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The Scotsman - December 2, 2005

A genius pill: would you be really stupid to swallow it?

by ALICE HART-DAVIS

AT 2:45am, I send two e-mails then sit back and rub my eyes. They're burning with fatigue, which isn't surprising as I've been awake since 5:30am the previous day. What is astonishing, though, is that my brain feels as sharp as it did mid-morning.

I have achieved this spectacular lucidity by obtaining, over the internet, a prescription drug that might easily become a lifestyle aid among the professional elite. Yet, as we all know, nothing is ever simple with drugs - and there are serious questions to be answered. There is no such thing as a free lunch.

Modafinil is a "cognitive enhancement" drug licensed in Britain and the US for the treatment of narcolepsy (a rare disorder in which patients fall asleep during the day), but is fast becoming the pep pill of choice for anyone who needs their brain to be working in overdrive or wants to stay up all night and still be functional the next day.

Made by pharmaceutical company Cephalon and variously branded as Provigil or Modavigil, it can keep a person awake and alert for up to 90 hours without either the highs or jitters that amphetamines or caffeine would induce. It is huge in the States (American Vogue devoted four pages to it this month), with sales doubling from a million in 2002 to two million last year. Its properties are also highly regarded by the military; French soldiers use modafinil and the British MoD has bought more than 24,000 tablets since 1998.

It is not precisely known how modafinil - otherwise known as 2-[(diphenylmethyl)sulfinyl]acetamide - works, though it appears to act on the central nervous system, slowing the release of GABA, a sleep-promoting amino acid, in the brain. It is a crystalline powder described as a "psychostimulant", but there is no "high", making it unlikely to become a street drug, and it's slow to act, taking a couple of hours to kick in.

Dr Irshaad Ebrahim, medical director of the London Sleep Centre, describes the drug as highly effective in combating narcolepsy. He also uses it for other sleep disorders and knows it is used by US air force pilots in Iraq. "It has been proven not to be addictive in clinical trials, which differentiates it from amphetamines," he says.

"But there are two problems associated with its use. A significant number of people who take it get headaches, though these usually disappear within a couple of weeks of daily use. There are also some cardiovascular effects, which are potentially dangerous in high doses (some narcoleptics need ten 100mg pills a day); raised blood pressure and abnormal heart rhythms."

There are other listed side effects, too, including nausea, diarrhoea, dry mouth, loss of appetite, sore throat, dizziness and anxiety.

So how do those willing to take the risk get hold of the drug? Some doctors, it is said, have been surprised at how many young professionals visiting their clinics claim to have previously undiagnosed narcolepsy, but no doctor of my acquaintance would contemplate prescribing a medicine I obviously didn't need. "I could be struck off for doing that," said one. Finally, I order it off the internet, which is disturbingly easy. For £49.11, inhousepharmacy.co.uk sent me 30 pills, no questions asked, which showed up eight days later, postmarked Vanuatu, an island in the South Pacific. Ebrahim is appalled. "These medications shouldn't be used for purposes for which they are not licensed," he says.

I take one 100mg pill, half the normal dose, first thing in the morning. After a while I feel anxious. The feeling gets worse and I can't settle at my desk.

Gradually a sense of purpose comes on and I need to get on with my work. I make calls, work through the post, write e-mails. But I find I am frequently typing gibberish and have to edit the words carefully. My husband tells me I'm gabbling when I talk.

And though I'm working hard, I'm not prioritising. By lunchtime, I haven't dispatched any of the three pieces waiting to be written, nor done my bit organising the school bazaar. Yet I feel keyed up and I know it's not caffeine or adrenaline doing it. At least there's no hint of the crushing fatigue that usually sets in for an hour after lunch and of all the possible side effects listed for the medication, I can only tick dry mouth, nervousness and loss of appetite.

The afternoon is calmer. The anxiety goes, replaced with a clear, tense focus. I organise the children and cook dinner for friends. I dare not drink, worried about the effect of alcohol when combined with modafinil. I'm not hungry, either, and everything tastes a bit odd. When they go, I return to my desk. I normally work at night, but not past midnight. Tonight, however, it's easy.

By 3am, I go to bed. One occasional modafinil user I spoke to warned me I might need sleeping pills, but I drop off instantly and am astonished to find, when my small son wakes me three hours later, that I feel fine. I feel alert all day. It may be billed as a "clever pill", but I'm well aware that there's nothing clever about taking drugs without a prescription. The thing is, though, this pill worked for me. Would I take it again? I'm afraid it's only a question of when.