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Provigil: Better Policing Through Chemistry

Written by Ed Nowicki

It is impossible to estimate the cost in human life, personal injury and property damage that is caused by having sleepy police officers behind the wheel of a patrol car on regular patrol. Consider a weeknight that has slow radio call volume along with the monotony of limited visibility due to fog, and the possibility of a sleep-related collision is in the making. A “hot” call gives an officer an extra jolt of adrenaline, but coming down from that jolt can worsen a potential sleep-related problem.

Working the midnight shift does strange things to the human mind and body. Somehow, usually between the hours of 3 a.m. and 6 a.m., officers do a great impression on an up-and-down bobble head. Then, the eyelids get heavier and heavier, as a bit of drool starts working its way down from the corner of the mouth. This is anything but a display of the hyper vigilance that police officers should possess.

The “old timer” third shift officers learned how to hold a cup of coffee in their hands throughout the entire third shift. The coffee drinking was occasionally interrupted by the chewing a couple of Tums taken from an industrial-sized bottle in the officer’s squad case. Three forces were battling for supremacy within the officer’s body: caffeine jitters, sleepiness and a sour stomach. Sometimes one force would be the victor, and sometimes all three would seem to win.

Beating Sleepiness
There is a drug that has been approved for certain U.S. Air Force pilots to reduce fatigue on long flights, including from the continental U.S. to Iraq and Afghanistan. That drug is Provigil (generic name, “monafinil”), which can fight off drowsiness and bolster alertness with, arguably, few side effects.

I discovered this drug a few years ago while reading an article in the office of my neurologist on “Less Sleep, More Energy.” The article appeared in the October 2005 issue of Reader’s Digest. It mentioned Provigil, and I thought that this might help me deal with fatigue caused by my neurological disorder. I asked my neurologist, and he wrote me a prescription for 100 mg tablets taken once a day upon waking for 30 days to see if it would help my fatigue. After day one, I immediately felt great and have no side effects. Yes, better living through chemistry!

Provigil is only available by prescription, and it isn’t cheap either. There are no generic alternatives. The average retail price for Provigil: 100 mg (30 ea) at about $175, and 200 mg (30 ea) at about $270. Due to its high costs, some agency prescription plans may refuse to cover the costs, while others may require prior approval. Still, the sale of Provigil in the U.S. is about $800 million a year and growing.

Just what is this “magic pill?” It’s not an amphetamine and contains no caffeine. Supposedly, it keeps you awake but it doesn’t give more cardiovascular stimulation. Provigil is also supposed to preserve a person’s ability to sleep.

A study by the Department of Psychiatry, School of Medicine, University of California-San Diego and Pacific Sleep Medicine Services Inc. of San Diego, CA, and North Side Hospital Sleep Medicine Institute of Atlanta, GA, was published in 2007. This study was “Modafinil for excessive sleepiness associated with chronic shift work sleep disorder: effects on patient functioning and health-related quality of life.” The conclusions stated, “Modafinil significantly improves functioning and quality of life in patients with SWSD. Modafinil is an effective treatment for excessive sleepiness associated with SWSD.”

Provigil has a 15-hour half-life (the amount of time before half of the drug’s peak plasma levels are eliminated by the body). This means that if you take a single dose of the drug in the morning, the drug will have little or no effect on your night-time sleep. If you take Provigil too often, it is possible to not get enough sleep. Users need to stay within the recommended dosages and get regular sleep.

The use of Provigil is banned for use by professional athletes and by the World Anti-Doping Agency and is a Schedule IV Controlled Substance. Provigil does not appear to be habit forming, and you are very unlikely to suffer from withdrawal when stopping its use. If you suffer from SWSD, you will begin to feel sleepy again.

Dr. Fabrice Czarnecki, MD, chairman of the International Association of Chief’s of Police (IACP) Physicians’ Section, believes that Provigil can be an effective treatment for SWSD. But he cautions, “The use of Provigil by any officer should be monitored by the agency’s physician or, in the absence of an agency physician, by a sleep specialist.”

There are a number of common side effects to look for when using Provigil. According to Cephalon Inc., the drug company that manufactures Provigil, these side effects include, “headache, nausea, nervousness, stuffy nose, diarrhea, back pain, anxiety, trouble sleeping, dizziness, and upset stomach.” It seems like one of those TV drug ads where the possible risks seem to outweigh the potential benefits. We saved the arm, but we lost the patient!

There’s another caution concerning side effects that were not common. Provigil users are warned, “If you experience chest pain, depression, anxiety, hallucinations, psychosis, mania, thoughts of suicide or other mental problems, stop taking Provigil and call your doctor right away or get emergency treatment.” Sounds scary, but I also take a liquid that kills more people than any other liquid. The liquid is water, and drowning is guaranteed to kill you.

Deputy James Trifiro of the Hampden County, MA Sheriff’s Department, also a Doctor of Pharmacy, cautioned, “Any law enforcement officer [who] is using Provigil has the potential for his or her thought process to be compromised or physical abilities impaired. These officers need to be constantly evaluated until such time as the benchmarks of therapy have been achieved and there are no deleterious effects.”

The Fall 2007 issue of the FDA Drug Safety newsletter noted: “FDA has been monitoring cases of serious skin reactions, including erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), in its postmarketing reviews of adverse event reports associated with the use of modafinil.” The labeling on Provigil was recently updated to include a warning about serious skin rash as a side effect.

There is a legitimate concern of how the use of Provigil will interact with other prescription drugs taken. An officer’s doctor and pharmacist can assist in providing information on possible drug interaction with Provigil. Deputy Trifiro is also concerned about an officer’s reaction time and the ability of the eyes to process light when using Provigil. He cautions, “In my opinion, the jury is still out on Provigil.”

Lieutenant Gregory Ruff of the Leavenworth, KS Police Department participated in an 18-month sleep study to treat his sleep apnea. Ruff’s nightly sleep was interrupted due to the sleep apnea, which left him sleepy during the day. He took a 100-mg dose of Provigil each morning, which Ruff said made him feel great.

He had an operation to address his sleep apnea, and he no longer uses Provigil. He said, “Without using Provigil before my operation, I was constantly exhausted and I felt angry, which was due to my loss of sleep. From day number one of taking Provigil, I no longer felt exhausted, and my anger was gone. My job performance was greatly diminishing without the use of Provigil.”

A Midwest police lieutenant, who asked to remain anonymous, has been taking in excess of 200 mg of Provigil per day for more than four years to treat narcolepsy. He said that he definitely could not function and perform his duties if it were not for Provigil. In fact, he believes that more officers should know what Provigil is and what it can do. This lieutenant believes that the increase of legitimate Provigil use can save lives. Although his agency knows that he takes Provigil, he said officials are sensitive of him being quoted, particularly as an administrative officer.

If an agency seems to have preventable collisions on the midnight shift, the root of the problem may be SWSD. If that’s the case, the agency may want to have the training unit provide third shift officers with information on the use of Provigil. Its legitimate use can certainly save lives.

Ed Nowicki, a nationally recognized use-of-force expert, is a part-time officer for the Twin Lakes (WI) Police Department. He presents use-of-force instructor certification courses across the nation and is the executive director of ILEETA. He can be reached at ed@ileeta.org.

Published in Law and Order, Aug 2008

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Comments

Comment on This Article

Aggression Side Effects

By Freddy Fudbucker

Is a drug that can cause aggression and other psychiatric side effects right for police officers ?
http://www.cchrint.org/psychiatric-drugs/stimulantsideeffects/provigilsideeffects/provigil-warnings/

Submitted Jan 17 at 7:45 AM

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