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Throawey comments on Open thread, Sep. 19 - Sep. 25, 2016 - Less Wrong
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Amphetamine is officially more dangerous than modafinil (for good reason), but doctors actually respond worse to patients asking for modafinil than asking for amphetamine because it's weird. The easiest way to get modafinil is probably to start with amphetamine and later ask for modafinil because it's weaker and safer.
That's... pretty goofy. I would hope sleep specialists, at least, would tend to reach for modafinil before amphetamines.
Yes, I'm sure that narcoleptics are referred to sleep specialists who know that it is on-label for narcolepsy. Probably that makes them more likely to prescribe it off-label.
But few people go to sleep specialists. Scott Alexander has written many times about how as a psychiatry resident he sees patients who need a stimulant, but can't take amphetamine. He brainstorms with his supervisor and suggests modafinil and even in this perfect setup, he gets pushback.
But I wasn't talking about sleep problems, which includes the approved use of modafinil. I was talking about using it in place of amphetamine for ADHD, which is further off-label.