Fort Myer Pentagram, February, 2003
Air Force testing new fatigue-combating drug Provigil
by Chris Walz
The Air Force is extensively researching a new drug, which may help pilots
stay awake and alert during missions, according to officials.
The Air Force has come under fire in recent months for prescribing pilots
a controlled substance -- amphetamine -- to combat fatigue while performing
long patrol missions lasting upwards of 30 hours.
Defense lawyers for two American pilots, who accidentally killed four
Canadian soldiers in Afghanistan last year, argue the Air Force-issued
dexamphetamine was to blame for the accident. The drug, known commercially
as Dexedrine, is called the "go pill" in military circles.
The Defense Department is currently researching a Dexedrine replacement
called Modafinil, both of which are approved to counter
narcolepsy sufferers. Modafinil can allegedly keep people awake up to
88 hours without sleep and leave the user free of the jittery irritability
associated with amphetamines. Some Pen-tagon officials say its time to
upgrade to a safer stimulant, like Modafinil. Res-earchers, however, arg-ue
the older amphetamine is gaining a bad reputation, but is perfectly safe
for pilots to use.
Dr. John Caldwell, who is performing much of the Defense Department's
Modafinil research at Brooks City-Base in San Antonio, said researchers
are looking closely at every conceivable aspect of the patient's reaction
to the drug.
"We are trying to find out if this is better than what we have or
just another drug to help pilots stay awake," Caldwell said. "It's
too early to say if it's a better choice right now. All indications say
Moda-finil is a safer drug, but we don't know that for sure. That's why
we go to exhaustive measures to make sure they're safe."
Modafinil is a memory-improving and mood-brightening psycho-stimulant
that en-hances wakefulness and vigilance, according to the Drug Guide.
The guide says the drug is notably different from amphetamines, cocaine
and methylphenidates -- like Ritalin.
The drug, commercially known as Provigil, has been shown
to increase both wakefulness and "vigilance." Researchers define
"vigilance" as the ability to stay on task, think clearly and
function normally. Critics argue amphetamines are liabilities when it
comes to keeping users mentally sharp and they often make people jittery,
shaky and anxious.
Modafinil is proving clinically useful in the treatment of narcolepsy,
a neurological disorder marked by uncontrollable attacks of daytime sleepiness.
Experimentally, Modafinil is also used in the treatment of Alzheimer's
disease, depression, attention-deficit disorder, myotonic dystrophy, age-related
memory decline and idiopathic hypersomnia.
Caldwell said he helped conduct a double-blind placebo research study
before getting the nod at Brooks. In a double-blind study, neither the
human subjects nor the researchers know who is receiving an active pill
and who is receiving a sugar-pill placebo.
Brooks City-Base researchers are currently studying at what point does
mental sharpness begin to fade in sleep-deprived subjects.
"We start off with short sleep deprivation of 40 hours, which is
only one night without sleep," Caldwell said. "If the subjects
perform well, then we'll increase sleep deprivation until we get to 80
hours and see if the subjects can stay awake and alert. Then, we'll go
up to 88 hours without sleep."
Thomas Scammell, a sleep expert from Boston's Beth Israel Deaconess Medical
Center, said Modafinil has kept people up for some 90-plus hours, but
the drug may not be advantageous for everyday use in normal individuals.
"Even if the drug is safe, it seems dangerous to mess with your
body's sleep needs," Scammell said. "Aside from the obvious
effects on brainpower, which Modafinil does seem to counter, there is
evidence the lack of sleep hurts the endocrine and immune systems."
Caldwell said Brooks City-Base, formerly known as Brooks Air Force Base,
is developing a flight simulator to take the research from the lab to
the flight environment under various conditions.
"We are always looking for upgrades on medication," Caldwell
said. "If new technology comes out for an aircraft, the Air Force
will upgrade so it can have the best edge in combat. The same goes for
fatigue counter measures. We try to upgrade the medications available
any time we can and safely protect lives."
Caldwell said he studied Dexedrine for many years and the amphetamine
can be addictive if not controlled properly, but there's no evidence showing
the pill impairs judgment. There is currently no evidence of dependence
leading to withdrawal symptoms after abrupt treatment cessation. He added
there is also no evidence suggesting any aviators have abused or are abusing
the drug. Pilots, he said, are awake and coherent -- they make good decisions
and have good instrument scan patterns on brain-wave monitors.
"Modafinil has shown to be less addictive [than Dexedrine], less
likely to impair recovery sleep and doesn't produce the cardiovascular
stimulation like an amphetamine," he said. "We are going to
see how it stacks up against the other existing medications."
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