Kakistocracy drug trade

How America’s Kids Got Hooked on Big Pharma’s Meth

Are Adderall and Ritalin the best answer for ADHD? NYT Reporter Alan Schwarz and Gabor Mate get to the bottom of the problems around these issues.

AMY GOODMAN: We’re joined by Alan Schwarz, who is the award-winning New York Times reporter who has extensively written about attention deficit hyperactivity disorder, or ADHD. His most recent article, on Sunday, front-page piece of The New York Times, looks at how the number of diagnoses soared amidst a 20-year drug marketing campaign. Yes, it’s called “The Selling of Attention Deficit Disorder.”

And we’re joined in Vancouver, Canada, by Dr. Gabor Maté. He is the physician and best-selling author who, among his books, has written Scattered: How Attention Deficit Disorder Originates and What You Can Do About It.

Let’s start with Dr. Gabor Maté. You have been dealing with this issue for a long time. You see ADHD as a very serious issue for children, as well as adults. In fact, you were diagnosed yourself as an adult. So, how do you reconcile that with the drugging, the massive drugging of America’s children? We don’t even know the numbers. I think it’s 3.5 million between the ages of four and 17, but it’s not counted in the United States beyond that.

DR. GABOR MATÉ: As Alan Schwarz indicated, it’s a genuine problem that does affect a lot of people, myself included. The question is how to understand it and how to deal with it. And the first thing to say is that not everybody who’s got trouble paying attention or has impulse-control issues has ADHD. There’s all kinds of other reasons why people might have various manifestations. So to put them all into the ADHD basket is to ignore the complexity of human behavior.

Secondly, to make the assumption that even if somebody has these traits, and even if they have them over a lifetime, that the significant or the only answer is medication is to ignore, again, the complexity of the human brain and human behavior. So, what we have here is a vast oversimplification of what is a fairly sophisticated problem. And it’s that oversimplification then that the pharmaceutical companies exploit to their great advantage, as Alan has documented.

AMY GOODMAN: Alan Schwarz, how did you get interested in doing this investigative series? I mean, you were the sports guy at The New York Times. You were writing, actually, about concussions.

ALAN SCHWARZ: Yeah, I was a sports guy at the Times. I was lucky enough to be able to cover the concussion issue from the beginning and get to break a lot of stories in that realm. And then, when I was a little tired of that, when I heard that high school kids were snorting Adderall before the SATs, I questioned: How much pressure are we putting on these kids? I don’t think they want to do this. And so the first story that I did was in the context of academic pressure and what some kids will do in order to deal with it.

And after doctors—doctor upon doctor upon doctor—told me that, “Oh, this is not an overdiagnosed condition; this is underdiagnosed,” and I looked at the numbers, and it was—it’s a preposterous assertion. I said, “Wait a minute. What are the doctors doing here? What are their motivations? What are their biases? How do they misunderstand probability and statistics?” And so, I looked into it further, and there were so many issues at play here, with regard to why doctors prescribe, how often doctors prescribe.

I think one of my regrets is that I haven’t been able to do a story on the good that Adderall can do. I try to acknowledge it in my stories. But, of course, it’s a good drug. What we have to be careful of is, how do we use it?

AMY GOODMAN: Explain its origins, Alan Schwarz.

ALAN SCHWARZ: Sure. Well, Dexedrine, an amphetamine, were around for a very long time. Benzedrine used to be an inhaler in the 1930s and ’40s, straight amphetamine, and people abused it then. They would take out the little soaked gauze pad and put it in their mouths in order to abuse amphetamine. And then Dexedrine became on the market in the ’50s and ’60s. So did Ritalin, by the way. And it was so abused among college students and adults in the late ’60s that that’s why we now have the Controlled Substances Act, was because of the Dexedrine epidemic. Now, cocaine took over in the ’70s and ’80s. But then, of course, that became—you know, it’s obviously illegal, and other issues.

But then, attention deficit disorder became so well known and so accepted among parents, and perhaps even appropriate for a lot of the kids in the ’80s and ’90s who got diagnosed—Jamison Monroe notwithstanding—what you see is that there’s now a very easy mechanism to get amphetamine if you want it. If you need it, you can get it, yes, but if you just want it, you can get it, too—free amphetamine, because it’s covered by insurance. And so, when a pharmaceutical executive named Roger Griggs, who had his own little—relatively little pharma company, he heard that this diet pill named Obetrol, OK, might have an application to this relatively newly appreciated childhood condition called—what was it?—hyper—I’m sorry, I’m forgetting right now. Oh, minimal brain dysfunction, which is a—

AMY GOODMAN: That’s what it was called at the time.

ALAN SCHWARZ: Yes, a charming—a charming name for it. But, OK, fine. And he said, “Gee, I wonder if this could treat that.” And, lo and behold, it could. But, of course, it’s been well known that amphetamines, you know, and diet pills have been abused. Hell, there was a Family Ties episode about it in 1984. And so, this has been a long-standing issue. I think now the main problem is that 15 percent of children, by the time they graduate high school, have been told that there is something basically permanently wrong with their brain chemistry, for which some of the most addictive and abusable substances known to medicine are the primary antidote. Now, a lot of people can take them just fine. It’s not the devil’s drug. We’ve seen a father talk about his son who committed suicide after, and we want to be careful that—

AMY GOODMAN: That was part one of our conversation with John Edwards.

ALAN SCHWARZ: That was, yes, part one of our conversation. But it’s not as if every kid, or even 2 percent—I mean, no, that’s an extremely rare, terrible disintegration of these people’s minds. We have to realize, you can take it safely. Just look out for the signs that things are going wrong.

AMY GOODMAN: Gabor Maté, weigh in here.

DR. GABOR MATÉ: Yes, well, about that particular James Edwards—is that the boy’s name?

AMY GOODMAN: John Edwards, Johnny Edwards.

DR. GABOR MATÉ: You know, the father—part of the issue is how the diagnosis was made. I mean, you don’t make a diagnosis by asking a college kid if he’s got trouble concentrating, because there’s all kinds of reasons why he might. Depression could have been another reason why that kid had all of a sudden trouble concentrating. You have to take a lifelong history. You actually have to talk to the family. You have to have information from the school that he went to as an elementary and a high school student. In other words, it’s a lifelong diagnosis. It doesn’t come along all of a sudden in college. And you don’t take somebody’s word for it. You actually have to do a much more rigorous questioning of the individual and people significantly known to him, and that way you can arrive at a sort of a globally based diagnosis. So, that young man was really badly treated by the medical system. I think, as Alan demonstrates, it’s not untypical. And the end was untypical, but the process was not untypical.

AMY GOODMAN: In the New York Times piece, Alan Schwarz, you write, “Dr. William W. Dodson, a psychiatrist from Denver, stood before 70 doctors at the Ritz-Carlton Hotel and Spa in Pasadena, Calif., and clicked through slides that encouraged them to ‘educate the patient on the lifelong nature of the disorder and the benefits of lifelong treatment.’ But that assertion was not supported by science, as studies then and now have shown that perhaps half of A.D.H.D. children are not impaired as adults, and that little is known about the risks or efficacy of long-term medication use.”

ALAN SCHWARZ: Well, this fellow was paid by Shire to indoctrinate doctors about their new long-acting formulation of Adderall XR. And he told them that it is a lifelong condition, and you should medicate for the rest of the person’s life. And, unfortunately, it’s been known, then and since, that only half, roughly—some say 30 percent, some say 70 percent, whatever, but roughly half of adults are not impaired as adults. I talked to Dr. Dodson about his assertion that day and since, and he said he does not believe that that is true, and that if you have ADHD, you have it for life, and he recommends to all of his patients—hundreds, perhaps even up to a thousand—that they do this. And I think it’s up to us to decide if he’s telling these people the truth.

AMY GOODMAN: Tell us about Dr. Keith Conners’ change of heart.

ALAN SCHWARZ: Well, Dr. Conners was absolutely one of the—

AMY GOODMAN: At Duke.

ALAN SCHWARZ: At Duke, yes—was one of the earliest advocates for recognition of ADHD. I mean, he came along in the late ’50s, early ’60s, when kids were just labeled—kids with this condition, severe condition, were just labeled “bad kids” and then thrown aside. What he did is he got a lot of people to realize this is a real issue, and he was one of the primary advocates of the use of Ritalin in the ’60s and ’70s and ’80s. I think that some of the articles—at least he’s told us that the articles that we’ve written this year in The New York Times have really woken him up to the fact that what he had evangelized, he did an awfully good job, and now, as we’ve talked about, 15 percent of high school kids graduate having been diagnosed with ADHD. And when he read that, and he read some of the horror stories of young people abusing these medications, I think he decided that he—he realized that he had been part of a problem, and he now wants to be part of a solution.

AMY GOODMAN: And you talk about Dr. Joseph Biederman, the prominent child psychiatrist at Harvard University and Massachusetts General Hospital. A Senate investigation revealed his research on many psychiatric conditions had been substantially financed by drug companies, including Shire, which owns Adderall, which sells Adderall. Those companies also paid him $1.6 million in speaking and consulting fees. He denies that the payments influenced his research.

ALAN SCHWARZ: Well, he is not really that atypical among prominent psychiatrists in the field, the degree to which he participated in pharmaceutical research and public statements about the use of medication for many psychiatric—child psychiatric diagnoses. He has been very involved with Risperdal and other antipsychotics. And, you know, he conducted a lot of studies that came in three flavors: One, ADHD is seriously underdiagnosed; two, it has devastating consequences if left untreated; and three, the medications associated with it—Ritalin, Adderall, Conserta, whatever—are basically harmless. And so, he sort of seeded a lot of the pharmaceutical messages that said, “Hey, look, we’re just relying upon the science of a Harvard University professor, an eminent psychiatrist.” And, yeah, they were.

I think that what some people are concerned about was just how one-sided he was. And whenever anyone would say, “Look, I think you’re a little off base here,” he would really shut down. And so, some people are concerned that he played such a role with giving pharma the messages that they wanted, that they now question, you know, whether that was appropriate. I certainly wanted to talk with him about the concerns that a lot of people had. And, by the way, this is not new. He is the most controversial figure in child psychiatry—by a lot. He didn’t respond to my requests to talk with him. And that was not unpredictable. And so, you know, I think that one point that we made in this story is that a lot of his critics say that his primary motivation was not financial gain; he was trying to help severely impaired kids. He went to a point that many people think was way too far.

AMY GOODMAN: Gabor Maté, your response?

DR. GABOR MATÉ: [inaudible] all the research, and he was paid all that money. But it only came out afterwards. So, when a guy doesn’t disclose that conflict of interest, you really wonder what’s actually going on. I’m not impugning him personally, but it’s just not appropriate procedure, as we all know.

AMY GOODMAN: Dr. Gabor Maté, talk about that progression from children to adults the expression of attention deficit hyperactivity disorder. And what’s the difference between ADD and ADHD?

DR. GABOR MATÉ: Well, you can have hyperactive—you can have attention problems without hyperactivity, so when you add the H, it’s simply to signify that a child or an adult also has difficulty regulating their body, in the sense of sitting still, not fidgeting, not interrupting, not being able to wait their turn in line, and so on. So it just adds a physical dimension to the hyperactivity that takes place in the brain itself, where too many thoughts follow one another randomly and with no rational progression. So it’s a physical manifestation of the emotional and intellectual dynamics that already occur in the brain of the person with ADHD. Boys, in general, tend to be more the hyperactive kinds. Girls very often have the attention problem, if they genuinely have it, without the physical manifestation.

AMY GOODMAN: And then, adults, the whole issue of—you know, we see it backwards, with children—

DR. GABOR MATÉ: Well, yeah.

AMY GOODMAN: —with the selling of cigarettes. Adults were sold cigarettes, and then they were—the companies wanted to get the kids—I mean, people addicted younger and younger, so you have a longer span of selling cigarettes. This goes the other way: First you got the kids, and now you move on to adults, and telling them that at the time it wasn’t known, and now you diagnose adults, and they take the drug.

DR. GABOR MATÉ: Well, interesting that you mention cigarettes, because cigarettes contain nicotine, and nicotine is a stimulant. And so, actually, a lot of people hooked on cigarettes are self-medicating ADHD, whether they know it or not. But the psychiatrist who Alan Schwarz quoted, who said that you don’t grow out of it, has it completely wrong, because he’s just not aware of the factor of neuroplasticity—neuroplasticity meaning the brain has capacity to develop new circuits even later on in life. So a lot of people actually do grow out of the deficit—that’s the first point—because their brains develop, number one.

Number two, there’s a lot of other reasons why kids might have difficulty paying attention. And the question very often is: Do they grow out of ADHD, or do they grow out of school? In other words, do they just grow out of an artificial environment, where human beings were never meant to sit for eight hours and behind a desk, and not be able to run around and play and not be able to create and express themselves and do art and be noisy? All the things that the human child naturally wants to be, and is, are suppressed, and very often in the school setting. So, we’re creating an artificially induced problem by the environments that kids are reared in. And so, when kids leave those environments, naturally they don’t have those symptoms anymore.

So, there’s all kinds of reasons why that psychiatrist who stands in front of a group of doctors and asserts that once you’re diagnosed, you have it for the rest of your life, is completely scientifically inappropriate.

And finally, not to mention that this isn’t unique. You know, I went to dinners—or one dinner, at least, 15, 20 years ago, a medical dinner, where a high-priced expert, flown in from Australia, was telling physicians that every woman, post-menopausal, should be on hormonal replacement therapy. And, boy, did they rake in the money. Well, of course, then it turned out that in fact those same hormones can cause heart disease and increase the risk of cancer and so on, so that this pharmaceutical propaganda that bewitches the medical profession—and they always find the experts; you can always find an expert to support whatever point of view—it’s unfortunately not unique to the problem that Alan has depicted in his recent article.

AMY GOODMAN: Alan Schwarz, what kind of response have you gotten to this series of articles? You did the piece on Johnny Edwards committing suicide at Harvard after being prescribed Adderall. His family is suing Harvard University. You’ve done this front-page piece, “The Selling of Attention Deficit Disorder.” I mean, you were a sportswriter. You certainly get a lot of response for that. How does that compare to this?

ALAN SCHWARZ: I think it’s not dissimilar, because the concussion work that I did in football—football is very good in a lot of settings. It’s very important to people. And so, it’s a real balance between what good can we get from this, while minimizing the bad, the risk. Here, it’s not that dissimilar. In fact, it’s probably accentuated. These medications have done a lot of good for a lot of people. And frankly, they do a lot of good for kids who don’t have ADHD. Who are we kidding? I mean, it does help you perform. I mean, it would help you and me, quite possibly—I’ve never tried it, but I’d probably be hooked in a second. So—

AMY GOODMAN: What about that issue of addiction? Can you get off it?

ALAN SCHWARZ: Well, that was flip, OK. I, by no means, do even more than 10 percent of people who try it.

AMY GOODMAN: Yes.

ALAN SCHWARZ: You know, but—I just—I think I’d like it a lot. The point is, is we have to look at the process, the process through which these diagnoses are made, the process through which we allow pharmaceutical companies to prey upon the fears and needs of, typically, mothers. And it’s pretty adjustable. We can make things better if we just pay a little attention. And I think that people have picked up on that in the stories. They’ve tried not to be hysterical. They’ve tried to just point out, hey, if—perhaps you want to take this into account so that we can do a better job for kids and adults. It doesn’t mean stop doing good by prescribing the medications when necessary. I mean, look, a chainsaw is a really helpful tool, you know? But sometimes, you’ve got to—or, usually, you’ve got to just be really careful with it. No one bans chainsaws. No one should ban Adderall. There’s just a way to handle it a lot better. And we, as human beings, are responsible for that.

Merchants of Meth: How Big Pharma Keeps the Cooks in Business

With big profits on the line, the drug industry is pulling out campaign-style dirty tricks to keep selling the meds that cooks turn into crank.

READ MORE http://www.motherjones.com/politics/2013/08/meth-pseudoephedrine-big-pharma-lobby

The Speed of Hypocrisy: How America Got Hooked on Legal Meth

Written by Alexander Zaitchik

A terrible number of words have been written about Breaking Bad, yet none have struck upon the irony at its core. For all of the cult hit’s vaunted fine-brush realism and sly cultural references, the show never even winked at the real world “blue” that grew up alongside it.

During the five years Heisenberg spent as a blue-meth cook, the nation experienced a nonfictional explosion in the manufacture and sale of sapphire pills and azure capsules containing amphetamine. This other “blue,” known by its trade names Adderall and Vyvanse, found its biggest market in classrooms like Walter White’s. As this blue speed is made and sold in anodyne corporate environments, the drama understandably focused on blue meth and its buyers, usually depicted as jittery tweakers picking at lesions and wearing rags on loan from the cannibal gangs of Cormac McCarthy’s The Road.

For presenting such a compelling one-sided cartoon of speed in America, Breaking Bad deserves recognition as a modern day Reefer Madness. That 1937 film immortalized the selective attentions of the first drug war, in which hysteria was stoked over Mexican marijuana but nothing was said about that era’s brisk drugstore trade in Benzedrine, the patented speed of the Great Depression.

To understand why the “edgy” AMC drama fits so snug in the Reefer Madness mold, it helps to see the show from the perspective of pharmaceutical executives, whom I suspect held some rowdy Breaking Bad viewing parties.

Because here’s the thing about hide-the-children caricatures of street speed and the class stigmas they weave: Without them, the needle starts to skip on pharma’s marketing lullabies about the safety and expanding therapeutic application of their purer product. Take away Goofus and Gallant-style contrasts between backwoods Crank Zombies and suburban Adderall Aspirationals, and suddenly we’re having some very awkward conversations about the periodic table, addiction, and the experience of getting high.

Aside from some foul cutting material, Winnebago methamphetamine and pharmaceutical amphetamine are kissing chemical cousins. The difference between them boils down to one methyl-group molecule that lets crank race a little faster across the blood-brain barrier and kick just a little harder. After that, meth breaks down fast into good old dextroamphetamine, the dominant salt in America’s leading ADHD drug and cram-study aid, Adderall.

Image: Michael Chen/Flickr

Writing as someone who has consumed his share of product from both buckets (more about which below) I can attest that the difference between Adderall and street crank is much overstated, bordering on complete social fiction.

This is not exactly a state secret. After legal speed started its comeback as a treatment for Attention Deficit Disorder, The Journal of Neuroscience published a study that functioned as a polite tap on the shoulder. Amphetamine and methamphetamine, the researchers wrote, are “about equipotent” and “produce qualitatively similar behavioral responses.” Both excite the central nervous system in nearly identical ways, flooding and blocking dopamine, serotonin, and adrenaline receptors. Also, meth is meth is meth. The brain responds the same whether it’s produced by the Sinaloa boys and slung by the gram-baggie as glass, or made by Lundbeck Inc. and sold in orange bottles at CVS as the meth-based ADHD drug Desoxyn®.

Most people understand that heroin and Oxycontin are both hard, addictive drugs. Not so with speed. When it comes to amphetamine, we’ve chosen a national split-screen in which doctors airily put millions of healthy children and adults on daily speed regimens while SWAT teams throw concussion bombs in baby cribs in pursuit of small-fry meth dealers.

This split-screen is held steady by media accounts that take the two-bucket speed paradigm for granted. The New Yorker reports on “cognitive enhancers” popular with Ivy League pioneers of “cosmetic neurology”—those “high-functioning, over-committed people tak[ing] Adderall and Ritalin to become higher functioning and more overcommitted.” Articles about meth, on the other hand, invariably sound as if penned by the slumming spawn of David Brooks and Jane Goodall. Anthropologist Jason Pine “embedded” with meth users in rural Missouri and described the experience to the New Republic. “They’re very happy and want to share,” Pine explained. “There’s some moodiness, too—they’ll quickly snap into some kind of aggressive reaction.”

Do they also have a hand signal for “banana”?

A meth cleanup in Bristol, Virginia. Image: Robert Spiegel, Wikimedia

The results of this split-screen speed fallacy have begun to come in. One-in-five American teenage boys have received an ADHD diagnosis; the adult market for prescription amphetamines is in boost phase, up by half since 2008. A growing number of prescription speed users are arriving at ER rooms and rehab centers across the country.

Dr. Lawrence Diller, author of Running on Ritalin, notes that amphetamines have overtaken opiates as the leading cause of admission to California addiction clinics. The ADHD drug industry response to this latest trophy-stat is hopefully more subdued than its likely reaction to surpassing diabetes drugs in 2012 as the country’s fastest growing drug category. For those who can’t afford rehab, addiction forums like QuittingAdderall.com are popping up.

New women users are driving the speed boom. In March, Express Scripts, which monitors industry trends, issued a report showing that women aged 26 to 34 have become the fastest growing market segment with an 85 percent increase in ADHD drug prescriptions over the last five years. The age bracket beneath them, female millennials, has spiked sharply in ADHD diagnoses over the same period.

Across all demographics, national spending on speed has nearly doubled since 2008. It is now a $10 billion market accounting for more than four-fifths of the world’s pharmaceutical speed. America’s speed consumption is projected to rise another quarter by the end of 2015. The Express Scripts report concludes with a rhetorical question: “Are we over-diagnosing and overmedicating the adult population?”

“Medicating” isn’t the word they’re looking for, but the query is a good start.

Today’s adult trend lines are no accident. For years, pharma has been modernizing the lucrative female-oriented speed marketing campaigns of the postwar decades. They were so successful the first time around that by the late ‘60s, millions of women had become dependent on prescription speed pills. It was during this period, with the US speed market peaking at around four billion pills annually, that the young field of brain science began to understand why, in the words of one scholar, “given access to enough amphetamine, any rat, monkey, or man would eventually self-destruct.”

When the World Health Organization studied America’s postwar speed crisis at its height, it concluded the dangers of amphetamines outweighed their benefits in general medical practice. Every industrial nation agreed with this assessment, including the United States, and changed its laws accordingly. Among the social convulsions of the 1960s was a speed backlash that took the form of critical press, public outrage, and Congressional hearings that led to limits on the production, marketing, and sale of amphetamines.

Today’s evolving speed boom looks eerily familiar. History and industry projections tell us America’s new pill party will soon resemble the old, and will end just as badly. It’s a party that’s just getting started. In the words of momswithADD.com, “We’re having an ADD PARTY tonight and you are invited!”

To see the future of America’s speed epidemic, you can study past speed epidemics. Or you can follow the travelling medicine show of Dr. Patricia Quinn. Both routes take you within view of the same hundred-car pileup.

Over the last 20 years, Quinn has emerged as a leading ADHD expert. A staple of the lecture circuit, she is the author of several books and appears regularly on national television. Like most of her peers in the incestuous network of pharma-funded ADHD organizations and websites, she fronts for drug manufacturers.

Over the years she’s worked as a consultant and speaker for Shire, Noven, and Janssen Pharmaceuticals. These companies sell amphetamines. The breakout demographic for these drugs happens to be young women: Quinn’s specialty. Her professional life revolves around concern that American women and girls aren’t consuming their fair share of the 200 tons of speed this country swallows annually. That the population of women seeking ADHD diagnoses is rising so quickly is validation of her life’s work.

The new industry numbers haven’t slowed Quinn or her comrades working to persuade women and girls to seek treatment for symptoms of ADHD. Quinn’s website ADDvance.com—“We’re here to help you learn to spread your wings and fly!” — offers the self-diagnostic quizzes peculiar to ADHD marketing.

For girls: “Is your room very messy?”

For their mothers: “Is your daughter a daydreamer, tomboy or ‘Chatty Kathy’?”

Quinn’s bio explains that she founded a group called the National Center for Girls and Women with ADHD. We’ll have to trust her, because the outfit doesn’t have a website. This is a curious commonality among female-oriented ADHD groups. The link to Dr. Kathleen Nadeau’s National Center for Gender Issues and ADHD takes you to a site promoting a different product line, e-cigarettes, in particular, a model called the Ave 40 Vape. As of this writing, Nadeau’s corporate runners haven’t bothered to change the ADD group’s acronym in the URL.

Whether or not these ADHD centers ever existed, the letterheads provide a veneer of legitimacy to touring advertorial slide shows like Quinn’s, titled “AD/HD in Girls and Women: The Hidden Disorder.” Quinn’s female audiences don’t always learn about her financial ties to the companies selling the drugs she praises.

Nor do they learn that speed is the earliest known synonym for the addiction spiral, the modern textbook understanding of physiological dependence and tolerance having come from studies of amphetamine’s effects on dopamine. Quinn’s slide show also fails to mention that speed once provided researchers with their best experimental simulation of schizophrenia. During the 1960s, researchers concluded that habitual amphetamine use produced a more accurate “model psychosis” than LSD.

What women do learn from Quinn is that a daily speed regimen will help their careers, love lives, and waistlines. A slide from “The Hidden Disorder” explains, “AD/HD symptoms predict aspects of overeating… which are correlated with Body Mass Index… and a pattern of eating carbohydrates (sweets and starchy snacks) in the evening.”

Slide from Dr. Quinn’s “The Hidden Disorder”

Indulgence in sweets and starchy snacks can apparently be more of a sign of ADHD than bad grades. As Quinn told an “ADD coaching” website, “It is important to treat ADHD in girls even if they seem to be doing well academically and holding it all together, because they may be doing so at a great cost.” Once they get on speed, they must stay on speed, says Quinn, because “ADHD is a chronic, life-long disorder” best treated by pills that “decrease the urge to binge.”

Quinn is among the busiest charlatans on the ADHD circuit. She’s also a candidate for the most retro. Her hard sell to women, filled with references to Body Mass Index and the stresses of “keeping house,” is a throwback to the successful midcentury business strategy of the legal speed cartels: market to women by exploiting their insecurities about weight, productivity, and positivity, then hand over the rest of the job to dependence—what pharma reps used to call “stickiness.”

Manufacturers of legal speed have never settled for a market limited to hyperactive boys, any more than an outlaw meth operation would limit its clientele to long-haul truckers. Indeed, pharma’s exertions in growing the speed market are as old as the first amphetamine patent.

In the mid-1930s, less than a decade after the first synthesis of amphetamine, the psychiatrist Charles Bradley conducted experiments with the Benzedrine salts produced by Smith, Kline & French. His conclusion was ahead of its time. The drug’s most promising medical use, reported Bradley, was a schoolhouse treatment for “problem” children. SKF didn’t like the numbers.

The company preferred researchers who envisioned a wider market for what one scientific contemporary called “a drug in search of a disease.” SKF found their man in Abraham Myerson, a Harvard professor and early practitioner of psychiatry who published papers recommending amphetamines as a “pick-me-up” for anyone with hangovers or “general tension.”

Myerson’s body of work, including the book “The Nervous Housewife,” provided the intellectual and commercial foundation for marketing speed to the general public — especially women. SKF sent mailers citing Myerson’s work to tens of thousands of general practice doctors. The company recommended their marvelous new drug as a treatment for as many as 39 conditions, including hiccups.

As with today’s industry-funded ADHD websites, these pamphlets made scant or zero mention of the known risks of addiction, depression, anxiety, and psychosis. Myerson’s Depression-era work for SKF began something of a crimson tradition. His legacy lives on today in the form Harvard Professor of Psychiatry Joseph Biederman, a key thought leader in the growth of ADHD meds who was censured in 2008 by the National Institutes of Health for concealing millions of dollars of pharma consulting income.

An early magazine ad for the weight loss drug biphatemine. Image: Public domain.

Speed became a huge commercial success after the war. During the ‘40s, ‘50s and ‘60s, amphetamines were widely used across all social strata. But its biggest profits came as a socially sanctioned tool to help American women shed pounds and “stay pepped” while grinding out lives in the Cold War suburbs. The nation consumed a wide variety of patented amphetamines, from the bestselling Benzedrine, Dexedrine and Dexamyl, to any number of generic copycats. More than a few of these brands contained methamphetamine.

The popular meth-based diet drug Obetrol, produced in Brooklyn by Rexar Pharmaceuticals, both controlled appetites in Levittown and kept the party going at Warhol’s Factory, where it was the speed of choice. (On the morning Valerie Solanas shot Warhol, the artist was on his way to the drug store to pick up his Obetrol prescription.)

By 1970, nearly 10 percent of American women regularly used or were dependent on some form of amphetamine, most prescribed for weight loss. In his book Speed-Speed-Speedfreak, Mick Warren reminds us that hooked housewives and twenty-something women were established cultural tropes, the sirens in songs like the Rolling Stones’ “Mother’s Little Helper” and Canned Heat’s “Amphetamine Annie.” Beginning in the mid-1960s, media exposés in Ladies Home Journal and other magazines fed calls for Congressional action. High-profile hearings followed. These led to the Controlled Substances Act and the classification of amphetamines, against fierce industry resistance, as a Schedule II drug defined by the high risk of addiction and potential for abuse. For the first time, federal limits were placed on annual speed production.

With help from friends in Congress, those quotas have been steadily loosened in recent years, and are now approaching pre-1970 levels.

The 1970 Act signed by Richard Nixon is no model for rational drug policy. But the hearings that led to it got some important things right. Looking back, one is struck by the realism that defined the proceedings that concerned speed. There was no dual-frame separating “good” medical and “bad” street speed. Anyone attempting to use two categories for the same drug would have been laughed at, or greeted as a marketing visionary from the future.

In the late 1960s, pharma produced as much as 90 percent of amphetamine sold on the street, and everyone knew it. In 1964, a CBS news team used crudely faked letterhead to procure hundreds of thousands of speed pills from major companies for a few hundred bucks. Walter Cronkite ended the report with a slap at leading “seemingly innocent” manufacturers. Sometimes pharma just dumped product directly onto the black market. Strasenburgh, maker of the popular Adderall-precursor known as Black Beauties, was fined repeatedly for pill diversion, including a bulk delivery to the 11 th hole at a golf course in Tijuana.

The 1970 hearings featured a baseline assumption that amphetamines are addictive and harmful even, and often especially, when “taken as prescribed.” Today we’re still miles from that starting line. Ditto our lost understanding of the symbiosis between speed and downer epidemics. As David Smith of the Haight-Ashbury Clinic testified, “What happens when a major speed scene develops [is that] a downer or depressant scene follows.”

Xanny bar, anyone?

In every dimension of today’s speed boom—chemistry, history, economics—”speed” is the only credible noun.

Dr. Quinn, Medicine Woman, isn’t alone in working to revive the postwar adult speed market. Take a stroll through pharma-linked ADHD sites and media coverage, and you’ll encounter the same handful of women, over and over again, all echoing Quinn’s view of women with undiagnosed ADHD as “the true ‘Desperate Housewives’.” They are the “hidden” afflicted whose suffering will end when they “own their ADD,” in the words of the direct-marketing campaign featuring Adam Levine of Maroon 5. (Expect more celebrity ADHD ads in the future.)

One star in this world of female adult ADHD advocacy is Terry Matlen of momswithADD.com. Like Quinn, Matlen claims to be helping women understand a disease. But the message delivered on the website of her business, ADDconsults.com, is aimed at a very different audience: pharma clients with products to push. Matlen makes a strong pitch to companies in the ADHD marketplace: “Would you like to have your product/service seen by thousands of people who are interested in AD/HD? Because of my high visibility online, I can: promote your service/product via many only venues, i.e., ADD Consults’ website, newsletters, blog, online store; write articles related to your product; be available to represent you or your product to the media.”

Matlen’s recent clients include the makers of leading speed brands. But since she acts as more of a fixer, and doesn’t actually prescribe the pills, she sees these relationships as irrelevant to her integrity as a therapist. “I am not compromised by ties to companies that make ADHD treatments—medications—as I cannot prescribe medications,” Matlen told Motherboard.

Sari Solden, the Ann Arbor-based therapist behind ADDjourneys.com, could mount the same defense. Like Matlen, Solden is no doctor, but she loves a good quiz to get women pointed in the right direction. In her “handy checklist” of ADHD symptoms published at ADDitudemag.com, Solden asks, “Is time, money, paper, or ‘stuff’ dominating your life and hampering your ability to achieve your goals?”

Women can gab with Solden about their struggles with “stuff” this July in Orlando, the geographical center of the Pill Mill State, where Solden will keynote the International Adult ADHD Conference. The organizer of this exciting annual networking event is the Attention Deficit Disorder Association, a front group for Johnson and Johnson’s Ortho-McNeil-Janssen Pharmaceuticals, the makers of Concerta. The 2014 conference agenda reflects important market trends. One panel is titled, “OMG – I Caught ADHD From My Children!” But there’s more to the event than just informative panels. The conference is an opportunity for doctors to meet some the 100,000 people who, in the words of ADDA, “are coming to our website looking for the experts who get it and the professionals who can help them.” [Emphasis mine.]

In Orlando, ADDA will officially celebrate 25 years in existence. The group will unofficially celebrate much more. After decades in suspended animation, the adult speed market is finally back on its feet, feeling pepped, and ready to go. A long-term strategy of cultivating professional societies, primary care doctors, the media, and political allies has paid off. From the beginning, the secret weapon of this strategy has been women like Quinn: pseudo-scientific quiz givers who talk like Oprah, who claim to suffer from ADHD and “get” you, and who have a little something that just might help you shed those pounds, manage house, and keep the blues at bay.

Anyone seeking to understand the treachery behind today’s medical-industrial ADHD complex should begin with Nicolas Rasmussen’s essential history, On Speed: The Many Lives of Amphetamine. Rasmussen, a science historian at the University of South Wales, tells a story that ought to inform every media treatment of the subject, but never does. When it comes to speed, the national amnesia is stronger than crank. Ryan D’Agostino’s recent Esquire feature about ADHD, “The Drugging of the American Boy,” dispatched with the history of speed in two references: 1955, the year Ritalin was patented, and 1987, when the American Psychiatric Association codified ADHD (as opposed to ADD). Otherwise, it’s as if we just discovered fire.

An early Ritalin ad. Image: Public domain.

This amnesia results in delusional and dangerous diction.

Americans love the word “speed.” We use it in movie titles, video games, ads for broadband, and pizza delivery. Its etymology even echoes the national mythos. The Old English “sped,” from which the modern noun derives, meant “success, prosperity, wealth, luck, opportunity, advancement.” This origin captures all the reasons speed is the quintessential American drug. It also suggests a perilous lexicon.

Articles about ADHD drugs are fine talking about success, work, competition, and advancement, but try finding one that calls the drug by its name: Speed. The word simply eludes us when we try to figure out why Johnny Prep is being rushed to ER. When our speed comes in a bottle covered by Blue Cross, we call it “medicine”; when it’s Blue Meth in a baggie, we don’t just call it a “hard drug,” we send out the SWAT team, declare “National Methamphetamine Awareness” day, and gawk in titillation at the poor, uninsured tweakers on basic cable.

Consider Alan Schwarz’s damning December 2013 New York Times investigation, “The Selling of Attention Deficit Disorder.” The story exposed pharma’s systematic decades-long efforts to expand the market and appeal of ADHD drugs. As strong as the piece is, Schwarz sticks to industry-approved marketing vernacular. The piece deals only with “medicine” and, at the far end, “stimulants.” Despite his intimate knowledge of “off-label” speed casualties, not once does Schwarz use the word “speed,” or reference the “Speed Kills” campaign of his childhood.

Flinching language even undermines first-person essays that attempt to traffic in blunt honesty. Kate Miller wrote for the Times “Anxiety” blog about faking an ADHD diagnosis and becoming addicted to Adderall. The piece ends with Miller flushing her “remaining medicine” down the toilet.

“I made a child’s miscalculation that there is a shortcut to maturity and success,” she writes. “It felt good to finally understand that the very self I was trying to shed had become my salvation.”

Translated from therapy-speak: “I got hooked on speed, tweaked for a while, and kicked.”

In every dimension of today’s speed boom—chemistry, history, economics—“speed” is the only credible noun. Only “speed” captures what amphetamines feel like and what they do to the brain. Only “speed” implies the crash, which defines the drug as much as the high. Only “speed” connects today’s corporate amphetamine sales to those of yesterday. “Speed” alone bridges the imaginary gap separating Walter White’s product and Shire’s.

For those who have never taken speed, it’s difficult to convey the seriousness of a public health disaster.

The clinical literature on speed isn’t very large, and that has something to do with the fact that pharma funds much of the research, then decides what gets released to the public. When independent reports do come out, like the American Heart Association study linking speed use to a more than tripled risk of a torn aorta—which leads to a gruesome and fast death—the conclusions don’t get much attention. When the AHA announced in 2007 a need for better research into speed’s little-understood long-term impacts on the cardiovascular system, the media hardly noticed. Most national magazines were too busy running misleading images of “meth mouth.”

There is a reason front groups like CHADD and ADDA focus on “the science of ADHD,” which is not hard science, and ignore the science of the drugs used to treat it, which is hard science. In the understated language of a 2009 paper published in Molecular Psychiatry, “Effects of prolonged stimulant treatment have not been fully explored, and understanding such effects is a research priority… Case reports indicate that prescription use can produce marked psychological adverse events, including stimulant-induced psychosis.”

The paper does not dwell on the distinction between street and pharma product, because this distinction is narrow and beside the point. It was born with the rise of ADHD meds and the (arguably not coincidental) concurrent national hysteria around dirty street meth. The distinction has over the years hardened into a thick plexiglass window that is the looking glass of our dysfunctional speed debate.

Let me remove this looking glass and share with you my own mini speed memoir.

For about five years in my twenties, I used “bad” speed. While living in Prague during the late 90s, then, as now, the speed capital of Europe, I snorted the local meth pervitin, which the Nazis once mass-produced in the chemical factories of occupied Bohemia. In Cambodia, I popped pink meth pills called yaba (Thai for “crazy medicine”). When I moved to New York in the early aughts, I dabbled in crystal meth, “as needed.” I did meth for the same reasons and to the same effects that sophomores at Stanford and busy professionals and parents in Bergen County seek scripts for Adderall, Ritalin, and Vyvanse. I did it to work, to compete, to increase productivity. After a day of teaching English or editing an understaffed newspaper, I wanted my energy back to pursue my own work.

Also, speed is euphoric and fun. At least it is until that miserable hollowing known as the Crash. Then you’ll do anything to stave the void. One easy way to do this is to take more speed. But you build tolerance. The crashes get worse. After just a week of steady use, I’ve found the demons start to gather, and life begins to lose savor. You start to become just a functioning shell.

The first time someone handed me 30 milligrams of Adderall, I wasn’t expecting much. As a connoisseur of crank, I thought it would be closer to the caffeine study pills we crushed up back in the more innocent ‘90s. Isn’t this the stuff they’re giving all those third-graders? How strong could it be?

Strong. My first pharma high was on par with any bathtub crank I ever bought in a Bratislava train station. It was just cleaner, with smoother slopes. After my first taste test, I never did “bad” speed again.

“If you went into a back alley and lined up pharmaceutical Dexedrine and Adderall next to a line of street meth, hardcore tweakers would choose the pure Dexedrine every time,” James Kent, a veteran drug journalist and editor of DoseNation.com, told me. “Though some might choose Adderall because the Benzedrine cocktail adds intensity to the rush.”

For the next few years, I bought my “good,” New Yorker-approved speed from the same dealers who once sold me “bad” send-in-the-SWAT-Team meth. Buying Adderall from dealers had two advantages. One, they sold benzos and opiates to help with the crash. Two, the street prices and discreet pick-ups never let me forget that I was buying a hard, addictive drug. Those without prior speed experience don’t have this knowledge to forget.

Around 2009, I noticed more friends and acquaintances getting scripts. These people would never in a million years be caught facedown in a caterpillar of street meth, but here they were singing in the rain about Adderall—Kate Miller’s “medicine.” More than one of these people asked me, “Why are you paying $20 a pill?” They suggested doing what they did: take an online quiz, find a friendly ADDA-approved doctor who “gets it,” and get sorted in a doctor’s office.

I never considered it. A cheap and limitless supply of pharma-grade amphetamine, signed off by a friendly medical professional, struck me as an incredibly unwise pursuit. That’s how you become a heavy or daily user. The road to tweakdom is paved with Duane Reade co-pay receipts. I’ve since been proved right, sadly, by watching speed hurt people I care about.

One of these people, a 24-year-old woman I’ll call Lily, got her first Adderall pill from a friend in high school. A succession of Manhattan psychiatrists happily filled her requests for a script beginning at age 17. She spent her college years in a hyper-productive speed daze, posting good grades and landing a job after graduation. Along the way, her daily dose increased with tolerance. She forgot who she was, developed acute anxiety, and damn near lost her mind, if not her soul. She tried to quit midway through her spiral, but her doctors told her it was dangerous to abruptly stop taking her “medicine.” Instead of taking her off the speed, which she knew was the problem, they put her on Effexor, an anti-depressant and anti-anxiety SNRI. She finally ditched her doctors after having a seizure in a Brooklyn bodega at the end of a long stretch of speed sleeplessness.

“By the time I had the seizure, I was taking 90 milligrams of Adderall a day,” she says. “I knew girls who were taking the same amount or more. I don’t know if any of us had so-called ADHD, but the effects [of the Adderall] started to look exactly like how ADHD symptoms are described. I was told I needed it, so I believed it, but it was really just addiction.”

For those who have never taken speed, it’s difficult to convey the seriousness of a public health disaster—and the depths of its underlying corruption—that results in healthy college students taking 90 daily milligrams of amphetamine salts under blasé doctor’s orders. At 90 milligrams a day, the question is not if the person will eventually experience some form of speed psychosis, but what grade and when. Jack Kerouac and Neal Cassady would have struggled to keep up with today’s Generation Speed.

I think adults should have access to speed if they want it, without fear of arrest, as well as free addiction treatment if they need it. The problem begins, and becomes a national scandal and crisis, when socially sanctioned corporate dealers are allowed to dishonestly market these drugs through a sophisticated network permeating the medical establishment, backed by the power of modern advertising. No pimply meth dealer ever tried to tell me his product was a harmless stimulant. No Mexican cartel ever made huge buys in medical journals to corner the market on fifth-graders, or hired pop stars to push their product on young moms on national television.

As Adam Levine could attest to, but won’t, speed crashes get deeper and blacker with age. By my mid-30s, my speed use became extremely rare and strategic—an emergency boost reserved for the most-dire deadline situations. I now dread even 10 milligrams of Adderall, that real world “blue,” as a kind of punishment. I’ve also come to see speed as the nemesis of creativity and thought, the ultimate good-little-robot drug. I won’t lie and say I ever flushed anything down the toilet, or that I’ll never take speed again. But it’s been a long time since I bought the stuff. I now stick to the weak classical highs of coffee and tea, which can honestly and without obfuscation be described as harmless stimulants.

I also tell people considering a script about Lily’s addiction, anxiety, and seizure. The industry trend lines are stark, and they all point up. She wasn’t the first unrecorded casualty of this new speed crisis. She’s nowhere near the last.