Chapter 37. Enter the "speed freak"

Amphetamines taken orally can be used in excess with unfortunate results; but enormous quantities of oral amphetamines were consumed in the United States during the 1940s and 1950s with apparently little misuse. As late as 1963, indeed, the American Medical Association's Council on Drugs, while recognizing the possibility of misuse, reported that "at this time compulsive abuse of the amphetamines constitutes . . . a small problem [in the United States]." Much the same finding was reported from Sweden (see Chapter 39).

The intravenous injection of large doses of amphetamines, in contrast, is among the most disastrous forms of drug use yet devised. The early history of amphetamine mainlining has been explored by a California criminologist and authority on illicit drug use, Dr. Roger C. Smith, in an, unpublished study he made available for this Report. Dr. Smith is now director of Marin Open House, a comprehensive center for drug and other problems in San Rafael, California. The Smith study was a part of the San Francisco Amphetamine Research Project, financed by the National Institute of Mental Health and launched by Dr. Smith in May 1968, in cooperation with the Haight-Ashbury Medical Clinic in San Francisco. Much of this chapter is drawn from Dr. Smith's study, "The Marketplace of Speed: Violence and Compulsive Methamphetamine Abuse," and from a report by a California psychiatrist, Dr. John C. Kramer, entitled "Introduction to Amphetamine Abuse," published in the  Journal of Psychedelic Drugs in 1969. Dr. Kramer began his amphetamine research while he was on the staff of the California Rehabilitation Center in Corona, California–– a center in which "speed freaks" as well as heroin addicts are incarcerated; he is at this writing on the faculty of the University of California at Irvine and on the staff of Dr. Jerome H. Jaffe's Special Action Office for Drug Abuse Prevention in Washington, D.C.

The earliest reference to the intravenous use of amphetamines that Dr. Smith was able to unearth concerned groups of American servicemen stationed in Korea and Japan during the early 1950s. These men were said to have learned to mix amphetamines–– then nicknamed "splash" with heroin and to inject the combination. This was, in effect, the traditional "speedball," with amphetamine substituted for cocaine. Servicemen brought the custom home with them after the Korean War. No doubt other small groups also learned to mainline amphetamine, alone or with heroin, during the 1950s; but no public furor was raised against the practice–– and it did not spread alarmingly–– until the 1960s.

Sigmund Freud's first dispensing of cocaine to a patient, it will be recalled, was to help his pain-wracked friend, Fleischl-Marxow, get along without morphine. During the late 1950s, in the San Francisco Bay Area, a number of physicians prescribed amphetamine injections for the same purpose–– or allegedly for the same purpose.

Dr. Smith reports there is little doubt that some Bay Area physicians were sincere in this use of amphetamines as a treatment for heroin addiction. They were nevertheless arrested for supplying drugs to heroin addicts. Other California physicians, it appears, were less conscientious. Some of them, for example, prescribed Methedrine (methamphetamine) "for heroin addiction" without even examining patients to see if they had needle marks. One Methedrine user told Dr. Smith:

Then there was a doctor ... who would write anything for anybody at anytime and he was making $7 a visit and on the day we went down there he wrote almost 400 prescriptions at $7 a head. So you can imagine how much money he was making. He made $2,800 that one day and they used to make caravans down there and even from [Los Angeles] to his place. You'd get within two blocks of his office and you'd start seeing people you knew from all over.

One heroin addict reported that for $6 or $7 he could get from one physician a prescription for 100 Methedrine ampules–– plus hypodermic needles and sedatives. He could then sell enough of the ampules at $1 or $1.50 apiece to make a living. "In many instances," Dr. Smith adds, "heroin addicts who had formerly engaged in burglary, bad checks, credit cards, or a variety of other 'hustles,' began to make money exclusively by sales of Methedrine." It was at about this time, in the early 1960s, that Methedrine came to be known as "speed"–– perhaps an allusion to its use in the traditional "speedball." More recently, "speed" has come to refer to  any amphetamine which is injected intravenously.

In addition to the "scrip-writer" physicians described above, some San Francisco pharmacies began selling injectable amphetamines without a prescription, or on the basis of crudely forged prescriptions, or on a telephoned "prescription" from a user posing as a physician. Federal, state, and local law-enforcement agencies cracked down on such practices in 1962 and 1963; physicians and pharmacists alike were convicted of law violations, accompanied by widespread publicity. Thus the delights of amphetamine mainlining, previously known primarily to heroin addicts, became a matter of common knowledge and general interest.

When the injectable amphetamine scandal broke publicly in 1962, and federal and state agents descended on the manufacturers, Abbott withdrew Desoxyn ampules from the market. In July 1963, Burroughs Wellcome similarly withdrew Methedrine ampules from distribution through retail pharmacies, but continued to make them available to hospitals as an adjunct to surgical anesthesia and for other essential uses. Withdrawal of legal supplies meeting FDA standards of purity for injectable products marked a turn for the worse. The black market next secured nonsterile amphetamines at trivial cost in vast quantity from large chemical manufacturing companies which shipped in bulk. The infection rate among addicts no doubt rose when these nonsterile products took the place of FDA-approved ampules.

The 1962 crackdown on legal sources of amphetamines also triggered the emergence of illicit factories, called "speed labs," where speed was manufactured. "According to many of the users interviewed during the course of this study," Dr. Smith reports, " 'speed labs' began to operate as early as 1962, and by 1963 several labs were in operation in the San Francisco Bay Area. Because of the shortage of speed in other cities on the West Coast [a shortage caused by the withdrawal of Burroughs Wellcome and Abbott ampules and by the crackdown on physicians and pharmacies], the manufacture and distribution of speed became an extremely profitable enterprise, and opened up new sources of revenue within the San Francisco drug scene." The further history of these labs will be reviewed in Chapter 40. *

* The 1965 amendments to the federal drug laws, by requiring manufacturers and wholesalers to keep records of all shipments, made it more difficult to divert legal amphetamines to the black market. This served to protect the "speed labs" from low price legal competition and enabled them to raise prices. American black-market operators got around the new law, however, by placing large orders for legal amphetamines to be sent to addresses in Mexico; they then smuggled the American amphetamines back into the United States. (The same dodge had been used by morphine traffickers during the first years after passage of the Harrison Act of 1914.) When law-enforcement officers at length caught up with this practice, excessive shipments to Mexico were curbed. This further protected the black-market speed labs in the United States from competition.

By 1965 or 1966, the full impact of speed mainlining became visible. A report entitled "Amphetamine Abuse: Pattern and Effects of High Doses Taken Internally," by Drs. John C. Kramer, Vitezslav Fischman, and Don C. Littlefield in the  Journal of the American Medical Association for July 31, 1967, outlined the problem–– and Dr. Kramer's 1969 paper, cited above, supplied later details.

The first use of intravenous amphetamine, Dr. Kramer notes, is "an ecstatic experience," and the user's first thought is, "Where has this been all my life?" Dr. Kramer goes on, "The experience somehow differs from the effects of oral amphetamines not only quantitatively but also qualitatively." After this first experience, the user mainlines intermittently for a time; "doses probably equivalent to twenty to forty milligrams per injection may be taken once or a very few times over a day or two. Days or weeks may intervene between sprees. Gradually the sprees become longer and the intervening periods shorter; doses become higher and injections more frequent." The sequence recalls Dr. von Fleischl-Marxow's experience with cocaine in Vienna in the 1880s. "After a period of several months," Dr. Kramer continues, "the final pattern is reached in which the user (now called a 'speed-freak') injects his drug many times a day, each dose in the hundreds of milligrams, and remains awake continuously for three to six days, getting gradually more tense, tremulous and paranoid as the 'run' progresses. The runs are interrupted by bouts of very profound sleep (called 'crashing') which last a day or two. Shortly after waking ... the drug is again injected and a new run starts. The periods of continuous wakefulness may be prolonged to weeks if the user attempts to sleep even as little as an hour a day. "

Dr. Kramer cautions against the simplistic view that anyone who once shoots amphetamine intravenously inevitably follows this pattern of escalation. "There are individuals who have tried it once or several times and have chosen not to continue." Nevertheless, the tendency to progress to compulsive use is very strong.

The desired effects of speed-injecting, Dr. Kramer continues, "are extremely vulnerable to the impingement of tolerance. It takes ever more drug to recreate this chemical nirvana. It is the desire to re-experience the flash and the desire to remain euphoric, and to avoid the fatigue and the depression of the 'coming down,' which drives the users to persist and necessarily to increase their dose and frequency of injection. And it is this persistence of use and these large doses which bring on all the other effects of these drugs."

Dr. Roger C. Smith here adds a highly significant fact about the intravenous-amphetamine euphoria. Many young people in our culture are brought up with a seriously damaged self-image. The methods of discipline imposed upon them as children, or other factors, convince them of their own inherent worthlessness, though they may mask this sense of worthlessness with bravado. "Many of the young people who are currently involved in the speed scene," Dr. Smith notes, "report that they were initially attracted to the drug because of the instant improvement noted in self-image. Many suffered from feelings of inferiority and lack of self worth, which manifested itself in chronic, and often debilitating, depression.

"Many [of these young people with damaged self-images] had experimented with a variety of depressants, including heroin, barbiturates, and alcohol, but found that this only increased their feelings of depression and self-deprecation. The alleviation of depression brought about by the use of speed may well be the key factor in determining why some individuals progress from occasional to compulsive use of the drug" –– though Dr. Smith also emphasizes that other factors may come into play as well.

In any event, Dr. Kramer points out, the improvement of self-image and relief from depression is purchased at a very high price if intravenous amphetamines are the mode of relief. Whether or not small oral doses of amphetamine are effective aids to dieting, the large doses taken during speed "runs" produce profound anorexia (lack of appetite). "Users uniformly lose weight during periods of abuse. Appetite suppression may be so profound that users may find the very act of swallowing difficult." Some users force themselves to take small amounts of highly nutritious foods or beverages, or inject themselves with vitamins and dietary supplements. Upon awakening after a prolonged speed run, a riser may eat large amounts. But even so, "undernutrition and malnutrition result, and undoubtedly complicate all the other effects of high dose amphetamine use."

Sleep deprivation similarly exacerbates and complicates the direct pharmacological effects of the drug. "The observation that many of the physical and psychological symptoms are largely dissipated after sleeping for a day or two suggests that the insomnia alone is a major contributor to the syndrome," Dr. Kramer notes. But, he adds, "the fact that some symptoms persist after weeks or months of abstinence indicates that sleep deprivation is not alone responsible. Considering that the usual pattern seen during well-established high dose abuse is of three to six days of wakefulness followed by one or two days of sleep.... users spend about one-fourth of their time in sleep, about the same proportion as non-users only distributed differently."

A paranoid psychosis, similar to the cocaine psychosis, is the almost inevitable result of long-term, high-dose, intravenous speed injection. This psychosis "can be precipitated by either a single large dose or by chronic moderate doses," Dr. Kramer adds.

Typical features of the speed psychosis include feelings of persecution, feelings that people are talking about you behind your back (delusions of reference), and feelings of omnipotence. * Unlike paranoid schizophrenics, however, "speed freaks" are usually aware that these feelings are drug induced; that is, they retain insight. "High-dose intravenous users of amphetamines generally accept that they will sooner or later experience paranoia. Aware of this, they are usually able to discount for it." Nevertheless, Dr. Kramer adds, "when drug use has become very intense or toward the end of a long run even a well-practiced intellectual awareness may fail and the user may respond to his delusional system." Dr. Kramer cites others as believing that the drug merely brings into the open preexisting paranoid tendencies. On the basis of his own experience with a large number of high-dose users, Dr. Kramer expresses the opinion, which he agrees is not testable, that despite differences in vulnerability to the paranoid effect, "anyone given a large enough dose over a long enough time will become psychotic."

* The formication hallucination first noted by Freud's friend Fleischl–– that is, imaginary snakes or insects crawling on or under the skin–– also characterizes the speed psychosis. Speed freaks call them "crank bugs," Dr. Roger C. Smith reports. "It is common to see speed freaks with open running sores or scabs on their faces or arms as a result of picking or cutting out these hallucinated crank bugs." He quotes an experienced twenty-four-year-old speed freak on the subject: "It's just that when you're shooting speed constantly you start to feel like there's bugs going around under your skin and you know they're not there, but you pick at them anyway.... Once in a while you'll see a little black spot and you'll watch it for ten minutes to see if it moves. If it doesn't move it isn't alive. You can feel them on your skin. I'm always trying to pick them out of my eyebrows.

Dr. Smith cites numerous examples of this paranoia of the speed freak. "Each user has several entertaining stories relating to something which he did in order to protect himself from the police or secret agents whom he suspected were about to arrest him. In some instances the individual will lock himself in a room and refuse to come out, will arm himself with a knife or gun, or may, on rare occasions, actually assault a suspected informant or policeman. Tales of such activity have now become an integral part of the lore of the speed scene......... The fact that the speed scene is actually heavily infiltrated with informers and narcotics officers does nothing, of course, to dispel this paranoia.

The paranoid behavior of the speed freak may at times look superficially like murderous aggression. Dr. Smith quotes a "veteran" of the speed scene on this point:

It happens quite often by mistake where somebody's all jacked up and has been for say a week, maybe two or three weeks, and somebody burns [cheats] them, they may go crash for a day or so to get their head back together somewhat, and when they get up they don't remember too much what the person looked like or who the person was, they're just out running around. I've seen people who are running around on the streets with a gun under their jacket, and they run up behind somebody and say ". . . that looks like him–– long blond hair. We got you." and then "Sorry, wrong one" and go on down the street and on to the next guy with long blond hair and stop him.

An even greater hazard of violence, Dr. Smith adds, accompanies the mainlining of amphetamines along with barbiturates:

In the course of our research, we have interviewed numerous individuals who regularly combine speed with barbiturates, boiled down and injected intravenously, who have exhibited highly irrational, often violent behavior. Barbiturates are commonly used to terminate the speed run and induce sleep, although they are sometimes used intermittently as the drug of choice. Even the most committed speed user agrees that individuals shooting [short-acting] barbiturates (sometimes as much as 10 Seconals per injection) are the most dangerous and irrational individuals in the drug scene. The barbiturates produce a state of disinhibition similar to alcohol intoxication, with slurred speech, staggering, and often, surliness and aggressiveness which can easily be escalated to physical violence, particularly when used in combination with speed.

In support of this view, Dr. Smith quotes a drug user's description of one of his friends:

He's a very nice person, and extremely generous; however, when he gets all jacked up and he is wired [stimulated with speed] and is doing reds [Seconals], then he is in trouble. Because pretty quick he's got a shot gun and everybody else has got a shot gun. I've seen him out in front of ... the freeway entrance herding the hitch-hikers away because he's paranoid of them. At four o'clock in the afternoon, with a full length shot gun, he's screaming "move on, you can't stand there, move on." That's just the way he gets.

Another user adds: "Barbs make you want to get out on the street and start kicking asses. Speed gives you the energy to get up and do it." Contrary to a widespread impression, Dr. Smith goes on to explain, the confirmed  heroin addict is a highly skilled individual. "It is his skill as a 'hustler' which economically sustains the heroin marketplace." It is the speed freak who is in fact unskilled and poorly adapted to the drug scene.

He is generally white, essentially middle-class in terms of education, family background and attitudes, and totally lacking in the kind of criminal skills which are essential to survival in a criminal environment. As critical as his lack of criminal skills is his failure to understand the values and norms traditionally associated with criminally oriented groups or subcultures. These values and norms are often antithetical to those of conventional society, but nonetheless they serve approximately the same function, namely, to offer guidance to participants and to control behavior which would be harmful to the group as a whole....

While there is a backlog of experience and tradition which the heroin addict in neighborhoods of high use can draw on, there is nothing similar in the speed culture, which emerged in its present form in late 1967, and is still undergoing rapid changes. Since there is little dependence on legitimate business for the exchange of merchandise for money, and very little integration with other illegal enterprises as one traditionally finds in heroin cultures, the "hustling" which does take place is sporadic, unskilled and predatory in nature, often directed toward fellow users and dealers, and only occasionally does it involve others outside the scene.

The speed freak is, in many ways, an outcast in a society of outcasts. He is regarded as a fool by heroin addicts, as insane and violent by those using the psychedelics or marijuana, and as a "bust" by non-drug-using hustlers.

Coming from a middle-class background, the speed freak attempts initially to support himself by "legitimate" means, "such as panhandling, selling underground newspapers, or working." But speed tends to incapacitate him for both legitimate employment and "hustling":

The compulsive speed user is usually incapable of hustles which demand composure, since he is highly agitated, suspicious and fearful that at any moment he may be detected, or the drug effect may leave him so paranoid that he would not take advantage of opportunities because they appear "too easy" or a "setup." Because of his compulsive verbalization, hyperactivity, emaciated physical state and bizarre demeanor, few businessmen will accept checks or credit cards from him. In our experience, many "speed freaks" who have attempted to pass bad checks have become panicked at a request for identification, convinced that his intended victim suspects him and will report him to police. In several instances, users have presented a check and immediately fled.

Because of the style of life which most compulsive users are involved in, their demeanor is overtly suspicious. While most heroin addicts can operate without fear of detection because of the drug effect, the speed user fits the popular stereotype of a "dope fiend."

Cut off in these ways from both licit and illicit employment, Dr. Smith continues, the speed freak survives by sponging on others and by dealing in drugs. Lacking skills and standards, he cheats. And the victims of his cheating are generally speed freaks like himself, paranoid like himself, on the verge of violence like himself. The violence that ultimately emerges–– a high level of violence, including rape, mayhem, homicide arises when the direct drug effect, the paranoia, occurs in a chaotic community where almost everybody is simultaneously engaged in sponging on everybody else, cheating everybody else–– and suspecting everybody else. This is the scene that leads even confirmed drug users to conclude that "speed is the worst."

Contrary to a popular belief, however, speed–– even in enormous doses–– very rarely kills. Dr. Smith, for example, cites one case in which a speed freak injected 15,000 milligrams of the drug–– 15 full grams–– in a twenty four-hour period without acute illness. For neophytes, it has been stated, "death has followed rapid injection of 120 mg"; but "doses of 400 to 500 milligrams have been survived." "Very few deaths have been recorded in which overdose of amphetamines has been causal" Dr. Kramer declares.

That even massive doses of speed rarely kill is surely a tribute to the inherent toughness of the human body. That the human mind can ultimately recover even from prolonged amphetamine paranoia is an equal tribute to its toughness–– yet that appears to be the case.

"What has been most striking in our experience," Dr. Kramer declares–– and Dr. Smith agrees–– "has been the slow but rather complete recovery of users who, according to their own descriptions and that of others, had become rather thoroughly disorganized and paranoid prior to their detention." The more florid symptoms fade within a few days or weeks. "Some confusion, some memory loss, and some delusional ideas may remain for perhaps six to twelve months. After that time, though there may be some residual symptoms, they are slight, and not disabling, and are noticed primarily by the (now abstinent) user himself. Most commonly, ex-users report slightly greater difficulty in remembering."

Following full or almost full recovery, curiously enough, ex-users also report a personality change that they deem favorable. Many of them, it will be recalled, were depressed, withdrawn, silent, and lacking in self esteem before turning to speed. "As a group they describe being more open and talkative than they had been prior to their use of amphetamines. They like the result and declare with certainty that it is due to their experience with amphetamines."

"Anyone concerned with the welfare of amphetamine users," Dr. Kramer goes on to stress, "and the users themselves, should recognize that most, if not all, can recover from even the most profound intellectual disorganization and psychosis given six months or a year of abstinence." This message, in addition to being true, is of considerably more publichealth significance than the false p6pular slogan, "Speed kills."

The problem is how to achieve prolonged abstinence. Many speed users, like most of the heroin users, Dr. Smith notes, have tried repeatedly to stop by a conscious act of will. Few succeed. Their withdrawal misery is too great. "Many users who attempt abstinence find it difficult because of the fatigue which results, extreme at first, gradually diminishing but persistent, perhaps for months, " Dr. Kramer adds.

Abstinence is often forced on a speed freak by a prison sentence, or by incarceration under a so-called civil commitment program, or by commitment to a mental hospital.

"No data has yet been collected to indicate the long-term value of such enforced abstinence," Dr. Kramer concedes; but on the basis of his own experience on the staff of the California Rehabilitation Center he is highly skeptical. "Certainly, many who have been incarcerated have returned to their drug use upon release." Thus the revolving-door pattern so familiar to heroin addicts may be the future of speed freaks as well. A person genuinely concerned for the welfare of speed freaks, Dr. Kramer sadly notes, is "in a bind. Users do not readily volunteer for care, but commitment programs offer little besides enforced abstinence. Should the user be permitted to live in the limbo of his drug or forced into the limbo of an institution? Can voluntary programs be devised which are sufficiently useful and attractive that users will seek them out and persist in their program? Can commitment programs be devised which do not resemble slightly benign prisons? Or, do we just let the user seek heaven or hell on his own terms while the community offers help only on its own terms ?" Dr. Kramer poses these questions; neither he nor Dr. Roger C. Smith nor we have any glib answers to offer. Drug-scene participants themselves, however, may currently be finding answers (see Chapter 42).

Footnotes
Chapter 37

1.  JAMA, 183 (1963): 363.

2. Roger C. Smith, "The Marketplace of Speed: Violence and Compulsive Methamphetamine Abuse"; unpublished (1969), p. 9.

3. Ibid., p. 11.
4. Ibid., P. 13.
5. Ibid., p. 17.
6. John C. Kramer, "Introduction to Amphetamine Abuse,"  Journal of Psychedelic
Drugs, vol. II, no. 2 (1969): 2.

7. Ibid., pp. 2-3.

8. Ibid., p. 3.

9. Ibid., p. 4.

10. Roger C. Smith, Marketplace of Speed," p. 46.

11. John C. Kramer, "Introduction to Amphetamine Abuse," p. 4.

12. Ibid., p. 5.

13. Ibid., p. 6.

14. Ibid.

15. Roger C. Smith, "The World of the Haight-Ashbury Speed Freak,"  Journal of Psychedelic Drugs, vol. II, no. 2 (1969): 178.

16. John C. Kramer, "Introduction to Amphetamine Abuse," pp, 6-7.

17. Ibid., p. 7.

18. Roger C. Smith, "Marketplace of Speed," p. 54,

19. Ibid., p. 109.

20. Ibid., pp. 110-111.

21. Ibid., p. 111.

22. Ibid.

23. Ibid., p. 113.

24. Ibid., pp. 113-114.

25. Ibid., p. 120.

26. Ian P. Innes and Mark Nickerson in  Goodman and Gilman, 4th ed. (1970), p. 504.

27. John C. Kramer, "Introduction to Amphetamine Abuse," pp. 9-10.

28. Ibid., p. 12.

29. Ibid., p. 13.

30. Ibid.

31. Ibid.

32. Ibid.

33. Ibid.

34. Ibid.