America’s sweetheart, Little Lisa, is spending her Saturday morning accompanying her mother while running errands. Lisa and her mom strolled to their local pharmacy, their final stop. As they walked down the street, hand in hand, Lisa noticed a strange-looking man. Lisa was a curious child and turned to her mother with questions, unable to take her eyes off of this puzzling sight. The man frantically argued with himself about something that he seemed to find incredibly important. The few teeth he still had were as yellow as the sun she had drawn in class on Friday, and the scabs all over his face made him look like a picture in her “Match the Dots” colouring book. Little Lisa’s mother picked up the pace as she explained, “Don’t worry about him, Lisa. He’s a meth addict. There’s no hope for him.”
Lisa could hear the unwavering disapproval in her mother’s tone; she had been the receiver of that tone many times before. Lisa’s curiosity got the best of her; she had to ask questions. “What’s meth, Mommy? And why does it make that man a bad person?” Without hesitation, her mother began, “Meth is a terrible drug, Lisa. The full name is methamphetamine, and junkies will spend all of their money to smoke, shoot, and snort it. They’re addicted, you see. They can’t function without it. But don’t feel bad for him, honey. He did it to himself! People like that should be wiped from society. How someone can put such dangerous chemicals into their body is beyond me.”
Lisa remained quiet for the rest of their walk, pondering the things her mother had said. Lisa realised that while she knew how her mother felt about meth, she had no idea what it was. Only once they had entered the pharmacy did another question arise in Lisa’s mind. “Why are we here, Mom?” Her mother smiled, “To get your Adderall and to get Mommy’s diet pills. We will each take one pill every morning after breakfast.” The two walked out of the pharmacy. One carbon atom and three hydrogen atoms are the only thing separating them from the junkie across the street.
What is Aderall?
Adderall, the catchiest name on the drug market, belongs to the amphetamine family, a cluster of stimulants that have been tweaked over centuries. Lazar Edeleanu, the father of amphetamines, was a Romanian chemist responsible for synthesising the first amphetamine compound in 1887. But doing something once is never enough, and in the late 1920s, the American chemist and pharmacologist Gorden Alles resynthesised the substances as amphetamine sulphate (amphetamine salts).
Much like table salt adds flavour to your favourite meals, amphetamine salts add flavour to your brain. Amphetamine is a salty stimulant that enters the central nervous system and goes to work on the catecholamine system of the brain. Unlike the twisty and endless catacombs, this catecholamine only has two important parts: norepinephrine, a pompous word for “adrenaline”, and dopamine, a happy little chemical that activates the brain’s reward centre. When amphetamine salts put on their suits and go to work on the catecholamine, they follow the same monopolisation system that allowed the diamond industry to flourish: cut the supply, then flood the system, and repeat. Amphetamine salts either enhance the release of catecholamine or block its reuptake; the dopamine allows for extended periods of concentration and higher pain tolerance, while norepinephrine increases wakefulness and focus.
The history
With a market swarming with hopeful souls chasing the American dream, a nifty tool to keep you awake, alert, focused, happy, and less snackish for hours on end is just what the client ordered. In 1933, Smith Kline & French introduced Benzedrine, amphetamine inhalers that one would snort to get rid of any pesky sinus issues. The history of the “pep pill” begins.
In 1937, the tablet form of amphetamine, Benzedrine sulphate, was introduced to the market. Doctors would prescribe these pills for depression, narcolepsy, and chronic fatigue. The pill coexisted with the amphetamine inhaler that had been on the market for four years. Amphetamine inhalers became a staple of jazz culture during the 1940s and ’50s. Jazz clubs were filled with talented musicians like Charlie Parker, who would snort amphetamine in between songs. The Beat Generation, a literary subculture movement started by authors who would frequent American cultural and political hotspots like jazz clubs, was greatly influenced by this. Jack Kerouac, an American novelist and pioneer of the Beat Generation, would spend hours in these jazz clubs admiring the erratic sounds, longing to model his writing after this free rush of music. After discovering the amphetamine inhaler, he used it as an aid to his writing for years.
Benzedrine did not discriminate when it came to its target market. While Dad was taking Benzedrine to stay awake during the war, Mom was at home taking it to fit into her new dress. During World War II, the US government provided soldiers with two of their very own Benzedrine pills for every combat mission, boosting patriotism through increased vigilance and energy. According to Nicolas Rasmussen, the author of On Speed: From Benzedrine to Adderall, by the end of the war, an estimated 16 million Americans had been exposed to Benzedrine pills.
The idea of youngsters abusing any substance they can get their hands on is not a new phenomenon. The first article discussing college abuse of amphetamine was in Time magazine in 1937. College kids started taking the gauze out of these amphetamine inhalers and chewing it to absorb the amphetamine at a faster rate (how innovative). By 1959, the state had had enough of all this silliness of jazz and amphetamine-filled college students, and the Federal Drug Administration (FDA) cracked down on Benzedrine inhalers, making them available by prescription only. Six years later, the United States Food and Drug Administration limited amphetamine to prescription use only, but non-medical use remained common.
Regulation
Regulation has never been synonymous with limitation. While the FDA may have put a locked door between individuals and amphetamine, all one needed was a key: a little piece of paper signed by an eager doctor. The frequency with which doctors would hand out prescriptions was no secret, and very soon, these laissez-faire doctors were branded “Speed Doctors”. The Beatles’ song “Dr Roberts” is inspired by a doctor-muse who worked in New York City and would freely prescribe amphetamine to any celebrity who walked through his door. Max Jacobs, a.k.a. Dr Feelgood, was one of these Speed Doctors and, for a time, held the coveted position of Pres. John F Kennedy’s favourite doctor. By the height of the pharmaceutical speed epidemic, 50 pills per man, woman, and child were being manufactured. The ingredients found in these pills are essentially the same as those used to treat ADHD today.
By the 1970s, the thought of using Benzedrine for runny noses and smaller hips became frowned upon. With the passage of the Controlled Substance Act, amphetamine became a Schedule 2 drug, or one “with a high potential for abuse, with use potentially leading to severe psychological or physiological dependence”. Boy, oh boy, seemed like people were catching on to the idea that this whole amphetamine business might not be as hot as it looks. But just when it seemed like folks were ready to walk away from amphetamine, psychiatrists, chemists, and doctors came together for the amphetamine resurrection. The seventies saw the clinical recognition of ADHD-like symptoms in a way that legitimised the condition now known as attention deficit hyperactivity disorder (ADHD).
Shifting focus to ADHD
With the legitimation of a medical condition comes the legitimation of the drugs used to treat it. In 1996, Adderall was brought to the market as the new, upgraded fix for ADHD. The catchy name was no coincidence. When the pill first made its way onto the market, it was marked with the label “Obetrol”. It was not long before a pharmaceutical businessman heard that the drug was being used to treat attention deficit disorder (ADD) and searched for a way to profit off of stigmatisation. He wanted individuals to feel included. This drug was not just for the few; it was for all. Adderall’s name reflects its makers’ hopes for expanding the customer base, “ADD for all”.
With the perfect name in hand, all that was left was to determine how to go about prescribing the drug. With no definitive test, how do you diagnose ADHD? Doctors came up with a perfectly profitable solution. They believed that if you prescribed a child with Adderall, and it worked, that child had ADHD. The problem with amphetamines, as we saw before, is that by its very nature, it does not discriminate. Mostly everyone who took the stimulant saw improved focus and concentration, which led to mostly everyone being diagnosed with ADHD. It has been nearly 30 years since Adderall found its place in the medicine cabinet. In 2021, about 41.4 million prescriptions were dispensed in the United States, up more than 10% from the previous year.
Currently, South Africa has refrained from allowing the legal distribution of Adderall. According to the South African Health Products Regulatory Authority, Adderall is classified as a Schedule 7 pharmaceutical substance under the Medicines and Related Substances Act of 1965 and is not legally available for purchase. Suppose you are caught walking the streets with Adderall in hand and no valid prescription by a South African medical professional to back it up. In that case you are staring down a criminal offence with a fine and imprisonment at the end of the tunnel.
Ts and Cs apply
You may take it upon yourself to resist this prohibition and endorse the availability of this drug that was meant for all. To those Adderall enthusiasts, think long and hard before you begin your fight for a pill with the nickname “college crack”. While you can expect short-term side effects like insomnia, anxiety, appetite loss, and nausea, the kicker is that amphetamine is inherently addictive. Because of its effects on dopamine, the feel-good chemical in your brain, Adderall can alter how dopamine neurotransmitters work. This means that after extended use of Adderall, users may not be able to feel any pleasure without taking the drug, making its existence a requirement as much as an addiction. With long-term use, you can expect side effects like seizures, cardiovascular disease, depression, aggression, panic attacks, and toxic psychosis.
Another consequence of long-term use is that the human body tends to develop a tolerance to amphetamine, meaning that the longer you use it, the higher the dosage you need to achieve the same effects. High doses of amphetamine can cause the body to produce high levels of a protein called FosB. This protein is essentially the master switch for addiction and, once activated, increases the severity of addiction behaviour. The alternatives discussed in the previous paper edition, such as Ritalin and Concerta, are by no means innocent and safe enough to give to your sibling’s new kid. However, these alternatives are made up of the chemical compound methylphenidates, which is less likely to cause addiction than other amphetamines like those found in Adderall. Much like Adderall, addiction does not discriminate.
There goes Little Lisa, walking hand in hand with her mother. It has been six months since they walked into the pharmacy for their first prescription. A shadow of silence follows them as they go along; neither one is as chatty as before. Lisa’s mother keeps letting go of her hand to pull up her pants, which keep slipping past her hip bones, before picking at the scabs that seem forever to be a part of her complexion. Looking a little closer, it seems Lisa has lost some weight, too. Neither have had a good night’s rest in quite some time. Lisa’s eyes do not leave the ground. No more room is left in her mind for curiosity as she mumbles argumentatively about her failures and anxieties. As they walk past, the junkie across the street, who has come to know them through their prompt monthly visits, watches their familiar behaviour with empathy. He mumbles to himself, “I got my daily fix from the streets, and there they go getting theirs from the doctor.”
