Sunday, October 09, 2016

Americans on Amphetamines

 How the first amphetamine epidemic came about (emphasis added):

From 2008:
America’s First Amphetamine Epidemic 1929–1971
Am J Public Health. 2008 June; 98(6): 974–985.
The first amphetamine epidemic was iatrogenic, created by the pharmaceutical industry and (mostly) well-meaning prescribers. The current amphetamine resurgence began through a combination of recreational drug fashion cycles and increased illicit supply since the late 1980s. On the basis of treatment admissions data, methamphetamine abuse doubled in the United States from 1983 to 1988, doubled again between 1988 and 1992, and then quintupled from 1992 to 2002. According to usage surveys, during 2004, some 3 million Americans consumed amphetamine-type stimulants of all kinds nonmedically, twice the number of a decade earlier. As noted, 250000 to 350000 of them were addicted. Thus, in terms of absolute numbers, the current epidemic has now reached approximately the same extent and severity as that of the original epidemic at its peak in 1970, when there were roughly 3.8 million past-year nonmedical amphetamine users, about 320 000 of whom were addicted. (Of course, the national population then was about 200 million compared with 300 million today, meaning that in relative terms today’s epidemic is only two thirds as extensive.)

Another striking similarity between present and past epidemics relates to the role of pharmaceutical amphetamines. Although illicitly manufactured methamphetamine launched the current epidemic, in step with rising amphetamine abuse in recent years, the United States has seen a surge in the legal supply and use of amphetamine-type attention deficit medications, such as Ritalin (methylphenidate) and Adderall (amphetamine). American physicians, much more than those in other countries, apparently are again finding it difficult to resist prescribing stimulants that patients and parents consider necessary, or at least helpful, in their struggle with everyday duties. According to DEA production data, since 1995, medical consumption of these drugs has more than quintupled, and in 2005, for the first time exceeded amphetamine consumption for medical use at the epidemic’s original peak: 2.5 billion 10-mg amphetamine base units in 1969 vs 2.6 billion comparable units in 2005. Thus, just as the absolute prevalence of amphetamine abuse and dependency have now reached levels matching the original epidemic’s peak, so has the supply of medical amphetamines.
(Of course, the national population then was about 200 million compared with 300 million today, meaning that in relative terms today’s epidemic is only two thirds as extensive.)
and (emphasis added)

Besides iatrogenic dependence and diversion to nonmedical users, there is another way that widespread prescription of amphetamine-type stimulants can contribute to an amphetamine epidemic. When a drug is treated not only as a legal medicine but as a virtually harmless one, it is difficult to make a convincing case that the same drug is terribly harmful if used nonmedically. This is what happened in the 1960s and is presumably happening today. Thus, to end their rampant abuse, amphetamines had to be made strictly controlled substances and their prescription sharply curtailed. Today, amphetamines are widely accepted as safe even for small children, and this return of medical normalization inevitably undermines public health efforts to limit amphetamine abuse. We have not yet reached the point where up to 90% of the amphetamines sold on the street are products of US pharmaceutical firms, as the federal narcotics chief reluctantly admitted before Congress in 1970. But with half the nation’s nonmedical users evidently consuming pharmaceutical amphetamines only, the comments made by Senator Thomas Dodd in those hearings echo strongly today. America’s drug problems were no accidental development, Dodd observed; the pharmaceutical industry’s “multihundred million dollar advertising budgets, frequently the most costly ingredient in the price of a pill, have pill by pill, led, coaxed and seduced post–World War II generations into the ‘freaked out’ drug culture” plaguing the nation. Any effort to deal harshly with methamphetamine users today in the name of epidemic control, without touching medical stimulant production and prescription, is as impossible practically as in 1970—and given historical experience, even more hypocritical.
We have seen a similar opioid epidemic created in a similar way; and opioids are a gateway to heroin. 

Obviously, criminalization is not a solution, but medical normalization, removal of tight regulations, and making it socially acceptable (e.g., the way alcohol is) is not going to help either.  It is not clear to me why society cannot find getting intoxicated/getting high as socially unacceptable as body odor or even perspiration.