Amphetamine Class

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Amphetamine stimulants are pharmaceutical products created in laboratories, not harvested or refined from natural products. When amphetamines debuted under the brand name Benzedrine during the Great Depression of the 1930s, they were an ingredient used for inhalers that people would sniff to relieve stopped-up noses. Another effect was a burst of energy and alertness, sometimes accompanied by a brightening of mood into euphoria, and people began using the nonprescription inhalers for recreational purposes. Such drugs were called Cartwheel, Euphodine, and Halloo-wach. Amphetamines became accepted therapeutically as a treatment for depression and worked best if a person simply had difficulty coping with stress during part of a day, as a dose wears off quickly and can leave a person feeling lower if nothing has changed in the situation causing the stress. For example, a dose might deal effectively with occasional aggravation in the workplace but not work so well for a person who stayed at home all the time with continual depression. In the 1930s oral tablets of Benzedrine ("Bennies") became available. Both inhalers and tablets tended to promote insomnia, and that effect was soon used medically to fight narcolepsy, an affliction in which a person suddenly falls asleep numerous times throughout the day. The drug was also used to treat Parkinson's disease, epilepsy, and alcoholism and to help persons suffering from attention deficit hyperactivity disorder (ADHD). ADHD begins in childhood and involves difficulty in paying proper attention to surroundings while also acting restless. Usually the condition goes away as children grow older, but it can continue into adult life. Treating the condition with a stimulant may sound counterproductive, but experience shows that low doses of amphetamine class stimulants can ease ADHD. Practitioners had to learn caution in prescribing to children, however, as occasionally this treatment could intensify rather than diminish the undesired conduct.

World War II brought wide use of amphetamines as military forces on all sides issued "pep pills" to give personnel an edge in combat. The most prominent combat pills were Benzedrine (amphetamine sulfate), Dexedrine (dextroamphetamine), and Methedrine (methamphetamine). Combining such drugs with hard physical labor can be risky, with a user crumpling from overexerting the heart and overheating the whole body, an additional combat hazard for users. In contrast to some other military forces, the United States did not routinely issue the pills except to bomber crews. Nonetheless, the drug was freely available to U.S. personnel who wanted it and was a standard item in survival packs. To improve alertness, national leaders such as British Prime Minister Winston Churchill and, later on, President John F. Kennedy freely used amphetamines as well.1 Kennedy's New Frontier rhetoric was characterized by his frequent call for "vigor," a prime effect of amphetamines, and a state of being that was important to him.

In athletic events, long-standing records fell after amphetamines became available; speculation exists about whether diet and training were solely responsible for a sudden burst of feats that no human had ever been able to perform. We know for sure that racehorses were doped with amphetamines in that era.

The wartime habit of using amphetamines to increase worker productivity made a peacetime transition in Japan and Sweden, where amphetamine abuse became a major concern in the 1950s. In the United States concern also grew with publicity about dangerous ingestion of these tablets by exhausted long-haul truckers. Even though federal officials had cracked down on "upper" sales at truck stops and gas stations, in 1965 the Interstate Commerce Commission (ICC) described amphetamines as a serious threat to motorists sharing the road with trucks, a claim disputed by the American Trucking Association.2

Reports that a drug is used for recreation traditionally raise suspicions about it in America, and an undercurrent of such reports about amphetamines picked up strength in the 1950s. Members of New York's fashionable "beautiful people" who used the drug were called the Benzedrine Set, and in Hollywood the tablets were called "Dolls." Connoisseurs began dosing themselves simultaneously with barbiturate depressants for what was called "a bolt and a jolt." At the social scale's other end, investigators confirmed a brisk business at various prisons where guards were illicitly selling inhalers to prisoners. Outside the jails, crimes against property and persons were attributed to inhalers.

Although restrictions governed sales of inhalers, they were officially non-prescription and priced under a dollar. One inhaler would yield the equivalent of 25 Benzedrine tablets. The original manufacturer of amphetamine sulfate, along with competitors who produced the drug, tried to mix substances into inhalers that would thwart misuse. Abusers found ways to overcome those deterrents, however.

Hearing about alleged results of amphetamine abuse may have been exotic entertainment for most Americans, but they became alarmed by stories of pleasure usage by youths. Inhaler parties by teenagers became so notorious around Kansas City, Missouri, that a U.S. senator introduced federal legislation to curb inhaler sales (Kansas City merchants were retailing hundreds more a week than would be expected in a medicinal context).3 Pharmaceutical companies began withdrawing brands from the market, and in 1959 the U.S. Food and Drug Administration (FDA) announced that the product would henceforth be available by prescription only.

In the 1960s amphetamines received publicity as an element of the hippie pharmacopeia, with that association promoting disdain for a type of drug that had originally been welcomed by ordinary people. Illicit usage of injectable amphetamines became known as "speeding," a reference to hyperactivity re-

suiting from such needle work. Federal authorities placed new restrictions on these stimulants during the 1960s. Varieties available from drugstores declined, as did physicians' ability to prescribe them. The 31 million prescriptions made in 1967 comprise a number never equaled since.

Amphetamines stimulate the central nervous system (the brain and associated anatomy). At one time evidence of damage to nerve cells was not clear enough to satisfy some credible researchers that such a hazard exists, despite any theoretical reasons for concern, but in the 1990s evidence was becoming persuasive. Among other things, researchers have found that persons who continually abuse amphetamines and persons with a certain type of organic brain injury ("focal damage to orbitofrontal PFC [prefrontal cortex]") have similar problems in making decisions.4 Severity correlates to length of amphetamine abuse. Nonprescription sales have long been banned in Sweden due to kidney system damage, and amphetamines are suspects in liver damage involving hepatitis. Amphetamines also excite the heart, increasing pulse rate and blood pressure. Normally cardiac effects are unharmful but can be risky at high doses. To a lesser extent, amphetamines help to open air pathways in the lungs while stimulating breathing. A less welcome action can be promotion of muscle and vocal tics, causing users to jerk or cry out uncontrollably. This problem, however, applies more to persons already troubled by tic afflictions than to persons having no such disability. Amphetamines can also cause rashes or hives. Libido can also change, perhaps involving a stronger sex drive, perhaps involving impotence.

Various foods and drugs can interact with amphetamines. Vitamin C and fruit juices lessen amphetamine effects, while common stomach antacid preparations increase them. Amphetamines can boost actions of widely prescribed psychological medicines called tricyclic antidepressants, an interaction also affecting heart action. Amphetamines can counteract medicines intended to control high blood pressure and can also release extra noradrenaline hormone that is stored in the bodies of people taking monoamine oxidase inhibitors (MAOIs, found in some antidepressants and some Parkinson's disease medication). That release can raise blood pressure enough to create headaches while simultaneously raising body temperature enough to kill a person. The danger of MAOI interaction is far less with oral amphetamine dosage than with intravenous injection, and some medical practitioners have simultaneously prescribed oral forms of amphetamine and MAOI drugs, believing that probable benefits outweigh possible risks. Lithium carbonate, a medicine used to control manic behavior, can reduce central nervous stimulation caused by amphetamines.

Psychological effects vary. In addition to results that many persons would find attractive (noted above), users can also become grouchy, jittery, unable to sleep, and suspicious of other persons. Someone highly intoxicated on amphetamines can act mixed up and pugnacious, be frightened, and have hallucinations. This type of drug promotes impulsive actions—not a good consequence if a user is angry and afraid. Overindulgence can leave a person tired, peevish, confused, and depressed when the drug session ends. A serious abuser can develop symptoms duplicating schizophrenia.

Over time some abusers feel a need to increase dosages in order to get the same effects that lower doses once provided. That suggests an abuser has developed "tolerance" to the drug, a classic component of addiction. In contrast to abusers of other drugs, amphetamine abusers commonly fight tolerance not by gradually increasing their dose but by alternating between periods of little use and binges of massive use, a practice promoting inconsistent behavior that can bewilder acquaintances. Despite all of this, into the 1980s amphetamines were described as not addictive.

Although amphetamines have a long history and widespread usage, their potential for causing cancer is unknown; necessary animal experiments had not been conducted as the twentieth century closed. Abnormal fetal development has occurred in mice receiving over 40 times the maximum safe human dose, but normal development of offspring has occurred despite administration of 12.5 times the maximum human dose to rats and 7 times the maximum to rabbits.5 One human study noted a tendency for more cleft palates than usual if mothers used amphetamines during the first two months of pregnancy.6 Amphetamines easily pass from a pregnant woman into the fetal blood supply. Standard medical advice cautions pregnant women against using the drug without first discussing the issue with a physician. Some studies claim to find that children born of women who abused amphetamines during pregnancy will have long-term problems with personality and intelligence—but these same women abused other drugs as well; some were displeased about their pregnancies; and about 80% of children in one study had been taken away from the mothers and put into foster homes.7 Problems faced by such youngsters may well originate outside amphetamines. Tracking amphetamines' physical effect on offspring is easier. Babies from women who abused amphetamines during pregnancy can exhibit anxiety and physical discomfort suggesting dependence and withdrawal. We know that excessive use by a pregnant woman can promote premature birth and reduce a newborn's weight. Genetic predisposition appears to influence how much this type of drug will affect fetal development.

Amphetamines enter human milk and can reach levels three to seven times higher than shown in maternal blood, so nursing mothers can be dosing their infants. Because this kind of drug can act as an appetite suppressant, causing a person to take in inadequate nutrition, that effect is still another concern if infants receive amphetamines through a mother's milk.

For information about specific amphetamine class stimulants, see alphabetical listings for: dextroamphetamine, ephedrine, khat, ma huang, metham-phetamine, methcathinone, and methylphenidate.

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