April 12, 2007: The U.S. Army is now issuing "Stay Alert" caffeine gum to combat troops. This is the latest in a long line of drugs troops have been given to keep them alert after long hours in a combat zone. This fatigue problem has existed for a long time, and has become particularly acute in the last century or so, as battles became endurance contests, with forces engaged for days on end.

The air force has a similar problem. In the last few decades, as long range bombers, and refueling in the air, became common, pilots have had to face alertness problems during very long (30 hours or more) missions. In sixty years of using "go pills" (amphetamines), the air force has never had an instance where the stimulant caused a crash or accident. In contrast, over a hundred crashes have been caused by pilot fatigue.

For over a century, one of the more popular fatigue solutions has been amphetamines ("speed"). However, this drug can impair judgment, making the user more aggressive. In the last decade, kinder and gentler medications have become available. The most effective of these has been Modafinil (sold as Provigil). This stuff is described as "a mood-brightening and memory-enhancing psychostimulant which enhances wakefulness and vigilance." Tests showed that user performance was degraded 15-30 percent, versus 60-100 percent for those who took nothing at all after 24 hours of being awake.

While the Modafinil did a pretty good job, the dextroamphetamine was still a bit better. So amphetamines remained competitive. A new stimulant, touted as superior to dextroamphetamine and Modafinil, CX717, was tested by the Department of Defense and found not appreciably superior to existing stimulants. Meanwhile, the U.S. Navy, continues to use coffee, and lots of it, to keep sailors on their toes during long hours of continuous duty. But for infantry and pilots, a hot mug of coffee is not an option.

Wakefulness can be a potent weapon, especially for commandos, or troops engaged in prolonged combat (like the Battle of Fallujah in 2004). Without these wakefulness drugs, you would have to either pull troops out of action so they could rest, or leave them in and risk having them make fatal mistakes. Either way, you have a problem, because there are never enough troops to get the job done. But with the wakefulness medications, you can solve the problem, for a few days, anyway.

Prolonged use of these drugs is not healthy. But neither is being drowsy during combat.