On Speed: The Many Lives of Amphetamine

Conclusion: The Lessons of History

Conclusion The Lessons of History ALTHOUGH MAJOR CHANGES in social structures and values may be needed if America’s craving for speed is ever to diminish, this is no reason to neglect the search for simpler, smaller-scale changes that might help mitigate the harms, both direct and indirect, of today’s heavy consumption of amphetamine-like drugs. And history does suggest, moreover, that harmful consequences will accrue beyond the immediate and obvious effects of crystal meth. Apart from an increase in cases of amphetamine psychosis by the thousands and the other harms of amphetamine-type addiction by the tens of thousands, as well as hepatitis and AIDS from amphetamine injection, America can expect redoubled problems with other drugs. “What happens when a major speed scene develops,” testified David E. Smith of the HaightAshbury Clinic before Congress in 1971, is that “a downer or depressant scene follows” inevitably.1 His predictions were borne out on the national level, in America’s late-1970s heroin epidemic. Heroin is not so easy to get as in the 1970s, and pharmaceutical barbiturates are no longer widely available, but we may already be seeing the same rebound effect in the recent massive wave of prescription pain-killer abuse in the United States. In the decade from 1993 to 2003, the number of first-time abusers of these drugs—most of them related to heroin, like Vicodin and Oxycontin—tripled to 2.5 million per year. This means that a huge wave of people has been turning to these mind-numbing opiates, tracking the rising tide of meth and Attention Deficit medications. And because these opiates are addictive, first-time users often become long-term abusers: in 2004, 11 million Americans used prescription pain relievers and 5 million used tranquilizers nonmedically, more than double the number a decade earlier. The relation of current opiate and sedative abuse to prior stimulant use is a question that demands further research, given that 10 million 255 Americans are now using amphetamines both for Attention Deficit Disorder and recreationally.2 Whether or not the rise in speed use (both medical and recreational ) is behind the rise in opiate abuse, the direct consequences of heavy methamphetamine use are bad enough to warrant strong and immediate action. The first lesson from the original speed epidemic that we might apply involves the way drug abusers are treated by society . While the U.S. has clung to a punitive “zero tolerance” approach that wages “war” on (illicit) drugs and drug abusers alike, much of the developed world has taken another path called “harm reduction.” Harm reduction seeks to take pragmatic action to limit the damage drugs cause society, by treating drug abusers as people that need medical help whether or not they are currently trying to quit. Apart from providing medical services in ways that do not scare away drug users (such as informing law enforcement or compelling detox), a key harm reduction strategy in the context of amphetamines would be needle exchange. People who shoot speed may inject very frequently while on a run, which helps explain why amphetamine injectors are at much higher risk of AIDS than people who only inject heroin.3 Providing clean needles helps prevent users from getting AIDS, or hepatitis, which means not only do they not get sick but they don’t make others sick, costing everyone a lot of money and trouble. Harm reduction works, both to lower infection rates and save society money. In Australia, for example, despite heroin and amphetamine drug abuse rates as bad as those in the U.S. and the early appearance of AIDS in the country, twenty years of effective needle distribution has led to a situation in which only about 5 percent of all new infections with the AIDS virus are caused by drug injection. Only about 2 percent of injecting drug users are infected with the AIDS virus in Australia. The rate of AIDS virus infection among injecting drug users in the United States is twenty times higher, thanks to hostility toward needle exchange. Moreover, America’s national rate of new AIDS virus infections (incidence) is about thirteen times higher than Australia’s. One-fifth of the forty-two thousand new AIDS virus infections in the United States each year occur among injecting drug users, and in addition most infections transmitted through heterosexual contact —about a third of all new infections with the AIDS virus—originate from injecting drug use. So, essentially, around half...