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Modafinil Abuse: Rethinking Use of “Smart” Prescription Drugs

Modafinil (Provigil) may be a narcolepsy drug, but a growing number of people are misusing the medication with ulterior motives. Drug abuse and addiction are serious public health issues that affect just about every community and family in one way or another. Rates of drug use and addiction in America have been increasing substantially for more than twenty years, and each year these issues cause millions of serious illnesses or injuries. Prescription drug abuse, in particular, is a major public health problem in America. The majority of people take their prescription medications responsibly, but according to the National Institute on Drug Abuse (NIDA) an estimated 54 million people (more than 20% of all people in the US aged 12 and older) have used such medications for nonmedical reasons at least once in their lifetime When the words “abuse” and “addiction” are brought up in conversations, many people automatically assume the terms are associated with illegal substances, but the truth is Americans struggle with alcohol, prescription drugs and other legal substances as well. The unfortunate reality is that many prescription drugs that were developed to treat people with legitimate medical needs have become notorious for their abuse potential. Drug abuse does not always start on the streets and does not only involve criminals. In many cases, prescription drug abuse begins because of people reaching into their own medicine cabinets.

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Prescription Stimulant Abuse: A Pervasive Problem

Over-prescribing and inadequate regulation of prescription stimulants have made it easier for people to get their hands on these potentially dangerous medications. In particular, prescription stimulants have a high abuse potential. They are typically indicated to treat disorders that affect alertness, attention and energy – for example attention-deficit hyperactivity disorder (ADHD) or narcolepsy. Data from NIDA show that between the early 90’s and 2010, the rate of prescription stimulants prescribed increased fourfold. Commonly prescribed stimulants include:

  • dextroamphetamine (Dexedrine®)
  • dextroamphetamine/amphetamine combination product (Adderall®)
  • methylphenidate (Ritalin®, Concerta®)

Stimulant abuse is not just an adult problem. NIDA data show that nearly 170,000 teenagers between the ages of 12 and 17 report using prescription stimulants without actually having a prescription.  Popular slang terms for prescription stimulants include Speed, Uppers, and Vitamin R. When it comes to stimulant abuse, smoking and injection use generally produce the fastest effects, while swallowing and snorting tend to be slower at increasing blood levels, thus producing less intense onset of effects. No matter how a stimulant is used, the user risks falling into a pattern of abuse and subsequent addiction. It is possible to die from prescription stimulant abuse due to heart attack, stroke, and seizure of drug-induced psychotic episodes. The signs and symptoms of a potential prescription stimulant overdose include:

  • Disorientation/confusion
  • Chest pain
  • Severe headache
  • Seizures
  • Overheating/high body temperature
  • Unconsciousness
  • Hallucination
  • Agitation and paranoia

What is Modafinil?

One of the lesser-advertised stimulants on the markets is modafinil. The Food and Drug Administration approved modafinil, sold as brand name Provigil, in 1998 as a treatment for narcolepsy. The drug can also be prescribed for people who have a sleep disorder due to shift work or for people with obstructive sleep apnea. Narcolepsy is a sleep disorder that is characterized by excessive sleepiness, sleep attacks, sleep paralysis, hallucinations and in some cases sudden loss of muscle control. The condition affects about one in every 2,000-3,000 people, although it can go undiagnosed for many years. Meanwhile, obstructive sleep apnea affects an estimated 22 million people in the US. Modafinil can cause a decrease or increase enzyme activity in the liver that can eliminate the effects of other drugs through metabolism. For some medications, this means a decreased level of efficacy, while for others this can mean an increased level of toxicity. Notably, among the drugs with reduced effectiveness when taking with modafinil include hormonal contraceptives.

Off-Label Use of Modafinil

Though modafinil was originally approved as a medication for narcolepsy, prescribing trends have shown a shift in how the drug is being used in clinical practices. An investigation published in the Journal of the American Medical Association (JAMA) found that, over time, physicians have also started prescribing modafinil off-label as a treatment for attention deficit/hyperactivity disorder (ADHD) and schizophrenia. Throughout the study period, which lasted from 2002 through 2009, the number of patients receiving modafinil increased nearly ten-fold. Ultimately, the researchers determined that most prescriptions written for modafinil are for off-label indications.

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Modafinil: The “Smart Drug”

Many people believe modafinil can enhance cognitive ability, and thus perceived intelligence, in healthy individuals. This has increased the drug’s abuse potential – especially among students. Anecdotal reports have suggested many students abuse modafinil in an effort to keep up with their peers in academic settings. The rising costs of education and increasing competition for scholarships, in part, fuel these competitive addictions. Factors like these are unlikely to go away, so the scientific and health communities have been taking a deeper dive into finding out how to address these types of addictions. Beyond competition, other stresses that can cause students to turn to modafinil to help them perform better academically include:

  • Bad sleeping habits
  • Full schedules and course loads
  • Poor eating habits
  • Cultural pressures

A case published in the Journal of Pharmacology & Pharmacotherapeutics shows that, though it is rare, people can become physically dependent on modafinil. The patient, a 44-year-old man, reported that he started consuming more modafinil tablets to increase the effects derived from the drug. He did this in order to keep up with his shift work schedule and ultimately developed a dependence. He claimed to experience symptoms of worsening of lethargy, tremors of hands, anxiety and erratic sleep hours when he did not take modafinil in high doses. In general, reasons for abusing prescription drugs can include:

  • To get high or otherwise feel good
  • To lower appetite
  • Peer pressure to fit in or to be social
  • To perform better in school or at work
  • To be legal, since prescription drugs aren’t prohibited there is sometimes a false sense of security in using them versus a stimulant like cocaine
  • To feed an addiction

Act-Alike, Sound-Alike Modafinil Drugs

Modafinil is one member of a drug family consisting of similar medications used to increase energy levels and improve focus and alertness. This family of drugs is called eugeroics. It is important to know the differences between them and what they are used for:

Modafinil vs. Armodafinil

Modafinil and Armodafinil are closely related drugs that are used to increase energy levels and improve focus and alertness. Armodafinil is actually a more potent version of modafinil introduced to the market several years afterward. It binds differently to receptor sites within the brain and body versus modafinil, and while the standard Modafinil dosage is 200 mg, people only need 150 mg of Armodafinil to get the same effects.

Modafinil vs Adrafinil

Modafinil is significantly more potent than adrafinil. Lower doses of modafinil are needed to achieve the same level of effectiveness. Modafinil also acts more rapidly than adrafinil, which must be processed by the liver before it takes effect. While the World Anti-Doping Association has banned both adrafinil and modafinil as performance enhancing drugs, right now adrafinil is unregulated and is available without prescription in the majority of countries.

Provigil vs Adderall

Adderall is FDA-approved to treat ADHD, while Provigil is prescribed for ADHD in an off-label capacity. Adderall is also available in both immediate-release (IR) and extended-release (XR) formulations, and is generally cheaper than Provigil. Most notably, Adderall is a Schedule II drug, which means it has a high potential for abuse that can lead to psychological or physiological dependence, while Provigil is a Schedule IV drug, which indicates a low potential for abuse or dependence.

The Effects of Modafinil Abuse

Despite the reputation as a “safe” stimulant, there have been no long-term studies on the safety profile for modafinil. Dr. Nora D. Volkow, Director of NIDA, authored a piece published in JAMA that says modafinil has the same effect on the dopamine centers of the brain as cocaine, methamphetamines and amphetamines. This, she suggests, means that modafinil is as addictive as those substances because it forcibly triggers the brain to release the particular neurotransmitter (dopamine) that is typically associated with feelings of euphoria and pleasure. Under normal circumstances, the brain reabsorbs dopamine after some time, but powerful medications can force the brain to continually pump out dopamine. Increased levels of dopamine can have several effects on the mind and body.

Modafinil Abuse and “Cocaine-Like” Effects

Modafinil has effects that are similar to medications like Ritalin or drugs like cocaine in that it increases dopamine levels, however it does not have nearly the same strength as either of these other stimulants. The potential side effects of modafinil include:

  • Anxiety
  • Headache
  • Diarrhea
  • Back pain
  • Dizziness
  • Sleep difficulties
  • Nausea or vomiting
  • Running or stuffy nose

Several investigations have compared modafinil and cocaine through several different lenses. A study published in the European Journal of Neuroscience found that modafinil enhances the effects of cocaine when the two drugs are taken together, while another study published in the journal Psychopharmacology found that modafinil has the potential to be a good treatment for cognitive function improvement in people who have had substance use disorder.

Modafinil Abuse and Sex Addiction

Studies have also linked modafinil dependence and hyperactive sexuality. Research published in the journal Clinical Psychopharmacology and Neuroscience showed increased and prolonged use of modafinil at higher-than prescribed doses can lead to hyperactive sexuality disorder due to increased concentration of dopamine. According to the American Psychiatric Association, symptoms of sex addiction involve recurrent and intense sexual fantasies, urges and behaviors over a period of more than six months associated with the following criteria:

  • Excessive time spent on fantasies and urges, including planning for and engaging in the behavior
  • Repeatedly engaging in these fantasies and urges as a response to certain mood states – namely anxiety, depression boredom, irritability or stressful life events
  • Failure to control or significantly reduce the recurrence of sexual fantasies and urges despite an expressed desire to do so
  • Repeated engagement in sexual behavior without regard for the risk for physical or emotional harm to self or others
  • Clinically significant personal distress or impairment in social, work or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges, and behaviors

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Recognizing Modafinil Misuse and Abuse

It is important to be able to recognize the signs and symptoms of prescription drugs like modafinil. These can include:

  • Stealing, forging or selling prescriptions
  • Taking medications in higher doses than prescribed
  • Dramatic mood swings
  • A notable increase or decrease in the amount of sleep one gets
  • Bad decision making
  • Behaviors that indicate being high, such as being unusually energetic or sedated
  • “Losing” prescriptions on a consistent basis to make the argument to have them refilled more quickly
  • “Doctor shopping,” which is a term used to describe when a person goes to more than one doctor to try and get multiple prescriptions

Addiction is not just a physical problem – it is also a mental one. Addiction is not a choice, and addressing this disorder requires a careful and compassionate approach. In the best-case scenario, you can help someone recognize addiction in themselves so that they seek treatment willingly. In other cases, loved ones may have to push an addict to seek rehab for their condition.

Have a Problem with Modafinil? Here is What You Need to Do

The allure of modafinil for some people can be very high, as it does not have the same stigma as some of the other more notorious stimulants on the market. Nevertheless, the drug can be dangerous and addictive, and if you or someone you love is facing modafinil addiction it is important to get help right now. Addiction and recovery from prescription drug abuse is not a journey anyone should have to go through alone. Admission coordinators and compassionate staff can answer any questions you have over the phone or during a scheduled consultation. You can find out more about how continued use of the drug can negatively affect your life and what the next steps should be in getting your life back on track and free from effects of modafinil abuse.

Modafinil Detox: What to Expect

Thankfully, the symptoms of withdrawal from modafinil are not major. People detoxing from modafinil can expect to experience the following symptoms:

  • Issues with concentration. People report having “poor focus” once they stop using modafinil. In the vast majority of cases, these focus issues are just a result of having experience enhanced cognition for a long time and not remembering what normal functioning feels like. This cognitive slowing is usually temporary.
  • Feelings of depression. Although not common, some people feel an antidepressant effect while taking this drug – so naturally, stopping the medication can bring on depressive symptoms.
  • Fatigue and Sleepiness. Modafinil is primarily used as an anti-fatigue agent, so stopping use of this drug can cause excessive tiredness during the withdrawal phase. Those who take the drug for narcolepsy will likely experience sleepiness after discontinuation.
  • Low levels of energy. Modafinil generally provides energy boosts for people, so not taking the drug can result in low levels of energy for the first few weeks after discontinuation.
  • Shortness of breath. Some people who discontinue modafinil report shortness of breath as a symptom.

There are several factors that can influence the intensity and duration of withdrawal from modafinil (Provigil), including: Time span. Withdrawing from modafinil will largely depend on how long the person has been taking the drug. Withdrawal symptoms will be stronger for people who have been taking or abusing the medication for years versus people who have only been abusing the medication or a few months. Dosage. Modafinil reportedly does not have additional therapeutic benefits beyond a dose of 200 mg per day, although some people take up to 400 mg each day. The higher the dosage, the more likely you are to experience withdrawal effects. Method of discontinuation. Going cold turkey (sudden discontinuation) from a medication produces different effects than tapering. If the medication has served as your wakefulness agent for an extended period, you have definitely become accustomed to the drug.  If you have been taking the drug for several years, you will likely experience withdrawal symptoms if you go cold turkey. Tapering is typically recommended to help avoid suffering from withdrawal symptoms. A medical professional should ideally advise on how to reduce the dose over time.

Therapy and Counseling for Modafinil Abuse Recovery

Once the immediate physical effects of detoxification are handled, it is time to get to work building a sustainable recovery. Addiction is a chronic disease that can be treated with the right combination of behavioral treatments and, if needed, medications to help manage symptoms associated with the detoxification process. Prescription drug counseling helps to address the underlying issues that may have caused you or your loved one to turn to drug abuse in the first place. Some people may be surprised to learn that addictions may have not have anything to do with physical dependence. Incorporating counseling into a recovery plan can have many benefits. Different therapy types you can expect to be included in your recovery form modafinil abuse and addiction include:

  • Individual therapy
  • Group therapy
  • Couples and family therapy
  • Cognitive behavioral therapy
  • Maintenance therapy

Many people falsely believe that going through treatment once is enough to fully kick an addiction. This is a dangerous misconception. Drug rehab is an amazing first step, but it should not be considered the final step. Addiction cannot be fully cured, and recovery is a lifelong process. Abuse and misuse of prescription medications, including modafinil, is becoming of the fastest growing health epidemics in the US due to the high potential for abuse and lethality. Getting treatment for yourself or a loved one is no easy task, but it could become one of the best decisions you will ever make in your lifetime.