July 24, 2007 -- In 2003, David Plotz, a busy writer and father of a toddler, was feeling sleep-deprived and run-down. Unable to catch up on rest, he searched for a solution other than sleep that might improve his performance on both the home and career fronts.
He began taking modafinil, a drug developed in France and approved by the Food and Drug Administration in 1998 to treat narcolepsy or daytime sleepiness. Modafinil is a memory-improving and mood-brightening psycho stimulant that enhances wakefulness -- not unlike cocaine or amphetamines.
Sleep-deprived groups ranging from truck drivers to the military have experimented with modafinil, marketed for nearly a decade by Cephalon under what Plotz calls the "creepy, pharma-Orwellian" name Provigil.
Military officials have found it so effective that some now refer to it as a "super drug." But its off-label uses have created a rich debate on how far to push the limits of the human body.
For Plotz, the results were immediate.
"I am the picture of vivacity," he wrote on Slate.com.
Even with only five hours sleep, he could write twice as fast and felt alert.
"I have a desperate urge to write, to make reporting calls and to finish my expense account – activities I religiously avoid," he wrote. "I find myself talking loudly and quickly. A colleague says I am grinning like a 'feral chipmunk.'"
But Plotz ended the experiment after three days, in part because it was so effective. He was worried that he would one day stash pills, scour the Internet for discounts and become addicted to a life of high energy.
No Rebound Effect
Despite his concerns, Plotz never did quit using Provigil. He restocked his supply and uses it twice a year for long-distance drives or bouncing back after a period of little sleep.
"The drug is fantastic," Plotz, now acting editor at Slate.com, told ABC News. "I am my best self. I just feel alert -- at the time period where you feel yourself to be at your sharpest and wittiest and your brain clicks."
A seemingly perfect stimulant, clinical trials found modafinil to be less likely than amphetamines to cause jitteriness or anxiety or have a "rebound" or "crash" effect. And because it does not produce a "high," it has never become a street drug, according to the New York University Sleep Center.
Tired and frenetic Americans are asking their doctors for more and more modafinil prescriptions, and college students have embraced the super drug for all-night study sessions.
In 2006, annual sales of modafinil were nearly $600 million, about one-third of Cephalon's earnings, according to the company's annual report. And about 90 percent of those sales are for off-label uses.
Doctors prescribe the drug to truck drivers, shift workers and people who experience disorders like sleep apnea. Other experimental uses of the drug are for Alzheimer's disease and for depressives who sleep or eat too much. Some suggest it might be useful for jet lag.
"The temptation for healthy people to use such a drug is tremendous," said Jonathan D. Moreno, a biomedical ethics professor at the University of Pennsylvania who wrote an article about military experiments on mental fatigue called "Juicing the Brain" in the November 2006 issue of Scientific American.
"Frequent flyers get prescriptions for the stuff, and it is sure to be the next craze on college campuses among students who want to pull all-nighters or just be able to party hardy for days."
The French used modafinil in the first Gulf War, and the U.S. Air Force tested the drugs on pilots flying 40-hour sorties during Operation Enduring Freedom in Afghanistan.
Unconfirmed reports say American soldiers took modafinil as they marched into Baghdad in 2003.
Tinkering With the Brain
Doctors have long "tinkered" with artificially enhancing the brain, and the military spends about $100 million each year on research to find ways to reduce soldiers' need for sleep and still retain cognitive function, according to Moreno.
"The human being is the weakest instrument of warfare," he said. "[Soldiers] must eat, sleep, discern friend from foe and heal when wounded … The first state to build superior fighters will make an enormous leap in the arms race."
Until now, the military has used amphetamines or "go pills" for its pilots, but the side effects of amphetamines can cause problems. Investigators blamed those drugs for a 2002 incident in which American pilots inadvertently killed four Canadian soldiers in Afghanistan.
In studies funded by the Air Force Office of Scientific Research and Cephalon, modafinil has proved to be a better drug.
Scientists treated 16 healthy subjects, depriving them of sleep for 28 hours and then expecting them to sleep from 11 a.m. to 7 p.m. for four days and stay awake through the night. Those on modafinil did far better on cognitive tests than those on a sugar pill. Some could stay awake for more than 90 hours, according to Moreno.
And rather than giving the user a high, it feels as if the user has "just taken a short nap," said Moreno, who has used the drug himself. "It's really fantastic."
But ethicists wonder why performance-enhancing drugs should be so readily available when they have been banned for Olympic athletes.
The military -- sensitive to the fine line between "enhancement" drugs used illegally by athletes and "super drugs" for soldiers -- euphemistically calls modafinil a "performance modification drug," according to Tom Erhard, a former Air Force colonel.
"Human performance modification will become an increasingly evident and problematic part of society, not to mention the military," Erhard, now a senior fellow at the Center for Strategic and Budget Assessments, told ABC News.
"In 10 years, you will be asking yourself about everyone you encounter -- 'I wonder what they're on?' -- because everyone will be on something," he said
Still, Erhard supports military research on performance drugs.
"We are really concerned about what other nations might do," he said. "In Fallujah [Iraq] we ran into insurgents and terrorist jacked up on various substances that enhance performance."
"Other cultures don't have the inhibitions we do and are more apt to look at illegal enhancement," he said.
The civilian battlefield is also rife with controversy over drugs like modafinil, which is increasingly being used as a lifestyle drug.
The Times of London reported last month that increasing numbers of students are using it as the "smart drug" of choice and prefer it to the anti-hyperactivity drug Ritalin. The growing use and acceptability is at the center of a larger debate on scientific advancement.
"We are entering new territory," said Moreno. "Traditional ideological lines break down around this."
Moreno and others worry about the long-term effects of using a drug that curtails sleep.
David Plotz, too, recognizes that modafinil is no panacea for his hectic life and stresses that he tries to use it judiciously.
On recent day in his news office, Plotz had just had lunch and was "nodding off a little" at his desk. He knew that with a pill of Provigil, he would "bull rush right through that afternoon low," but he resisted the urge. He also said he won't share the drug with friends.
But that doesn't mean he doesn't still find a use for it.
Recently he took a 6:30 a.m. dose -- one-third of a 200-milligram pill -- and drove from Washington, D.C., to New Hampshire, a 10-hour drive.
"It's just amazing," he said. "I had to unpack the car at the end and move into house. It was a snap -- as easy as pie."