Since amphetamine first emerged as an over-the-counter drug in 1932, it has been widely embraced by military personnel, writers, actors, politicians, pilots, physicians, musicians, students, artists, professors, truck drivers and other people from all walks of life. As a form of self-medication I occasionally used during my college years in the late 1960s, amphetamines gave me an extra boost when I needed to cram for finals. It wasn’t until the mid–1970s when I began working as a toxicologist that I learned about the problems that could be caused by amphetamine abuse. Within my first month as a toxicologist, I encountered a middle-aged doctor whose leg had been amputated as a result of gangrene caused by his injecting amphetamines intravenously. Since, I have found that amphetamines, despite their benefits, have a potential for abuse that is most likely to occur when the drug is smoked, injected or snorted.
Used orally in low doses, amphetamines induce alertness and elevate mood. It’s no wonder that college students evaluating amphetamines during a University of Minnesota study in the early 1930s showed an overwhelming enthusiasm for the drug. It wasn’t long before researchers began to interpret a few rare cases of excess enthusiasm for the drug as signs of potential abuse. Consequently, in 1937 when the American Medical Association approved advertising the first marketed amphetamine, Benzedrine sulfate, as a treatment for narcolepsy, Parkinson’s disease, mood elevation, and mild depression, the approval specifically excluded the use of amphetamine by normal, healthy people. Articles began appearing in medical journals as early as 1938 warning against the potential abuse of amphetamines by college students. Thus, amphetamines’ reputation for abuse emerged before any true signs of abuse occurred.
Unfortunately, because of amphetamines’ growing reputation for abuse, when one 1936 study showed that amphetamines benefited the majority of children with learning disabilities, the results were quickly swept aside. In 1937, Rhode Island physician Charles Bradley observed that Benzedrine had a distinct calming effect on the behavior of hyperactive children confined to a residential treatment center. However, fears of the danger of drug abuse discouraged pursuing these benefits. These fears are expressed today in concerns that amphetamines may be being overused for children with attention deficit disorders and abused by individuals using amphetamines to improve cognitive performance.
Several parents I interviewed for this book reported that because of these fears they waited several months to years after their children were diagnosed with attention deficit hyperactivity disorder (ADHD) before starting stimulant medications. Some parents who eventually filled prescriptions for methylphenidate or Adderall stated that the improvement in their children was so dramatic after starting meds that they regretted not starting treatment sooner.
In his book Speed>Ecstasy>Ritalin: The Science of Amphetamines, Leslie Iversen describes a 35-year-old male posting on the Harvard University forums who wasn’t diagnosed with ADHD until the age of 30 despite having classic if not extreme symptoms of ADHD his entire life. Now on Wellbutrin SR for mild depression and Ritalin SR for ADHD, he and those closest to him have noticed a remarkable improvement in his ability to pay attention and communicate effectively. Before starting medication, he often felt as though he were in a mental fog. In regards to the debate over stimulants, he wishes more people would speak about their success stories. He finds that those individuals against the use of stimulants are the most outspoken (Iversen 2008, 2).
Although several non-stimulant drugs for ADHD have been introduced, the superiority of amphetamines and methylphenidate for ADHD in children and in adults is widely acknowledged by psychiatrists worldwide. Furthermore, studies by the National Institute of Drug Abuse (NIDA) confirm that the use of amphetamines for ADHD rarely leads to abuse. In fact, studies show that children with ADHD who remain untreated are more likely to abuse drugs than children with ADHD who receive medical treatment.
Although the reasons for amphetamines’ desirable effects weren’t understood in 1937, it’s now known that amphetamines increase production of dopamine and other neurotransmitters that affect attention, motivation and other aspects of behavior. With this knowledge, researchers are better able to understand why amphetamines help most, but not all, children with ADHD, and why specific types of amphetamine compounds work better for one child than another. Advances in neuroscience have also led to the emergence of more research centers such as the Center for Neuroscience and Society at the University of Pennsylvania, which are introducing programs and workshops that are pursuing the use of neuroenhancers in individuals without behavioral disorders.
The biochemical effects of stimulants also explain the performance enhancing effects observed by some, but not all, individuals. The love affair many professional athletes and academics have developed with amphetamines has led to the description of amphetamines as neuroenhancers, psychostimulants, and “smart drugs,” a topic with sociological and anti-aging implications that is explored in this book.
Used responsibly, under the medical supervision of a physician who determines the optimal drug dose and type for an individual, amphetamines have tremendous potential. At inappropriately high doses, however, amphetamines can cause serious side effects including hypertension and psychosis, and in some people amphetamine use leads to dependence. Isolated reports of amphetamine abuse have been well documented although they are far more often seen with the illicit use of methamphetamine or with injection drug use. While the subjective effects of amphetamine and methamphetamine are virtually indistinguishable, methamphetamine is easy to synthesize with a few raw chemicals, and it remains impervious to heat. Consequently, methamphetamine is often manufactured illegally and injected or smoked, markedly enhancing its absorption and potential for abuse and detracting from the legitimate benefits obtained from prescription methamphetamine.
The similarities and differences between the different types of amphetamines and the ways in which they’re used or abused lie at the root of the amphetamine debate. The reputation of amphetamine compounds has been influenced by their abuse potential. Drug dependence of the amphetamine type was officially recognized in 1964 and it’s a problem that some see as occurring in epidemic cycles. The key issue, as Hippocrates famously explained centuries ago, is that any compound, even water, can have toxic effects with excessive use. This book aims to establish the role of psychostimulants as medical therapies and to define the fine line that exists between amphetamine use and abuse.