Off-license users of modafinil—a drug developed to treat various sleep disorders—have known for some time that it doubles as a surprisingly effective cognitive enhancer, and with very few side effects. A new systematic review shows it’s true, raising some important ethical questions about the use of smart drugs.

Modafinil, which is sold under such brand names as Alertec, Provigil, and Modavigil, is a wakefulness-promoting drug used to treat conditions such narcolepsy, the effects of shift work, sleep apnea, and other sleep disorders. But it’s also used off-license by people—especially students—hoping to exploit its nootropic qualities.

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Previous studies have shown that modafinil improves cognitive function among sleep-deprived individuals, but consensus has been lacking about the drug’s ability to affect people without sleep issues. To correct this, researchers Ruairidh Battleday and Anna-Katharine Brem from the University of Oxford and Harvard Medical School poured through all research papers pertaining to modafinil and its effect on cognitive performance from January 1990 to December 2014. They managed to find 24 studies dealing with various cognitive benefits, including planning and decision making, flexibility, learning and memory, and creativity. The details of their review can now be found in the Journal of European College of Neuropsychopharmacology.

Looking at those two-dozen studies, the researchers learned that modafinil had virtually no effect on working memory, or flexibility of thought—but the drug did improve decision-making and planning.

Also, the effects of modafinil varied according to the task at hand. The longer and more complex the task, the more consistently the drug conferred cognitive benefits. Though more research is needed, the researchers claim that the drug appears safe to take in the short term, with very few side effects and no addictive qualities.

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“This is the first overview of modafinil’s actions in non-sleep-deprived individuals since 2008, and so we were able to include a lot of recent data,” noted Battleday in a statement. “Interestingly, we found that the type of test used to assess modafinil’s cognitive benefits has changed over the last few decades. In the past, people were using very basic tests of cognition, developed for neurologically-impaired individuals. In contrast, more recent studies have, in general, used more complex tests: when these are used, it appears that modafinil more reliably enhances cognition: in particular ‘higher’ brain functions that rely on contribution from multiple simple cognitive processes.”

The researchers reached two main conclusions: (1) owing to so very few side effects, modafinil should officially be recognized as safe and genuine cognitive enhancer, and (2) new ways of testing supra-normal cognition, i.e. brain-enhanced cognition, need to be developed.

Guy Goodwin, the President of the European College of Neuropsychopharmacology, offered some insights that deserve a long quote:

This overview suggests that, on current evidence, modafinil enhances cognition independent of its known effects in sleep disordered populations. Thus, the authors say that ‘modafinil may well deserve the title of the first well-validated pharmaceutical nootropic agent’. In other words, it’s the first real example of a ‘smart drug’, which can genuinely help, for example, with exam preparation. Previous ethical discussion of such agents has tended to assume extravagant effects before it was clear that there were any. If correct, the present update means the ethical debate is real: how should we classify, condone or condemn a drug that improves human performance in the absence of pre-existing cognitive impairment?

As the authors point out, modafinil is not licenced for this use, and it will not be because it would be outside the current terms of reference of regulatory bodies. The non-medical use of mind altering drugs has hitherto broadly conflicted with the work ethic of many societies, has been very popular but leads to a range of demonstrable harms. Regulation has been and remains problematic. We cannot know either if demand for modafinil in the same societies will actually be significant, whether society will be more accepting and how regulation will then be framed.

Indeed, the use of smart drugs, such as modafinil, Adderall, Ritalin, and Dexedrine, is widespread, particularly among students. Studies have shown that between 31 to 34% of students surveyed have admitted to off-license use of prescription stimulants at least once. And that was five years ago. Revealingly, the number of monthly ADHD prescriptions issued to 20-somethings climbed from 5.6 million to 14 million between 2007 and 2011.

Brem and Battleday made it clear that they’re not advocating for people to take the drug.

“It is still unlicensed for healthy people—but it is time for a wider debate on how to integrate cognitive enhancement into our lives,” said Brem in a Guardian article. “We need to explore the ethics, and scientist, politicians and the public need to be involved.”

Read the entire study at the
Journal of European College of Neuropsychopharmacology.


Email the author at george@io9.com and follow him at @dvorsky. Top image by Palau/Shutterstock