CLARIFICATION: This article has been updated to clarify the prescription of Modafinil in Singapore.
Whenever Jasmine Tan needed a boost to cope with her school assignments, she would pop a pill that helped her focus for the next couple of hours.
The pill is Modafinil, a prescription drug that hit film “Limitless” is widely believed to be based on. Also known as Provigil, the leading brand of Modafinil, it is used to treat sleep disorders like narcolepsy, where patients suffer from excessive sleepiness during the day.
Jasmine, a 22-year-old undergraduate at a local university said that she took the pills without a prescription to get her work done as she was a “huge procrastinator”.
“It’s been my routine to take either one pill or two pills everyday together with coffee for me when I study to help me focus [so] I wouldn’t think of sleeping or get distracted easily,” said Jasmine.
“Among my clique of seven friends, three of us are taking it. I’m not sure how they got it or how long they have been taking it but that’s when they offered to give it to me.” Those who consume the drug claim that it’s helped them concentrate on tasks at hand or think clearer.
However, some medical experts warned that students like Jasmine who take the drug without proper prescription could face serious health issues. People who misuse the drug might have trouble sleeping or aggravate their pre-existing medical conditions, they said.
Harmful side effects
The exact way Modafinil works is not fully understood by scientists. However, it is said to interact with chemicals in the brain, called neurotransmitters, to induce alertness in a user.
According to Singapore General Hospital’s senior pharmacist Dr Wang Aiwen, these neurotransmitters are dopamine, norepinephrine, serotonin, and GABA (Gamma-Amino-Butyric Acid).
“It then effects as a ‘wakefulness-promoting’ agent acting on the brain to treat excessive sleepiness, particularly for narcolepsy,” said Dr Wang. But using Modafinil as a stimulant raises safety concerns for patients with heart or neuropsychiatric conditions, she added.
Asia Sleep Centre’s sleep specialist Dr Kenny Pang noted that consuming Modafinil can bring about a whole host of side effects, such as insomnia, anxiety, aggressiveness, palpitations, nausea, and diarrhoea.
Dr Pang said, “It keeps the mind active and perhaps work on an overdrive mode, which may not necessarily be good for the body and the brain.”
But Modafinil might not even produce its intended effect. The evidence of the drug’s ability to enhance the cognitive function of those without sleep disorders is mixed, according to Dr Wang. Half of the currently available studies analysed in a review had not shown benefits in the areas of attention, learning and memory, she said.
“In view of potential side-effects and limited benefit, Modafinil is not recommended for such a use,” said Dr Wang.
Potentially dangerous mix
Diki Lim, a 17-year-old student at a local polytechnic, said that he takes Modafinil three times a week, a month before the start of exams. The drug makes him more focused on the things he want to do, Diki said.
For Jasmine, who also works part time, the drug sharpened her focus and kept her studying longer hours. However, her stomach felt uncomfortable after a few days.
“I felt that the effect was wearing out, and took it with double shots of coffee at the same time, and I can really feel the effectiveness after doing so,” she said.
Jasmine’s practice of mixing Modafinil with coffee, however, was flagged by Dr Wang as “potentially harmful”.
“Modafinil is a stimulant, and may cause increased the heart rate as well…These side effects can be exacerbated when used together with caffeine,” said Dr Wang.
Buying Modafinil online
Modafinil is approved by the US’s Food and Drug Administration (FDA) for use by prescription. The drug can promote wakefulness in people with narcolepsy, sleep apnea, and shift work sleep disorder, according to the FDA.
In Singapore, the drug isn’t registered as a therapeutic product. “Usually, Modafinil is prescribed by neurologists or psychiatrists, after detailed patient review,” said SGH’s Dr Wang.
When asked about the effects of taking Modafinil, the Health Sciences Authority (HSA) said that inappropriate use of the drug by healthy individuals “can be harmful”.
“Unless authorised by the Health Sciences Authority for use by a doctor in patients under his care, the supply of an unregistered health product such as Modafinil is an offence under the Health Products Act,” said the HSA.
Any person convicted of selling Modafinil illegally faces up to two years in jail or a maximum fine of $50,000, or both penalties.
Yet the hefty penalty has not deterred some online sellers from peddling Modafinil. Students like Jasmine and her friends get the drug from portals such as Carousell. Others turn to online pharmacies overseas to import the drug into Singapore.
Seller Walter Goh first bought Modafinil pills for his own consumption and sold the leftovers to his friends or their friends by word of mouth. The 30-year-old copywriter said that his buyers are “often students looking to get an edge, or working adults with a lot on their plate”.
Another seller, Sky Lum, said that her buyers were mostly students trying to study around the clock. The 27-year-old content producer, who sells her pills on Carousell, said she also takes the pills herself “when things get overwhelming”.
When asked about the students’ misuse of Modafinil, Dr Pang said he was “appalled” by their behaviour. He stressed that the use of the drug for the purpose of studying longer hours was “absolutely” dangerous.
“This is a bad habit and [Modafinil] should not be used as a fashion drug or a booster drug, just because one has more task at hand or exams to cope with. It can deplete the mind and body of rest and make one very tired and lethargic after stopping its use.”
*All names have been changed to protect the identities those interviewed.