Chapter 36. The amphetamines

The drug now known as amphetamine was first synthesized in 1887; but medical uses were not noted until 1927, when its effectiveness in raising blood pressure was discovered, as well as its effects in enlarging the nasal and bronchial passages and in stimulating the central nervous system. The drug was accordingly marketed in 1932, under the trade name Benzedrine. In 1935, its effectiveness as a stimulant led physicians to try it, with excellent results, against a rare but serious disease, narcolepsy, the victims of which fall asleep repeatedly.

Other amphetamines, and other uses for these drugs, soon followed. In 1937 the discovery was made that the amphetamines have a paradoxical effect on some children whose functioning is impaired by an inability to concentrate. Instead of making them even more jittery, as might be expected, the amphetamines calm many of these children and notably improve their concentration and performance.

By the end of 1971, at least 31 amphetamine preparations (including amphetamine-sedative, amphetamine-tranquilizer, and amphetamine analgesic combinations) were being distributed by 15 pharmaceutical companies.

The more scientists learned about these new drugs, the closer the parallel with cocaine appeared. The following description of the psychic effects of a modest dose of amphetamine, written by Drs. Ian P. Innes and Mark Nickerson in Goodman and Gilman's textbook (1970), may be compared with Sigmund Freud's description of the effects of cocaine (see Chapter 35):

The main results of an oral dose ... are as follows: wakefulness, alertness, and a decreased sense of fatigue; elevation of mood, with increased initiative, confidence, and ability to concentrate; often elation and euphoria; increase in motor and speech activity. Performance of only simple mental tasks is improved; and, although more work may be accomplished, the number of errors is not necessarily decreased. Physical performance, for example, in athletics, is improved. These effects are not invariable, and may be reversed by overdosage or repeated usage.

Large doses of cocaine, it will be recalled, are followed by depression. Precisely the same proved true of the amphetamines: "Prolonged use or large doses are nearly always followed by mental depression and fatigue.

Many individuals given amphetamine experience headache, palpitation, dizziness, vasomotor disturbances, agitation, confusion, dysphoria, apprehension, delirium, or fatigue."

Cocaine, it will also be recalled, first came into common use after a German army physician issued it to Bavarian soldiers. During World War II, the American, British, German, and Japanese armed forces similarly issued amphetamines to their men to counteract fatigue, elevate mood, and heighten endurance. In at least two respects, the amphetamines proved superior to cocaine. First, they can be taken orally in tablet form; cocaine is poorly absorbed from the gastrointestinal tract and is therefore usually either injected under the skin or into a vein, or else sniffed. Second, the amphetamines taken orally have a much longer duration of effectiveness–– seven hours or so–– while cocaine must be taken at more frequent intervals for a sustained effect.

After World War II, many physicians prescribed the amphetamines routinely for depression. In many cases they proved worthless or even harmful. In certain cases, however, they proved helpful during the depressive phase of a manic-depressive psychosis; and in certain cases patients unable to concentrate on their work, because of the kind of " neurasthenic" depression and fatigue from which Sigmund Freud suffered, reported that the drug elevated their mood just enough to enable them to work effectively–– as cocaine had aided Freud.

just as cocaine and heroin users learned that a combination of the two drugs (the speedball) provided results superior to either drug taken alone, so some psychiatrists and pharmacologists concluded on the basis of clinical experience that a combination of an amphetamine and a barbiturate or tranquilizer secured improved effects in some cases of depression. This superiority has not been fully established through adequately controlled, double-blind tests, in which neither the physician who administers the drug nor the patient taking it knows whether medication or an inert substance (placebo) is being taken. Nevertheless, Dexamyl and other combinations of this kind are still commonly prescribed by physicians, not only against chronic fatigue and against depression but also as supposed aids to dieting.

Do amphetamine users escalate their doses, as is so often the case with cocaine users? Not always. A small daily dose of an amphetamine, for example, may continue to be effective for years for narcolepsy and among those children for whom the drug has a calming effect. Some patients who occasionally use an amphetamine for fatigue or depression report that the same modest dose remains effective year after year. Other users escalate their dose rapidly to enormous levels–– swallowing whole handfuls of amphetamine tablets instead of only one or two. The eventual outcome is often an amphetamine psychosis very similar to the cocaine psychosis from which Fleischl suffered–– even to the feeling of ants, insects, or snakes crawling over or under the skin.

Side by side with the expansion of the legal market for prescribed amphetamines after World War II, a modest black market in the drugs also grew up. Early black-market patrons included in particular truck drivers trying to maintain schedules which called for long over-the-road hauls without adequate rest periods. Soon truck stops along the main transcontinental routes dispensed amphetamines as well as coffee and caffeine tablets (see Chapter 22) to help the drivers stay awake. Students, who had long used caffeine tablets, now turned instead to these new amphetamine "pep pills" when cramming for exams. The use of amphetamines by athletes and by businessmen (and their secretaries) was reported as early as 1940.

Periodic law-enforcement drives to curb black-market amphetamines proved ineffectual, or perhaps even counterproductive; for the publicity surrounding the arrests served to advertise the product–– and the arrests, by increasing the risk and therefore the price, served to attract additional entrepreneurs. When amphetamines were hard to get from other sources, users purchased Benzedrine inhalers, broke them open, and ingested the substantial quantities of amphetamine found inside. Later the Benzedrine inhalers were withdrawn from the market; they were replaced by inhalers that do not contain amphetamine.

Cocaine users also turned to the black market for amphetamines, and used them much as they had formerly used cocaine. The cost of the amphetamines is trivial–– as little as 75 cents per thousand tablets at wholesale, even during the 1960s. Thus peddlers could sell black-market amphetamines at a fraction of the cost of imported cocaine and still make a substantial profit. The "speedball" of the 1960s contained heroin and an amphetamine rather than heroin and cocaine.

In 1965, amendments to the federal food-and-drug laws were passed, designed to curb the black market in amphetamines as well as in barbiturates and other psychoactive drugs. The amendments did indeed make it harder to divert legally manufactured amphetamines into the black market. A second effect, however, was to stimulate greatly the illegal manufacture of amphetamines in kitchens and garages within the United States. This is a topic to which we shall return.

Footnotes
Chapter 36

1. John C. Kramer, "Introduction to Amphetamine Abuse,"  Journal of Psychedelic Drugs, vol. II, no. 2 (1969): 1.

2. Roger C. Smith, "The Marketplace of Speed: Violence and Compulsive Methamphetamine Abuse"; unpublished (1969), p. 6.

3.  Physicians' Desk Reference to Pharmaceutical Specialties and Biologicals, 26th ed., 1972 (Oradell, N.J.: Medical Economics, 1972), pp. 202, 302, 308, 317.

4. Ian P. Innes and Mark Nickerson, in  Goodman and Gilman, 4th ed. (1970), p. 502.

5. Ibid.

6. lago Galdston, "Pep Teasers,"  Hygeia, 18 (October 1940): 878-880, cited by Roger C. Smith, "Marketplace of Speed," p. 8.