'Amphetamines, amphetamines? I do wish, Mr Er; you would not constantly contli.se me with these new technical terms. Are these what we used to call "pills" in connection with juveniles?'
Stipendiary Magistrate, February 1966.
The pharmacological action of this class of drug is relatively simple. By stimulating the central nervous system it produces euphoria, self-confidence, energy, alertness and endurance. There are about fteen brands of amphetamine licitly available in England; the most common of these used illicitly, with their slang names, are: Benzedrine — bennies, Dexedrine — dexy, Methedrine — meths, Durophet — black bombers, and Steladex. Another group combines amphetamine in a mixture with barbiturate, compounding the problems of both. The principal example is Drinamyl — whose former distinctive shape gave its name, purple hearts; now in a new, non-heart shape, French blue. All of these except Durophet are manufactured by one firm, Smith Klein and French of Welwyn Garden City, which provides the bulk of the National Health Services amphetamine supplies.
Amphetamine was first prepared in 1887, and as Benzedrine, was first used medically in 1935 for the treatment of narcolepsy. The first non-medical use was in ships' survival packs during the Spanish Civil War; at about the same time it was issued to German paratroops for routine operational use. Both sides had it during the Second World War. Seventy-two million tablets were issued to British forces to be used tactically to keep troops in the line when they, and the other side too, would norniially have been too exhausted to fight. Amphetamines were to be 'withheld until the men were markedly filigued physically or mentally, in circumstances calling for a special effort'. The maximum military doses were 10 mg. in twelve hours, or 30 mg. in a week — roughly the ordinary teenager's weekend dose, but one fourth of the maximum clinical dose recommended, say, for Benzedrine.1
In a mild way, amphetamine is a 'superman' drug. Although the only clinical sign of having taken it is its presence in the urine, it objectively increases the capacity for simple physical and mental msks, and increases intelligence by an average of up to eight points — as measured by simple tests? However, highly coordinated tasks like playing golf or flying an aeroplane are unaffected in quality, though they can be prolonged beyond the normal duration.3
As we have seen, Eysenck finds that amphetamine moves the personality towards the introversion end of the spectrum, and decreases nervous inhibition (see p. 67).4 As with barbiturates this finding agrees well with the characters of the people who seem to use the drug illicitly: exhausted housewives and teenagers, both groups who, as well as needing energy for their several pursuits, are also sadly bored and understimulated. They perhaps take the drug to make the most of the stimuli that are available to them. Another interesting effect, probably connected physiologically with this decrease in inhibition, is that users of the drug become more amenable to the standards and behaviour of those around them. The effect has been exploited in the treatment of disturbed and delinquent young people. Eysenck quotes a couple of American experiments, in one of which a group of disturbed children was treated with amphetamine in an institution:
During the preliminary preparations a unique opportunity for observation of each subject was afforded under conditions which required cooperation. During the period of Benzedrine medication, sociability, cooperation, attention and &airless all seemed to be 1mPrOVed.3
The drug is generally held not to be physically addictive, though for six weeks after the end of an intensive period of use some disturbance in the brain's electrical activity is reported.6 However, this does not seem to correspond with any observable alterations to personality or mood, although the authors of the paper just referred to claim that the presence of a measurable withdrawal symptom implies genuine addictiveness. The point is, however, academic. The commonly experienced unpleasant effect of amphetamines is due simply to the way in which they increase energy. Renewed energy cornes as a forced loan from the body's resources; an immediate lift lasting a few hours is followed by exhaustion and depression. If more of the drug is taken to fight off the 'come-down' the user gets himself into a bankrupt's predicament, with a large overdraft against his physical reserves. The literature on amphetamine says that exhaustion and death are likely consequences of over-use of the drug, but reported cases are so rare as to be invisible, and it seems that the majority of the minority of teenagers who use amphetamines avoid such over-indulgence.
Much is said about teenage misuse of pills; little is known. The practice seems to have started in the West End of London in 1960 or so, and became noticeable by 1963. It has spread to the centres and suburbs of most cities in the British Isles, and is, with imports from the continent guaranteeing the black market, now an apparently ineradicable part of adolescent life. The point of using the drug is' to extend and intensify the weekend, a short period of escape from tedious school or dull jobs. The kids sit in beat clubs, coffee bars; they dance, talk, wander the streets, which for once they have to themselves,*from Friday night to Sunday. It is probable that this intensive period of group sociability and exploration, which for a few is emphasized by amphetamines, lasts roughly two years between leaving school at sixteen and starting serious courting at eighteen.
The meagreness of the literature on this subject is shown by the continued references in scientific papers to Anne Sharpley's celebrated pieces on pill-taking in Soho published in the Evening Standard in the spring of 1964. Although her articles are remembered more for the exotic and desperate characters she discovered, many of her observations are moderate and intelligent.
They [the teenagers] are looking for, and getting, stimulation, not intoxication. They want greater awareness, not escape. And the confidence and articulacy that the drugs of the amphetamine group give them is quite different from the drunken rowdyness of previous generations on a night out.7
The important difference between purple hearts and alcohol is that for the first time people in the mass are experiencing a cerebral sense; tion. Not a physical one. purple hearts taken in the quantity that most teenagers take them — half a dozen to a dozen,* to keep them going over the weekend and save them the expense of hotel rooms and food — are not specially harmful. Indeed they have an enhancing effect in giving them confidence and clarity.8
She might have added that young girls, staying up all night, keeping awake and alert on amphetamines, with their sex drives reduced, are less likely to be seduced and made pregnant than they would be using alcohol. Since pills came into use, there has been a noticeable decline in teenage drunkenness, though one can only guess at the causal connection.9
One might even compare the experience and excitements of a two-day, three-night, Soho pills weekend with the central experience of an Outward Bound Course, designed for people of the same age-group. One of the high points of this character-building course is a four-day mountain expedition. Both this and the weekend make considerable demands on the individual's initiative and stamina, both expose him to dangers he would otherwise not know about, both test his self-reliance and increase his self-confidence, both by transcending his normal endurance and capabilities enlarge his knowledge of himself and the world he lives in. Accidents happen in both situations, but for the large majority no lasting harm results; the weekend on pills has the
advantage that it is voluntarily chosen and relevant to urban living.
(The parallel is even closer. The psychic malleability produced by amphetamines is induced in the Outward Bound situation by exhaustion, fear, isolation and feelings of guilt due to unavoidable breaches of the Course regulations. The resulting plasticity is acted on by strong motivating pressure from the Course instructors. In effect the Outward Bound Course is a form of brainwashing consciously or unconsciously designed to bring teenage values into line with the Establishment's. The methods adopted tally very closely with Dr William Sargant's account of the best brainwashing procedures used in Russia and China; methods which he describes as being superior to the use of drugs.)10 The connection between amphetamines and juvenile delinquency is also somewhat exaggerated. An often quoted survey of young people admitted to a remand home showed that 18 per cent had the drug in their urine, but otherwise there was nothing to distinguish these from the 82 per cent who had not." It is possible that in a few individuals the drug releases latent anti-social action, but in as many others, normally repressed and frustrated, it enables better adjustment and acceptable social behaviour. Howard, in an article whose tenor is that far more teenagers claim to have used pills than have actually done so, reports a few cases of repressed sexual deviance made actual under the stimulus of amphetamines, particularly the quick-acting methedrine - which is now unobtainable.I2 But any form of social activity throws up a few people whose behaviour is unacceptable. The police object to juvenile amphetamine use because it is thought to cause fights, because cars parked near beat clubs get scratched and children stay up all night.13 These are all things likely to happen anyway when teenagers are allowed out all night; there is no evidence of any increase attributable solely to pills. It seems likely that the campaign against amphetamines, resulting in thé Drugs (Prevention of Misuse) Act, 1964, is an attempt by adult society to seize on something concrete in the apparent morass of changing adolescent standards.
A more promising line of criminal inquiry might be into the fraud of those who supply teenagers with amphetamines. In the thriving black market the supply of amphetamines stolen off the production lines of the firms that make them, and imported - often from Spain - is supplemented by a variety of home-made and sometimes noxious substances. This aspect of the trade shows interesting analogies with the American black market in heroin. Howard13 says that harmless powder compressed into pills is often sold as Benzedrine for 124-p a tablet; another ruile is to dye aspirins with purple ink (not easy - the surface of the pill flakes off) and sell them as a new brand of Drinamyl. Stimulants, or some colourable simulacra, are available in dubs, dante coffee bars, either passed from hand to hand, or dissolved bottles of squash. Such manoeuvres must -decrease even ,mo the customers' check on their purchases. Their distributi appears to involve a fairly sophisticated network and a 1. archy of suppliers who handle quantities of pills numbered in millions.
Apart from exhaustion, and the legal penalties attendant ii possession of the drug, the chief danger of indiscriminately used amphetamines lies in habituation and psychosis. These are often, but not always, found together. A large enough dose - 50 mg. or 10 Benzedrine tablets - is said to be very likely to precipitate siJ psychosis lasting up to a week in any normal person.15 (Incidentally, this seems to dispose of some teenagers' widely reported boasts that they take 100 pills at a time - exaggeration on a level with the nightly dozen pints' of some habitual drinkers.) Here again we touch on the mysterious connection between drugs and madness: amphetamine is thought to act in the body by competing for amine oxidase and so potentiating the body to adrenaline - an essential chemical in the brain, very similar in structure to mescaline. Also, in view of heroin's possible efficacy in preventing schizophrenia (see p. 156), it is interesting that amphetamine and the opiates cancel each other out3
The symptoms of madness induced by prolonged overdoses of amphetamines are 'primarily of a paranoid psychosis with ideas of reference, delusions of persecution, auditory and visual hallucinations in a setting of clear consciousness, possibly indistinguishable from acute or chronic schizophrenia'.14 The condition is treated by withdrawal of the drug and giving barbiturates; there is a high relapse rate, and in the physical and mental depression after large doses suicide is common. But it seems that taking doses of this magnitude is in itself a symptom of acute mental disturbance. Of forty-six cases reviewed by Connell who bad been admitted to London hospitals with psychotic symptoms, 66 per cent had been treated before for psychiatric illness, 26 came from families with a history of alcoholism and psychiatric illness, and in the group that bad used amphetamines for some time, everyone had used some other drug or excessive alcohol.
Case 6: He felt depressed and bought an amphetamine inhaler, ingesting the contents over six hours. Soon people began to look at him in a I peculiar way. He began walking the streets and slept in the park. The next day he spent looking for gold in the park; stones there seemed to be gold. That evening he heard people talking about him and was sure that people were going to kill him. Cars and people followed him, and there were numerous special signs. Finally he climbed onto the roof of a building and began throwing tiles at the gang in the street below.
Case 23: There was a five-day history of wandering on a special mission for God. This was partly to test her and there were numerous special signs, special meanings and persecutory figures in this experience. She had been taking dexedrine for weight reduction and fatigue. She finally went to a relative's house in a filthy state and defecated on the carpet.
Case 29: This patient habitually ingested the contents of methedrine inhalers for depression. He began to feel that everyone was against him and heard pro' and 'anti' voices. Finally he felt that his wife was against him and when she threatened to leave him he became acutely depressed and sought admission to hospital.
Connell reports that a much smaller dose than is needed to produce psychosis in normal people will markedly increase the hallucinations of schizophrenics.14 It seems likely that in some persons whose body chemistry is nearly that of the schizophrenic (often betrayed by their previous abnormal behaviour), a relatively small dose of amphetamine will tip them temporarily over the edge into a psychotic state that lasts until their precarious chemical balance is restored. The doses one could get from amphetamine inhalers before the drug was put on the Poisons Schedule 4 in 1955 could amount to a hundred times the clinical dose. Dramatic results were to be expected.
In another paper Connell reviews nine adolescents who had been referred to the Maudsley Hospital with amphetamine troubles. All had had short-lived paranoid experiences, and all, without exception, had problems of adolescent adjustment, and the majority had shown the beginnings of difficult behaviour before taking drugs.'15
Of 263 ex-Borstal boys under the supervision of the Cen I After-care Association in 1962, a third used or had used phetamines, and a tenth had to 'excess'. These must represent a very small proportion of the teenage population at risk. Interestingly, the Director says that of twenty-five boys recently brought to his notice as drug users only one had had a normal home. Seven were illegitimate and in the history of fifteen of the others there was gross parental rejection.16
An Australian study of thirteen people dependent on the drug - who also displayed an extraordinary variety of sexual deviations - confirms the importance of original personality disturbance in forming this condition. Among these there were six cases with a family history of addiction to alcohol or drugs, and overt mental illness in seven families Of the thirteen only four had no history of either of these, all but one had been openly rejected by their parents, and the exception had been an orphan brought up on an island by a cruel step-father. However, perhaps , as nature's compensation, one couple claimed that they could, with amphetamines, prolong sexual intercourse to ten hours or more. In most people, though, the authors conclude, the drug can Increase sexual desire if it is already present, but reduces performance. All these patients said they used amphetamine because it made them feel powerful, great, 'in control'.
The occurrence of marked regression and the use of passive-receptive forms of mastery indicate the presence of considerable personality defect 17
Another series of fourteen patients dependent on the drug showed that eleven had used other drugs to excess: morphine, bromide, barbiturate, alcohol and even caffeine. ‘. . The basic reason for addiction must lie in the personality of the addict.'18
The published accounts of amphetamine habituation and psychosis overwhelmingly suggest that these states are, like all other drug dependence, symptoms of severe personality disorders rather than disease-like conditions that are 'caught' through bad company and the want of proper control of drugs. Hector and Karen (p. 58) are hardly normaL Tony Parker in Five Women gives a vivid portrait of one such personality. Carol Dean, known in Soho as Carol the Pill because she would buy any quantity at any time, was a runaway from a family in a remote Cornish village. Emotionally very unstable, the only steady mark in her world was her elder sister who had earlier run away to London. Carol lived with a boy, but without sex. This is her first introduction to the pills scene:
I stayed up all night in the club, taking these pills every hour or so, and I'd never enjoyed myself so much in all my life, I felt on top of the world, as though I could go on dancing and talking and laughing for ever and ever, just listening to records on the juke box and drinking coffee.
But next morning when the pills had all gone and the effect had worn off-it was like I wanted to fall down dead, honest - you know, all the stuffing gone out of your body, your mouth dry, your head spinning, your head going a mile a minute, oh you feel shocking, terrible, I can't describe it. All I wanted was to go to bed and sleep and sleep and sleep.... Like I said, you' don't care, when you're on the pills, what you look like or what you do, and you can get very abusive too. I was elfin' and blindin' at the law when I went out of the station, for taking me in, but somehow I knew it wasn't going to be long now before they'd really got something to hang on me.19
Here seems to be an extremely insufficient, bleak, unstable personality who suddenly equates the use of amphetamines with the delights of the city and her own enjoyment of independence and new easy social relationships. Naturally she becomes attached to them.
The most worrying aspect of teenagers' amphetamine use is their indifference to dosage. The faith the young have, in common with their elders, that anything pharmaceutical is both safe and beneficial, is touching but ill-advised in these days of potent drugs. The regular pill-user doubtless learns his safe dose or goes under; in the process he may fall out with his family, lose jobs, get into trouble with the police. But among the recommendations of the Report of the Advisory Committee on Drug Dependence* was this: The occasional oral use of a pep pill ought to be regard as much less serious than the injection of amphetamine which it as dangerous as any form of drug abuse.' Injection of a liquid preparation, methedrine, became a problem in 1967, and when, from April 1968, heroin could only be got from clinics, the methedrine 'misuse problem soon reached epidemic proportions'. Methedrine was quickly taken off the market (see below, p. 178). Of all the drugs which are abused in Britain, methedrine was probably the most troublesome. Users would be violent, insulting, criminal under its influence (see above, p. 80). Several hospitals and social work schemes dealing with drug users have reported that their lives became much easier after it was banned.
More serious perhaps than adolescent extremism, is domestic habituation to amphetamines. Prescription of these drugs is not on the vast scale as for barbiturates, but still amounts - with 375 million scripts in 1964 - to 179 per cent of all prescribing.20 This is in spite of a general decline in their use in hospitals, and a medical disenchantment with their efficacy. Oswald and Thacore wrote eleven years ago: 'Therapeutic indications for amphetamine are today becoming vanishingly small '6. diet is best for obesity, they are no use in endogenous depressions and there are better things for narcolepsy. But again, like barbiturates, they are used by G.P.s and psychiatric out-patient departments almost as placebos, simply to do something for the vague miseries that abound in our society. A survey of the prescriptions for the forty or so preparations that contain amphetamines was made in Newcastle-on-Tyne for May and November 1960. About 200,000 tablets were prescribed each month on some 4,000 scripts. Expressed as a proportion of all prescriptions in these periods for this area, these come to 34 per cent. A detailed inquiry showed that no more than one per cent of registered patients were being prescribed amphetamines regularly; so that roughly 2,600 people were being given 77 tablets each a month. It was estimated that 20 per cent of these, or 520, were in fact dependent on the drug, had used it a long time, and strongly resisted its withdrawal?'
It is interesting to try to estimate from this work how many people there might be in England and Wales who are dependent on amphetamines. There are formidable statistical difficulties and at the best we can only come within an order of magnitude. The Newcastle prescribing rate for amphetamines, at 3.4 per cent, is considerably higher than the national rate for amphetamines. But we can perhaps correct this by making the otherwise arbitrary assumption that amphetamine misuse is a feature of urban life. About half the population of England and Wales lives in towns of more than 100,000 inhabitants. In Newcastle we had a year's total of 2,400,000 prescriptions associated with 520 people dependent on amphetamines. Applying this relationship to half the year's prescriptions for the whole country - 104-7 million scripts - we get a figure of 23,000 people who are likely to be dependent. It is unfortunate that Drinamyl is so popular -53 per cent of the prescriptions in Newcastle were for it - because it is an amphetamine-barbiturate mixture; the psychic dependence that can be formed for any drug can be complicated here by genuine physical addiction to the barbiturate component.
In Newcastle, 85 per cent of those who had the drug regularly were women, housewives like this unfortunate:
I started taking the tablets about three and a half years ago when I _ felt I could not get through my housework after working in the mill. At first I only took half a tablet a day. They made me feel fine and I was much better tempered with the children. But gradually I needed more and more - I could not get enough from my own doctor and used to wait until he was away and then go to other doctors who were acting for him. Plenty of housewives are taking these tablets. It is the only way they can get through, especially if they have to go out to
She was twenty-eight with five children, had been put on probation for fraudulently getting prescriptions for Drinamyl, and was sent to hospital for a year to be 'cured'. Her children were put in the care of the local authority. Who should be blamed: the drug, a weak personality, our society where the mother of five small children has to go to work?
Another woman, looking after her husband and five children in a minute flat, was charged with forging a prescription to get 136 Drinamyls. She is forty-seven and said,
They seemed to do me a lot of good. Without them I don't seem to have the energy to cope with things. There is a lot more work to be done since the baby arrived six months ago. At normal times I need about three a day, then I can face problems in the house much better.24
An interesting and well-constructed recent inquiry in Liverpool into domestic Drinamyl dependence found that although 58 per cent of a sample of patients who were regularly being prescribed these pills said 'they could not do without them', more than half of these, or 30 per cent of the whole sample, were just as satisfied with blue heart-shaped dummy tablets. Of the rest, who said they could do without, a smaller proportion were deceived by the dummies. Altogether, it seems that about half the people who are regularly prescribed these tablets are Rely to be just as happy with a placebo. For them the significance of the medicine probably lies in its symbolism of society's concern. Wilson and Beacon conclude:
If general practitioners cannot obtain adequate psychiatric help for their patients, the prescription of Drinamyl to these under carefully controlled conditions cannot wholly be condemned even though the patients get habituated to it. In the case of the psychologically dependent patients, it is the act of taking the medication rather than its pharmacodynamic action which was more important, and continued prescription of Drinamyl to these patients cannot be too strongly condemned.23
In recent years a 'new' stimulant drtig has appeared on the Illicit British market: cocaine. Derived from the leaves of the South American coca plant, it has been used for centuries by the natives of the Andes to inure themselves against cold and exhaustion. It became an important part of the Spanish colonial economy when they took these mountain people down into the steamy coastal jungles to cultivate their haciendas. Without the drug the natives were useless; with it they could labour three months before they died of exhaustion and pneumonia.
A vast range of cocaine preparations were sold in America in the latter decades of the last century: as linctus, chewing gum, syrup, nose sprays. The best-known survivor is Coca-Cola, first sold as a syrup in 1886 and advertised as the intellectual beverage'. The drink's characteristic flavour was produced by coca leaves, which brought with them a hefty and commercially advantageous charge of the drug, producing in the customers a psychological habituation. In 1915 cocaine was removed to prevent Southern blacks enraging themselves on it, and this state of affairs continues to this day, though the previous obligation to demonstrate the lack of cocaine to the Federal Government was removed in 1965.
The effects of cocaine are very hIce amphetamine: to give physical and mental energy, exhilaration, and to increase alertness and capacity for work and pleasure. Much lauded as a sex aid, it is said to increase the intensity of orgasm, while, since it is also an anaesthetic, delaying it. The sort of people who might use it are public performers — musicians, comedians, salesmen — because it gives the taker an aliveness that may be hard to procure by ordinary means. But, as with amphetamine, today's increased energy must be paid back in tomorrow's exhaustion.
It also makes prolonged exertion possible and was much favoured by nineteenth-century armies to enable soldiers, to withstand the fatigues of campaigning, The French Army swore by vin Marian,.
Cocaine has now, owing to its high price, a sort of champagne status among illicit drugs. It was last widely used in Britain on its own during the twenties.* For a fictional account of this period see Dorothy Sayers' Murder Must Advertise. Heroin addicts have used it for many years to remove the dulling effect of the opiate.
The U.S. Commission on Marihuana and Drug Abuse found in 1973 that 10 per cent of high-school students had tried cocaine.
*The clinical dose advised by the manufacturer for Drinamyl is three pills a day, the last not after 4 p.m. A dozen in three days hardly exceeds this; allowing that teenagers do not want to sleep, it is a dose unlikely to carry any risk of psychosis.
*The Amphetamines and Lysergic Acid Diethylamide (LSD), Report by the Advisory Committee on Drug Dependence, H.M.S.O., 1970.
*See, generally, Ashley, R., Cocaine, Its History, Uses and Effects, St Martin's Press, New York, 1975.