Sleep Disorder Drug May Be Effective for Stimulant Abuse


The wakefulness-promoting drug modafinil may be effective in the management of stimulant use disorders, especially when used along with other nonpharmacological interventions, new research shows.

Overdoses from opioids and fentanyl are currently in the spotlight, but stimulant use disorders are also a growing concern with many experts sounding the alarm that it is the next wave of addiction.

“Stimulant use is a serious public health concern in the United States, and as an addiction psychiatrist, I found it frustrating that there are no Food and Drug Administration-approved medications for the treatment of cocaine, methamphetamine, or other stimulant use disorders,” Patricia Dickmann, MD, medical director of addiction services at the Minneapolis VA Medical Center, University of Minnesota Medical School, told Medscape Medical News.

“I have a large patient population struggling with treatment-refractory stimulant use disorders, where the combination of bupropion and naltrexone is not effective, residential treatments are not effective, and I had read some smaller studies suggesting modafinil could be a possible treatment option,” Dickmann said.

The findings were presented here at the American Academy of Addiction Psychiatry (AAAP) 29th Annual Meeting.

Lower Abuse Potential

Modafinil antagonizes dopamine transporters to increase dopamine availability in the brain, but to a lower extent than amphetamines. Therefore, it has a lower potential for abuse or misuse compared with traditional prescription stimulants such as Adderall and Ritalin, she said.

Between July 2017 and September 2018, Dickmann and colleague Erica Dimitropoulos, PharmD, also from the Minneapolis VA Medical Center, performed a prospective case series of 15 patients seen in the Addiction Recovery Services clinic who had a DSM-5 diagnosis of stimulant use disorder.

The patients were offered treatment with off-label modafinil, titrated based on efficacy and tolerability.

All care, including psychotherapy and other psychotropic medications, was continued as usual. Five patients were diagnosed with cocaine use disorder, 10 patients with methamphetamine use disorder, and one patient was diagnosed with both.

The majority of patients had comorbid mental health disorders, including mood disorders, post-traumatic stress disorder, and schizophrenia, as well as comorbid substance use disorders.

None of the patients were prescribed atomoxetine, bupropion, naltrexone, stimulants, or topiramate, although one patient was prescribed mirtazapine for insomnia.

At the time of data collection (November 2018), the average prescribed dose of modafinil was 300 mg/day (range, 200 to 400 mg/day).

Self-reported stimulant use was reduced or eliminated in 10 patients (67%). Six patients (40%) reported abstinence, four patients (27%) reported reduced use, and five patients (33%) reported no change in use pattern. These self-reports were confirmed by urine drug screens. Two patients (13%) overused their prescribed modafinil.

Modafinil was well-tolerated in all cases, with no reported side effects, Dickmann said.

“These results are encouraging, and will be used to support the addition of modafinil to our formulary for use in patients with stimulant use disorders,” she said.

Limited Treatment Options

Jonathan C. Fellers, MD

Commenting on the findings for Medscape Medical News, Jonathan C. Fellers, MD, Tufts University School of Medicine and Director, Integrated Medication-Assisted Treatment, Maine Medical Center, Portland, said there are very limited treatment options for stimulant use disorders.

“Unlike opioids or alcohol, there’s no medications that we have available, so whenever you have a study that has a positive result it’s always encouraging,” Fellers told Medscape Medical News.

“Modafinil is a stimulant but it’s a mild stimulant. Instead of Adderall or Ritalin, which are schedule II stimulants, and have more abuse potential, modafinil is a schedule IV, which is less abusable,” he added.

Modafinil Is The First Confirmed Drug That Makes You smarter.


Though initially made for narcoleptics (people having trouble sleeping), many soon caught on that modafinil can enhance cognitive abilities. Right now, it’s a favorite among students who use it when preparing for exams with visible results, they claim. But modafinil isn’t the first such “smart drug” we’ve come across. It’s likely that you’ve seen some TV or internet ads marketing ‘smart pills’ that supposedly enhance cognitive abilities, but with mere anecdotal evidence backing it up. In contrast, modafinil really seems to be a legit smart drug, according to a systematic review of reports documenting the effects of the drug. The meta-analysis was made by a team at University of Oxford and Harvard Medical School.

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Make me smarter The researchers looked at the studies documenting the cognitive enhancing effects of modafinil published between January 1990 and December 2014. In total, 24 such studies were identified which discussed modafinil cognitive benefits in areas like planning and decision making, flexibility, learning and memory, and creativity. Performance gains varied from task to task, but the longer, more complex the task was, the better the improvements. The most significant improvement was registered in decision-making and planning tasks, while the least significant dealt with working memory, or flexibility of thought. Most importantly, 70% of the studies reported little to no side effects. Some, however, found that participants showed insomnia, headache, stomach ache or nausea.

The researchers point out, however, that these reported side effects were observed in the placebo group as well. “This is the first overview of modafinil’s actions in non-sleep-deprived individuals since 2008, and so we were able to include a lot of recent data. Interestingly, we found that the type of test used to assess modafinil’s cognitive benefits has changed over the last few decades. In the past, people were using very basic tests of cognition, developed for neurologically-impaired individuals. In contrast, more recent studies have, in general, used more complex tests: when these are used, it appears that modafinil more reliably enhances cognition: in particular ‘higher’ brain functions that rely on contribution from multiple simple cognitive processes,” said Dr. Ruairidh McLennan Battleday, a University of Oxford researcher. The researchers seem confident to label modafinil as the world’s first ever confirmed cognitive enhancing drug. The findings raise some important questions.

For one, the studies mainly concern the short-term effects of modafinil. The word isn’t out yet on what might happen to a person were him to take the drug every day for years. Secondly, there’s an ethical consideration. Is it okay to take a cognitive enhancing drug in the absence of a cognitive disability? Some might see it like cheating. On a competitive level, modafinil could definitely be seen as cheating. The president of the European College of Neuropsychopharmacology welcomed the findings, but was also careful to point out the ethical discussion. “Modafinil is the first real example of a smart drug which can genuinely help, for example, with exam preparation,” said Guy Goodwin.

“Previous ethical discussion of such agents has tended to assume extravagant effects before it was clear that there were any. If correct, the present update means the ethical debate is real: how should we classify, condone or condemn a drug that improves human performance in the absence of pre-existing cognitive impairment?” In the UK, modafinil is already quite popular among university students who couldn’t wait for an ‘official’ word. A survey by Oxford University student newspaper The Tab found one in four students took modafinil. A fifth of students at Imperial, Sheffield, Nottingham and Manchester also admitted using the drug. Just like some body builders and athletes use supplements to enhance their physical performance, some might decide to take cognitive enhancers for their brain. The brain – more specifically, intelligence and creativity – isn’t exactly like a biceps.

You can’t pop pills and expect turning into Einstein or Bradley Cooper from Limitless, which is full of fallacies by the way. Forget Limitless. The point I’m trying to make is you should see cognitive enhancers with a weary eye. Whether you want to overclock your brain or not is up to you, but really if you feel you’re not smart enough, try the traditional approach first. Flex that brain. Study, read, talk to people, write. And don’t forget to exercise.

World’s first safe ‘smart drug’ really does boost brain power – scientists — RT UK


© Sukree Sukplang
Brain enhancing ‘modafinil’ is the world’s first safe “smart drug” according to researchers at Oxford University and Harvard Medical School, who confirmed it really does enhance mental performance.

Scientists looked at 24 studies into modafinil, a drug which promotes wakefulness and is used to treat narcolepsy, excessive sleepiness and sleep disorders resulting from shift work.

They concluded the drug can improve decision making, problem solving and may even make people think more creatively.

Researchers said the drug is safe when taken on a short-term basis, but acknowledged there is limited data available on the effects of long-term use.

Modafinil is the first ‘smart drug’ to be declared effective, but scientists warn the discovery raises serious ethical questions about how it should be treated by society.

Modafinil can and does enhance some cognitive functions,” said Dr Ruairidh Battleday of Oxford University.

For the first time, we have a cognitive enhancer that appears not to have significant detrimental cognitive, emotional, or physical side effects.

This means that it is time for a wider societal debate on how to integrate and regulate cognitive enhancement. The ethical exploration is a huge and important goal for the near future: one that both scientists, politicians, and the public need to be involved in.”

The president of the European College of Neuropsychopharmacology welcomed the drug’s development, but he echoed Battleday’s concerns about the ethical dilemma that a safe smart drug brings.

Modafinil is the first real example of a smart drug which can genuinely help, for example, with exam preparation,” said Guy Goodwin.

Previous ethical discussion of such agents has tended to assume extravagant effects before it was clear that there were any. If correct, the present update means the ethical debate is real: how should we classify, condone or condemn a drug that improves human performance in the absence of pre-existing cognitive impairment?

Modafinil is already popular in universities across the UK and US, where students commonly use it when revising for exams.

A survey by Oxford University student newspaper The Tab found one in four students took Modafinil.

Similar usage figures have been reported for universities in Newcastle and Leeds, while a fifth of students at Imperial, Sheffield, Nottingham and Manchester also admitted using the drug.

It has also been used by US Air Force pilots to stay alert during long distance flights.