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The survey invitation was sent out to roughly 2,000 students, regardless of their prior knowledge or experience with Provigil. Participation was anonymous, and no demographic details such as age or gender were collected. Based on similar anonymous surveys previously conducted within the department, a response rate between 7% and 33% was expected (data unpublished). To ensure a 95% confidence level with a 10% margin of error, the target was set at a minimum of 100 responses. However, after a 14-week period, only 33 students responded, resulting in a low 1.65% response rate. This limited participation makes it difficult to draw firm conclusions and highlights the limitations of using surveys to assess drug use among medical students. Though the small sample size restricts the broader applicability of the findings, the responses still offered valuable insights into patterns and key factors surrounding Provigil use within this group.

Around three-quarters of the respondents were familiar with the concept of smart drugs, and over half stated they would consider taking something to enhance focus, memory, or concentration (see Figure 1A, B). Interestingly, despite this general awareness, nearly 45% of participants who knew about smart drugs had not heard of Provigil, indicating they might be more acquainted with other cognitive enhancers (Figure 1C).

Most students reported learning about smart drugs from friends (53%) or through media sources (22%), while very few had encountered information about Provigil via academic publications (7%) or medical professionals (7%) (Figure 1D, Supplemental Table 1).

Among those familiar with Provigil, 44% reported having used it. Half of these users described frequent consumption, taking the drug more than 20 times, often three or more times a week. Others reported more occasional use, typically around 5 to 10 times per year, averaging six or fewer uses annually.

The most commonly reported dose was 100 mg, although frequent users indicated taking between 200 mg and up to 400 mg per use (see Figure 1E, F, G). Most individuals stated they did not combine Provigil with other substances, though one respondent mentioned pairing it with caffeine.

Motivations for using Provigil included improving focus and attention (28%), boosting productivity (25%), preparing for exams (17%), and extending work hours (14%). Less frequently mentioned reasons involved enhancing clarity of thought or managing night shifts. Nearly all users described the drug as effective, except for one participant who took 200 mg several times per week and remained unsure about its benefits (Figure 1H).

Participants commonly reported immediate positive effects from taking Provigil, such as heightened motivation, sharper concentration, sustained focus, alertness, and the ability to work in a "flow state." Some users also noted additional benefits like increased energy levels, mental clarity, greater confidence, enhanced creativity, sociability, and an overall improvement in mood. A few individuals mentioned experiencing appetite suppression, which they considered favorable. Several respondents indicated that some of these effects persisted beyond the initial use (Figure 1I, J, Supplemental Table 1).

However, alongside these benefits, Provigil was associated with various negative effects. The most frequently mentioned issues were difficulty sleeping (insomnia), followed by digestive problems (such as diarrhea), headaches, mood swings, and reduced appetite. Less common side effects included tremors, heart palpitations, and fatigue. Some negative experiences, particularly insomnia, mood disturbances, and appetite loss, were reported as lasting beyond immediate use (Supplemental Table 1). Interestingly, most individuals did not feel dependent on Provigil, with the exception of one respondent who used the drug more frequently and expressed uncertainty about potential dependency (Supplemental Table 1).

The survey’s second part focused on participants’ opinions regarding the use of Provigil for cognitive enhancement, regardless of whether they had previously used or heard of the drug (Figure 2, Supplemental Table 1).

A significant portion (38%) believed that taking Provigil did not pose a risk to their well-being, while 33% were unsure and 27% acknowledged potential risks. Follow-up questions revealed a moderate level of caution, with 45% of respondents indicating that they did not fully consider Provigil safe (Figure 2A).

When asked about peer influence, responses were varied. Many participants stated they wouldn’t feel pressured to use the drug even if their peers did, though some admitted that their decisions might be swayed by others (Figure 2B). Additionally, the majority felt that using Provigil would not provide users with an unfair academic or professional edge (Figure 2C).

Notably, all current users of Provigil agreed that taking the drug did not constitute cheating, whereas only 48% of non-users shared this opinion. Another 24% remained neutral, and 28% believed it could be considered cheating (Supplemental Table 1). While most participants disagreed with the idea that "there is nothing wrong with people taking Provigil," they generally supported personal freedom of choice regarding cognitive enhancement (Figure 2C, Supplemental Table 1).

Despite the limitations in sample size and participation, the data gathered offers valuable preliminary insights. The findings highlight a high level of awareness (75%) regarding Provigil and other so-called smart drugs, which may include substances like Adderall® (Amphetamine and Dextroamphetamine), Ritalin® (Methylphenidate), Aricept® (Donepezil), and Namenda® (Memantine).

One notable concern was the primary sources from which students learned about these drugs—mainly friends and media outlets—rather than trusted healthcare professionals or academic sources. This trend may reflect the way the media often emphasizes the potential benefits of cognitive enhancers while downplaying associated risks (Partridge et al., 2011).

It is crucial that individuals base their decisions on reliable, high-quality information regarding the potential risks of using such substances. This highlights the need for a clear policy and well-structured, professionally reviewed guidance specifically directed at medical students about the use of Provigil and other cognitive enhancers, to help minimize associated risks.

Survey results indicated that Provigil appeared to improve perceived cognitive abilities, with many participants noting that some positive effects persisted over time. At the same time, users reported immediate negative side effects, most commonly difficulty sleeping—an expected outcome given Provigil’s primary prescription use for narcolepsy. Importantly, all the effects and side effects described by participants aligned with findings already documented in existing literature (Kredlow et al., 2019), with no additional effects noted under the “other” category.

In terms of potential dependency, none of the respondents considered themselves dependent on Provigil, though one participant remained unsure. This aligns with prior research suggesting that Provigil carries a low risk of addiction (Myrick et al., 2006). Interestingly, the drug has even been explored as a possible treatment option for dependence on other stimulants, such as cocaine (Kapman, 2019). However, isolated case reports have noted instances of physical dependence (Krishnan and Chary, 2015; Alacam et al., 2018), underscoring the need for caution, particularly when used long-term. These concerns are especially relevant for students, as early exposure to Provigil could have lasting consequences on their health and well-being.

Regarding attitudes toward Provigil, most respondents—whether they had used the drug or not—expressed a willingness to consider it for cognitive enhancement but voiced moderate concerns about its safety profile. Notably, peer pressure did not appear to be a significant influence on participants' decisions. Additionally, most did not view the use of Provigil as a form of academic dishonesty, which reflects similar findings in recent studies (Kesta and Newton, 2024).

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