naturally,” the 26-year-old German tells me in a small bar in Mitte. Blue-eyed and blond with a slightly beatnik beard, he is currently pursuing a PhD in cultural studies. “For others, there is this gap between what they have a disposition to enjoy, and what they think is right to enjoy.”
Trying to bridge that gap can feel Sisyphean. We’ve all underachieved at least once, all been scratched by that accompanying self-loathing, and yet most of us too easily re-descend right back into procrastination. But what if a drug could eradicate our unwanted inefficiency? What if one little pill could override any impeding sleep deprivation, eliminate work-related anxiety and tunnel our focus for days at a time?
The thing about taking smart drugs is that you’re not doing it for a fleeting pleasure, but to achieve a goal. I think that makes a lot of people feel a lot less guilty.
This is the promise of modafinil – a substance manufactured by the pharmaceutical company Cephalon and originally introduced onto the market in 1998 to treat narcolepsy. Modafinil has been dubbed the “go-pill” by US Air Force pilots, named the most popular drug in Silicon Valley by Michael Arrington on the web publication TechCrunch and rumoured to be the model for the fictional pills that allow Bradley Cooper’s character to use 100 percent of his brain in Neil Burger’s film Limitless. In the US, modafinil is sold under the Big Brother-reminiscent name Provigil. In Germany, it’s simply called Vigil.
“I first tried the drug around three years ago, when I was once again late starting an essay, and it was great. I assure you, it was just great,” Axel says, moving his hand in a slow point to flick the ash off his cigarette, grinning like the Cheshire Cat. “I was up all night working with this incredible sense of elation, a confidence in whatever I was doing.” Yet, despite his wholehearted endorsement of ‘smart drugs’, he will not publicly admit to using them – and will only talk of their effects under a pseudonym.
Stigma in Germany
“Germany’s discussion of neuroenhancing drugs makes me really furious,” says Dr. Isabella Heuser, director of the psychiatry and psychotherapy clinic at the Charité hospital. Together with six colleagues, she recently completed a meta-analysis of research carried out up until 2011 on the effects of ‘smart drugs’ on healthy people. “Americans take a very pragmatic view of the issue. Here people see it in moralistic, almost religious terms. Or they describe catastrophic scenarios of how these drugs will lead to this terrible 24/7 society.”
In the US, smart drugs have been widespread for over a decade. Studies suggest as many as one in three students on major college campuses have engaged in such ‘cosmetic neurology’ (as the neurologist Anjan Chatterjee dubbed it in 2004), usually with Ritalin or Adderall (both used to treat ADHD and said to increase concentration) or beta blockers (used to treat cardiac arrhythmia and said to reduce anxiety). Programmers, writers and entrepreneurs boast of ‘hacking their biology’ with the drugs; well-known businessman David Asprey from the Bulletproof Executive web forum showed no qualms in posting a modafinil ode under the headline “Why you are suffering from a modafinil deficiency”.
In Germany, the subject is more polemic, and, as a result, reliable numbers on ‘smart drug’ consumption are unavailable. However, student surveys from recent years suggest between 4 and 20 percent have tried the drugs at least once, while a full 80 percent would want to use them were their effectiveness proven and side effects negligible. As to professionals, a 2008 survey of people aged between 20 and 50 by the Deutsche Angestellten Krankenkasse (DAK) revealed that 2 percent, 80,000 people, were regularly taking neuroenhancers. And if production numbers (and the lack of a narcolepsy epidemic) are to be believed, their drug of choice is increasingly modafinil. But is it really working?
One writer’s test
Heuser’s study repudiated modafinil’s supposed effects, concluding that no pills presently available can improve intelligence or creativity. According to the Charité group, modafinil does extend wakefulness, allowing you to work for longer – but only at your normal level.
As I continue working on this article, however, I become increasingly derailed by tiredness and distraction – and the idea of “kickstarting my drive,” as Axel had put it, becomes more and more appealing. I decide it’s high time I did my own study.
But how do I get my hands on it? “It’s illegal to prescribe modafinil here to anyone who doesn’t have narcolepsy,” says Heuser. “But I regularly get patients coming to me to ask for it – mostly politicians who seem to be under a lot of stress working long hours. And you know everything is available over the internet.” A quick Google search yields dozens of (mainly American) websites on which one can order the pills without a prescription. A possibly safer route is using a tor browser to access the online black market Silk Road.
When Axel first tried modafinil, he bought 10 pills for €25 from an American friend. The actual market price is €3 per pill. “Modafinil is a lot harder to come by than Ritalin or even Adderall if you don’t want to order it online,” he says, sliding a tightly folded piece of tin foil with a single pill of the elusive substance over the wooden table to me. I hand him €10.
The night before taking the pill, I keep myself awake: excessive tiredness makes the drug’s effects more tangible. I unwrap the little silver package the next morning, feeling like a kid tearing into a birthday gift – except new toys generally don’t come with links to potentially fatal cardiac arrhythmias.
The pill is white and oval. Unobtrusive, really. Twenty minutes after taking it I feel a tightening at the bridge of my nose, which slowly spreads to my entire brow and jaw within the next hour. It’s like there’s a fizzy drink in my brain, like my synapses are shorter and firing straighter. It’s true that as I write I’m more focussed and less tired, but I only become aware of that after I remind myself to pay attention to myself. Then I enjoy the ease with which I slip right back into work without any effort to resist diversions, my thoughts seamlessly lining up before me on paper. Unfortunately, five hours later, my body seems to have fully metabolised the substance, and my stiff jaw cracks open in a yawn.
“That’s one of the biggest dangers with these drugs, which I prefer to think of as diligence pills because really, they don’t make you smarter,” Axel tells me that night. “They let you get used to them. You need them to perform at that same level. And afterwards it’s hard even to just get back to your normal level.” I do notice that while writing on modafinil, my mind won’t pause long enough between thoughts to consolidate an argument or take an overview. But I’m almost grateful for that, because otherwise I may be tempted to try other pills. Axel’s preferred substance is extended release Adderall, a combination of four equal portions of amphetamines packaged in tiny rotund beads that dissolve at varied speeds to sustain a consistent effect. “You can almost feel those little pellets bursting inside you,” he tells me in hushed tones.
Heuser says she would never tell a healthy person to try a prescription neuroenhancer for off-label purposes. “It’s illegal for one thing, but really a healthy brain is very different from a diseased brain and the risk-benefit calculation is different. At the moment we have no idea what these substances could lead to in healthy people.” Even their effectiveness requires further assessment, which is why Heuser is currently conducting another study – set to be completed in October 2013 – testing how healthy individuals react to different ‘smart drugs’.
The ontological debate
No matter how reticent the Germans are about the drugs’ effects, Heuser says, “it’s only a matter of time before someone designs a drug that will increase intelligence or memory. Cognitive drugs are where the money is.” Eric Kandel, who won the Nobel Prize for Medicine in 2000, is currently working on developing drugs that boost mental speed and memory in old age. And it seems reasonable to assume that as the pharmacopoeia of neuroenhancers expands, more and more people will try to get an edge from them.
But is this ‘cheating’? What will happen to the non-users who can’t keep up? I still feel somewhat uneasy about my modafinil adventure: caffeine aside, I prefer to treat my mind as a muscle rather than a playground, believing the rewards reaped by manipulating my biology would be undeserved. Axel tells me such qualms are linked to an almost superstitious belief that at some point we will have to pay for these magic potions.
“What counts as cheating runs along a continuum. We’ve just drawn a somewhat arbitrary divide so that what happens outside your body is not cheating; but when it’s inside your body, it is,” he says, reaching for a sip of his beer. To Axel, using chemicals to improve our brains is no different from the many other improvements, both medical and technological, we readily and thoughtlessly accept every day. “The thing about taking smart drugs is that you’re not doing it for a fleeting pleasure, but to achieve a goal. I think that makes a lot of people feel a lot less guilty.”
Whether more people overworking on ‘smart drugs’ could raise the standards for the rest of us seems a more legitimate objection. But the drug use is a symptom of a 24/7 working culture, not the cause of it: technology and white-collar competition set us down that path a long time ago.
At the moment, though, no chemical neuroenhancer that is safe, effective and legal exists, so I’m going to return to overdrinking coffee. As to my modafinil recommendation for others, to paraphrase Robert Bolt’s play about politician Thomas Moore: I don’t recommend it, but I point it out.
Modafinil in Germany at a glance
- Modafinil is the name for the compound 2-diphenylmethyl-sulfinyl-acetamid.
- In 1998, Cephalon introduces modafinil on the German market under the brand name Vigil.
- In 2003, Vigil’s use is expanded to include treatment for sleep apnoea (abnormal breathing patterns during sleep).
- In 2005, it is expanded again to include treatment for “shift-worker sleep disorder”.
- In 2008, modafinil becomes the first smart drug in Germany to be removed from the list of controlled substances and made available via regular prescriptions.
- In 2011, the European Medical Agency withdraws the expanded use of modafinil because of its high off-label consumption and possible link to cardiac arrhythmia. Modafinil can again only be prescribed to treat narcolepsy.
- Although there are no official figures, production has been continually increasing, which suggests more and more people are using modafinil for its off-label benefits.