Are the presidential candidates taking any prescription drugs to aid their performance?

The drug is called modafinil or Provigil.

It is generally prescribed for narcolepsy and shift-work sleep disorder (when, for example, people switch from day-shifts to night-shifts and need to adjust their body clocks).

It also has off-label uses as a cognitive enhancer. It can, in some circumstances, improve spatial planning, memory and overall cognitive performance. For this reason, it is used by militaries around the world, including by pilots flying long-distance missions.

It is a Schedule IV drug in the U.S., which generally means you can only get it with a prescription from a doctor, but it is considered low-risk for dependency or abuse. How it is treated in other nations varies widely. China considers it high-risk, whereas it is available in Mexico over the counter. 

I took it once, by prescription from the White House Medical team, when I was working there. The conditions under which I did so would probably be considered typical for its use — after more than 24 hours of travel across 11 time zones. Indeed, the day I took it, we landed on Air Force One in the late afternoon and had a diplomatic event just a few hours later. It worked exactly as planned. My mind was clear and I was not drowsy, nor was I “high” in any sense. And I had none of the occasional side effects.

To my knowledge, Donald Trump has never taken this drug. Indeed, Trump is well-known for his ability to function normally on only a few hours of sleep each night, and for his aversion to drugs of any sort (including alcohol).

But to be clear, if I had ever observed a critical circumstance where the president of the United States needed to be at his absolute highest levels of cognitive performance, and where I thought he might be impaired by lack of sleep, I surely would have condoned, even recommended — with the approval of the White House physician — use of modafinil. 

Which raises this question for Thursday night: Is a presidential debate one of those sorts of times?

Donald Trump’s team raised more than a few eyebrows several months back when it suggested that a pre-condition to any debate would be that the candidates both take a drug test. That demand came hard on the heels of Biden’s performance in the State of the Union address this past March. Somehow, Biden went from a man who shows so many signs of cognitive decline — shuffling when he walks, appearing easily confused and distracted, even calling on people who he knew were dead  — to giving what can fairly be described as an energetic performance.

“He was high as a kite,” Trump has suggested more than once. 

There is no hard evidence of that, of course. But Trump was not the only one questioning whether Biden had taken anything to help improve his performance that evening. Yes, he might have just had a good bit of time to rest and prepare. Maybe he had just the right amount of coffee (which also can act as a cognitive enhancer). The first place my mind went, however, knowing what I know and given my own personal experience was modafinil.

Looking ahead to Thursday, it would be not only be fair but helpful to the voting public for the moderators at CNN to ask each candidate in turn whether he is taking any prescription medication whatsover in order to help his performance.

I would fully expect Trump to answer in the negative. I have no idea what Joe Biden would say. Even if he says “yes,” I don’t think it should necessarily be determinative for voters. But I do think it would be helpful to know whether or not either of the men seeking the highest office in the land feels like he needs medication to get through a presidential debate.  

After all, debates are important. But they pale in comparison to the gravity of other events — sometimes encountered on a daily basis, or even multiple times in the same day — when a president needs to be at his best.

And while low-risk, like so many drugs, you cannot keep taking modafinil forever.

Mick Mulvaney, a former congressman from South Carolina, is a contributor to NewsNation. He served as director of the Office of Management and Budget, acting director of the Consumer Financial Protection Bureau and White House chief of staff under President Donald Trump.