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.