Why'd I take speed for twenty years? (Part 1)

24:55The story of amphetamine and World War II, after the break.

25:14Thank you.

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27:37Welcome back to the show. Chapter 3. Amphetamine for combat fatigue. How did they decide during World War II to start giving soldiers amphetamines? Well, you know, Smith, Kline, and French tried very hard to get it included, Not just in this kind of formulary available to medics in the Army. They actually sort of intervened with the Assistant Secretary of War, McCloy, to try to get it issued as a weapon, like in amphibious assaults or, you know, sustained offensives in general. The troops should be issued with amphetamine on hour 10 or hour 12. They really tried to kind of force it on the military.

28:14The military never required anybody to use it, but they issued it very widely. it was in first aid kits and emergency kits that were on like lifeboats and bombers and stuff. If people had to bail out, there's the amphetamine because they might be landing in enemy territory and have to stay awake, or they might be in a life raft and have to stay awake to like signal the rescuers. But it was also issued to medics. Medics carry it around just like they did morphine, which was also widely abused. But anyway, it is extremely widely distributed in the allied military, both the British and the American.

28:44And the Germans and the Japanese use methamphetamine in virtually the same way. And I mean, I think for most people, methamphetamine has a reputation as a drug you wouldn't give like a C-minus student. Like it's a strong, serious drug. Are they giving it in like a small dose? Like is meth, in this case, meth or is meth something else? No, it's meth, but they're taking it in pill and in kind of an equivalent dose to amphetamines that you would use for attention deficit today. The adult doses for minor depression, like 10 milligrams, is pretty much the same thing you're giving kids today for retention deficit.

29:20And so that's what the Germans were using. And I think that, you know, look, blind tastings have been done with experienced users. And in those kind of doses, I'm not talking about injecting a large amount, in those kind of doses, you can't tell the difference.

29:35The idea that there are good medicines and bad drugs is one of those slightly arbitrary notions that most of us subscribe to. It can be easier to notice other people's contradictions. The friend who doesn't get high on anything illegal, but seems to have a suitcase full of prescriptions. The friend who is highly suspicious of big pharma, but puts a lot of faith in big internet supplement. The locavores who do massive amounts of cocaine. Our contradictory attitudes towards amphetamine, though, to me, can feel like one of the strangest things to chart. Methamphetamine is a terrifying street drug done exclusively by society's ne 'er-do-wells.

30:12Except the thing is, a doctor can also still legally prescribe methamphetamine pills to a kid who is struggling in college. It will do the same thing as Adderall. Dose matters, and how you take it. An illicit speed user is going to take more meth, and they'll probably smoke it or shoot it. So that's different. But if you're a college kid taking Adderall, if you start doubling your doses, or if you start snorting your pills, your experience will begin to slide towards the one the street user is having. In my own mind, I don't call anything a medicine anymore. I think the downside of labeling something a medicine is that for some of us, for me anyway, it can be permission to take it pretty automatically.

30:51It came, after all, from a doctor. Anyway, in World War II, the Nazis were taking college kid doses of methamphetamine. The Allies were taking college kid doses of a popular American amphetamine called Benzdrin. Both sides probably having about the same experience. Okay, so all these soldiers on both sides of World War II are taking these drugs. Are the drugs making them better soldiers? Are they doing tests to figure out if the drugs are making them better soldiers? Well, the Allies did a fairly extensive set of tests to measure whether there was any benefit to amphetamine over the existing drug, which was caffeine pills.

31:31And to make a long story short, the more careful these tests were, the less they showed that there was any benefit to amphetamine over caffeine. But the soldiers liked it better. And furthermore, amphetamine convinced people that they were doing better. And that kind of morale effect was ultimately why the Allied military issued amphetamine. So it wasn't that they were making them better soldiers. It was that they felt more confident in their soldiering. But a more confident soldier who's willing to fly at a lower altitude in flack is a better soldier. I see. So they're using them effectively as mind-altering drugs, not to fight fatigue.

32:08But fatigue was the official rationale. Combat fatigue, as it came to be known by soldiers. This was a colloquial name for what was also sometimes called war neurosis, a term used by psychiatrists for the very specific kind of mental illness experienced by soldiers at war. But the fact that the soldiers adopted the term combat fatigue, that wasn't an accident. Rasmussen says it was actually something closer to marketing. Why didn't they call it war neurosis? Why did they call it combat fatigue instead? Well, first of all, they wanted to reduce friction with the brass, okay? They didn't want the generals saying, you know, get these shrinks out of here.

32:46They're telling our soldiers that they're severely mentally ill just because they've, you know, they've seen too much action. And so it's a bit of, it's a euphemism that's designed both for the consumption by the brass, you know, combat fatigue suggests that they need to be out of combat and rest a bit. And it did the same for the soldiers, right? The soldiers didn't get the idea that they were now, you know, going to be sectioned out because of a mental illness and would never have to fight again. They were given the idea that a bit of rest would fix them up. And actually, the psychiatrists believed they got better results in this very serious condition of, you know, war neurosis.

33:21If they took the soldiers not too far away and gave them talking therapy to talk about the traumatic situation, but not so far removed from the front line that they couldn't hear guns in the background, you know, artillery and stuff. And so the soldiers would always be thinking about going back to their buddies. It's kind of a beautiful illustration of just the relationship between our idea of what is healthy and language and our idea of what is sick and language. and the idea that someone whose job is to get you better might just be trying to make you more usefully participate in something that other people want you to participate in.

33:55Absolutely, but I say why not both? They are trying to help you get better, but their idea, medicine's idea, which is also society's idea of what would be better. Better is useful, functional. And this is one of the reasons why concepts of diseases change over time, because people's roles in society and what's normal and expected change over time. After the war, the soldiers go home, and amphetamine enters American culture in earnest. Chapter 4, Stimulants for Pretty Much Everybody. 1945. World War II is over. U.S. soldiers return to civilian life. Remember, amphetamine was given very freely to a lot of these soldiers, and many have picked up habits.

34:40Those habits continue when they get home. At that point, the easiest way to get amphetamine was to buy a Benzadrine inhaler. Amphetamine was in asthma medicine too. So if you bought one of these inhalers and just chewed up the amphetamine gauze inside of it, you'd get a very powerful high. The equivalent of taking an entire bottle of pills. Those inhalers were available very cheap without a prescription. Around the same time, sales of amphetamine for legitimate medical uses also took off. And it's not just treating depression and asthma anymore. Smith, Klein, and French have another market for their star drug, weight loss.

35:18So it becomes a legitimate weight loss drug, even though it had been heavily used by kind of dodgy diet doctors since the 30s. It becomes a big official prescription drug for weight loss. And weight loss doctors accounted for something like a third of the, what is it, 10 billion pills that are being distributed in the U.S. in the late 60s. They just dispense them directly. They're a doctor. They can just give a patient a year's supply. And they were dispensing them like, you know, like candy. Rasmussen says at this point in history, we are nearing the peak of what he calls the first amphetamine epidemic in America.

35:53Soon, 10 million Americans will be taking prescription stimulants for something. Antidepressant, weight loss, fun. What's crazy is that while it took decades for stimulants to become this popular, they'll actually go away very quickly. Society, for a host of reasons, will rapidly turn against them. First, the mainstream medical reputation of stimulants takes a hit. New and seemingly improved antidepressants have been released. Second, maybe more importantly, the culture itself just starts to shift. And that's what brings about this anti-amphetamine campaign. First starting with the hippies, people like Allen Ginsberg start this speed kills campaign.

36:33And so this idea that it's a dangerous street drug sold by bikers helped tarnish the medical reputation of this already code of obsolete antidepressant. There are other scandals that affected the drug as a medicine, particularly the diet drug industry. There's a bunch of exposés. This is sort of the emerging feminist backlash against body image control by the patriarchy and the weight loss industry. And there's this general kind of cultural reaction to the drug problem that you see in 1969, 1970. The Vietnam veterans coming home addicted to heroin was a big kind of a moral panic around that because there was very high drug usage among Vietnam soldiers.

37:14In 1970, looking around America, what a lot of people saw was a country on too many drugs. Heroin, LSD, barbiturates, but also stimulants. The warnings about speed had been mounting out for years. Many Americans had become addicted or were using the pills unprescribed. Not just hippies and poets, but also people in the mainstream. The dieting suburban housewife, her army vet husband, one in 20 Americans. This report is concerned only with the abuse of two socially acceptable prescription drugs. There were PSAs, like this one from actor and future salad dressing entrepreneur Paul Newman. Pills and capsules that you keep in your medicine chest, your night table, your pocket, your purse.

37:58I would like to suggest that you do not use speed. But also rock stars like Frank Zappa were out there telling fans, speed is not just dangerous, worse, it was uncool. It is going to mess up your heart, mess up your liver, your kidneys, rot out your mind. In general, this drug will make you just like your mother and father. And there was a feeling in Richard Nixon's America that the country was taking too many drugs and needed to calm down. America's public enemy number one in the United States is drug abuse. In order to fight and defeat this enemy, it is necessary to wage a new all-out offensive.

38:42I have asked the Congress to provide the legislative authority and the funds to fuel this kind of an offensive. This will be a worldwide offensive, dealing with the problems of sources of supply as well as... So Congress responds with one of the most influential drug regulation bills in history, the Controlled Substances Act of 1970. This is the law that creates schedules for different drugs. Schedule 1, stuff like heroin and psychedelics, which are deemed to have no medical use. Schedule 2 drugs have proven medical uses, but their circulation is controlled because they can be abused. amphetamine and methylphenidate become Schedule II.

39:21And that's why you still require a special prescription, and the prescribing and manufacturer of those drugs is still monitored, which is the only reason why we have accurate figures on how much is still being consumed in the U.S. So that's the moment where it stops being something that a diet doctor will give you a year's supply for or that people can walk into a pharmacy and grab relatively easily. That's when it becomes something that is restricted. Well, it did become a prescription. You know, like there's a general trend of making it harder to buy prescription drugs without a prescription.

39:49So there's that. But yes, in terms of it being like an officially problematic substance, it's that act, 1970. And now even though doctors are free to prescribe these Schedule II drugs, they have to report every prescription back to the agency that becomes the DEA, right? And as soon as they have to start reporting, guess what? Prescribing rates drop by like tenfold in the first year. and then another half the next year. So by 1971, the legitimate pharmaceutical market for amphetamines is 1 20th of what it was in 1969. Wow. Wow. Wow. Because all of a sudden these doctors feel like they might have to justify these prescriptions.

40:28Yes, the DEA is watching them. So that's how amphetamine basically goes off the market. The FDA is meanwhile working to show that it's not actually effective as an antidepressant and has only very limited short-term efficacy in dieting. So the main indications are struck as well as legitimate uses. Of course, the fall of amphetamines in the 1970s will clear the stage for a newly popular street drug that will become very pervasive. Huge spike in cocaine consumption in the U.S. in the 1970s. So, you know, think about it that way. It's like this is why the white-collar people turn to cocaine, maybe some of them.

41:03Well, this was actually, that's a question that I had for you. It's like, how different are cocaine and amphetamine as two drugs? Well, they're very similar if you compare the kind of the lower dose range and also in the higher dose range. But to get to that rush feeling that you get from a fair sniff of cocaine, you're going to be injecting the amphetamine. So like many drugs, they actually have slightly different mechanisms of action at different dosage levels. But the short answer is they're very similar. if you take them in comparable doses. I see. But the cocaine wears off like five times faster.

41:39Right. Okay, so amphetamine disappears mostly from American, like legitimate, described American life in the 70s. Yep. And even from the illegitimate scene, it's not that common.

41:53So that is the story of how America fell in love with prescription stimulants, used them to treat a bunch of different ailments, some old, some new, and then decided this drug was just too dangerous to have in wide circulation. After the break, why we then decided to start giving it to children like me?

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43:26Welcome back to the show. Now for our fifth and final chapter, ADHD. So in its first act, amphetamine had been wildly popular, but then almost entirely disappeared from American life after the big 1970s anti-drug law. When amphetamine becomes a Schedule II drug, the FDA also starts ruling it out for a lot of its previously approved uses. The FDA takes away amphetamine for depression. The FDA takes away amphetamine for weight loss. Those are only off-label prescriptions now. Here's what's left. Amphetamine for narcolepsy and amphetamine for this other fringe case, a disorder called hyperkinetic disorder of childhood.

44:08These were children who were understood to be overactive, restless, and easily distracted. Kids like this had always existed, and psychiatrists over the decades had theorized that their brains might be different. At times, they'd even come up with names for different possible disorders that might describe these kids. Abnormal defect of moral control, minimal brain damage, minimal brain dysfunction. You can sort of see why parents never rushed to get their kids any of these diagnoses. Actually, as far back as 1936, A man who ran a psychiatric institution for children, Charles Bradley, was thinking about these kids.

44:46He'd gotten a hold of some amphetamine, and he was testing it on some of his child patients. And he noticed that some of the students who were particularly unruly in the classes seemed to do better. But it didn't affect all of them in that way, and he was never able to pin down what kind of a problem student it was that he tried electroencephalograms and this kind of thing to figure out. What is it about these students who benefit from it as opposed to the others? He was never able to pin it down. Now, interestingly, that trial was not paid for by Smith, Kline, and French. But Smith, Kline, and French did fund and help design another trial at the same time on kids in an institution, very similar population, you know, problem kids in a reform school.

45:29And so they thought that there might be a market here. They thought, let's encourage these ortho-psychiatrists, they were called child psychiatrists who dealt with learning disabilities and behavior disorders. Let's encourage them to try and find a use for this drug because, you know, it does seem to improve cognition. Now, I say seem with an underline under it because the drug company had already commissioned extremely thorough studies with the University of Pennsylvania's psychology department that established that the drug does not, in fact, improve any cognitive ability, at least in the normal subjects that they use, okay?

46:02It only gave them this confidence and this feeling that it was making them do better. And if what you're not confident about is your learning ability, it might actually help you do better on a test. Not because it's changing the way you think, but by altering your mood. I want to pause here for a second, because the questions about these drugs that science can't fully answer in the 1930s, why exactly do these drugs change kids' behavior, and which kids should we give these drugs to? We're still arguing about the answers to those questions today. Today, we do have a lot more studies about what these drugs might be doing, While working on the story, our team read dozens of these studies.

46:39We talked to psychiatrists who prescribe or don't prescribe these drugs. And we just found less consensus on basic facts here than I would have expected. Broadly speaking, the skeptics of these drugs will point to studies suggesting that there is little reliable evidence that prescription stimulants meaningfully enhance cognition. Some of these skeptics also point out that stimulants may just increase your perception of your own performance. which could be one reason why they're so popular. They'll say they're confidence pills. They're turbo-placebos. Advocates for the drugs, broadly speaking, point to other studies that show how these drugs can help people be less impulsive, boost processing speed, and lengthen attention span, or at least change how our attention works so it's more like a focused flashlight and less daydreamy and lantern-like.

47:32Where we found the most consensus is the idea that the drugs help you concentrate and the idea that they elevate your mood. But what's funny is that we basically knew that in the 1930s. The pharmaceutical companies knew their drugs made kids peppy and alert and gave them a drive to accomplish, but they didn't chase that market. They didn't need to. They had other markets. Depression. Weight loss. In 1961, a new methylphenidate called Ritalin is approved for use in distracted children. At the time, some doctors are saying those kids might suffer from childhood hyperkinesis, but the consensus is that that should only describe a tiny percentage of America's rambunctious youth.

48:16And so in the 1970s, one of these hyperkinetic kids who was being prescribed speed to sit still, they would have been rare. Like, it wouldn't have been a thing that was in the pop culture. Oh, yeah. The estimates were like either thousands or tens of thousands of patients a year only, you know? They undercounted. That's how rare the condition was. So why does that change? Well, remember, the 1970s Drug Control Act passes, which made both amphetamines and methylphenidates schedule two drugs. In the wake of that law, hyperkinetic disorder of childhood becomes one of the few conditions that the FDA will still approve these drugs to treat.

48:55Once that decision's made, prescriptions for kids start to climb. In 1970, American psychiatrists identify 150 ,000 kids who need the medication. By 1980, that number more than triples to 500 ,000. The same year, the disorder is rebranded to attention deficit disorder, which will later become ADHD. By 1990, around a million kids a year are being prescribed stimulants for ADHD. Today, six million kids have been diagnosed. And the diagnosis also now applies to adults. Last year, an estimated 14 million Americans of all ages received prescriptions for stimulants. From tens of thousands of cases in the 1960s to over 10 million cases today, that wave is remarkable.

49:43It's also remarkable that so many of these were found in America. Other countries have ADHD, other countries prescribe for it, but not at the rate that we do. So what's actually going on here? I don't know. You can tell this as a story about pharmaceutical marketing. I think that's part of it. But I also think it's a story about how society changes, and it changes you with it in ways that are powerful, but sometimes hard to perceive. The same way the surf tugs you out to sea without you ever quite noticing. Back in 1999, in the Philly suburbs, before I was diagnosed, I was struggling with a problem in my mind that was very real for me.

50:21It was not invented by a drug company. I was doing poorly in school, not just academically, but socially. I didn't fit in. And so my parents took me to see this child psychiatrist who gave me a neuropsychological exam. Two days of intense tests. She also interviewed my parents and my teachers. I remember this all pretty well, but I hadn't seen the report in years. I asked my mom to mail it to me while we were fact-checking the story. This was the first time I'd seen it as an adult. It begins with biography. PJ lives with his parents and three younger sisters. Mr. Vogt is a lawyer. Mrs. Vogt is a decorator.

50:56My parents hadn't split up yet. The report describes me as a kid having a hard time. When she asks me to interpret a picture of a kid holding a chair, I tell her either he's smashing it out of anger because he doesn't fit in it, or he's smashing it out of joy because he has graduated school and the chair belongs to the school. As she runs her tests, what she finds is actually kind of bizarre. Verbal scores are unusually high, 99th percentile, which sounds great. Except my performance IQ, which is a lot of what we actually consider smarts, organization, visual learning, the ability to read social cues, other people, that, in fact, is quite low.

51:36She says a discrepancy of this magnitude is found in something like 2 % of the kids she tests. It's very strange to see a picture of your own mind at 13. It is stranger, 25 years later, to recognize it essentially as a mind you still have. A very smart, dumb person. A very dumb, smart person. I'm never sure which. The specialist tests me for ADHD on two different scales. I fit five of the criteria. I often fail to give close attention to details. I often don't follow through on instructions. I often have difficulty organizing tasks. I often lose things. I'm often forgetful in daily activities.

52:15If this sounds like you, or lots of people you know, if it sounds kind of surprising that I was diagnosed with ADHD based on just these five criteria, you should know, according to this report, I did not have ADHD. The test said I needed six criteria. I only hit five. The specialist did not recommend medication and said I did not have the disorder. I'm sorry to bury the lead, but I found this out in fact-checking last week. October 2023 is when I found out the four letters I have used to describe myself, casually, self-deprecatingly, sometimes very seriously for 25 years, ADHD, were not entirely accurate.

52:58Instead, this specialist had a bunch of great suggestions for how I might modify the way I studied, how the teachers at my school might accommodate my weird, not quite typical brain, one-on-one instruction, extra time on tests, permission to bring a laptop to class, The problem is, I don't think anybody at that very strict school was into making a bunch of accommodations for some annoying C student who, it turned out, didn't even have a disability. So I continued to struggle, and soon after, my parents sent me to another specialist. This was the doctor I described at the beginning of the episode.

53:33He took a lot less time. He gave me a survey, an analogy about glasses, and a diagnosis, ADHD. This story that would help explain me to myself and help me explain myself to other people. ADHD got me the accommodations I needed in school. It forced my teachers to be a bit gentler with me. And ADHD gave me an answer to a question people close to me sometimes asked. Why do you take those pills? ADHD, I'd answer. Not knowing the truth was a weirder, longer story. Not knowing these drugs had had a long life in America before I was even born. So, Speed's history, it has been used to treat stuffy noses, depression, combat fatigue, obesity, ADD.

54:20What do you think is next? What do you think is the next disease the drug will find? Well, I think it's amazing that it found a disease after it was basically internationally banned. So, there's no limit on the inventiveness of the pharmaceutical industry and its marketing endeavors. So, I'm afraid I can't propose a new disease for it. And I wouldn't want to if I had an idea. You're not trying to help the gene get out of the bottle. Yeah, well, it's out of the bottle. But, you know, attention deficit, I'm not saying that it's not a real disease. I'm saying that what makes it a real disease is the misfit between the symptoms and the signs of the condition and the expectations of society.

54:59Like, you don't have attention deficit in a place where repetitive work is not expected. Attention is not a problem unless an enormous amount of attention is required. Today, I still do a job that requires an enormous amount of attention. And I do it without the drug I once took to improve my focus, which also may have increased my confidence. Off the drug, I've noticed some things. I've noticed I spend less time feeling paranoid. I spend less time thinking things are a huge deal that often aren't. I believe that I've gotten a little more thoughtful. Mainly what I noticed is I lost this feeling I'd had for years, which is that I often felt like I had the nervous system of a person who'd been stuck on a traffic-jammed freeway for several hours.

55:46So it's nice to be off the drugs, but I do have less confidence. A lot less. I notice it. This show you're listening to, making it fills me with self-doubt. And the self-doubt, just surviving it, is absolutely the hardest part of this job. It's actually what the job is. just sitting in a place of pressure and absorbing it without going to pieces. Everything else, the writing and the interviews and the camaraderie here, that's the reward. The pressure is the job. And without the pills, I have to do the job alone. I never learned before. It's not easy. And because confidence is such a bad measure of ability, I will never know if I'm actually objectively better at my job off the drug or if I'm worse.

56:32we don't get answers to every question some we just learn to stop asking

56:46next week we're going to tell you a different story one that's not mine somebody else's but where prescription stimulants also star this is the story of a brilliant doctor who instead of wondering why she took stimulants for 20 years wonders why it took 20 years for her to find them Can you just tell me the story of your brain as you understand it? Sure. My story is a little bit different, I think, than a lot of people who may be listening to this. I had a brain tumor when I was eight. And my dad is the one who said, you're going to have to have a little operation, you know, to take something out of your brain.

57:24That's next week on Search Engine.

57:59The End feeling. Only pay for what you need at LibertyMutual.com. Liberty, Liberty, Liberty, Liberty. Savings vary underwritten by Liberty Mutual Insurance Company and affiliates excludes Massachusetts. Your sausage McMuffin with egg didn't change. Your receipt did. The sausage McMuffin with egg extra value meal includes a hash brown and a small coffee for just$5. Only at McDonald's for a limited time. Prices and participation may vary.

58:32Search Engine is a presentation of Odyssey and Jigsaw Productions. It was created by me, PJ Vogt, and Shruti Pinamaneni, and is produced by Garrett Graham and Noah John. Theme, original composition and mixing by Armin Bazarian. Fact-checking by Sean Merchant. We have some special thanks, but we're going to list them all in part two. Our executive producers are Jenna Weiss-Berman and Leah Reese-Dennis. Thanks to the team at Jigsaw, Alex Gibney, Rich Pirello, and John Schmidt. and to the team at Odyssey. JD Crowley, Rob Mirandy, Craig Cox, Eric Donnelly, Matt Casey, Casey Clouser, Maura Curran, Josephine Francis, Kurt Courtney, and Hilary Schaaf.

59:09Our agent is Oren Rosenbaum at UTA. If you want to help our fledgling show, please tell people about it. And if you want to help it get discovered, the best thing you can do is rate and review us in Apple Podcasts. I know, it's weird, really helps. follow and listen to search engine with me pj vote now for free on the odyssey app or wherever you get your podcasts thanks for listening see you next week

59:56Thank you.