Amphetamines in America: A Love Story

The United States is in the midst
of a stimulant kick. With each passing year, increasing numbers of Americans
are ingesting ADHD medications—Adderall, Ritalin, and Vyvanse, to name a few—both
for prescription and non-prescription use. A study of 15 million annual
prescriptions in the United States by Express Scripts, a pharmacy benefit
management company, found that prescriptions for ADHD increased by 36% between
2008 and 2012 to reach 4.8 million individuals, with the largest increase (85%)
occurring in women aged 26-34.

These
numbers only include prescription users, but stimulant use for non-medical
purposes is also quite common. According to a 2005 University of
Michigan Substance Abuse Research Center study, which used data from 2001, 4.1 percent of respondents had used stimulant meds for non-medical use in the past year. A more recent study
from the University of California, Berkeley, utilizing data collected in 2009,
updated that number to 10.1%, an increase of 246% in eight years.

This is not the first time in American history that stimulants
have been used and abused for recreational and ostensibly medical
purposes. Amphetamine, the compound from which many ADHD medications are based,
was first synthesized in the United States in 1929 as a decongestant, and first
sold pharmaceutically for inhalers in 1933. By the 1940s, psychiatric
prescription of amphetamine, fueled largely by pharmaceutical companies’
advertisements, had become somewhat of a panacea and was medically recommended
for narcolepsy, Parkinsonism, weight-loss, overeating and depression. 

Amphetamines were also widely used by the
American military during World War II to promote alertness and ‘courage,’ with
estimates suggesting as many as 16 million service members were exposed to amphetamines during the war.

The stimulant
epidemic reached its peak in the 1960s, during which American production of
amphetamines reached 100,000 kilograms a year—enough for about 50 doses per person per
year for every American citizen. The drug was flowing freely throughout
American society, with about half the 8 billion
tablets produced annually being diverted for non-medical use. Even President
John F. Kennedy was in on the amphetamine epidemic, receiving regular
injections of 15 milligrams methamphetamine.

But the tide was
soon to turn against the cure-all “therapeutic weapon,” as psychiatrists and
citizens alike saw the crippling effects of amphetamine abuse, namely pernicious
addiction and severely disturbed psychosis. The onset of Nixon’s War on Drugs
placed quotas on amphetamine production in the U.S., and by the end of the
70’s, the amphetamine epidemic was over in the United States.

Given this
historical context, the current stimulant rush feels much like a nuanced remake
of an old classic film. Pharmaceutical companies are still aggressively pushing
stimulants as simple cures for complex problems like academic underachievement,
inattention at work, or acting out in school.

And though the
federal government has supposedly learned its lesson when it comes to
regulating amphetamine manufacture and traffic, the restrictions often seem all
too malleable. Every major drug company has been fined in the tens of millions
of dollars by the Food and Drug Administration (FDA) for overzealous or
inaccurate advertising of ADHD medication. And yet, in February the FDA
approved the use of Vyvanse, an amphetamine, for treating binge-eating disorder
despite little evidence as to its efficacy.

As with the
mid-century epidemic, usage rates are climbing to unparalleled heights. Some
ADHD experts, like Dr. Lawrence Diller, believe the FDA-imposed quota on how
much stimulant medication can be produced and sold in the United States each
year is the best estimator of usage, as a purchased drug is likely to be used
and drug companies are unlikely to produce more drugs than can be sold. 

The
quota for amphetamine in 1990 was 417 kg. In 2013, it stood at 65,000 kg, a
155-fold increase over a period where U.S. population increased by a factor of
1.2. Overall, the FDA approved the production of 175,000 kg of ADHD medications
in 2013—a staggering 193 tons. 

In spite of shady pharmaceutical marketing practices and what may seem like lax
governmental oversight, the roots of this modern epidemic are more complicated
than a Big Pharma/crony capitalism pessimist might have you believe. Part of
the explosion has been driven by doctors aiming to do genuine good for people
struggling with a complex and exhausting disorder.

But another,
perhaps more important part of the equation comes from American culture itself.
There is something distinctly American about the quick-fix mores of modern
society. We are constantly in search of self-improvement and of becoming better
versions of ourselves, but we are often loath to put in the work for true
improvement. It is the reason why self-help books amount to a $10 billion
annual industry, and the most likely buyer of a self-help book is someone who
has bought one in the past year and a half. It is the reason why over half of
Americans take vitamin supplements instead of simply eating more fruits and
vegetables.

Perhaps the
doctors and pharmaceutical companies that we are quick to blame are merely trying
to answer a question that we have generated ourselves: What’s the easiest way
to solve my lack of focus in school, my impulsive habits, my weight gain, my
fill-in-the-blank? Nobody wants to go to a doctor with a problem and hear that
the best solution is “lifestyle changes.” And often, nobody listens when that’s
exactly what their doctor prescribes.

As I said, the
roots are complicated. There are absolutely people who struggle with ADHD and
who benefit tremendously from medication. I am in no way asserting that ADHD is
not “real,” and I don’t seek to place blame. Rather, I aim to question whether
our impulse to solve our social problems quickly and cleanly comes at the cost
of being drowned in a sea of pills, prescriptions and broken promises.

Warren Szewczyk PO ‘15 is hoping to spend the next couple years researching schizophrenia and continuing to write about science. If you are reading this, you hopefully read the entire preceding column, so thanks for that.

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