The need for speed: the fast and furious marketing of amphetamines

Abstract

Amphetamines were for years a “drug looking for a disease.” Allen Shaughnessy considers a chronicle of their many uses in that time

Ask most doctors about methamphetamine and they will describe its ability to ruin many lives, causing a societal blight. Ask most doctors about methylphenidate and they will describe its valuable role in treating children and adults who can’t focus.

On Speed tracks “the many lives” of the amphetamines, from the discovery of amfetamine in 1929 to current use today as black market drugs of misuse and white market treatments for obesity and attention deficit hyperactivity disorder. Amfetamine started as a potent drug without a role—until one was created. The author characterises it as a “drug looking for a disease.” On Speed also traces the development of the market for amphetamines and the evolution of drug companies into the potent marketing machines they have become.

The first recorded use of amfetamine was by its developer, the biochemist Gordon Alles, who had a colleague inject him with 50 mg, five times more than what would become the usual dose. Concerned with its haemodynamic effect, Alles scrupulously recorded blood pressure readings for eight hours. In the margins he noted a “feeling of wellbeing.” In an addendum he noted, “Rather sleepless night. Mind seemed to run from one subject to another.”

Indeed. Such would become the hallmarks of amphetamine use. In the United States the effects of amphetamines were seen as “increasing pep” and making users more efficient. In Britain people admired its ability to make them feel confident, clever, and witty. Higher doses created aggressive soldiers in the battle theatre, unleashed creativity in the Beatnik generation, and served as a social lubricant for suburban parties.

Initial pursuit of a market for amphetamines considered all things neuropsychological, including alcoholism, schizophrenia, anxiety, bipolar disorder, dysmenorrhoea, Parkinson’s disease, performance enhancement, and narcolepsy. After many misses amfetamine was marketed to treat depression, a diagnosis with only some similarity to its definition today. Early advertisements for the drug defined depression as heralded by a difficulty in thinking or acting, hypochondria, a “sensation of weakness,” and “apathy or discouragement,” allowing the drug to cut a wide swath through a doctor’s day in the office.

At the same time amfetamine and methamphetamine gained a huge reputation as motivators of soldiers, a sanctioned role the drugs would play through to the end of the Vietnam War. Used by both sides during the second world war, German troops consumed 35 million tablets of methamphetamine during the peak three months of the Blitzkreig. The British military distributed 72 million tablets of amfetamine over the course of the war.

These “wakey wakeys” or “pepper uppers” were shown in many studies to be ineffective in improving work output and generally had a negative effect on judgment on the battlefield. However, amphetamines were prized by generals, who saw them increase morale and aggression, making men more determined to fight.

By the end of the war amphetamines enjoyed widespread use in many countries. Jazz artists would use high doses by opening plastic canisters of Benzedrine (amfetamine) inhalers sold without prescription for nasal congestion and eating the paper sections that contained 250 mg of the drug. Charlie “Bird” Parker used so much during a performance that “the floor around him would sometimes be covered by so many white plastic empties that it looked like snow.”

The Beat generation fully embraced amfetamine use as an essential component of creativity. Legend has it that Jack Kerouac put a continuous roll of paper into his typewriter, went on an amfetamine bender, and pounded out On the Road in three weeks.

Speed remained a part of the counterculture through the 1960s. Royston Ellis showed members of the “Silver Beetles” how to use amfetamine. George, John, and Paul would later move on to the Beatles and to other forms of pharmacology. Amphetamines played a major role in the storyline of the Who’s rock opera Quadrophenia. Andy Warhol used his inspiration that “seeing everybody so up all the time [on speed] made me think that sleep was becoming obsolete” to create the film Sleep.

Amphetamine use was also part of the mainstream culture; in 1960, about 3% of all prescriptions in both Britain and the United States were for an amphetamine. By the late 1960s it was estimated that 7% of Americans either used a prescribed amphetamine or took the drugs regularly for recreational purposes.

Heavy prescribing occurred despite the well known psychological addiction that can occur with regular use. A reporter describes attending a “white collar pill party” where “colorful pills were being passed around like canapés.” It wasn’t until 1964 in Britain that possession of amphetamines without a prescription became a criminal offence.

The eventual stiffer rules regarding the manufacture and sale of amphetamines did not decrease demand but simply set up different supply chains; with commonly available chemicals an amateur chemist can manufacture methamphetamine or its new cousins such as methylenedioxyamphetamine (ecstasy).

The author also points out that licit makers of amphetamines had to find suitable commercial outlets, which they did by targeting overweight and underattentive people. The worldwide market in drugs to treat obesity is expected to expand to be worth some $1.3bn by 2010 (Nature Reviews Drug Discovery 2002;1:257-8), a large part of it from the (legal) amphetamine sibutramine. In the United States, between 1990 and 2000 the number of children with a diagnosis of attention deficit hyperactivity disorder grew fivefold. In 2005 more than 2.5 billion doses of amphetamine or methylphenidate were dispensed in the US.

On Speed is a fascinating and thoroughly researched “biography” of a class of drugs for which markets had to be created. The history of amphetamines over the past 70 years shows the iron fisted grasp the drug industry has had and continues to have over the medical industry. Diagnoses are created (see today’s “social anxiety disorder”), regulators fail to regulate, drugs are peddled, prescribers are convinced, drugs get sold, and, sometimes, epidemics get created. On Speed shows how easy it is for societies to get run over by the fast and furious locomotive of commerce.

Cite this as: BMJ 2008;337:a741