Fast Times: The Life, Death, and Rebirth of Amphetamine
After World War II, Benzedrine began to be prescribed for “fatigue.” (College of Physicians of Philadelphia)
The plan succeeded. By the late 1930s college students used “pep pills” to increase their productivity. Amphetamine fueled American soldiers marching into World War II, served as the chatty muse to famous 1950s Beatniks, and worked as a “little helper” for disappointed 1960s housewives. It was the chemical copilot for long-haul truckers and the “speed” that roiled the Flower Children. Amphetamine and its variants would be hailed as medical miracles, then demonized as an addictive, life-destroying social scourge. But once Alles and SKF brought amphetamines into public consciousness, they never truly went away: the crystal meth and Ritalin of today are essentially the same drugs used (and abused) 70 years ago.
The story of amphetamine—its rise, fall, and inevitable return—is the story of the first psychoactive prescription drug, a drug valued almost entirely for its mood-altering effects. It began a new era of pharmaceuticals, and we are still working through the consequences today.
From Chemical to Medicine
In December 1934, SKF purchased the rights to Alles’s amphetamine. But along with the purchase came the question of what the drug was actually good for. This was still the era of patent medicines, a time when newspaper ads hawked dubious cure-alls made from unspecified ingredients. These activities were all perfectly legal: with virtually no government oversight SKF could sell its new product without testing it beforehand. But getting word out to doctors meant advertising in medical journals, which required permission from the American Medical Association (AMA). And to gain the AMA’s imprimatur, a drug had to be proven both safe and effective, which meant commissioning studies that could persuade the AMA Council on Pharmacy, an august body of doctors and scientists.
That said, safety studies were a relative formality. Animal testing helped establish a safe dosage range and revealed any obvious harm at high doses. With this information in hand researchers could move on to human testing, further refining the drug’s application and looking for side effects. But many of the long-term questions we would expect to be addressed today—about the possibility of addiction, for example—went unanswered. A University of Pennsylvania study SKF used to prove amphetamine’s safety focused mainly on its blood- pressure effects. The drug demonstrated no apparent ill effects, and the research later appeared in the highly regarded American Journal of Medical Science. That was proof enough for the AMA: amphetamine’s safety stood confirmed.
The question of effectiveness, however, was of a subtly different kind. Eli Lilly’s asthma and cold medicines were already successful, and SKF’s Benzedrine inhaler aimed at roughly the same market. But amphetamine worked no better than ephedrine in that capacity; indeed, it was arguably worse. Without the cold-treatment option, SKF wanted another large market. So the effectiveness question had an implied addendum: what problem does amphetamine effectively treat in a profitable way?
Amphetamine kept narcoleptics awake and seemed to quell the tremors of Parkinson’s sufferers, but patient numbers in these groups were too small to create a profitable market. Both afflictions have a biological basis in the nervous system, and so it made sense to treat them with a nervous-system stimulant. SKF, though, chose to exploit the more subjective effect of amphetamine—what Alles had called the “feeling of well being.”
In early 1937 the new drug debuted: Benzedrine Sulfate, which evoked a positive association with SKF’s own inhaler brand. This new version was a pill, though, and no simple cold medicine. In a mailing sent to 90,000 doctors (almost the entire AMA membership) SKF declared “the main field for Benzedrine Sulfate will be its use in improving mood.”
Meanwhile, several clinical studies had shown that amphetamine had little effect on severe depression, anxiety, or schizophrenia. In fact, it often exacerbated the last two: a revealing finding that became significant only later, when physicians began to see cases of “amphetamine psychosis.” Amphetamine did, however, help cases of mild depression, which fit SKF’s plan to emphasize the drug’s mood-altering effects. In December 1937 the AMA Council on Pharmacy granted permission to advertise the drug as a new treatment for narcolepsy, Parkinson’s, and mild depression. Benzedrine Sulfate had become the first prescription anti-depressant, and SKF’s marketing began in earnest.