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

high search engine listeners. It's July and we have a lot of new listeners and so we're re-broadcasting some of our absolute favorite episodes from earlier in our run when a lot of you new folks were not yet here. The episode that we want to play for you this week is called "Why did I take speed for 20 years?" Part one. It's one of my absolute favorite stories we've worked on. It's very personal for me about a topic that is complicated and which a lot of people puzzle through for themselves or for their kids. The decision to take or not take stimulant medications. We worked on this for over a year. We were really trying to strike a balance in the stories two parts so that people across the spectrum on this topic might be able to listen and hear their own experiences represented. But also we worked very hard just to answer this question that I had never asked myself in my many years taking these compounds. What was the story of their rise? Like how did they get here? How did they get to be so popular? We also in this story get into the surprising studies about the actual effects of these shrugs which are not what I expected. There have been more good studies since we first published. There's a great Paul Tuff article you can read about them rolling to it in our show notes. But the emerging story fits the story that we captured here. So you can follow along with this re-broadcast without any anxiety that you might be missing out. Okay, after these ads, part one. The first time anyone convinced me to take drugs, I think I was 14. At the time the adults in my life were annoyed because my grades were pretty bad. They'd started using the word potential very ominously, uttering it like a curse word. The man I'd been saddled with a lot of debt I couldn't quite pay. My parents had me go see a doctor. The doctor told me I'd 80 HD. I already knew I had 80 HD. Everyone knew I had 80 HD. I lost my backpack pretty much every three days. My brain heard everything my math teacher said in the adults from Charlie Brown Trumpet voice. Pretty much the only thing I could reliably focus on was gold and I for the Nintendo 64. I was amazing at it. Still, when the doctor told me the solution to all this might be a drug called Dexadrin, I told him I wasn't comfortable with that. I considered myself straight edge at the time. And so it stood to reason I wasn't going to take speed. Dexadrin was speed and speed was a drug. That's what I said. And then I think I may have even folded my arms. The doctor was unruffled in a way that suggested I might not have been his first tough customer. He made his counterargument. I remember it very clearly because I'm pretty sure it changed my life, although I'm still trying to figure out how. The doctor said, "Look, if you needed glasses to see, you'd use them. No question. You wouldn't have some big hang up about it. Dexadrin was like glasses, but for my brain." Plus he asked me, "I was 14. Had I smoked pot? Once, yes, I had." So then why would I trust pot from some sketchy drug dealer and not medication from him, a doctor with an office with tasteful sand art in the lobby? It's easy to make this guy sound like some sort of pusher, but the more rigorous truth is I wanted to be talked into it. I was tired of disappointing everybody. A pill that would make it easier to sit still and focus sounded pretty magical. I just needed to put up a fight before I gave in. Hence this little performance me and the doctor were putting on for an audience of, "I don't know, I guess my ego." I took the drugs. I took the drugs and the drugs worked. They helped. Dexadrin didn't do my homework for me, but it seemed to make doing my homework much easier. I remember thinking, "Oh, this is what it's like for other people and other people's brains. I could pay attention in class. I could clean my room. I could accomplish those things in life, which the ABHD literature so beautifully calls "non-preferred tasks." The mountain of to-do's that Tana saw. The pills got me through the end of high school. Helps me nose my grades up enough to get into a decent college. It got me through four years of that college and all its bureaucracy. And they saved me in the early days of an office job, where I started catching my boss's eye for forgetting to save things in the right folders. I started on Dexadrin in high school. I had a riddle in phase, moved to Adderall for a while, then Adderall XR, before settling on Vivans, with a brief and chaotic detour in Concerta, the less said about that time the better. These drugs are all amphetamines or amphetamine-like drugs called methylphenidates, prescription stimulants. And while different formulations or doses of these prescription stimulants might have a spikeier high or a more gentle end of day crash, they all do basically the same thing. They wake up your brain so you feel a lot more attentive and energized and full of pep. I took one or two or sometimes three of these pills almost every day of my life for 20 years. And then a couple years ago, I abruptly stopped. What happened is a long story, but the comically short version would be, I decided to switch psychiatrists. And my new guy told me something that no psychiatrist had ever said to me before. He told me that he thought, over the years, I'd been prescribed too many drugs. There's the amphetamine I swallowed when I woke up in the morning, the second one in the afternoon, the sleeping pills I needed to wind down at night, the antidepressant that helped mitigate the deep sadness I sometimes felt. Those pills plus a self-prescribed drinking regimen. This doctor said, "I think you need to come up with everything, at least for a while." It felt really scary to do that, but my life had stopped making sense to me. And this seemed like a way that it might make sense again. And so for the first time since I was 14, I experienced several weeks where I just did not take any drugs, not even caffeine. Those weeks turned into months, the months became a year. After a year, I did come back to some things. For instance, I drank alcohol now, I drank coffee, but I never came back to the pills. It's hard to understand a relationship while you're in it, but in my time, apart from the stimulants, my feelings about them had changed. Before, I felt straightforwardly very grateful for the drug. I felt like I'd accomplished a life I was proud of, and that I owed no small part of it to the molecules. Those 60-hour weeks, the 9-hour edit sessions, I couldn't have done them otherwise. I thought how if I had been born before the invention of emphetamine, I would just have had a different, less fulfilling life. And because I've held that way, I tended to react pretty badly when people in my life had expressed reservations about any of this. I'd actually get really offended. My feeling was I had a diagnosed disability, attention deficit, hyperactivity disorder. This was a treatment for it. You wouldn't judge someone for wearing glasses. Why would you judge me for this? That's how I felt. But when I stopped taking the pills, I started to feel very confused about what had happened. Because it turned out I really liked being off of them. Sure, working was harder to do sometimes piled up. But I also felt like I could think differently. It's an impossible thing to measure, but I felt more capable of thinking thoughtfully. And I started wondering in those two decades what I'd missed. That is a question I still can't fully answer. But I did have another question, a smaller one, which felt to answer a ball. And it was this. How did I end up taking these pills in the first place? Not me personally, I remembered the doctor with the analogy about the glasses, but on a zoomed out level. My generation. What was the story of how this drug, which would have been considered a recreational drug by my parents' friends, had become for us a drug used to get through school and to get through the long hours of the office jobs that would come after. How had these drugs become so popular, so fast? Turns out it is a hell of a story. I'm going to tell you that story in five chapters. Chapter one, the invention of amphetamine. How should I refer to you in this interview? Oh, whatever you think is better, you can call me Nicholas if you like, or you can call me Dr. Rasmussen or Professor Rasmussen. Dr. Rasmussen is a historian of modern life science. His main research interest, the one he keeps coming back to, is drugs. He wrote a book called On Speed, a cheekily titled but very serious work of scholarship, which follows the path of prescription stimulants in America. I started to tell Dr. Rasmussen a little bit of my own story with the drug and he immediately jumped in with a question. Just out of curiosity, so you're prescribed as a juvenile, and then you started using amphetamines without a prescription as an adult? No, no, so I was always prescribed. I found nothing recreational about it. I took them prescribed, but what would happen is like every so often I would sort of be like, I don't think I want this, I don't think I need this, I'd go off. I would begin to struggle in school or later in work. I would go back to a doctor and say, hey, I was diagnosed with ADD as a kid, he prescribed me something. And usually when that would happen, they would change the drug for whatever reason. And so I really went through, I think I've taken all the ones I've heard of, except for the real throwback ones. did my Mphetamine career on five ends, but it's, yeah, it's been very interesting not taking it. Okay. All right. So it's interesting. I've never been prescribed Mphetamine. So one of the questions I want to ask you if it's not too personal, is have you taken them? Yes, but if you're going to ask me that, don't ask if I've ever been prescribed them. Right. Okay. Yes. Understandable. Mphetamines for millennials like me are prescribed medication. Or in some cases, a mildly illicit study drug. Mphetamines for boomers were known as speed, a street drug that I think was mainly associated with truckers and beatniks. I had wondered how it made that jump, but it turns out the story of these drugs actually goes back much further. Mphetamine was first synthesized in Germany in the 1800s, developed as a dye, actually, Mphetamine as a drug, very much an American story. Okay. So can you just tell me like from the beginning, like, what is the story of Mphetamines? Like, like, who creates them, where, why, when, how, like, where do they start? So Mphetamine was discovered in an effort to develop a superior asthma medication. So it was first tested as an asthma medication and as a decongestant, and it did work. With Gordon Alley, who was the first to test it, he tested it on himself in 1929, noticed, you know, if you look at his notes, he said, you know, decongestant effect is still working, heart racing, and he noticed his mind was racing, too, and he stayed up late at night with his mind racing, so he noticed immediately it had a central nervous system effect. This was during an earlier era where, like, now someone developing a novel compound wouldn't just take it and see what happens, but at this, at this time, people did. They might very well now, but they probably wouldn't report it, you know, in the same way. I mean, they would, they would test it on a, on guinea pigs, first, of course, so it's not to, like, kill themselves, and he had already done plenty of tests on lab animals to see just to get an idea of what would be the, the right dosage for himself, you know, what would probably kill him and, you know, divide that by 10, something like that. So he takes it and he has a high. Yes. He notices he's having what we'd call a high, and so he was aware right away that it had a central nervous system effect, but there wasn't any opportunity that he saw there for marketing it in that way. So it was first systematically tested as an asthma medicine. In general, it didn't do very well. It had some effect, but it was not judged promising after a few tries. So they started looking for other uses, and, you know, Ali's was getting interested already by 1930 in its central nervous system effects. So they realized they have this drug that has like a powerful central nervous system, stimulant effect, and they're just like, I think for someone who doesn't think hard about the history of medicine, I think I, I start with an idea that like, there are diseases, and then they go out and they try to find a cure for the disease. With a metamine, it's like, they found a drug with an effect, and then they kind of look around the world for what it might help with. Exactly. It's a drug looking for a disease. I think that that's often the way drugs are still developed, although there's much more kind of rational planning and basic kind of biology in producing drug candidates these days. Nevertheless, the drug looking for a disease phenomenon still happens. This idea of a drug looking for a disease contend a little sinister, I think, and if your suspicion is a big pharma, you will find a lot to support your suspicion in this story. But I do want to offer an alternate, more neutral way to think about this drug looking for a disease concept. A lot of scientific history involves some researcher accidentally discovering a drug, realizing it has a powerful effect, and then looking around to figure out what kind of suffering that effect might alleviate. And in metamine, in particular, it's a powerful drug that increases dopamine in your brain. Because dopamine regulates so much of how our mind works, metamine has a lot of powerful effects. And for the next century, our culture is going to experiment with many of them. But that's what's to come. For now, it's the 1930s, or in Los Angeles, and Gordon Alley's is just a guy with a powerful new drug. And so he starts looking for a disease to apply it to. Asma hasn't worked so well, but he finds a different one. Narcolepsy, and metamine is very good at keeping you awake. The only problem, narcolepsy is a pretty rare condition, which means the market for that drug is going to be pretty small. And Alley's isn't looking for a base hit. He wants a home run. So he teams up with a company that he thinks might help him get there. An American pharmaceutical company named Smith, Klein, and French. They're going to market and test this drug on a way broader scale than he ever could. So in 1934, the process of finding markets for this new drug goes into Smith, Klein, and French's hands, and they know what they're doing. What they do is they produce lots of the drug as a free sample, and then they produce placebo identical versions of it. And they put ads and medical journals saying we have this valuable drug. If you want to try a free sample in your practice, just write us. We'll send you the drug and some placebos, and you can do your own trial. Maybe to the ideas, we'll just give a bunch of amphetamines to doctors. They can just start giving it to their patients. And then they'll get back to us and be like, this is what it works for. Yes. So this is before there's any FDA regulation on medicines other than on their labeling. So the FDA is remit in the 1930s is simply that anything sold as a medicine for human use have to have its active ingredients listed. That's it. So the medical profession to find safety and efficacy, right? This is wild to me. The back then, a pharmaceutical company could sell a drug without proving its safety or its efficacy. All they needed was an accurate list of ingredients on the packaging. That did change after scandal involving a strep throat medicine that killed over 100 people. It had anti-freeze in it. But even with the regulations that followed that incident, amphetamines were still marketed in a much laxer pharmaceutical environment than the one we have today. Here's what that looked like. Smith, Klein, and French, the pharma company that marketed amphetamine would just mail large amounts of the drug to different doctors and ask them to run their own trials and report back. Not all of those trials were on the kinds of patients who today we would think of as consenting. In fact, a lot of this drug testing took place in psychiatric institutions. People patients had very little say in what their treatment was. And they were hoping that this would be something that this is quite a large potential market if amphetamine would be good for whatever, any of the major things that people were in mental hospitals for. So it was tested quite early for schizophrenia, for senile, dementia, for alcoholism. It showed some promise in alcoholism. And that was another early indication. So there was some efficacy there, some other kinds of neuropathies, but it wasn't really a hit for the big indications in the asylum by polar disorder, schizophrenia, it didn't really work. In other words, they had not found the home run yet. But the drug was out there now. And so other doctors kept volunteering to test amphetamine on different types of patients. Some even get experimenting with it themselves. And one of these volunteers that sort of jumped in quite early and became a big champion of amphetamine was the psychiatry professor Abraham Myerson from Tufts and Harvard medical schools. And he thought amphetamine was great. He took it himself. He thought it was really good for his lecturing style. But what did he like about it? He just thought it gave him like some bigger? Well, he tested, basically, you could look at this as him testing it on himself in the same way that alleys did to start get a sense of what the psychiatric effects were. But why he liked it, he liked it in a professional sense more importantly, because it was a very effective remedy for depression as he understood it. Depression as he understood it. That actually brings us to chapter two, amphetamine as the world's first anti-depressant. I only recently started to wonder about the history of depression, like how depression has been understood throughout time. Calling it depression is relatively recent, but the idea of a disease called melancholia goes way back. The ancient Greeks worried about it, the Romans ancient Persians. You can actually find good ideas about how to treat depression in antiquity, exercise, talking about it, hot baths, and some terrible ones, bloodletting, beating the demons out of the patient. In the modern era, when we start calling melancholia depression, our idea of what exactly it is and how exactly it works gets subtly updated every few decades. In the 1930s, when our heroes are looking around for some condition that amphetamine might cure, there is actually not yet such a thing as a prescription anti-depressant. But luckily for them, in that very moment, depression is once again being redefined in a way that would benefit their efforts to market their new drug. Abraham Myerson, that psychiatrist who was taking amphetamine himself and really enjoying its effects, he had never knew theory of what depression was. Before Myerson, depression was seen as essentially "nearestinia," which meant chronic weakness or fatigue. But Myerson believed that depression's definition should be updated, to include something else, a lack of drive or motivation. A depressed person wasn't just a loa-- energy sad person, it was also someone who's sadness made them unproductive in a capitalist society. Depression went from Elliot Smith to Elliot Smith if he's not producing Elliot Smith records. Myersson had noticed that workers in our newly industrializing country often were reported a feeling of emptiness. The solution to that feeling of emptiness, Myersson believed, might be infatimate. Also, the American company making it happened to be providing him some funding. Smith, coin, and French. And when the company applies for its seal approval from the AMA Council on Drugs, depression is like the lead indication. They can see that that's where the market's going to be. So now we have anti-depressants. We have anti-depressants. Yep, the anti-depressants. Is the anti-depressant? It's advertised now, which has got approval in 1937 quite heavily and lots of medical journals, general medicine journals. And in some of these ads, you have like quotes from Myersson's papers trying to convince doctors to recognize depression in this new way, not the old exhaustion way, but in this new lack of zest way. So our idea of what depression is, like our idea culturally of who is depressed, is going to shift in the marketing for this drug. It's going to go for a link. Yep. It really catches on in the fifties, of course. And that's the era of booming consumerism, right? So it's the drug for the time. And it gets hardwired. And even though it amphetamine sort of goes out of fashion in the late fifties as an anti-depressant, the criteria by which you recognize depression were established in the 1940s. And the new anti-depressants that come in and replace them fetamine were measured by their ability to do what amphetamine does only better. So even once we give up on this as the cure, amphetamine has already described the disease. That's right. I believe that depression, as we know it, might well be different if amphetamine hadn't been discovered or marketed this way. It's something unique to mental illness versus physical illness that I'm still trying to figure out how to articulate. Consider a strep throat. A doctor today definitely has a better understanding of what causes strep than a doctor in ancient Rome. But the strep itself is the same. We all agree that my strep is the same as Julius Caesar's. But depression is stranger than that. Depression is a way of acknowledging that certain kinds of sadness are normal and others are not. But abnormal sadness gets defined differently at different times. Society never makes up its mind permanently about how sad a healthy person is allowed to be. That's why I don't know if I could say I've experienced the same depression as Julius Caesar, or Abraham Lincoln, or even as my grandparents. It's strange because it's not like to say there's a version that like my grandfather who is like very skeptical. If you were alive and ever talking to him and I said, depression was invented by the drug companies. He'd be like, yes, but it's like it's describing something real that people experience. I have experienced it, but it's also mediated through this marketing. And that's very confusing to me. Well, with any illness, there's a lot of mediation. So there's, you know, the experience of symptoms or the physical or mental, then the medical profession treats these symptoms and groups. Some of them together and others not. You know, they say, well, that headache has nothing to do with your depression. That's because of this. But the lack of energy and not wanting to get out of bed, that's the depression. So you have a bunch of experiences. The medical profession based on its theories, groups some of them together as symptoms and leaves others on the side, right? So there's that kind of filtration process. And then you have to accept their diagnosis, right? So, you know, if you don't like what they're saying, then you just, you know, see another doctor or don't fill the prescription or whatever. So yes, I'm not denying that the conditions to which the concepts refer exist, just that we can divide them up and think of them in different ways. And that thinking then feeds back on our experience of our symptoms. So after a brief life as an unpopular nasal decongestant, amphetamine becomes the world's first anti-depressant, treating a condition that it has helped redefine. We're in the 1940s now. And with this new, more expansive understanding of depression, more and more doctors are prescribing amphetamine to their patients. But something's about to happen to make amphetamines really take off. The number of depressed patients who might benefit from a little extra zest in their life, it's about to get way bigger. Smith, Klein, and French spot a new opportunity to market their drug. A huge market of people who might be experiencing a real lack of pleasure in their daily work lives. Soldiers. The story of amphetamine in World War II, after the break. [MUSIC PLAYING] Welcome back to the show. Chapter three, amphetamine for combat fatigue. How did they decide during World War II to start giving soldiers amphetamines? Well, that Smith, Klein, and French tried very hard to get it included, not just in this kind of formulary available to medicine in the army. They actually sort of intervened with an assistant secretary of war, McCloy, to try to get it issued as a weapon, like in amphibious assaults, or a sustained offensive in general. This troop should be issued with amphetamine on hour 10 or hour 12. They really tried to force it on the military. The military never required anybody to use it. But they issued it very widely. It was in first aid kits, emergency kits that were unlike lifeboats and bombers and stuff. They had to bail out. There's the amphetamine because they might be landing an enemy territory and have to stay awake, or they might be in a life raft and have to stay awake to 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 about the British and the American-- and the Germans and the Japanese use methamphetamine in virtually the same way. And I think for most people, methamphetamine has a reputation as a drug you wouldn't give a C-minus student. It's a strong serious drug. Are they giving it in a small dose? Is meth in this case meth, or is meth something else? No, it's meth. But they're taking it in pill and in an equivalent dose to amphetamines that it would use for attention to episode today. The adult dose is for minor depression. 10 milligrams is pretty much the same thing you're giving kids today for attention deficit. And so that's what the Germans were using. And I think that 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. The 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 legal but seems to have a suitcase full of descriptions. The friend who is highly suspicious of big pharma but puts a lot of faith in big internet supplement. The local force 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 narrative elves. Except 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 math and they'll probably smoke it or shoot it. So that's different. But if your 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 about us and 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. It came, after all, from a doctor. Anyway, in World War II, the Nazis were taking college kid doses of methamphetamine to allies were taking college kid doses of a popular American infetamine called Benzdrin. Both sides probably having about the same experience. Okay, so all these soldiers, not 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. And 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 moral effect was ultimately why the allied military issued amphetamine. So 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 and flack is a better soldier. I see. So they're using them effectively as mind-altering drugs, not to fight fatigue, but 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? Now, why did they call it combat fatigue instead? Well, first of all, they wanted to reduce friction with the brass. They didn't want the generals saying, get these shrinks out of here. They're telling our soldiers that they're severely mentally ill just because they've seen too much action. So it's a bit of, it's a euphemism that's designed both for the consumption by the brass. 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 gonna be sectioned out because of a mental illness who 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 a war neurosis if 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. Artillery and stuff. And so the soldiers would always be thinking about going back to their bodies. - 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 like better might just be trying to make you more usefully participate in something that other people want you to participate in. - Absolutely, but I say why not both? They aren't 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 emphetamine enters American culture in earnest. Chapter four, stimulants for pretty much everybody. 1945, World War II is over. US soldiers returned to civilian life. Remember, emphetamine was given very freely to a lot of these soldiers and many have picked up habits. Those habits continue when they get home. At that point, the easiest way to get emphetamine was to buy a benz-drain inhaler. Emphetamine was in asthma medicine too. So if you bought one of these inhalers and just chewed up the emphetamine gons inside of it, you 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 emphetamine 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. - So it becomes a legitimate weight loss drug even though I've been heavily used by kind of dodgy diet doctors since the '30s, becomes a big official prescription drug for weight loss. And weight loss doctors like account for something like a third of the, what is it, 10 billion pills that are being distributed in the US in the '80s, '60s. They just dispense them like 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 emphetamine epidemic in America. Soon, 10 million Americans will be taking prescription stimulants for something. Anti-depression, 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 breaks about this anti-emphetamine campaign. First, starting with the hippies, people like Alan Ginsberg start this speed kills campaign. And so this idea that it's a dangerous street drug sold by bikers helped tarnish the medical reputation of this already code of obsolete anti-depressant. There are other scandals that affected the drug as a medicine, particularly the diet drug industry. There's bunch of exposés. This is the 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 kind of a moral panic around that 'cause there was very high drug usage among Vietnam soldiers. - In 1970, looking around America, what a lot of people saw was a country on too many drugs. Heroin, LSD, barbituates, but also stimulants. The warnings about speed had been mounting now 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. - Heroes and capsules that you keep in your medicine chest, your night table, your pocket, your purse. - I would like to suggest that you do not use speed. - But also rock stars, like Frank Zappa, were out there telling fans, speed. It's not just dangerous, worse, it was uncool. - It's gonna mess up your heart, mess up your liver, your kidneys, right out your mind. In general, this drug will make you just like your mother and father. - And there's 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. I've 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 - So Congress responds with one of the most influential drug regulation bills in history. The Controlled Substances Act of 1978. This is the law that creates schedules for different drugs. Schedule one, stuff like heroin and psychedelics, which are deemed to have no medical use. Scheduled two drugs have proven medical uses, but their circulation is controlled because they can be abused. Emphetamine and methylphenidate become schedule two. And that's why he still requires 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 US. - 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 didn't become a prescription. Oh, like there's a general trend of vacate harder to buy prescription drugs without a prescription, so there's that. But yes, in terms of it being like an officially problematic substance is that at 1970. And even though doctors are free to prescribe these scheduled two 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 10 fold in the first year and then another half the next year. So by 1971, the legitimate pharmaceutical market for amphetamines is 120th of what it was in 1969. - Wow. - Wow. - Wow, because all the sudden these doctors feel like they might have to justify these prescriptions. - Yes, 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 it has only very limited short term if I could see it 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 US in the 1970s. - Oh, interesting. - So think about it that way. So this is why the white collar people turn to cocaine. I'll be some of them. - Well, this is actually that's a question that I had for you is 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 you say get to that rush feeling that you get from a fair, 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. - Right. - 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. - So that is the story of how America fell in love with prescription stimulants. Use 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 the children like me. Welcome 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 scheduled to 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. These 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. Animal 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. He'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-Claude and French, but Smith-Claude 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. And 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 underlying under it because the drug company had already commissioned extremely thorough studies with the University of Pennsylvania Psychology Department that established that the drug does not, in fact, improve any cognitive ability, at least in the normal subjects that they is, okay? It 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. We 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 placemos. 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. Where 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 hyperchinesis, but the consensus is that that should only describe a tiny percentage of America's rambunctious youth. And so in the 1970s, one of these hyperchkinetic kids who was being prescribed speed to still, they would have been rare. 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? That's how rare the condition was. So why does that change? Well, remember, the 1970s drug control act passes, which made both emphetamines and methylphenidates scheduled to drugs. In the wake of that law, hyperchkinetic disorder childhood becomes one of the few conditions that the FDA will still approve these drugs to treat. Once 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. This year, an estimated 14 million Americans of all ages receive prescriptions for stimulants. From tens of thousands of cases in the 1960s to over 10 million cases today, that wave is remarkable. It'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. It 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 this story. This was the first time I'd seen it as an adult. It begins with biography. She J lives with his parents and three younger sisters. Mr. Vote is a lawyer, Mrs. Vote is a decorator, my parents hadn't split up yet. The report describes me as a kid having a hard time. When she asked 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. And she runs her tests which 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. She 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 the 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 often forgetful and daily activities. If 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, or not entirely accurate. Instead, this specialist had a bunch of great suggestions for how I might modify the way I studied, had the teachers at my school might accommodate my weird, not quite typical brains. 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 had 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. He took a lot less time, he gave me a survey and analogy about glasses and a diagnosis, ADHD. The 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 a speed history, it has been used to treat stuffy noses, depression, combat fatigue, obesity, ADHD. What do you think is next? Like 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 you know basically internationally banned. So you know there's no limit on the inventiveness of the pharmaceutical industry and it's 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. Like you don't have attention deficit in a place where repetitive work is not expected. Attention is not a problem unless the 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 and which also may have increased my confidence. Of 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 have 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. So 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. We don't get answers to every question. Some we just learn to stop asking. Next week we're going to tell you a different story. One that's not mine, somebody else's, but we're 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. That's next week on Search Engine. Search Engine is a presentation of Odyssey Productions. It was created by me, PJ vote, and Shruthy Pinumini. This episode was produced by Garrett Graham and Noah John. Theme original composition and mixing by Armand Bizarrean, back checking by Sean Merchant. We have some special thanks, but we're going to list them on part two. At Odyssey, our executive producer is Leah Restennis and thanks to the rest of the team at Odyssey. Rob Morandi, Craig Cox, Eric Donnelly, Colin Gainer, Moore Curran, Josephina Frances, Kurt Courtney, and Hilary Schaff. Our agent is Orrin Rosenbaum at UTI. If you'd like to support our show and get ad free episodes, zero reruns, and some additional bonus audio, please consider signing up for Incognito mode. You can learn more at search engine.show. Follow and listen to search engine for free on the Odyssey app or wherever you get your podcasts. Thanks for listening. We'll see you next week. [Music]