The name Gordon Alles may not be as famous as that of Albert Hoffman but the chemist who synthesised beta-phenylisopropylamine deserves as much recognition as the progenitor of lysergic acid diethylamide (LSD) if the impact of his drug in the world were your guide. Alles’ creation is better known as amphetamine, which, with its numerous sister compounds, including methamphetamine, MDMA (ecstasy), methylphenidate and fenfluramine, are pivotal in the history of psychiatric therapeutics in ways that have been forgotten in the light of awareness of the potential misuse of these drugs and their behavioural toxicity.
Rasmussen is to be congratulated for excavating this hidden history. If you are interested in the history of addictive substances, then the 85 pages of footnotes that go with the 260 pages of text and 37 illustrations prove a distraction to a fascinating narrative. The story will take you by surprise in many ways, whether it be the scale of military use of amphetamine in Second World War and subsequently or the forgotten history of amphetamine as the first mass-marketed antidepressant (textbooks that start the story with imipramine need revision). Rasmussen documents in some detail how the discovery of the neuropharmacology of the amphetamines over several decades, much based on Skinner box experiments with rats, relates to development of the antidepressants (monoamine oxidase inhibitors, tricyclics, selective serotonin reuptake inhibitors) and the dopamine hypothesis of psychosis. Connell’s work on amphetamine psychosis is cited along with British studies from Newcastle on the use and misuse of prescribed amphetamines in the early 1960s in what is mainly a US-centred story with diversions to Germany, Australia and Japan along the way.
The potential for misuse of amphetamines was apparent from the outset when Alles tried his own creation and described a euphoriant and energising effect. The early, pre-1950 descriptions of amphetamine misuse and drug-induced psychosis among military personnel, students and those in the jazz music world, who were breaking open benzedrine inhalers in order to ingest high doses of amphetamine, are a prelude to the better known stories of the stimulants as they relate to the Beatniks, the 1960s counterculture and the ‘ rave’ scene. However, official recognition of the harmful nature of these drugs and effective regulation of the pharmaceutical industry in relation to their production comes late in the story and had to await an epidemic of methamphetamine injecting and a broader concept of the nature of drug dependency from the World Health Organization than one restricted to the presence of a definite physiological withdrawal syndrome. Large profits were, of course, at stake.
If Rasmussen had finished his story in the 1970s, it would be one of rise and fall; bringing it up to the present day it becomes rise and fall and rise again. The recent rise is multi-faceted and includes the MDMA story, the rise of methamphetamine or ‘ice’ as an illicit drug easily made in a kitchen laboratory and as readily smoked as injected and, most surprising of all, a resurrected licit market for methylphenidate and amphetamine itself in relation to attention-deficit hyperactivity disorder (ADHD) as well as a persistence of the diet-pill industry. The use of amphetamines for ADHD, once seen as a rare disorder, in the USA is now on such a large scale that once again the diversion of these drugs into the illicit market is a significant concern.
This is a work of impressive scholarship on the life story of a family of drugs that continue to offer ‘pep’ in abundance in the capitalistic culture of the industrialised world despite a lack of evidence for objective performance enhancement.
- © 2009 Royal College of Psychiatrists