Unsafe At Any Speed

Amphetamines—variously known as speed, ice, crystal, pep pills, Benzedrine, Dexedrine, Adderall, Ritalin, and countless other brand names—have played a persistent role in the pharmaceutical armamentarium since the 1930s. In 1969 alone, the U.S. pharmaceutical industry produced at least 8 billion 10-mg standard doses of amphetamine salts, enough to supply 40 pills for every man, woman, and child in the country. After a brief drop in both supply and demand due to federal narcotics regulation in the 1970s, by 2006 nearly 20 million Americans were once again taking some form of amphetamine on a regular, mostly prescription, basis.

The very prevalence of such a mind-altering drug would make it a book-length study of interest to chemists and other pharmaceutical researchers. But more than this, Nicolas Rasmussen, author of "On Speed: The Many Lives of Amphetamine," argues that the story of the rise, fall, and lasting legacy of amphetamines can be seen as a stand-in for the modern pharmaceutical experience. The unnerving implications of this argument for our society as a whole only slightly complicate the pleasure of reading this engagingly written and frequently entertaining book.

The discovery of the physiological and psychotropic effects of amphetamines might, at first blush, seem to belong to another era. In 1929, Gorden Alles, a 27-year-old chemist working in an allergist's shop in Los Angeles, had a physician friend inject him with 50 mg of his latest creation, β-phenylisopropylamine. Although concerned about the drug's effects on Alles's blood pressure, the two men noted with approval that it cleared Alles's sinuses and left him with a "feeling of well being." But Alles was not simply another backroom chemist self-experimenting with random compounds. Instead, his research represented a solid step toward modern drug-screening processes.

In response to the phenomenal discovery of insulin's effect on diabetes less than a decade earlier, researchers had been searching high and low for the next biologically based wonder drug. Back at the allergist's office, Alles had been systematically looking for compounds that shared structural components with adrenaline (recently isolated from the adrenal gland) and ephedrine (the active compound in the Chinese herb Ephedra). By the time that he came to test the compound that would become known as amphetamine on himself, Alles had already studied its effects on dogs and rabbits, administered both orally and by injection. His search for related compounds also led him to the discovery of methylene-dioxyamphetamine—better known now as ecstasy. After further animal testing and a patent, Alles licensed the salt of amphetamine to the Philadelphia firm of Smith, Kline & French (SKF), which soon marketed it as a decongestant under the brand name Benzedrine Sulfate.

And here the story of amphetamine might have ended were it not for an innovative marketing and research campaign by SKF that Rasmussen details. Not knowing what, exactly, the drug might be used for, research managers at SKF distributed it to any physician who asked for it, provided the company was kept informed of the results. Soon doctors across the country were trying out amphetamines as a treatment for everything from asthma to narcolepsy to weight loss. The use that stuck, however, was as a treatment for depression, thanks in large part to an enthusiastic push from Abraham Myerson, a leading psychiatrist at Harvard University. Myerson's embrace of amphetamine as the first antidepressant was important not only because it established anhedonia, or lack of pleasure, as the key clinical indicator for depression; it also established a pattern in which pharmaceutical companies partnered with academic thought leaders to identify markets for their drugs. Myerson found that moderate (20 to 40 mg) doses of Benzedrine reduced anxiety, removed despondency, and generally cheered up anhedonic patients. SKF's advertisements for Benzedrine were just as much advertisements for the new condition of "mild depression" as they were for the treatment itself.

Amphetamines' ability to improve users' zest for life was, Rasmussen argues, perfectly suited for the changing needs of 20th-century society. German, British, and U.S. military leaders believed the feeling of well-being associated with the drug improved soldier morale. British office workers declared that it made them feel more "self-confident." University students in the U.S. liked the perceived edge it gave them on exams. Psychologists around the world praised its abilities to help their patients cope with the anomie of modern, postindustrial society. And soon—perhaps inevitably—beatniks, jazz musicians, and biker gangs had discovered the thrills and perils of speed jags.

The increasing frequency of "amphetamine psychosis," including hallucinations and paranoia, among long-term users served as a warning sign that something was amiss. Doctors and regulatory agencies were shockingly late to recognize the addictive and destructive properties of amphetamines: At the height of what Rasmussen calls an "epidemic of speed" in the late 1960s, he estimates that about 5% of the U.S. population had taken amphetamines in the previous year, with somewhere between a half million and a million people having become at least somewhat dependent on the drugs. Remarkably, amphetamines did not become controlled substances in the U.S. until 1971.

Although the book contains many distressing stories about the effects of amphetamine addiction, the theme of selective ignorance is particularly disheartening. The book repeatedly tells of military doctors, family practitioners, psychiatrists, and psychologists who recommended that their patients take amphetamines without much, if any, evidence that the drugs were either safe or effective. In the military's case, Rasmussen uncovers studies that make clear that military brass knew that amphetamines were no more effective in improving the performance of exhausted troops than caffeine, but they nonetheless recommended the addictive and psychosis-inducing amphetamines because they improved soldiers' willingness (rather than their ability) to fight. Similarly, Rasmussen quotes numerous psychologists who recommended amphetamines as the treatment of choice for patients stuck in dead-end, mind-numbing jobs. In these and other examples, experts recommended amphetamines because they provided an easy, and profitable, solution to the most discouraging aspects of contemporary life.

Given this history, it is perhaps not surprising that a new use for amphetamines has emerged. Two of the leading drugs for attention deficit disorder (a diagnosis introduced only in 1980) are amphetamines; in the case of Adderall, the active ingredient is, in fact, the original amphetamine. Somewhere between 4 million and 5 million Americans are now receiving medication each year for ADD, most of them children. Although Rasmussen is hardly the first critic to question the wisdom of medicating so many children, his critique is rather more compelling in light of the obvious, and tragic, historical consequences of the overprescription of amphetamines he has detailed. This is, after all, a drug that was once used to create models of schizophrenia in animals. Should we really be giving it to children? he asks.

Ultimately, Rasmussen argues, Americans' need for speed is largely the result of a deregulatory philosophy that has allowed the pharmaceutical industry to promote whatever drugs the market will bear. From this perspective, direct-to-consumer advertising of pharmaceuticals is as much a symptom as a culprit in the overmedication of contemporary society. Though some readers may quibble with its policy recommendations, the book is an eye-opening window into a darker, more ethically suspect world lurking behind the cheerful advertising. It's enough to keep one up at night.