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The History of Methamphetamine: An Epidemic In Context Patricia Case, Sc.D. Harvard Medical School Acknowledgements This research is partially supported by funding from the National Institute on Drug Abuse The views expressed in this paper are solely my own and do not reflect the views of NIDA or the institutions by which the author is employed. I would like to express my gratitude to my tireless research assistants Ari Reiter and Sean Ferriter and to brainybetty.com for this PowerPoint template. The past is never dead. It's not even past. William Faulkner A Brief History 1887 -1945 • • • • • • • • • • • 1887 1919 1927 1932 1935 1937 1937 1938 1938 1940 1940-45 Amphetamine first synthesized in Germany Methamphetamine synthesized in Japan Amphetamine used as a substitute for ephedrine Benzedrine (amphetamine) in OTC nasal inhalers Benzedrine tablets available by prescription Benzedrine used to treat ~39 other conditions Gorell recommends Benzedrine for fatigued doctors First published report of amphetamine addiction First description of amphetamine psychosis Eggleston: “there is not much danger of …addiction” Critical wartime period as all sides go to battle on amphetamines Medical Advance – Benzedrine 1930’s Wonder Drug Wartime Benzedrine Wartime Field Supplies “About that time I discovered Benzedrine. Loved those little white suckers. We could get a sack full in those days. It sure didn't bother to get up at 3:00 AM anymore. Pop a couple of pills and you were wide awake ready to take on the whole world. If it kept you awake, just take a few sleeping pills. Boy! Isn't medical science great or what!!” from the memoirs of USAF Captain Bryant L. Smick on flying missions over Italy Everyone on the ship had taken two Benzedrine capsules when we reached bombing altitude – as if I needed anything to wake me up. From the memoirs of Herb Bach on a bombing run to Japan War Surplus and the Streets 1944-1948 Benzedrine Goes Bad 1950 -1959 A Brief History – II 1950 - 1970 1951 1958 1959 1959 1960 1962 1965 1965 1967 1970 Prescriptions required by federal law for amp containing products ~3.5 billion tablets of legal amp tablets produced First injection of Benzedrine extracted from inhaler reported OTC Benzedrine inhalers withdrawn from the market First OTC methamphetamine inhaler hits the market Early reports of illicit domestic production by biker gangs Federal law requires prescriptions required for meth products OTC Methamphetamine inhalers withdrawn from the market 31 million prescriptions written -- most to women ~10 billion tablets of legal amp/meth tablets produced Selling Speed 1950 -1965 The Hidden Agenda - Housework Methamphetamine Goes Bad 1962-1969 Outbreak Emergence 1970 – 1975 (or so) Power and Writing 1942 Hitler begins methamphetamine injections – perhaps 1944 London newspaper claims “Methadrine wins the Battle of London” - maybe 1951 Jack Kerouac, under the influence, writes On The Road in 21 days on a single scroll of paper 1956 British Prime Minister Anthony Eden “lived on Benzedrine” during the Suez Crisis 1962 JFK relies on injections of methamphetamine during the Cuban missile crisis 1970 William Burroughs publishes “Speed” Old Made New Again What Did We Know Then? Early Epidemiology • 1955: Newspaper estimates 3% of University of Md students using Benzedrine • 1966: Sadusk estimated that 800,000,000 methamphetamine pills made annually and 50% distributed illegally • 1970: Black surveyed 5,482 enlisted men, with 27% reporting drug use and of those, 37% reported lifetime use of amphetamines, 10% more than 100 times • 1971: Chambers estimates 35,000 New York household residents use “speed” regularly – 30 percent without prescription (compared to 6,000 regular users of cocaine) Association with Sexuality • 1937: “Stated that he was able to have sexual intercourse following the administration of the drug but that orgasm was almost instantaneous” • 1946: “A symptom which can regularly be observed in chronic alkaloid addicts is the homosexually toned perversion of their sex life”. • 1947: “The drug enabled him to indulge in auto-erotic activity four times in succession, making it indescribably delightful.” • 1952: [an addicted woman reported that] “an increase in sexual desire but a decrease in satisfaction” • 1953: [methamphetamine treated schizophrenic] “This is great. My penis feels much longer”. Lessons of History • Stimulant use is cyclic and endemic with outbreaks in the US. Stimulant cycles often followed by opiate/sedative/painkiller cycles. • The trajectory of an outbreak appears to be – 1) exploratory – 2) medicalization – 3) concern and regulation – 4) diffusion and criminalization – 5) severe social impact – 6) regression • New emergence and outbreaks with changes in technology, drug, economy or affected population group. What is different now? Methods of manufacture • Until mid-1990’s, the P2P method was used to produce D,Lmethamphetamine -- a racemic mixture • P2P, a precursor, was regulated and subject to strict enforcement and arrest for possession - 1996 • Producers switched to the easier Birch (so-called Nazi) pseudoephedrine reduction method, producing very potent Dmethamphetamine • The Birch reduction produces better “product” – diffusion brings more reliance on home production, less reliance on imported finished supplies. • Importation of precursors and theft of precursors now rampant. Key Differences • • • • • • • • • The Internet Diffused local production, less reliance on imports Multi-drug use – no one uses only crystal National outbreak Varied sub-populations More smoking Strong association with HIV, hepatitis C, STDs Community level responses to AIDS deaths, 9/11, war National discussion Meditations for the Conference • What is the role of social class, poverty, abuse and marginalization in the present-day methamphetamine outbreak? • Is it an outbreak or a continuation of an old pattern? • What strategies have and haven’t worked worked in the past to lessen the problems of methamphetamine use? • What are the “silences” – what population, what area, what pattern is not being discussed that needs to be? • How does the knowledge presented here relate to everything you know about what’s going on at home? Meditation on the Future • What will happen with ProVigil, approved in 1998 and now used extensively by the military in Iraq? Drug keeps pilots awake By Peter Mucha, Inquirer Staff Writer A much-ballyhooed anti-drowsiness drug made by West Chester-based Cephalon Inc. is taking off as the Air Force's new "go-pill.“ Provigil, also known by its generic name, modafinil, has been used more than 150 times this year by bomber crews to ward off sleepiness on missions of more than 12 hours. 2005 Projected Sales: $400 million “Faster, faster, until the thrill of speed overcomes the thrill of death” -Hunter S. Thompson