Tchort
Bluelight Crew
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This is a very interesting article I just happened across. I hope other BL'ers find it interesting as well. I am only posting maybe a third or half of the whole article (as it is fairly long). The link to the full article is at the end of the post. Enjoy!
America's First Amphetamine Epidemic 1929-1971
By Rasmussen, Nicolas
"Using historical research that draws on new primary sources, I review the causes and course of the first, mainly iatrogenic amphetamine epidemic in the United States from the 1940s through the 1960s. Retrospective epidemiology indicates that the absolute prevalence of both nonmedical stimulant use and stimulant dependence or abuse have reached nearly the same levels today as at the epidemic's peak around 1969. Further parallels between epidemics past and present, including evidence that consumption of prescribed amphetamines has also reached the same absolute levels today as at the original epidemic's peak, suggest that stricter limits on pharmaceutical stimulants must be considered in any efforts to reduce amphetamine abuse today. ( Am J Public Health. 2008;98:974- 985. doi: 10.2105/AJPH.2007.110593) THE UNITED STATES IS experiencing an outbreak of amphetamine abuse. The latest national surveys show that about 3 million Americans used amphetamine- type stimulants nonmedically in the past year, 600000 in the past week, and that 250000 to 350000 are addicted.1 Although survey data indicate that the number of nonmedical users of amphetamine-type stimulants may have stabilized, the number of heavy users with addiction problems doubled between 2002 and 2004.2 Thus, the public health problem presented by amphetamines may still be increasing in severity; in many ways it surpasses that of heroin.3 Although all of this is widely appreciated, the history of an even larger amphetamine epidemic 4 decades ago is less well-known.
ORIGINS OF THE EPIDEMIC, 1929-1945
The original amphetamine epidemic was generated by the pharmaceutical industry and medical profession as a byproduct of routine commercial drug development and competition. Searching for a decongestant and bronchodilator to substitute for ephedrine, in 1929, biochemist Gordon Alles discovered the physiological activity of beta-phenylisopropylamine (soon to be known as amphetamine). Alles published his first clinical results with the compound in 1929,4 began amphetamine's clinical development in collaboration with pharmacologists and clinicians at the University of California, and received a patent on its orally active salts in 1932.5 Meanwhile, possibly inspired by Alles's work, the Philadelphia firm Smith, Kline and French (SKF) investigated the base form of amphetamine and patented it in 1933. SKF marketed it as the Benzedrine Inhaler, a capped tube containing 325 mg of oily amphetamine base and little else. For congestion, one was meant to inhale amphetamine vapor every hour as needed.6 Although no legal category of prescriptiononly drugs existed in the 1930s,7 the Benzedrine Inhaler was advertised for over-the-counter sale upon its introduction in 1933 and 1934 and for the next 15 years.8
At the end of 1934, Alles transferred his patent on amphetamine salts to SKF, and the firm sponsored the drug's further clinical development.9 In 1937, the American Medical Association (AMA) approved advertising of SKF's "Benzedrine Sulfate" racemic amphetamine tablets for narcolepsy, postencephalitic Parkinsonism, and minor depression.10 (The voluntary AMA "Seal of Approval" system, in which mainly academic medical experts evaluated data submitted by manufacturers before allowing advertising in cooperating journals, was the only drug efficacy regulation at the time.11) Amphetamine therapy for minor ("neurotic") depression quickly found acceptance among psychiatrists and neurologists in the late 1930s. SKF-funded Harvard psychiatrist Abraham Myerson played a particularly influential role, theorizing that amphetamine adjusted hormonal balance in the central nervous system by creating or amplifying adrenergic stimulation so as to promote activity and extraversion. Because Meyerson understood minor depression as anhedonia caused by suppression of natural drives to action, amphetamine represented an ideal depression therapy to him.12
Fueled by advertising and marketing urging general practitioners to prescribe the drug for depression, and at the same time promoting Myerson's rationale for that use, annual sales of Benzedrine tablets (mainly 10 mg) grew steadily to about $500000 in 1941, over 4% of SKF's total sales.13 Thus, by World War II, amphetamine in tablet form was finding commercial success and gaining credibility as a prescription psychiatric medication (the first "antidepressant"), despite sporadic reports of misuse.14 The war years did nothing to diminish the drug's growth in popularity; by 1945, SKF's civilian amphetamine tablet sales had quadrupled to $2 million, including $650000 in sales of the firm's new "Dexedrine" dextroamphetamine tablets.15
The US military also supplied Benzedrine to servicemen during the war, mainly as 5-mg tablets, for routine use in aviation, as a general medical supply, and in emergency kits.16 The British military also supplied Benzedrine tablets during the war, and the German and Japanese military supplied methamphetamine.17 Of course, not all amphetamine supplied by the military was ingested by servicemen, nor did users ingest it ad libitum; there were rules limiting the drug's use.18 However, these were not well observed. For instance, in a 1945 army survey of fighter pilots, of the 15% (13 of 85) who regularly used amphetamine in combat, the majority "made their own rules" and took Benzedrine whenever they "felt like it" rather than as directed.19
Along with growth in amphetamine use for psychiatric indications, the war years also saw an explosion of amphetamine consumption for weight loss, although this medical usage was not yet approved by AMA and not advertised by SKF. Off-brand pills manufactured by smaller companies dominated this market. In 1943, SKF filed suit for patent infringement against one of these manufacturers, a New Jersey concern named Clark & Clark, producer of both 10-mg Benzedrine look- alike tablets and colorful diet pills containing metabolism- boosting thyroid hormone and 5 mg of amphetamine. The company's output was a matter of dispute, but on the basis of sworn testimony from both sides, combined amphetamine production for civilian use by SKF and Clark & Clark in late 1945 must have stood between 13 million and 55 million tablets monthly and may be conservatively estimated at about 30 million tablets monthly, each containing 5 to 10 mg of amphetamine salts.20 This national (civilian) consumption rate for the United States in 1945 was sufficient to supply half a million Americans with 2 tablets daily, the standard dosage schedule for depression and weight loss. Pastyear use in 1946 would have almost certainly been higher, because many were only occasional users.
Unsurprisingly, given such widespread availability of so inherently attractive a drug, significant abuse of amphetamine quickly developed. One noteworthy 1947 publication hinted at its dimensions. Psychiatrists Russell Monroe and Hyman Drell, stationed at a military prison in 1945, encountered large numbers of agitated, hallucinating patients. A survey revealed that one quarter of the imprisoned personnel were eating the contents of Benzedrine Inhalers, which then contained 250 mg of amphetamine base. Almost one third of the abusers (8% of the prison population) had begun this practice in the military before imprisonment. Only 11% of the inhaler abusers (3% of the prison population) had used some form of amphetamine nonmedically before the war. Twenty-seven percent of abusers had been given amphetamine during military service, mainly by an officer and in tablet form, compared with 5% of nonabusers-an odds ratio of 7.0. There is thus strong evidence that Benzedrine abuse, although an existing practice, was multiplied many times by military exposure, at least among vulnerable subpopulations. And although these prisoners were not typical of military personnel, neither, in the judgment of the psychiatrists, were most of them particularly abnormal young men.21
To sum up, by the end of World War II in 1945, less than a decade after amphetamine tablets were introduced to medicine, over half a million civilians were using the drug psychiatrically or for weight loss, and the consumption rate in the United States was greater than 2 tablets per person per year on a total-population (all ages) basis.22 Up to 16 million young Americans had been exposed to Benzedrine Sulfate during military service, in which the drug was not treated as dangerous nor was its use effectively controlled, helping normalize and disseminate nonmedical amphetamine use. Misuse and abuse, especially of the cheap nonprescription Benzedrine Inhaler but also of tablets, were not uncommon. However, as often occurs in the first flush of enthusiasm for new pharmaceuticals, abuse, adverse effects, and other drawbacks had not yet attracted much notice.
GROWTH OF THE EPIDEMIC, 1945-1960
In 1945 and 1946, the courts upheld Alles's patent on amphetamine salts, affirming SKF's monopoly control of oral amphetamine until late 1949.23 With recouped business from infringing firms, SKF's annual sales of amphetamine tablets (Benzedrine and Dexedrine Sulfate) doubled, from $2.9 million in 1946 to $5.7 million in 1947.24 With AMA approval to advertise amphetamine for weight loss that year, sales climbed further to $7.3 million in 1949, despite competition from methamphetamine-based weight loss and antidepressant products such as Abbot's Desoxyn and Wellcome's Methedrine.25 Following expiration of Alles's patent in late 1949, consumption of pharmaceutical amphetamines in the United States surged. On the basis of voluntary manufacturer surveys, the Food and Drug Administration (FDA) placed 1952 production of amphetamine and methamphetamine salts at nearly quadruple the agency's 1949 estimate by similar methods.26 Given that SKF amphetamine sales in the period did not grow significantly, virtually all this expansion in amphetamine supply was driven by the marketing efforts of competitors.27 During the 1950s, fierce commercial competition helped drive amphetamine consumption higher still. In a particularly innovative effort to expand medical usages for the drug, in late 1950, SKF introduced a product called Dexamyl, a blend of dextroamphetamine and the barbiturate sedative amobarbital. 28 Intended to overcome the unpleasant agitation that many users experienced with amphetamine and to quell anxiety without drowsiness, Dexamyl was marketed with great success for everyday "mental and emotional distress" in general practice and also as a weight-loss remedy striking at the emotional causes of overeating. 29 Competing firms answered with their own sedative- amphetamine combinations, such as Abbot's Desbutal and Robins's Ambar, blends of methamphetamine and pentobarbital or phenobarbital, respectively.30 Creative amphetamine combination products from both SKF and its competitors proliferated throughout the 1950s.31
According to FDA manufacturer surveys, by 1962, US production reached an estimated 80000 kg of amphetamine salts, corresponding to consumption of 43 standard 10-mg doses per person per year on a total-population basis.32 Thus, in amphetamine alone, the United States in the early 1960s was using nearly as much psychotropic medication as the 65 doses per person per year in the present decade that social critics today find so extraordinary. 33 And the 1960s are rightly remembered for excessive minor tranquilizer consumption, around 14 standard doses per person per year on the basis of retail prescription sales.34 It is rarely appreciated that in the early 1960s, amphetamines were actually consumed at a higher rate than tranquilizers. This oversight may be caused by excessive reliance on retail prescription audits (inappropriate for amphetamines when billions were dispensed directly; see the next section) and neglect of the fact that amphetamine obesity medications were just as psychotropic as amphetamine- based antidepressants. Through the rest of the 1960s, FDA estimates of amphetamine production would grow little beyond 8 billion 10-mg doses, implying that consumption of the drug had already reached saturation levels in 1962. This conclusion, based on voluntary FDA production surveys, draws independent support from flat retail prescription sales from 1964 to 1970.35
The best published evidence of the nature and prevalence of medical amphetamine consumption around 1960 comes from studies in the United Kingdom, thanks to the National Health System, which facilitates comprehensive prescription monitoring and correlation of physicians with base populations. A study of retail prescriptions filled in the Newcastle area during 1960 found that about 3% were for amphetamines, consistent both with UK national prescribing figures and with contemporary prescribing in the United States according to commercial audits.36 Given similarities in culture and medical practices, the British findings therefore shed light on amphetamine use in America around 1960, at least for drugs dispensed at pharmacies.37
In the Newcastle study, quantities dispensed were sufficient to supply more than 1% of the total population with 60 tablets per month; two 5-mg doses of dextroamphetamine daily was the most common prescription, according to a 1961 companion study that audited family practitioners in the same area.38 Dexamyl-in Britain called Drinamyl-was the most commonly prescribed amphetamine product. About one third of amphetamine prescriptions were for weight loss, one third for clear-cut psychiatric disorders (depression, anxiety), and the remaining third for ambiguous, mostly psychiatric and psychosomatic complaints (tiredness, nonspecific pain). The largest age group among the medical users were those aged 36 to 45 years, and 85% of all amphetamine patients were women.39 Even making the simplifying assumption that weight loss prescriptions were entirely for women and taking into account that women seek medical attention more often than men, these figures indicate that per doctor visit around 1960, a woman was twice as likely as a man to receive an amphetamine prescription to adjust her mental state-much like minor tranquilizers in the same period.40
By about 1960, widespread consumption had begun to make amphetamine's negative health consequences more evident. Amphetamine psychosis had already been observed in the 1930s among long-term narcoleptic users of the drug, and individual case reports mounted during the 1940s and early 1950s.41 Initially, psychotic episodes were attributed to latent schizophrenia "unmasked" by the drug or to some other preexisting psychiatric pathology in the user.42 In Philip Connell's definitive 1958 study of 40 cases, however, the British psychiatrist persuasively showed that amphetamine psychosis could happen to anyone, and eventually would, given enough of the drug.43 The highly uniform set of paranoid symptoms- sinister voices emanating from toilet bowls, spies following one's every move-in a wide variety of personality types argued against any shared constitutional feature of the patients' mentality or neurology. Also, the psychosis generally took time to develop, suggesting a dosage-dependent cumulative effect. And although almost all of Connell's patients had engaged in nonmedical use before their crises, a large proportion had first taken amphetamines by prescription, so they could not be dismissed as deviant thrill- seekers. Finally, patients recovered fully a week or two after they ceased amphetamine use, essentially proving they had not been schizophrenic.44
Evidence was also emerging around 1960 that amphetamine is truly addictive, instead of merely "habituating" like caffeine, as leading pharmacologists had asserted when the drug was first introduced. 45 Postwar changes in thinking about addiction, promoted particularly by the World Health Organization, facilitated this new perspective on amphetamine by moving the concept away from an opiate model, defined by acute physiological withdrawal, toward a psychosocial model of "drug dependency" defined by compulsive behavior and erosion of function.46 Indeed, the previously mentioned British research uncovered evidence of significant dependency on prescribed amphetamines. In Newcastle in 1961, 0.8% of a very large study population received amphetamine prescriptions during a 3-month audit period; according to their physicians, between one fifth and one quarter of these amphetamine patients were "habituated or addicted" or dependent to some extent.47 Taking the sample in these studies as representative (as the investigators intended), between 2% and 3% of the total population must have received amphetamines by prescription in the course of a year.48 This, together with the 0.2% of the general population identified as "habituated or addicted," implies a dependency rate among past-year medical amphetamine users of 6.7% to 10%.49 "
. . .
Here is a link to the rest of the article.
http://www.redorbit.com/news/health/1413747/americas_first_amphetamine_epidemic_19291971/
America's First Amphetamine Epidemic 1929-1971
By Rasmussen, Nicolas
"Using historical research that draws on new primary sources, I review the causes and course of the first, mainly iatrogenic amphetamine epidemic in the United States from the 1940s through the 1960s. Retrospective epidemiology indicates that the absolute prevalence of both nonmedical stimulant use and stimulant dependence or abuse have reached nearly the same levels today as at the epidemic's peak around 1969. Further parallels between epidemics past and present, including evidence that consumption of prescribed amphetamines has also reached the same absolute levels today as at the original epidemic's peak, suggest that stricter limits on pharmaceutical stimulants must be considered in any efforts to reduce amphetamine abuse today. ( Am J Public Health. 2008;98:974- 985. doi: 10.2105/AJPH.2007.110593) THE UNITED STATES IS experiencing an outbreak of amphetamine abuse. The latest national surveys show that about 3 million Americans used amphetamine- type stimulants nonmedically in the past year, 600000 in the past week, and that 250000 to 350000 are addicted.1 Although survey data indicate that the number of nonmedical users of amphetamine-type stimulants may have stabilized, the number of heavy users with addiction problems doubled between 2002 and 2004.2 Thus, the public health problem presented by amphetamines may still be increasing in severity; in many ways it surpasses that of heroin.3 Although all of this is widely appreciated, the history of an even larger amphetamine epidemic 4 decades ago is less well-known.
ORIGINS OF THE EPIDEMIC, 1929-1945
The original amphetamine epidemic was generated by the pharmaceutical industry and medical profession as a byproduct of routine commercial drug development and competition. Searching for a decongestant and bronchodilator to substitute for ephedrine, in 1929, biochemist Gordon Alles discovered the physiological activity of beta-phenylisopropylamine (soon to be known as amphetamine). Alles published his first clinical results with the compound in 1929,4 began amphetamine's clinical development in collaboration with pharmacologists and clinicians at the University of California, and received a patent on its orally active salts in 1932.5 Meanwhile, possibly inspired by Alles's work, the Philadelphia firm Smith, Kline and French (SKF) investigated the base form of amphetamine and patented it in 1933. SKF marketed it as the Benzedrine Inhaler, a capped tube containing 325 mg of oily amphetamine base and little else. For congestion, one was meant to inhale amphetamine vapor every hour as needed.6 Although no legal category of prescriptiononly drugs existed in the 1930s,7 the Benzedrine Inhaler was advertised for over-the-counter sale upon its introduction in 1933 and 1934 and for the next 15 years.8
At the end of 1934, Alles transferred his patent on amphetamine salts to SKF, and the firm sponsored the drug's further clinical development.9 In 1937, the American Medical Association (AMA) approved advertising of SKF's "Benzedrine Sulfate" racemic amphetamine tablets for narcolepsy, postencephalitic Parkinsonism, and minor depression.10 (The voluntary AMA "Seal of Approval" system, in which mainly academic medical experts evaluated data submitted by manufacturers before allowing advertising in cooperating journals, was the only drug efficacy regulation at the time.11) Amphetamine therapy for minor ("neurotic") depression quickly found acceptance among psychiatrists and neurologists in the late 1930s. SKF-funded Harvard psychiatrist Abraham Myerson played a particularly influential role, theorizing that amphetamine adjusted hormonal balance in the central nervous system by creating or amplifying adrenergic stimulation so as to promote activity and extraversion. Because Meyerson understood minor depression as anhedonia caused by suppression of natural drives to action, amphetamine represented an ideal depression therapy to him.12
Fueled by advertising and marketing urging general practitioners to prescribe the drug for depression, and at the same time promoting Myerson's rationale for that use, annual sales of Benzedrine tablets (mainly 10 mg) grew steadily to about $500000 in 1941, over 4% of SKF's total sales.13 Thus, by World War II, amphetamine in tablet form was finding commercial success and gaining credibility as a prescription psychiatric medication (the first "antidepressant"), despite sporadic reports of misuse.14 The war years did nothing to diminish the drug's growth in popularity; by 1945, SKF's civilian amphetamine tablet sales had quadrupled to $2 million, including $650000 in sales of the firm's new "Dexedrine" dextroamphetamine tablets.15
The US military also supplied Benzedrine to servicemen during the war, mainly as 5-mg tablets, for routine use in aviation, as a general medical supply, and in emergency kits.16 The British military also supplied Benzedrine tablets during the war, and the German and Japanese military supplied methamphetamine.17 Of course, not all amphetamine supplied by the military was ingested by servicemen, nor did users ingest it ad libitum; there were rules limiting the drug's use.18 However, these were not well observed. For instance, in a 1945 army survey of fighter pilots, of the 15% (13 of 85) who regularly used amphetamine in combat, the majority "made their own rules" and took Benzedrine whenever they "felt like it" rather than as directed.19
Along with growth in amphetamine use for psychiatric indications, the war years also saw an explosion of amphetamine consumption for weight loss, although this medical usage was not yet approved by AMA and not advertised by SKF. Off-brand pills manufactured by smaller companies dominated this market. In 1943, SKF filed suit for patent infringement against one of these manufacturers, a New Jersey concern named Clark & Clark, producer of both 10-mg Benzedrine look- alike tablets and colorful diet pills containing metabolism- boosting thyroid hormone and 5 mg of amphetamine. The company's output was a matter of dispute, but on the basis of sworn testimony from both sides, combined amphetamine production for civilian use by SKF and Clark & Clark in late 1945 must have stood between 13 million and 55 million tablets monthly and may be conservatively estimated at about 30 million tablets monthly, each containing 5 to 10 mg of amphetamine salts.20 This national (civilian) consumption rate for the United States in 1945 was sufficient to supply half a million Americans with 2 tablets daily, the standard dosage schedule for depression and weight loss. Pastyear use in 1946 would have almost certainly been higher, because many were only occasional users.
Unsurprisingly, given such widespread availability of so inherently attractive a drug, significant abuse of amphetamine quickly developed. One noteworthy 1947 publication hinted at its dimensions. Psychiatrists Russell Monroe and Hyman Drell, stationed at a military prison in 1945, encountered large numbers of agitated, hallucinating patients. A survey revealed that one quarter of the imprisoned personnel were eating the contents of Benzedrine Inhalers, which then contained 250 mg of amphetamine base. Almost one third of the abusers (8% of the prison population) had begun this practice in the military before imprisonment. Only 11% of the inhaler abusers (3% of the prison population) had used some form of amphetamine nonmedically before the war. Twenty-seven percent of abusers had been given amphetamine during military service, mainly by an officer and in tablet form, compared with 5% of nonabusers-an odds ratio of 7.0. There is thus strong evidence that Benzedrine abuse, although an existing practice, was multiplied many times by military exposure, at least among vulnerable subpopulations. And although these prisoners were not typical of military personnel, neither, in the judgment of the psychiatrists, were most of them particularly abnormal young men.21
To sum up, by the end of World War II in 1945, less than a decade after amphetamine tablets were introduced to medicine, over half a million civilians were using the drug psychiatrically or for weight loss, and the consumption rate in the United States was greater than 2 tablets per person per year on a total-population (all ages) basis.22 Up to 16 million young Americans had been exposed to Benzedrine Sulfate during military service, in which the drug was not treated as dangerous nor was its use effectively controlled, helping normalize and disseminate nonmedical amphetamine use. Misuse and abuse, especially of the cheap nonprescription Benzedrine Inhaler but also of tablets, were not uncommon. However, as often occurs in the first flush of enthusiasm for new pharmaceuticals, abuse, adverse effects, and other drawbacks had not yet attracted much notice.
GROWTH OF THE EPIDEMIC, 1945-1960
In 1945 and 1946, the courts upheld Alles's patent on amphetamine salts, affirming SKF's monopoly control of oral amphetamine until late 1949.23 With recouped business from infringing firms, SKF's annual sales of amphetamine tablets (Benzedrine and Dexedrine Sulfate) doubled, from $2.9 million in 1946 to $5.7 million in 1947.24 With AMA approval to advertise amphetamine for weight loss that year, sales climbed further to $7.3 million in 1949, despite competition from methamphetamine-based weight loss and antidepressant products such as Abbot's Desoxyn and Wellcome's Methedrine.25 Following expiration of Alles's patent in late 1949, consumption of pharmaceutical amphetamines in the United States surged. On the basis of voluntary manufacturer surveys, the Food and Drug Administration (FDA) placed 1952 production of amphetamine and methamphetamine salts at nearly quadruple the agency's 1949 estimate by similar methods.26 Given that SKF amphetamine sales in the period did not grow significantly, virtually all this expansion in amphetamine supply was driven by the marketing efforts of competitors.27 During the 1950s, fierce commercial competition helped drive amphetamine consumption higher still. In a particularly innovative effort to expand medical usages for the drug, in late 1950, SKF introduced a product called Dexamyl, a blend of dextroamphetamine and the barbiturate sedative amobarbital. 28 Intended to overcome the unpleasant agitation that many users experienced with amphetamine and to quell anxiety without drowsiness, Dexamyl was marketed with great success for everyday "mental and emotional distress" in general practice and also as a weight-loss remedy striking at the emotional causes of overeating. 29 Competing firms answered with their own sedative- amphetamine combinations, such as Abbot's Desbutal and Robins's Ambar, blends of methamphetamine and pentobarbital or phenobarbital, respectively.30 Creative amphetamine combination products from both SKF and its competitors proliferated throughout the 1950s.31
According to FDA manufacturer surveys, by 1962, US production reached an estimated 80000 kg of amphetamine salts, corresponding to consumption of 43 standard 10-mg doses per person per year on a total-population basis.32 Thus, in amphetamine alone, the United States in the early 1960s was using nearly as much psychotropic medication as the 65 doses per person per year in the present decade that social critics today find so extraordinary. 33 And the 1960s are rightly remembered for excessive minor tranquilizer consumption, around 14 standard doses per person per year on the basis of retail prescription sales.34 It is rarely appreciated that in the early 1960s, amphetamines were actually consumed at a higher rate than tranquilizers. This oversight may be caused by excessive reliance on retail prescription audits (inappropriate for amphetamines when billions were dispensed directly; see the next section) and neglect of the fact that amphetamine obesity medications were just as psychotropic as amphetamine- based antidepressants. Through the rest of the 1960s, FDA estimates of amphetamine production would grow little beyond 8 billion 10-mg doses, implying that consumption of the drug had already reached saturation levels in 1962. This conclusion, based on voluntary FDA production surveys, draws independent support from flat retail prescription sales from 1964 to 1970.35
The best published evidence of the nature and prevalence of medical amphetamine consumption around 1960 comes from studies in the United Kingdom, thanks to the National Health System, which facilitates comprehensive prescription monitoring and correlation of physicians with base populations. A study of retail prescriptions filled in the Newcastle area during 1960 found that about 3% were for amphetamines, consistent both with UK national prescribing figures and with contemporary prescribing in the United States according to commercial audits.36 Given similarities in culture and medical practices, the British findings therefore shed light on amphetamine use in America around 1960, at least for drugs dispensed at pharmacies.37
In the Newcastle study, quantities dispensed were sufficient to supply more than 1% of the total population with 60 tablets per month; two 5-mg doses of dextroamphetamine daily was the most common prescription, according to a 1961 companion study that audited family practitioners in the same area.38 Dexamyl-in Britain called Drinamyl-was the most commonly prescribed amphetamine product. About one third of amphetamine prescriptions were for weight loss, one third for clear-cut psychiatric disorders (depression, anxiety), and the remaining third for ambiguous, mostly psychiatric and psychosomatic complaints (tiredness, nonspecific pain). The largest age group among the medical users were those aged 36 to 45 years, and 85% of all amphetamine patients were women.39 Even making the simplifying assumption that weight loss prescriptions were entirely for women and taking into account that women seek medical attention more often than men, these figures indicate that per doctor visit around 1960, a woman was twice as likely as a man to receive an amphetamine prescription to adjust her mental state-much like minor tranquilizers in the same period.40
By about 1960, widespread consumption had begun to make amphetamine's negative health consequences more evident. Amphetamine psychosis had already been observed in the 1930s among long-term narcoleptic users of the drug, and individual case reports mounted during the 1940s and early 1950s.41 Initially, psychotic episodes were attributed to latent schizophrenia "unmasked" by the drug or to some other preexisting psychiatric pathology in the user.42 In Philip Connell's definitive 1958 study of 40 cases, however, the British psychiatrist persuasively showed that amphetamine psychosis could happen to anyone, and eventually would, given enough of the drug.43 The highly uniform set of paranoid symptoms- sinister voices emanating from toilet bowls, spies following one's every move-in a wide variety of personality types argued against any shared constitutional feature of the patients' mentality or neurology. Also, the psychosis generally took time to develop, suggesting a dosage-dependent cumulative effect. And although almost all of Connell's patients had engaged in nonmedical use before their crises, a large proportion had first taken amphetamines by prescription, so they could not be dismissed as deviant thrill- seekers. Finally, patients recovered fully a week or two after they ceased amphetamine use, essentially proving they had not been schizophrenic.44
Evidence was also emerging around 1960 that amphetamine is truly addictive, instead of merely "habituating" like caffeine, as leading pharmacologists had asserted when the drug was first introduced. 45 Postwar changes in thinking about addiction, promoted particularly by the World Health Organization, facilitated this new perspective on amphetamine by moving the concept away from an opiate model, defined by acute physiological withdrawal, toward a psychosocial model of "drug dependency" defined by compulsive behavior and erosion of function.46 Indeed, the previously mentioned British research uncovered evidence of significant dependency on prescribed amphetamines. In Newcastle in 1961, 0.8% of a very large study population received amphetamine prescriptions during a 3-month audit period; according to their physicians, between one fifth and one quarter of these amphetamine patients were "habituated or addicted" or dependent to some extent.47 Taking the sample in these studies as representative (as the investigators intended), between 2% and 3% of the total population must have received amphetamines by prescription in the course of a year.48 This, together with the 0.2% of the general population identified as "habituated or addicted," implies a dependency rate among past-year medical amphetamine users of 6.7% to 10%.49 "
. . .
Here is a link to the rest of the article.
http://www.redorbit.com/news/health/1413747/americas_first_amphetamine_epidemic_19291971/
