Off-label use of “smart drug” proving foolish

For years, the stimulant modafinil – better known by its brand name, Provigil – has been a drug of choice on college campuses across the nation.

The so-called “smart drug” offered students a way to pull all-nighters without the big pots of coffee and the bigger crash the next day. Shift workers began taking it to cope with their unusual hours, along with anyone else who thought the drug would give them a mental edge. The U.S. Air Force even found it helped sleep-deprived pilots function at high levels, which some people considered to be practically an endorsement.

But what really set this drug apart was the fact that it was safe and non-addictive. Or so we were led to believe by news stories touting its benefits.

Well, let’s get ready to bury another wonder drug, because the latest research shows that modafinil may have a lot more in common with traditional stimulants than previously thought.

The study, published in the Journal of the American Medical Association, found that modafinil stimulates the brain’s pleasure centers, leading to an increased risk of addiction and making the drug far less safe than previously thought.

In fact, the human study found that a typical dose of modafinil can affect the dopamine levels in the brain just as much as a dose of Ritalin, a drug that comes with a big black- box warning on the label.

Ritalin, by the way, also enjoys a huge black market.

The simple reality is, even many of the people with prescriptions for modafinil simply shouldn’t be taking it. The FDA approved this drug only for narcoleptics having trouble with daytime sleepiness, yet these patients probably make up the minority of modafinil users.

In fact, up to 90 percent of the prescriptions written for modafinil are for off-label uses, according to an estimate in the Penn Bioethics Journal. Provigil sales approached $1 billion last year, which also hints at a very high number of off-label users.

People see media hype like that Air Force study and they want to use the drug, too. Some turn to that black market. But others turn to their own doctors, who instead of protecting their patients, end up giving them prescriptions.

And now, all those people who may have thought they were taking a “safe” or “harmless” drug are at risk and potentially becoming addicted.

There’s nothing smart about that.