'Americans have been in love and in trouble with stimulants since before the Revolution, and the love affair continues,' said Harvard University professor of social science and infectious disease Patricia Case in her keynote address to the First National Conference on Methamphetamine, HIV, and Hepatitis.
'I have to question the use of the word 'epidemic' [ to describe current patterns of use of meth in the U.S. ] . The reason we use the word epidemic is to convey our urgency with the current situation, and our fears. But the word also suggests that after the epidemic there won't be any more stimulant use, and that is simply incorrect.'
'Stimulant use is endemic to the United States. It is related to our society and our culture ... . We've been here before, we've learned lessons before,' she told the conference meeting in Salt Lake City, Aug. 19-20.
Case outlined how amphetamine was first synthesized in 1887, but 'basically laid on the shelf' because the associated euphoria was antithetical to Victorian sensibilities. It came to the market in 1932 as an over-the-counter nasal inhaler with 325 milligrams of Benzedrine.
'People learned within about two seconds to take the cotton [ containing the Benzedrine ] out and soak it in coffee for a walloping hit of amphetamine.' Benzedrine tablets were available by prescription and by 1937 it was used to treat 39 other conditions. A combination with vitamin C was pushed as treatment for colds.
'Everybody—the Japanese, Germans, Americans, British—I mean everybody, went to war on amphetamine' in the 1940s. It was included in every GI's field kit, with more than 200 million pills 'distributed liberally.'
Ads touted the pharmaceutical industry's war contribution 'to high flying personnel' in bomber crews and proclaimed over drawings of soldiers rushing into combat, 'When the going gets tough, the tough take Benzedrine.'
That experience with the drug returned home with demobilizing troops, while no longer needed war stockpiles of the drug were sold as surplus, providing cheap access on the street for those who didn't want to bother with a prescription.
By the early 1950s the media portrayal of amphetamine began to change and increasingly it was linked to antisocial behavior such as robbery and drug trafficking.
In 1959, over-the-counter Benzedrine inhalers were withdrawn from the market.
'Within six months the first methamphetamine inhaler hit the market.' By 1965 they required a prescription—'31 million prescriptions were written in 1967, mostly for women. Methamphetamine was seen as a women's drug … for weight loss and an antidepressant. And I think that most meth users will tell you, that's exactly their experience.'
Ten billion tablets of legal amphetamine and methamphetamine were produced in the U.S. in 1970.
'She looks like the tweaker of the week,' Case said in exhibiting one ad. 'These ads were creating demand for weight loss products, targeting physicians who would then target their patients ... . The problem of obesity among normal-sized women was being created in the 1950s; we live with anorexia today because of it.'
Many women who had joined the workforce as part of the war effort were out of work when the men returned home. 'They also had three kids, this is the baby boom, they were all under ten, she was going out of her mind,' Case said. No wonder many women sought antidepressants in the 1950s.
But prosecution of non-prescription drugs was also growing. By 1971 indictments for methamphetamine manufacturing and distribution were handed down in more than a dozen cities across the nation, even while the Pentagon continued to hand them out to troops in Vietnam.
As early as 1937 a medical journal article mentioned premature ejaculation associated with use of the drug, while a 1946 article noted users' 'homosexually toned perversion of their sex lives.' Treating depression associated with sexual dysfunctions was one of the primary medical uses of meth.
Case said the lessons of history are that 'Stimulant use is cyclic and endemic with outbreaks in the U.S.,' and often are followed by longer periods of increased use of opiate depressants.
One of the central differences with this cycle is that the meth that is produced is about 50% stronger, while legal crackdowns have reduced the role of pharmaceutical companies and 'brought more reliance on home production.' This results in greater impurities and toxicities from the industrial chemicals used to produce the homemade batches, and may be contributing to side effects such as 'meth mouth.'
The Internet has facilitated greater knowledge of meth and how to make it, further diffusing local production. That has contributed to making it a national rather than a local outbreak of increased use. Smoking meth is more common than in the past, with its own associated risks. And users are more likely to combine it with other drugs.
Case said that various subpopulations use meth for different reasons. 'Relatively middle-class gay men using it for pleasure are very different from someone in Appalachia where that drug represents the only hope and the only joy in a very tough community. And that differs greatly from someone who is working three jobs at a meat-packing plant, just trying to get through.'
'People are suffering, and methamphetamine is, above all, a profound antidepressant,' Case said. 'It is no surprise that most users in the U.S. are not gay men but poor people trying to get by.' She mentioned the impact of 9/11, and within the gay community the decimation of a generation lost to AIDS, as generating 'tremendous community levels of grief that have yet to be addressed.'
She recounted her experience living as 'a lesbian fag hag' in a collective with a dozen gay men in San Francisco in 1970, and all but one of them are now dead. The lone survivor is an orthopedic surgeon trained at Harvard who is sitting in jail because he relapsed on meth.
'Methamphetamine is a very powerful antidepressant. It makes you have a sense of control over uncontrollably bad situations. It is not a surprise that we are having an outbreak.'
She urged the audience to examine the language being used in describing a drug and how it reflects bias of power, class, and marginalization. The most recent experience has been with crack cocaine. 'When freebase cocaine was used by rich people, it was an eccentricity. When it diffused to the middle class, it was a concern. When it got to poor people, it is demonic, satanic; there are crack babies and crack hos. It's the same drug.'
Case urged them to keep an eye on Provigil, an amphetamine-like product approved in 1998 and used extensively by the military in Iraq to keep forces alert for up to 40 hours. 'We've heard this before.' Sales in 2005 are projected to be $400 million.
She quoted drug historian David Musto: methamphetamine 'is a chemical of the mind that plays perfectly to our shared American qualities—the desire to be better, to have way more fun, to be perfect, to work harder, be smarter, get ahead, make more money, be bigger, be thinner, have more sex … win at all costs.'
'So is the intervention with the drug, or with ourselves?' she asked. 'We are going to have to address that.'
