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Emergency Medicine News:
doi: 10.1097/01.EEM.0000403713.17660.3c
Toxicology Rounds

Toxicology Rounds: The Culture of Amphetamine

Gussow, Leon MD

Free Access

When a previously healthy 25-year-old man died suddenly way back in 1939 while taking an examination at Purdue University in Indiana, the event was not only the occasion for a journal article but for an rebuke as well.

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The student was known to use amphetamine to enhance studying, and although post-mortem toxicology testing was still an uncertain science at that time, traces of amphetamine were found in his stomach contents. In an article titled “Collapse with Death Following the Use of Amphetamine Sulfate” in the Journal of the American Medical Association, the author noted that he was spurred into reporting the case to discourage “the promiscuous use and drugstore sale without a prescription of amphetamine sulfate as a ‘pep pill.'” (1939;113[11]:1022.)

Those were indeed different times, as we are reminded by Nicolas Rasmussen's fascinating history of stimulants and psychotropic medicine, On Speed: The Many Lives of Amphetamine. (New York University Press; 2008.) Mr. Rasmussen, an associate professor of the history of science at the University of New South Wales in Sydney, begins his story in 1929, when Gordon Alles, a Los Angeles chemist searching for new medications to treat asthma and allergies, injected himself with a chemical he had recently created to study its effects. His notes document that this injection created a “feeling of well being,” although afterwards he spent a rather sleepless night during which his “mind seemed to race from one subject to another.”

The chemical Mr. Alles had discovered was amphetamine. It did not prove useful for treating asthma, but in 1934 a drug company released the Benzedrine inhaler, a decongestant nasal spray containing drug-soaked paper wads packaged as a tube. Benzedrine was, in fact, a volatile form of amphetamine. (Whether the company came upon amphetamine independently or adapted Mr. Alles' work appears to be a matter of dispute.)

Mr. Rasmussen describes well how, over the next four decades, the advertising for amphetamine and other stimulants (such as methamphetamine, Dexedrine, and methylphenidate) reflected the zeitgeist of each era and the pharmaceutical industry's need to find ever-expanding indications for these products.

By the late 1930s and early 1940s during the Great Depression and the onset of World War II, advertisements in medical journals heralded Benzedrine sulfate tablets as “a milestone in medical history” for their ability to treat mild depression and bring about “a sense of increased energy, mental alertness and capacity for work.” Of course, during these hard times, the market for an antidepressant was limitless.

During World War II, when amphetamine and other stimulants were used widely by armed forces on both sides of the conflict, advertising copy emphasized this military connection: “To save the lives of men in combat through sustaining their mental efficiency by overcoming the symptoms of fatigue, Benzedrine Sulfate tablets are available for issue in the Armed Forces.” Despite multiple attempts, studies never demonstrated that stimulants actually improved combat performance. Rather, they tended to impair judgment, and with large sustained doses, bring about paranoid hallucinations.

By the end of World War II, Mr. Rasmussen estimates that Americans were downing 30 million tablets of amphetamine and similar drugs each month. But the popularity of these drugs was about to expand even more dramatically. As the 1940s slid into the 1950s, both Benzedrine (racemic amphetamine) and Dexedrine (the d-isomer) were being marketed as diet pills. One ad in a medical journal read:

“You see them at the club … you see them at the clinic … victims of overeating and underactivity. For these lethargic overweight patients: Dexedrine.”

And then in the 1950s, with burgeoning but fragile affluence and angst about The Bomb, drug ads became downright existential:

“Modern man is the victim of this era. War … rumors of war … atomic devastation … too much government, economic uncertainty. Mental depression is one of the most common results. ‘Dexedrine' Sulfate can do much to help the depressed patient.”

Of course, drug companies were well aware that a common adverse effect of stimulants was increased anxiety and agitation. Later in the decade, products combining an amphetamine with a barbiturate came on the market, claiming to be the perfect solution for treating depression and anxiety. One such product was Dexamyl, a mixture of Dexedrine and amobarbital. The trade name Benzebar was rejected as too awkward, perhaps better suited to the title of a Bing Crosby-Bob Hope movie: The Road to Benzebar! Opening soon at a theater near you!

There is much more in this comprehensive book. Mr. Rasmussen goes into detail about the widespread abuse of the Benzedrine inhaler; if the product's delivery tube was cracked open, the amphetamine-soaked paper wads inside containing either 250 mg or 350 mg of amphetamine could be eaten straight or steeped in coffee. He talks about the common use of stimulants in sports, especially cycling, where they were associated with several tragedies, most notably that of Tom Simpson, a world champion who collapsed and died on the climb up Mont Ventoux in the 1967 Tour de France, and was found to have amphetamine in his system.

Bringing the story up to the present time, Mr. Rasmussen discusses designer stimulants such as MDMA (ecstasy). Interestingly, the first version of ecstasy — MDA — was discovered by Gordon Alles in 1930.) He also outlines the development and marketing of new indications for amphetamines, such as attention deficit hyperactivity disorder.

On Speed does tend to get wordy and repetitive, and the last 100 pages particularly are a bit of a slog, but there is a wealth of information here that anyone with an interest in toxicology will find irresistible. The illustrations — mostly vintage drug advertisements — alone would make the book worth owning. And the more than 80 pages of notes will serve as a valuable resource for anyone writing about amphetamines in the future. I highly recommend it.

Comments about this article? Write to EMN at emn@lww.com.

Dr. Gussow is a volu...
Dr. Gussow is a volu...
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