The amphetamine drugs include Benzedrine, Dexedrine, Methedrine, Desoxyn, Biphetamine, and Dexamyl. They go by the street names of "speed," "ups," "crank," "splash," "pep pills," "meth," and "A." The first of the amphetamines (Benzedrine) was discovered in 1887, but it was not marketed as a prescription drug until the 1930s. Initially, Benzedrine was used as an inhaler for nasal congestion. Later, the amphetamines were used to treat narcolepsy (compulsive and involuntary sleep), depression, alcoholism, schizophrenia, obesity, hyperkenesis (it seems to have the paradoxical effect of calming down hyperactive children), Parkinson's disease, and fatigue. It became known fairly quickly that amphetamine drugs have a num ber of side effects—including euphoria—that make them attractive for recreational use. Throughout the 1940s and 1950s, prescription amphetamines were increasingly diverted into illegal channels, and by the 1960s, amphetamine had become one of the half-dozen most popular street drugs. In addition, amphetamines were used for instrumental purposes—to combat fatigue and drowsiness.

Amphetamines are used instrumentally and quasitherapeutically in tablet or capsule form; between 2.5 and 10 milligrams would constitute a typical dose. In such low dosages the typical bodily and mental effects of the amphetamines are:

1. a heightened competence in motor skills and mental acuity (measured IQ increases on the average by eight points under the influence of amphetamine in small doses);
2. an increased alertness, a feeling of arousal or wakefulness, a diminution of fatigue and drowsiness;
3. a feeling of increased energy;
4. a stimulation of the need for motor activity, particularly walking about and talking;
5. a feeling of euphoria, an inhibition of depression;
6. increased heartbeat;
7. an inhibition of appetite;
8. constriction of the blood vessels;
9. dryness of the mouth;
10. a feeling of confidence and even grandeur

   Among most groups in the population, between the 1960s and the early 1980s, amphetamines remained the second most popular illicit drug or drug type in the United States. (Marijuana was, of course, the first, and remains so to this day. Today, for most groups, cocaine occupies the number two position.) In the past, amphetamines were used illegally mainly in three modes, circles, or scenes of use. Of these, only two remain, and two have been significantly scaled back.

The first type of illegal amphetamine use is instrumental. Amphetamines were immensely popular in the 1960s and 1970s as prescription "diet pills" iGrinspoon and Hedblom, 1975, pp. 207-217). When physicians cut off a patient's supply as a result of overuse, he or she readily found another supply illegally, on the street. The drug does inhibit the appetite, but any weight loss is temporary; most doctors today agree that taking amphetamine is not only ineffective but dangerous as well. Nowadays, hardly any physicians prescribe amphetamine for weight loss, and illicit use for this purpose seems to be less frequent as well. In addition, in past decades, amphetamines were used without a prescription by a large number of individuals *\ho wished to allay drowsiness—long-distance truck drivers who had no time to rest or sleep, students cramming for an exam, executives, housewives, athletes, and so on. The instrumental use of the amphetamines for this reason still takes place, but controls on these drugs have diminished its frequency and extent. A typical dosage for someone using amphetamine instrumentally would be 2.5 to 10 milligrams.

The second type of illicit amphetamine use, which has existed for decades, is practiced by recreational multiple drug users, who take speed in combination with other drugs, especially alcohol, marijuana, and barbiturates or Quaalude. A recreational user might take two to four 10-milligram tablets or capsules at a time. This type of amphetamine use, like instrumental use, still exists, but is less common than it used to be.

The third category of illegal amphetamine use is the high-dose intravenous use of Methedrine, a sister drug of the amphetamines. (Methedrine is no longer legally manufactured in the United States.) This pattern of use sprang up and died out in the late 1960s, and will be discussed shortly.

In the 1985 national household survey, just under one American age 12 and older in ten (9 percent) said that they had taken amphetamine outside of a medical context at least once in their life—a total of 17.6 million individuals; 1 percent, or 2.7 million people, had used it within the previous month (NIDA, 1986). The lifetime-prevalence figure represented a slight rise from 1982, when 8 percent, or 14.6 million individuals, had used amphetamine; the thirty-day-prevalence figure, however, represented a slight decline from 1982, when just under 2 percent, or 2.8 million people, had taken the drug in the past month .

Even with the recent dip in amphetamine use, it remains a frequently used drug. Among high school seniors, it is still the number-two illicit drug (after marijuana) in lifetime prevalence and annual prevalence, and it ranks third (after marijuana and cocaine) in thirty-day prevalence. In the national household survey, only marijuana (30 percent in lifetime prevalence, 10 percent in monthly prevalence) and cocaine (12 percent and 3 percent respectively) ranked higher in illicit use (NIDA, 1986). Even today, although it attracts practically no publicity at all, and although it is used somewhat less often than in the past, amphetamine remains an extremely popular street drug. Of course, a substantial proportion of this use is made up of illicit instrumental use—for staying up all night to study for exams, driving cross-country, keeping alert on the job, performing well on the athletic field, and so on—and not recreational use.

It should be pointed out that much of what passes for illicit amphetamine use in the United States is bogus. That is, tablets and capsules containing mild stimulants, such as caffeine, are manufactured to look exactly like amphetamines and sold as "energy" tabs and caps. They are called "lookalike" pills, and many young and naive users will take them, thinking they will experience the amphetamine high. After 1982, the researchers who conducted the high-school survey (Johnston et al., 1986, 1987) "adjusted" their statistics on amphetamine use to take account of the "lookalike" phenomenon. It is possible that the figures on amphetamine use in the national household drug survey (NIDA, 1986) should also be scaled down because of overstating due to the use of bogus sustances.

As we saw in Chapter 4, the prescription use of the amphetamines has literally dropped off the charts. Between 1971 and 1986, the number of prescriptions written for the amphetamines declined by 90 percent: Only 10 percent of the number of prescriptions written fifteen years ago are being written nowadays. For some of the amphetamines (methamphetamine, or Methedrine, and Benzedrine), no prescriptions are being written today at all. Currently, the number of medical and psychiatric ailments for which the amphetamines are being used is extremely limited.

As I noted above, a sizable "speed scene" developed and flourished on the street in the late 1960s. It consisted of tens of thousands of young men and women who took amphetamines or Methedrine in huge doses day in and day out. Use peaked in about 1967, and declined sharply after that. Many "speed freaks" (as compulsive, high-dose users of amphetamine were called) at the time became heroin addicts because they alternated the use of amphetamine, a stimulant, with heroin, a depressant, so that they could "come down." They used more and more heroin and less and less amphetamine, and eventually heroin took over completely. Incredible as it may seem, considering the way that amphetamine was used by the speed freaks, heroin was a safer and easier drug to take, and it had less of an impact on their lives.

Although the street "speed scene" did not last a very long time, it had a tremendous impact on the participants' lives. What was it like? The "speed freak" of the late 1960s took amphetamine or Methedrine to get high. More specifically, amphetamine was injected intravenously (IV) to achieve a "flash" or "rush" whose sensation was likened to an orgasm—a "full-body orgasm." Extremely large quantities of the drug were taken in this manner. While 5 or 10 milligrams of Dexedrine, Desoxyn, or Dexamyl taken orally, via tablet or capsule, is a typical therapeutic or instrumental dose, the speed freak may inject half a gram or a full gram (500 or 1,000 milligrams!) in one IV dose. Such massive doses of speed would cause unconsciousness or even death in a nonhabituated individual, but a pleasurable rush in the experienced user. Since amphetamine inhibits sleep, IV use will cause long periods of wakefulness, often two to five days at a stretch (called a "run"), when the drug is injected into the user's system every four to eight hours. This would be followed by long periods of sleep ("crashing"), often lasting up to twenty-four hours.

Such a pattern of heavy, compulsive amphetamine abuse inevitably had a dramatic impact on the user's life and body. Taking huge quantities of a strong stimulant, combined with chronic sleeplessness, produced a state of hyperactivity and hyperexcitement. Researchers believe that the "amphetamine psychosis" is an inevitable accompaniment of high-dose IV amphetamine abuse; its features include paranoia, a tendency toward violence, a schizophrenialike psychosis, hallucinations, delusions, and wild mood swings. One medical observer has noted that "anyone given a large enough dose [of amphetamine] for a long enough period of time will become psychotic" .

Another feature of heavy amphetamine use was the development of certain behavioral fixations, which are repeated over and over again, such as picking at bits of dust in a rug or spending a whole night counting the cornflakes in a cereal box. (This repetitive activity is called "punding," and can be induced in laboratory animals.) One speed freak I interviewed told me of a fellow user who had spent two years engaged in covering an entire wall with heads of George Washington, carefully cut out from canceled postage stamps; supposedly, he had pasted 60,000 of these figures on the wall. In addition, some chronic, compulsive users feel the sensation of bugs crawling under the skin.

Is amphetamine addicting? Specifically, does taking amphetamine in high doses, intravenously, in the manner of the speed freak of the 1960s, build a physical dependence? Discontinuing the use of amphetamine after taking it in quantity over a period of time does produce withdrawal symptoms, but they do not closely resemble those associated with withdrawal from heroin or the barbiturates. The amphetamine withdrawal consists of severe depression—often to the point of being obsessed with suicide—as well as anxiety, fatigue, lethargy, lassitude, sleeplessness, nightmares, irritability, fear, terror, constipation, and muscular aches and pains . A 19-year-old speed freak I interviewed at the height of the street speed epidemic describes his experience with withdrawal as follows:

Now for the comedown. The amphetamine starts to go away. Wears off. You're   still awake. And you can't get to sleep. You start to come down. And it's the worst   feeling in the world. It's not as physical as heroin withdrawal... It's a mental  withdrawal, when all these illusions you've been having high come crashing  down. It's like a celebration of disillusionment. All of a sudden, nothing in the   world is right, nothing—absolutely nothing. Usually you just sit there with all   your nerves burnt out, with your stomach shrunk, with your lips and mouth too   dry to be comfortable so that you're always chewing, your eyeballs twitch, you're   pretty nervous, but at the same time, you're too depressed and too nervous to   do anything, you just sit there feeling miserable. It's the kind of thing where you   wanna cry, but you usually can't cry . . . and so you just have to sit around and   be the dregs. From people who have seen others when they're coming down, the   normal reaction is that they look like they're dead, 'cause that's what you look   like. Your extremities are deprived of blood. Your nose is freezing cold, your   cock shrivels up. . . . You're constantly chewing, but you can't swallow very well.

And because you haven't been eating or sleeping, everything is worse. Your skin   is all spiny and prickly, nervous, hot and cold at the same time, cold sweating,   things like that, but they're all from the nervous system, so they're, like, half   mental and half physical. You feel as if Genghis Khan had you chained to a pole   for twelve hours .

If addiction is defined by the "classic" abstinence syndrome described in Chapter 3, then amphetamine is not addicting. On the other hand, the withdrawal symptoms that are produced by amphetamine are serious, and many of them occur reliably. It is possible that what we call addiction is characteristic only of the depressants, and that other drugs produce a somewhat different set of withdrawal symptoms . Thus the question of which drugs are addicting in the physical sense seems partly a semantic question. Moreover, amphetamine, especially if taken IV in large doses, is strongly reinforcing, and thus causes a psychic or psychological dependence that is, in fact, nearly as great as cocaine's in strength. Consequently, the question of whether or not amphetamine is literally physically addicting seems irrelevant, since heavy, chronic users of amphetamine display a pattern of behavioral dependence that seems to be identical to those displayed by individuals who are physically dependent on drugs such as heroin or barbiturates; clearly, it makes little difference as to whether users are technically physically addicted or not.

The street speed scene is interesting today mainly for historical reasons. After about 1967, physicians began curtailing their prescriptions for Methedrine; fewer than one-third as many prescriptions for this drug were written in 1971 as in 1966. In the 1970s, Methedrine was outlawed as a prescription drug altogether, and classified as a Schedule I substance. Of course, it is still manufactured in clandestine laboratories, both in the United States and abroad, but the total volume of its use is a fraction of what it was in the late 1960s. Today, drug users take amphetamines more sporadically, less compulsively, in smaller doses than the 1960s speed freak—and almost never intravenously. Contemporary drug users take the amphetamines simply as one item on a total menu of multiple drug use—as just another of many drugs to get high on. In many respects, and for most groups in the population, cocaine has supplanted amphetamine as the number-two illicit drug in the country.