Why Can’t We All Take Modafinil?

A pack of modafinil. Photo by Hannah Ewens

Chances are you've heard of the drug modafinil. You know the one: the "smart drug," sometimes called the Limitless pill, that turns sleep-deprived college students and young professionals into energetic work horses.

It turns out modafinil can do even more: It's a promising treatment for stimulant drug abuse, as well as neurodegenerative disorders like Alzheimer's and Parkinson's. It's also been shown to normalize cognitive function in sleep-deprived populations (which is basically everyone these days) and is the drug of choice for astronauts on the International Space Station and members of the armed forces on long duration missions. And since modafinil is non-addictive, it's only about as risky as drinking a few cups of coffee.

But unlike the UK, Australia, India, Germany, Canada, Mexico, and other countries that have approved modafinil as a non-controlled prescription drug, the United States still classifies modafinil as a Schedule IV controlled substance, putting it alongside drugs like Xanax and Valium. Given America's ongoing amphetamine crisis and generalized sleep deprivation, legalizing a safer alternative like modafinil makes a lot of sense. So why don't we?

Modafinil was developed in the 1970s by a French professor of experimental medicine to treat narcolepsy and other sleep disorders. After decades of clinical trials in France, the US Food and Drug Administration (FDA) okayed modafinil as a treatment for narcolepsy in 1998. In 1999, the Drug Enforcement Administration (DEA) classified modafinil as a Schedule IV substance.

At the time, there wasn't enough research to clearly show modafinil's mechanism of action. Modafinil didn't appear to directly affect specific neurotransmitters, the chemicals released by nerve cells to communicate with other nerve cells. Instead, it seemed to act indirectly on several different neurotransmitters (namely serotonin, dopamine, and GABA) unlike other stimulants such as Adderall, which work more directly on the dopamine system.

The DEA noted in its ruling that the behavioral effects brought on by modafinil were similar to other stimulants, like cocaine, which do directly affect the dopamine system. Dopamine acts as a sort of natural reward system in the brain and is largely associated with addictive drugs, which gave the DEA reasonable concern.

Yet not all dopaminergic drugs are made equal. Some drugs, like MDMA, work by increasing the release of dopamine in the brain. Others, like cocaine, function as dopamine reuptake inhibitors. That means when the dopamine released by one nerve cell is not entirely absorbed by the receiving nerve cell, the leftover dopamine is blocked from re-entering the original nerve cell and stays in the gap between the two nerve cells. It's this extracellular dopamine that gets you feeling the way you do when you do a line. Modafinil is also a dopamine reuptake inhibitor, but it's not nearly as effective as taking something like cocaine.

"It doesn't matter how much modafinil you take—you can never shut off the dopamine transporter as well as a little bit of cocaine or amphetamine would," Peter Morgan, an associate professor of psychiatry at Yale University, told me. "That's part of the reason why people don't really feel high when taking modafinil."

For that reason, research has shown that modafinil is actually an effective way of treating cocaine and amphetamine addiction. If you're chronically using strong dopamine blockers like cocaine, your brain essentially adjusts to the presence of this extracellular dopamine as the new normal. If you then suddenly take the cocaine out of the equation, the brain has a much harder time functioning. Modafinil can function as a safe alternative to coke—it's still a dopamine reuptake inhibitor, but its effects are way milder and there's virtually no addictive potential.

Although modafinil has been successfully used to treat cocaine addiction in certain populations, this isn't one of its FDA-approved uses—so insurance companies won't pay for it as a treatment. This means that those who need it most are forced to pay out of pocket for access, which generally isn't an option for someone recovering from a serious coke habit. When I called a pharmacy to inquire about pricing, I was told 30 100mg pills would cost $870.

Some who use modafinil off-label order it illegally from producers in countries like India for far cheaper (about $2 per 200mg pill), but also risk getting a diluted product. Others turn to "approved" prescriptions for drugs like Adderall, which may accomplish the same results but come with far more risk (namely, that Adderall itself can be addictive).

"There is no question in my mind that modafinil is much, much safer to use than any of the amphetamines or amphetamine-like drugs, like Adderall or Methylphenidate ," said Morgan. "It's not clear to me that it's substantially worse than caffeine, but it's definitely much better than the amphetamines."

Part of the issue is that pharmaceutical companies aren't too keen on re-introducing modafinil as an addiction treatment. "There isn't a lot of support for pushing modafinil as a treatment for cocaine dependence," Morgan added. "It's hard to get any drug company interested in a treatment for cocaine dependence because no brand wants their brand associated with cocaine dependence."

But plenty of people are using modafinil for other things as well—most popularly, as a cognitive enhancer.

Barbara Sahakian, a neuroscientist at Cambridge, conducted a survey on off-label modafinil use after she realized a number of her perfectly healthy colleagues were using it at work. Her 2007 report in Nature surveyed 1,400 people from 60 countries who had used drugs like modafinil or Ritalin. The majority of them used them to increase concentration rather than for medical reasons, and a full one third of the respondents acquired their drugs over the internet, rather than with a prescription.

"The big issue is that there are no long-term safety studies in healthy people with drugs such as modafinil," Sahakian told me. Even though the drug seems to be wholly beneficial, there just aren't enough people researching it to change the FDA classification.

Like any drug, modafinil is not for everyone. Some people experience stomach pains or headaches and, ultimately, there is no substitute for natural cognitive enhancers like getting more sleep or exercise.

But for those who need it for addiction treatment, to make up for cognitive deficits induced by overwork, or are unable to adjust their lifestyles to accommodate more sleep and exercise, making modafinil accessible could be a godsend. And as of now, the United States is one of the only countries to regulate modafinil as a controlled substance, approving its use only for a handful of sleeping disorders.

The first step toward legalizing modafinil is promoting it as a safe alternative to the widely available stimulants used today and encouraging more research to be done on long-term use. De-scheduling a drug in the United States is a long and arduous process, but given the benefits of legalizing modafinil, the struggle could be worth it.

Follow Daniel Oberhaus on Twitter.

Where Can the Green Party Go from Here?

Jill Stein speaking in Boston in October. Photo by Pat Greenhouse/The Boston Globe via Getty Images

Jill Stein thinks the Democratic Party as we know it is dead. "Historically, this is kind of what happens—there's a life, and there's a death of political parties," she told me. "And I think their time is over."

It's a pretty bold proclamation for a Green Party presidential candidate who won just over 1.2 million votes, far more than she earned in the 2012 presidential election but well behind Libertarian Gary Johnson. But Stein has remained, stubbornly, in the news more than most third-party (or fourth-party) candidates—two days after I spoke to her, Stein's campaign announced that it'd be raising funds for a recount in Wisconsin, Michigan, and Pennsylvania, the three Rust Belt states that doomed Hillary Clinton's presidential bid, on the advice of security experts who were worried of hacking or manipulation. Soon enough, millions of dollars came pouring in, and since then, Stein has filed for recounts in Wisconsin and Pennsylvania (she's expected to file in Michigan as well).

Stein's recount efforts—which is opposed by many Greens, including her running mate, Ajamu Baraka—have energized those on the left desperate for any loophole that could potentially lead to Donald Trump being denied the presidency. The president-elect, for his part, has ranted on Twitter about the recount and said, against all evidence, that he actually won the popular vote. And though Clinton reportedly doesn't support the recount, her lawyers are on hand in Wisconsin to monitor the effort.

The recount, which few people expect to actually overturn any results, shows where Stein and her party are situated at a unique moment in history—the Democrats have less power at the federal, state, local levels than they have had since 1928, the far-right flank of the Republican Party is triumphant, and there are countless debates among Democrats about how best to reinvigorate their party.

One could argue that there's never been a better time for the Greens to grow, with the Democrats weak and disorganized, with no clear future ahead of them. But interviews with both Stein voters and campaign officials alike show that the question of whether to help the downed Democrats in the days ahead is up for debate.

David Cobb, the 2004 Green Party presidential nominee and Stein campaign head, sounded open to cooperation, in light of the coming Trump administration. "Absolutely, 100 percent yes, we are committed to working with progressives," he told me. "It doesn't matter who they are.... If someone wants to work on sanctuary cities, if they're progressive Democrats, or Libertarians, or principled Republicans, I want to work with them. If there are people who want to work on abolishing the racist criminal justice system we have, I want to work with them."

Cobb, who coordinates with Green state parties across the country, then outlined several initiatives that his party had planned: The Green News Network, a daily program on Facebook Live; planning for Occupy Inauguration, a huge rally set for January 20 on Washington DC's National Mall, with "teach-ins" the following day; conferences, talks, and possible "movement/campaign schools"; and a mobilization of Green candidates at the municipal level, where policy change in the Trump era seems most likely to succeed.

"The Green Party is a movement party," Cobb told me. "Not a protest party."

This approach reflects what Greens have long been about: a lot of talking at the grassroots among like-minded people, but not much of a path to elected office. To put it in nakedly Trump-ian terms, how can the Green Party start winning? Or is it time to pull a Bernie Sanders jump into the Democratic Party, and push it leftward? At least some voters are thinking about that latter approach.

"I think remaking the Democratic Party into a home for humane populism, as opposed to the barbaric populism of the GOP, is the only way out of our electoral nightmare," said Michael Youhana, who wrote in "Just Jill Stein" on Election Day, out of distaste for her running mate.

Youhana thinks Massachusetts senator Elizabeth Warren—who was recently elevated to a leadership position among Senate Democrats—was "probably" best-suited to unite the party under progressive rule, but right now, "there's clear leader that unites the wings." But, he added, "I also think it will be a long shot to reform the Democrats. Maybe less of a long shot than creating a viable third party, but still difficult."

Another Stein voter, Joey (who wouldn't give his last name), laid out two futures: Either the Greens moderate their position, moving away from their more controversial factions—some are pro-Russia, others oppose vaccines, both positions Stein has flirted with—to attract leftover Sanders supporters, or Democrats shift left to take back any votes they might've lost to Stein this election. "If they just went progressive, and pushed for Bernie, a lot of Stein voters would've went for him," he said.

Joey admitted that he didn't see any "real growth" with the Green Party on the national level in the immediate future, and argued that they should, instead, concentrate on local races to build a formidable base worth fighting for. "Greens can't come around every four years and say, 'There's another party here,'" he said. "It'll be hard for them to win on a national level without winning smaller battles."

When we spoke, Stein noted the opportunity the Greens had down-ballot. Most American cities are run by Democrats, and officials in those cities wield enormous influence over social and economic policies that affect the millions of Americans who live there. "The most powerful place to fight those battles is at the local level, and the example of that is Eugene V. Debs and the socialist movement," she said. "He didn't get many votes at the national level, but he was part of a transformation of social policy that pressured the Democratic Party to adopt his party, from the New Deal down to public health, workers' rights, child labor."

She added, "They came through at the local level. And their national campaign was a piece of that. We definitely see that as a whole."

But Stein was hesitant to praise the recent shifts or reports of self-reflection in the Democratic Party as signs of change. "Those who are calling the shots aren't changing. The faces may be changing, but just look—what kind of discussion is actually going on?" she asked. "Literally nothing. It's mostly how terrible Donald Trump is."

Stein thinks that Congresswoman Debbie Wasserman Schultz, who resigned as the head of the Democratic National Committee after DNC emails critical of Sanders leaked, should be "blacklisted by the party." The failure of party officials to do so, Stein told me, is a sign they aren't serious about changing course.

"And again, Bernie's touted as the guy who's going to save us, but what position was he assigned to, exactly?" Stein added. "Outreach director?" (Sanders is chair of outreach, and, also, the top-ranking Democrat on the powerful Senate Budget Committee.)

Perhaps what the Greens should be banking on, Stein continued, is this idea that 2016 was the start of something totally new in American politics—a sort of anti-politics that began with the ascension of an unchained reality TV billionaire to the White House. Democrats are naturally worried, but for outsider candidates looking to find their way into the two-party system—or to simply burn it all down—maybe that's reason to be hopeful.

"Our lives are literally on the line now," Stein said. "And it creates a whole new set of possibilities with a very different mindset, in which we're getting out, we're ready to take some risks, and we're ready to mobilize."

Follow John Surico on Twitter.