Why'd I take speed for twenty years? - Part 1 (classic)

One of the millions of millennials given prescription stimulants to treat ADHD decides to quit. And afterwards wonders -- how did these drugs becomes so popular, so fast? This week, the story of amphetamine's birth, life, death, and rebirth in America. (Methylphenidates, too.) Have We Been Thinking About A. D. H. D. All Wrong? https://www.nytimes.com/2025/04/13/magazine/adhd-medication-treatment-research.html by Paul Tough Comment on the episode https://pjvogt.substack.com/p/whyd-i-take-speed-for-twenty-years Support the show! https://searchengine.supercast.com/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00PJ Vogt?

  Hi, Search Engine listeners. It's July and we have a lot of new listeners. And so we're rebroadcasting some of our absolute favorite episodes from earlier in our run, when a lot of you new folks were not yet here. The episode that we want to play for you this week is called, "Why Did I Take Speed For 20 Years? Part 1." It's one of my absolute favorite stories we've worked on. It's very personal for me, about a topic that is complicated and which a lot of people puzzle through for themselves or for their kids. The decision to take or not take stimulant medications. We worked on this for over a year. We were really trying to strike a balance in the story's two parts so that people across the spectrum on this topic might be able to listen and hear their own experiences represented. But also, we worked very hard just to answer this question

• 0:45PJ Vogt?

  that I had never asked myself in my many years taking these compounds. What was the story of their rise? Like, how did they get here? How did they get to be so popular? We also, in this story, get into the surprising studies about the actual effects of these drugs, which are not what I expected. There have been more good studies since we first published. There's a great Paul Tough article. You can read about them. We'll link to it in our show notes. But the emerging story fits the story that we captured here. So you can follow along with this rebroadcast without any anxiety that you might be missing out. Okay. After these ads, Part 1. This episode of Search Engine is brought to you in part by Vanguard. To all the financial advisors listening, let's talk bonds for a minute.

• 1:28PJ Vogt?

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• 2:13PJ Vogt?

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• 2:24PJ Vogt?

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• 3:09PJ Vogt?

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• 3:51PJ Vogt?

  The first time anyone convinced me to take drugs, I think I was 14. At the time, the adults in my life were annoyed because my grades were pretty bad. They'd started using the word "potential" very ominously, uttering it like a curse word that meant I'd been saddled with a lot of debt I couldn't quite pay. My parents had me go see a doctor. The doctor told me I had ADHD. I already knew I had ADHD. Everyone knew I had ADHD. I lost my backpack pretty much every three days. My brain heard everything my math teacher said in the adults from Charlie Brown trumpet voice. Pretty much the only thing I could reliably focus on was GoldenEye for Nintendo 64. I was amazing at it. Still, when the doctor told me the solution to all this might be a drug called Dexedrine,

• 4:36PJ Vogt?

  I told him I wasn't comfortable with that. I considered myself straight edge at the time. And so it stood to reason I wasn't going to take speed. Dexedrine was speed, and speed was a drug. That's what I said. And then I think I may have even folded my arms.

• 4:54PJ Vogt?

  The doctor was unruffled in a way that suggested I might not have been his first tough customer. He made his counterargument. I remember it very clearly because I'm pretty sure it changed my life, although I'm still trying to figure out how. The doctor said, "Look, if you needed glasses to see, you'd use them, no question. You wouldn't have some big hangup about it. Dexedrine was like glasses, but for my brain."

• 5:20PJ Vogt?

  Plus, he asked me, I was 14, had I smoked pot? Once, yes, I had. So then, why would I trust pot from some sketchy drug dealer and not medication from him? A doctor with an office with tasteful sand art in the lobby?

• 5:36PJ Vogt?

  It's easy to make this guy sound like some sort of pusher, but the more rigorous truth is I wanted to be talked into it. I was tired of disappointing everybody. A pill that would make it easier to sit still and focus sounded pretty magical. I just needed to put up a fight before I gave in. Hence, this little performance me and the doctor were putting on for an audience of, I don't know, I guess my ego.

• 6:04PJ Vogt?

  I took the drugs. I took the drugs, and the drugs worked. They helped. Dexedrine didn't do my homework for me, but it seemed to make doing my homework much easier.

• 6:14PJ Vogt?

  I remember thinking, "Oh, this is what it's like for other people in other people's brains." I could pay attention in class. I could clean my room. I could accomplish those things in life which the ADHD literature so beautifully calls "non-preferred tasks," the mountain of to-dos that haunt us all.

• 6:36PJ Vogt?

  The pills got me through the end of high school, helped me nose my grades up enough to get into a decent college, got me through four years of that college and all its bureaucracy, and they saved me in the early days of an office job, where I started catching my boss's ire for forgetting to save things in the right folders.

• 6:52PJ Vogt?

  I'd started on Dexedrine in high school. I had a Ritalin phase. Moved to Adderall for a while, then Adderall XR, before settling on Vyvanse, with a brief and chaotic detour in Concerta. The less said about that time, the better. These drugs are all amphetamines, or amphetamine-like drugs called methylphenidates, prescription stimulants. And while different formulations or doses of these prescription stimulants might have a spiky or high, or a more gentle end-of-day crash, they all do basically the same thing. They wake up your brain so you feel a lot more attentive, and energized, and full of pep. I took one, or two, or sometimes three of these pills almost every day of my life for 20 years. And then, a couple of years ago, I abruptly stopped.

• 7:42PJ Vogt?

  What happened is a long story, but the comically short version would be, I decided to switch psychiatrists. And my new guy told me something that no psychiatrist had ever said to me before. He told me that he thought, over the years, I'd been prescribed too many drugs. There's the amphetamine I swallowed when I woke up in the morning, the second one in the afternoon, the sleeping pills I needed to wind down at night, the antidepressant that helped mitigate the deep sadness I sometimes felt. Those pills, plus a self-prescribed drinking regimen. This doctor said, "I think you need to come with everything, at least for a while." It felt really scary to do that, but my life had stopped making sense to me. And this seemed like a way that it might make sense again.

• 8:27PJ Vogt?

  And so, for the first time since I was 14, I experienced several weeks where I just did not take any drugs, not even caffeine. Those weeks turned into months. The months became a year. After a year, I did come back to some things. For instance, I drink alcohol now. I drink coffee. But I never came back to the pills. It's hard to understand a relationship while you're in it, but in my time apart from the stimulants, my feelings about them had changed. Before, I felt straightforwardly very grateful for this drug. I felt like I'd accomplished the life I was proud of and that I owed no small part of it to the molecules. Those 60-hour weeks, the nine-hour edit sessions, I couldn't have done them otherwise. I thought how if I had been born before the invention of amphetamine, I would

• 9:11PJ Vogt?

  just have had a different, less fulfilling life. And because I felt that way, I tended to react pretty badly when people in my life had expressed reservations about any of this. I'd actually get really offended. My feeling was, I had a diagnosed disability, attention deficit hyperactivity disorder. This was the treatment for it. You wouldn't judge someone for wearing glasses. Why would you judge me for this? That's how I felt. But when I stopped taking the pills, I started to feel very confused about what had happened. Because it turned out, I really liked being off of them. Sure, working was harder, to-dos sometimes piled up, but I also felt like I could think differently. It's an impossible thing to measure, but I felt more capable of thinking thoughtfully.

• 9:55PJ Vogt?

  And I started wondering, in those two decades, what I'd missed. That is a question I still can't fully answer, but I did have another question, a smaller one, which felt answerable, and it was this.

• 10:09PJ Vogt?

  How did I end up taking these pills in the first place? Not me personally, I remembered the doctor with the analogy about the glasses, but on a zoomed-out level, my generation, what was the story of how this drug, which would have been considered a recreational drug by my parents' friends, had become for us a drug used to get through school and to get through the long hours of the office jobs that would come after? How had these drugs become so popular so fast? Turns out, it is a hell of a story. I'm going to tell you that story in five chapters. Chapter one, The Invention of Amphetamine.

• 10:49PJ Vogt?

  How should I refer to you in this interview?

• 10:52Speaker 01

  Oh, whatever you think is better, you can call me Nicholas if you like, or you could call me Dr. Rasmussen or Professor Rasmussen.

• 11:00PJ Vogt?

  Dr. Rasmussen is a historian of modern life science. His main research interest, the one he keeps coming back to, is drugs. He wrote a book called On Speed, a cheekily titled but very serious work of scholarship, which follows the path of prescription stimulants in America. I started to tell Dr. Rasmussen a little bit of my own story with the drug, and he immediately jumped in with a question.

• 11:23Speaker 01

  Just out of curiosity, so you were prescribed as a juvenile, and then you started using amphetamines without a prescription as an adult?

• 11:30PJ Vogt?

  No, no, so I was always prescribed. I wasn't, I found nothing recreational about it.

• 11:35Speaker 01

  I see.

• 11:37PJ Vogt?

  I took them prescribed, but what would happen is like, every so often, I would sort of be like, I don't think I want this. I don't think I need this. I'd go off. I would begin to struggle in school or later in work. I would go back to a doctor and say, hey, I was diagnosed with ADD as a kid. Can you prescribe me something? And usually when that would happen, they would change the drug for whatever reason. And so I really went through like, I think I've taken, I've taken all the ones I've heard of, except for like, the real throwback ones. And I ended my amphetamine career on five ends. And but it's, yeah, it's been very interesting not taking it.

• 12:11Speaker 01

  Mm hmm, okay. All right, that's interesting. I've never been prescribed amphetamine.

• 12:17PJ Vogt?

  So one of the questions I want to ask you, if it's not too personal, is have you taken them?

• 12:21Speaker 01

  Yes, but if you're gonna ask me that, don't ask if I've ever been prescribed them.

• 12:28PJ Vogt?

  Right, okay, yes, understandable. Amphetamines for millennials like me are a prescribed medication, or in some cases, a mildly illicit study drug. Amphetamines for boomers were known as speed, a street drug that I think was mainly associated with truckers and beatniks. I'd wondered how it made that jump, but it turns out the story of these drugs actually goes back much further.

• 12:53PJ Vogt?

  Amphetamine was first synthesized in Germany in the 1800s, developed as a dye, actually. Amphetamine as a drug, very much an American story.

• 13:04PJ Vogt?

  Okay, so can you just tell me, like, from the beginning, like, what is the story of amphetamines? Like, who creates them? Where, why, when, how? Like, where do they start?

• 13:14Speaker 01

  So, amphetamine was discovered in an effort to develop a superior asthma medication. So it was first tested as an asthma medication and as a decongestant. And it did work, but Gordon Allies, who was the first to test it, he tested it on himself in 1929, noticed, you know, if you look at his notes, he said, you know, "decongestant effect is still working, heart racing." And he noticed his mind was racing too. And he stayed up late at night with his mind racing. So he noticed immediately it had a central nervous system effect.

• 13:45PJ Vogt?

  This was during an earlier era where, like, now someone developing a novel compound wouldn't just take it and see what happens. But at this time, people did.

• 13:54Speaker 01

  They might very well now, but they probably wouldn't report it, you know?

• 13:57PJ Vogt?

  Oh, I see.

• 13:58Speaker 01

  In the same way. I mean, they would test it on guinea pigs first, of course, so as not to, like, kill themselves. And he had already done plenty of tests on lab animals to see, just to get an idea of what would be the right dosage for himself, you know, what would probably kill him and, you know, divide that by 10, something like that.

• 14:19PJ Vogt?

  So he takes it and he has a high?

• 14:24Speaker 01

  Yes, he notices he's having what we'd call a high. And so he was aware right away that it had a central nervous system effect. But there wasn't any opportunity that he saw there for marketing it in that way. So it was first systematically tested as an asthma medicine. In general, it didn't do very well. It had some effect, but it was not judged promising after a few tries. So they started looking for other uses. And, you know, Allies was getting interested already by 1930 in its central nervous system effects.

• 14:54PJ Vogt?

  So they realize they have this drug that has, like, a powerful central nervous system stimulant effect. And they're just like, I think... For someone who doesn't think hard about the history of medicine, I think I start with an idea that like there are diseases and then they go out and they try to find a cure for the disease. With amphetamine, it's like they found a drug with an effect and then they kind of look around the world for what it might help with.

• 15:17Speaker 01

  Exactly. It's a drug looking for a disease. I think that that's often the way drugs are still developed, although there's much more kind of rational planning and basic kind of biology in producing drug candidates these days. Nevertheless, the drug looking for a disease phenomenon still happens.

• 15:37PJ Vogt?

  This idea of a drug looking for a disease can sound a little sinister, I think. And if you're suspicious of Big Pharma, you will find a lot to support your suspicion in this story. But I do want to offer an alternate, more neutral way to think about this drug looking for a disease concept.

• 15:53PJ Vogt?

  A lot of scientific history involves some researcher accidentally discovering a drug, realizing it has a powerful effect, and then looking around to figure out what kind of suffering that effect might alleviate. And amphetamine in particular, it's a powerful drug that increases dopamine in your brain. And because dopamine regulates so much of how our mind works, amphetamine has a lot of powerful effects. And for the next century, our culture is going to experiment with many of them. But that's what's to come. For now, it's the 1930s, we're in Los Angeles, and Gordon Allies is just a guy with a powerful new drug.

• 16:32PJ Vogt?

  And so he starts looking for a disease to apply it to. Asthma hasn't worked so well, but he finds a different one, narcolepsy. Amphetamines are very good at keeping you awake. The only problem, narcolepsy is a pretty rare condition, which means the market for that drug is going to be pretty small. And Allies isn't looking for a base hit. He wants a home run. So he teams up with a company that he thinks might help him get there. An American pharmaceutical company named Smith, Klein, and French. They're going to market and test this drug on a way broader scale than he ever could.

• 17:04Speaker 01

  So in 1934, the process of finding a, you know, markets for this new drug goes into Smith, Klein and French's hands and they, they know what they're doing. What they do is they produce lots of the drug as a free sample. And then they produce placebo identical versions of it. And they put ads in medical journals saying, we have this valuable drug. If you want to try a free sample in your practice, just write us. We'll send you the drug and some placebos and you can do your own trial.

• 17:33PJ Vogt?

  Wait, so the idea is we'll just give a bunch of amphetamines to doctors. They can just start giving it to their patients and then they'll get back to us and be like, this is what it works for?

• 17:41Speaker 01

  Yes, so this is before there's any FDA regulation on, on medicines other than on their labeling. So the FDA's remit in the 1930s is simply that anything sold as a medicine for human use have to have its active ingredients listed. That's it. It was up to the medical profession to find safety and efficacy, right?

• 18:04PJ Vogt?

  This is wild to me that back then, a pharmaceutical company could sell a drug without proving its safety or its efficacy? All they needed was an accurate list of ingredients on the packaging. That did change after a scandal involving a strep throat medicine that killed over 100 people. It had antifreeze in it. But even with the regulations that followed that incident, amphetamines were still marketed in a much laxer pharmaceutical environment than the one we have today. Here's what that looked like. Smith, Klein and French, the pharma company that marketed amphetamine, would just mail large amounts of the drug to different doctors and ask them to run their own trials and report back. Not all of those trials were on the kinds of patients who today we would think of as consenting.

• 18:48PJ Vogt?

  In fact, a lot of this drug testing took place in psychiatric institutions.

• 18:53Speaker 01

  Mental patients had very little say in, you know, what their treatment was. And they were hoping that, you know, this would be something that this is quite a large potential market. If amphetamine would be good for whatever, any, you know, any of the major things that people were in mental hospitals for. So it was tested quite early for schizophrenia, for senile dementia, for alcoholism. It showed some promise in alcoholism and that was another early.

• 19:16PJ Vogt?

  Really?

• 19:16Speaker 01

  Yeah, early indication. So there was, you know, there was some efficacy there, some other kinds of, you know, kind of neuropathies, but it wasn't really a hit for the big indications in the asylums. Bipolar disorder, schizophrenia, it didn't really work.

• 19:33PJ Vogt?

  In other words, they had not found the home run yet. But the drug was out there now. And so other doctors kept volunteering to test amphetamine on different types of patients. Some even began experimenting with it themselves.

• 19:45Speaker 01

  And one of these volunteers that sort of jumped in quite early and became a big champion of amphetamine was the psychiatry professor Abraham Meyerson from Tufts and Harvard Medical Schools. And he thought amphetamine was great. He took it himself. He thought it was really good for his lecturing style.

• 20:02PJ Vogt?

  What did he like about it? He just thought it gave him like some vigor?

• 20:06Speaker 01

  Well, he tested, basically, you could look at this as him testing it on himself in the same way that Ali's did, to sort of get a sense of what the psychiatric effects were. But why he liked it, he liked it in a professional sense, more importantly, because it was a very effective remedy for depression as he understood it.

• 20:25PJ Vogt?

  Depression as he understood it. That actually brings us to chapter two, Amphetamine as the World's First Antidepressant. I only recently started to wonder about the history of depression, like how depression has been understood throughout time. Calling it depression is relatively recent, but the idea of a disease called melancholia goes way back. The ancient Greeks worried about it, the Romans, ancient Persians. You can actually find good ideas about how to treat depression in antiquity. Exercise, talking about it, hot baths. And some terrible ones, bloodletting, beating the demons out of the patient. In the modern era, when we start calling melancholia depression, our idea of what

• 21:10PJ Vogt?

  exactly it is and how exactly it works gets subtly updated every few decades. In the 1930s, when our heroes are looking around for some condition that amphetamine might cure, there is actually not yet such a thing as a prescription antidepressant. But luckily for them, in that very moment, depression is once again being redefined in a way that would benefit their efforts to market their new drug. Abraham Myerson, that psychiatrist who was taking amphetamine himself and really enjoying its effects, he happened to have a new theory of what depression was. Before Myerson, depression was seen as essentially neurasthenia, which meant chronic weakness

• 21:53PJ Vogt?

  or fatigue. But Myerson believed that depression's definition should be updated to include something else: a lack of drive or motivation. A depressed person wasn't just a low-energy sad person, it was also someone whose sadness made them unproductive in a capitalist society. Depression went from Elliott Smith to Elliott Smith if he's not producing Elliott Smith's records. Myerson had noticed that workers in our newly industrializing country often reported a feeling of emptiness. The solution to that feeling of emptiness, Myerson believed, might be amphetamine. Also, the American company making it happened to be providing him some funding: Smith, Klein, and French.

• 22:37Speaker 01

  And when the company applies for its seal of approval from the AMA Council on Drugs, depression is like the lead indication. They can see that that's where the market's going to be.

• 22:46PJ Vogt?

  Okay, so now we have antidepressants.

• 22:49Speaker 01

  We have am-.

• 22:49PJ Vogt?

  Amphetamine is the antidepressant.

• 22:51Speaker 01

  Is the antidepressant. It's advertised now, which has got approval in 1937, quite heavily in lots of medical journals, general medicine journals. And in some of these ads, you have like quotes from Myerson's papers, trying to convince doctors to recognize depression in this new way. Not the old exhaustion way, but in this new lack-of-zest way.

• 23:09PJ Vogt?

  So our idea of what depression is, like our idea culturally of who is depressed, is going to shift in the marketing for this drug. It's going to go from like-

• 23:18Speaker 01

  Absolutely. Yep. It really catches on in the 50s, of course, and that's the era of booming consumerism, right? So it's the drug for the time. And it gets hardwired in, even though amphetamine sort of goes out of fashion in the late 50s as an antidepressant, the criteria by which you recognize depression were established in the 1940s, and the new antidepressants that come in and replace amphetamine were measured by their ability to do what amphetamine does only better.

• 23:45PJ Vogt?

  So even once we give up on this as the cure, amphetamine has already described the disease?

• 23:50Speaker 01

  That's right. I believe that depression as we know it might well be different if amphetamine hadn't been discovered or marketed in this way.

• 23:58PJ Vogt?

  There's something unique to mental illness versus physical illness that I'm still trying to figure out how to articulate. Like, consider strep throat. A doctor today definitely has a better understanding of what causes strep than a doctor in ancient Rome, but the strep itself is the same. We all agree that my strep is the same as Julius Caesar's. But depression is stranger than that. Depression is a way of acknowledging that certain kinds of sadness are normal and others are not. But abnormal sadness gets defined differently at different times. Society never makes up its mind permanently about how sad a healthy person is allowed to be. That's why I don't know if I could say I've experienced the same depression as Julius

• 24:40PJ Vogt?

  Caesar, or Abraham Lincoln, or even as my grandparents. It's strange because it's not like to say, there's a version that like my grandfather, who was like very skeptical, if he were alive and I were talking to him and I said, depression was invented by the drug companies, he'd be like, yes. But it's like, it's describing something real that people experience. I've experienced it, but it's also mediated through this marketing. And it's very confusing to me.

• 25:05Speaker 01

  Well, with any illness, there's a lot of mediation. So there's, you know, the experience of symptoms, or the physical or mental. Then the medical profession treats these symptoms and groups some of them together and others not. You know, they say, oh, that headache has nothing to do with your depression. That's because of this. But the lack of energy and the not wanting to get out of bed, that's the depression. So you have a bunch of experiences. The medical profession, based on its theories, groups some of them together as symptoms and leaves others on the side, right? So there's that kind of filtration process. And then you have to accept their diagnosis, right? So, you know, if you don't like what they're saying, then you just, you know, see another doctor or don't fill the prescription or whatever.

• 25:46Speaker 01

  So, yes, I'm not denying that the, uh, the conditions to which the concepts refer exist, just that we can divide them up and, and think of them in different ways. And that thinking then feeds back into our experience of our symptoms.

• 26:01PJ Vogt?

  So after a brief life as an unpopular nasal decongestant, amphetamine becomes the world's first antidepressant, treating a condition that it has helped redefine. We're in the 1940s now, and with this new, more expansive understanding of depression, more and more doctors are prescribing amphetamine to their patients. But something's about to happen to make amphetamines really take off. The number of depressed patients who might benefit from a little extra zest in their life is about to get way bigger. Smith, Klein, and French spot a new opportunity to market their drug. A huge market of people who might be experiencing a real lack of pleasure in their daily work lives. Soldiers.

• 26:46PJ Vogt?

  The story of amphetamine and World War II, after the break.

• 27:22PJ Vogt?

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• 28:06PJ Vogt?

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• 28:20PJ Vogt?

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• 29:34PJ Vogt?

  Welcome back to the show. Chapter three, Amphetamine for Combat Fatigue. How did they decide during World War II to start giving soldiers amphetamines?

• 29:43Speaker 01

  Well, you know, Smith, Klein & French tried very hard to get it included, not just in this kind of formulary available to medics in the Army. They actually sort of intervened with the Assistant Secretary of War, McQuaid, to try to get it issued as a weapon, like in amphibious assaults or sustained offensives in general. The troops should be issued with amphetamine on hour 10 or hour 12. They really tried to kind of force it on the military. The military never required anybody to use it, but they issued it very widely. It was in first aid kits, emergency kits that were on like lifeboats and then bombers and stuff. If people had to bail out, there's the amphetamine because they might be landing in enemy territory and have to stay awake, or they might be in a life raft and have to stay awake to like

• 30:28Speaker 01

  signal the rescuers. But it was also issued to medics. Medics carried it around, just like they did morphine, which was also widely abused. But anyway, it is extremely widely distributed in the Allied military, both the British and the American. And the Germans and the Japanese use methamphetamine in virtually the same way.

• 30:45PJ Vogt?

  And I mean, I think for most people, methamphetamine has a reputation as a drug you wouldn't give like a C minus student, like it's a strong, serious drug. Are they giving it in like a small dose? Like, is meth, in this case, meth? Or is meth something else?

• 31:01Speaker 01

  No, it's meth, but they're taking it in pill and in kind of an equivalent dose to amphetamines that you would use for attention deficit today. The adult doses for minor depression, like 10 milligrams, is pretty much the same thing you're giving kids today for retention deficit. And so that's what the Germans were using. And I think that, you know, look, blind tastings have been done with experienced users. And in those kind of doses, I'm not talking about injecting a large amount, in those kind of doses, you can't tell the difference.

• 31:32PJ Vogt?

  The idea that there are good medicines and bad drugs is one of those slightly arbitrary notions that most of us subscribe to. It can be easier to notice other people's contradictions. The friend who doesn't get high on anything illegal, but seems to have a suitcase full of prescriptions. The friend who is highly suspicious of Big Pharma, but puts a lot of faith in big internet supplement. The locavores who do massive amounts of cocaine. Our contradictory attitudes towards amphetamine, though, to me, can feel like one of the strangest things to chart. Methamphetamine is a terrifying street drug done exclusively by society's ne'er-do-wells. Except the thing is, a doctor can also still legally prescribe methamphetamine pills to a kid who is struggling in college.

• 32:16PJ Vogt?

  It will do the same thing as Adderall. Dose matters and how you take it. An illicit speed user is going to take more meth, and they'll probably smoke it or shoot it. So that's different. But if you're a college kid taking Adderall, if you start doubling your doses, or if you start snorting your pills, your experience will begin to slide towards the one the street user is having. In my own mind, I don't call anything a medicine anymore. I think the downside of labeling something a medicine is that, for some of us, for me anyway, it can be permission to take it pretty automatically. It came, after all, from a doctor. Anyway, in World War II, the Nazis were taking college kid doses of methamphetamine.

• 32:56PJ Vogt?

  The Allies were taking college kid doses of a popular American amphetamine called Benzodrine. Both sides probably having about the same experience.

• 33:07PJ Vogt?

  Okay, so all these soldiers on both sides of World War II are taking these drugs. Are the drugs making them better soldiers? Are they doing tests to figure out if the drugs are making them better soldiers?

• 33:17Speaker 01

  Well, the Allies did a fairly extensive set of tests to measure whether there was any benefit to amphetamine over the existing drug, which was caffeine pills. And to make a long story short, the more careful these tests were, the less they showed that there was any benefit to amphetamine over caffeine. But the soldiers liked it better. And furthermore, amphetamine convinced people that they were doing better. And that kind of moral effect was ultimately why the Allied military issued amphetamine.

• 33:50PJ Vogt?

  So it wasn't that they were making them better soldiers, it was that they felt more confident in their soldiering?

• 33:54Speaker 01

  But a more confident soldier who's willing to fly at a lower altitude in flak is a better soldier.

• 34:00PJ Vogt?

  I see.

• 34:01Speaker 01

  So they're using them effectively as mind-altering drugs, not to fight fatigue, but fatigue was the official rationale.

• 34:07PJ Vogt?

  Combat fatigue, as it came to be known by soldiers. This was a colloquial name for what was also sometimes called war neurosis, a term used by psychiatrists for the very specific kind of mental illness experienced by soldiers at war. But the fact that the soldiers adopted the term combat fatigue, that wasn't an accident. Rasmussen says it was actually something closer to marketing.

• 34:30Speaker 01

  Why didn't they call it war neurosis? Why did they call it combat fatigue instead? Well, first of all, they wanted to reduce friction with the brass, okay? They didn't want the generals saying, you know, "Get these shrinks out of here. They're telling our soldiers that they're severely mentally ill just because they've, you know, they've seen too much action." So it's a bit of, it's a euphemism that's designed both for the consumption by the brass, you know? Combat fatigue suggests that they need to be out of combat and rest a bit. And it did the same for the soldiers, right? The soldiers didn't get the idea that they were now, you know, going to be sectioned out because of a mental illness and would never have to fight again. They were given the idea that a bit of rest would fix them up. And actually, the psychiatrists believed they got better results in this very

• 35:14Speaker 01

  serious condition of, you know, of war neurosis if they took the soldiers not too far away and gave them talking therapy to talk about the traumatic situation, but not so far removed from the front line that they couldn't hear guns in the background, you know, artillery and stuff. And so the soldiers would always be thinking about going back to their buddies.

• 35:34PJ Vogt?

  It's kind of a beautiful illustration of just the relationship between our idea of what is healthy and language and our idea of what is sick and language and the idea that someone whose job is to get you like better might just be trying to make you more usefully participate in something that other people want you to participate in.

• 35:52Speaker 01

  Absolutely, but I say, why not both? They are trying to help you get better, but their idea, medicine's idea, which is also society's idea of what would be better. Better is useful, functional. And this is one of the reasons why concepts of diseases change over time, because people's roles in society and what's normal and expected change over time.

• 36:15PJ Vogt?

  After the war, the soldiers go home, and amphetamine enters American culture in earnest. Chapter four, stimulants for pretty much everybody.

• 36:27PJ Vogt?

  1945, World War II is over. US soldiers return to civilian life. Remember, amphetamine was given very freely to a lot of these soldiers, and many have picked up habits. Those habits continue when they get home. At that point, the easiest way to get amphetamine was to buy a Benzedrine inhaler. Amphetamine was in asthma medicine, too. So if you bought one of these inhalers and just chewed up the amphetamine gauze inside of it, you'd get a very powerful high, the equivalent of taking an entire bottle of pills. Those inhalers were available, very cheap, without a prescription. Around the same time, sales of amphetamine for legitimate medical uses also took off. And it's not just treating depression and asthma anymore. Smith, Klein, and French have another market for their star drug.

• 37:13PJ Vogt?

  Weight loss.

• 37:15Speaker 01

  So it becomes a legitimate weight loss drug, even though it had been heavily used by kind of dodgy diet doctors since the 30s. It becomes a big official prescription drug for for weight loss. And weight loss doctors like accounted for something like a third of the, what is it, 10 billion pills that are being distributed in the US in the late 60s. They just dispense them like directly. Their doctor, they can just give a patient a year's supply. And they were dispensing them like, you know, like candy.

• 37:42PJ Vogt?

  Rasmussen says, at this point in history, we are nearing the peak of what he calls the first amphetamine epidemic in America. Soon 10 million Americans will be taking prescription stimulants for something. Antidepressant, weight loss, fun. What's crazy is that while it took decades for stimulants to become this popular, they'll actually go away very quickly. Society, for a host of reasons, will rapidly turn against them.

• 38:10PJ Vogt?

  First, the mainstream medical reputation of stimulants takes a hit. New and seemingly improved antidepressants have been released. Second, maybe more importantly, the culture itself just starts to shift.

• 38:21Speaker 01

  And that's what brings about this this anti amphetamine campaign. First, starting with the hippies, people like Allen Ginsberg start this speed kills campaign. And so this this like idea that it's a dangerous street drug sold by bikers helped tarnish the medical reputation of this already kind of obsolete antidepressant. There are other scandals that affected the drug as a medicine, particularly the diet drug industry. There's a bunch of exposes. This is the sort of the emerging feminist backlash against body image control by the patriarchy and the weight loss industry. And there's this general kind of cultural reaction to the drug problem that you see in 1969, 1970. The Vietnam veterans coming home addicted to heroin was a big kind of a moral panic around that

• 39:06Speaker 01

  because there was very high drug usage among Vietnam soldiers.

• 39:11PJ Vogt?

  In 1970, looking around America, what a lot of people saw was a country on too many drugs. Heroin, LSD, barbiturates, but also stimulants. The warnings about speed had been mounting out for years. Many Americans had become addicted or were using the pills unprescribed. Not just hippies and poets, but also people in the mainstream. The dieting suburban housewife, her army vet husband. One in 20 Americans.

• 39:39Speaker 02

  This report is concerned only with the abuse of two socially acceptable prescription drugs.

• 39:45PJ Vogt?

  There were PSAs, like this one from actor and future salad dressing entrepreneur Paul Newman.

• 39:50Speaker 02

  Pills and capsules that you keep in your medicine chest, your night table, your pocket, your purse.

• 39:56Speaker 03

  I would like to suggest that you do not use speed.

• 40:00PJ Vogt?

  But also rock stars like Frank Zappa were out there telling fans, "Speed is not just dangerous. Worse, it was uncool."

• 40:08Speaker 03

  It's going to mess up your heart, mess up your liver, your kidneys, rot out your mind. In general, this drug will make you just like your mother and father.

• 40:19PJ Vogt?

  And there was a feeling in Richard Nixon's America that the country was taking too many drugs and needed to calm down.

• 40:26Speaker 04

  America's public enemy number one in the United States is drug abuse. In order to fight and defeat this enemy, it is necessary to wage a new, all-out offensive. I have asked the Congress to provide the legislative authority and the funds to fuel this kind of an offensive. This will be a worldwide offensive dealing with the problems of sources of supply as well as Americans.

• 40:52PJ Vogt?

  So Congress responds with one of the most influential drug regulation bills in history, the Controlled Substances Act of 1970. This is the law that creates schedules for different drugs. Schedule I, stuff like heroin and psychedelics, which are deemed to have no medical use. Schedule II drugs have proven medical uses, but their circulation is controlled because they can be abused. Amphetamine and methylphenidate become Schedule II.

• 41:18Speaker 01

  And that's why you still require a special prescription and the prescribing and manufacturer of those drugs is still monitored, which is the only reason why we have accurate figures on how much is still being consumed in the US.

• 41:28PJ Vogt?

  So that's the moment where it stops being something that like a diet doctor will give you a year's supply for, or that people can walk into a pharmacy and grab relatively easily, that's when it becomes something that is restricted?

• 41:38Speaker 01

  Well, it did become a prescription, like there's a general trend of making it harder to buy prescription drugs without a prescription, so there's that, but yes, in terms of it being like an officially problematic substance, it's that act 1970. And no, even though doctors are free to prescribe these Schedule II drugs, they have to report every prescription back to the agency that becomes the DEA, right? And as soon as they have to start reporting, guess what? Prescribing rates dropped by like tenfold in the first year, and then another half the next year. So by 1971, the legitimate pharmaceutical market for amphetamines is 1/20th of what it was in 1969.

• 42:19PJ Vogt?

  Wow, wow, wow, because all of a sudden, these doctors feel like they might have to justify these prescriptions.

• 42:24Speaker 01

  Yes, the DEA is watching them. So that's how amphetamine basically goes off the market. The FDA is meanwhile working to show that it's not actually effective as an antidepressant and has only very limited short-term efficacy in dieting. So the main indications are struck as well as legitimate uses.

• 42:41PJ Vogt?

  Of course, the fall of amphetamines in the 1970s will clear the stage for a newly popular street drug that will become very pervasive.

• 42:50Speaker 01

  Huge spike in cocaine consumption in the US in the 1970s.

• 42:55PJ Vogt?

  Oh, interesting.

• 42:56Speaker 01

  So you know, think about it that way. It's like, this is why the white collar people turn to cocaine, probably some of them.

• 43:00PJ Vogt?

  Well, this was actually, that's a question that I had for you is like, how different are cocaine and amphetamine as two drugs?

• 43:08Speaker 01

  Well, they're very similar if you compare the kind of the lower dose range and also in the higher dose range, but to get to that rush feeling that you get from a fair sniff of cocaine, you're going to be injecting the amphetamine. So like many drugs, they actually have slightly different mechanisms of action at different dosage levels. But the short answer is they're very similar if you take them in comparable doses.

• 43:31PJ Vogt?

  I see.

• 43:32Speaker 01

  But the cocaine wears off like five times faster.

• 43:36PJ Vogt?

  Right. Okay, so amphetamine disappears mostly from American, like legitimate, prescribed American life in the 70s.

• 43:43Speaker 01

  Yep. And even from the illegitimate scene, it's not that common.

• 43:50PJ Vogt?

  So that is the story of how America fell in love with prescription stimulants, used them to treat a bunch of different ailments, some old, some new, and then decided this drug was just too dangerous to have in wide circulation. After the break, why we then decided to start giving it to children like me?

• 44:18PJ Vogt?

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• 45:01PJ Vogt?

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• 45:22PJ Vogt?

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• 46:05PJ Vogt?

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• 46:28PJ Vogt?

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• 47:12PJ Vogt?

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• 47:41PJ Vogt?

  Welcome back to the show. Now for our fifth and final chapter, ADHD. So in its first act, amphetamine had been wildly popular, but then almost entirely disappeared from American life after the big 1970s anti-drug law. When amphetamine becomes a Schedule II drug, the FDA also starts ruling it out for a lot of its previously approved uses. The FDA takes away amphetamine for depression. The FDA takes away amphetamine for weight loss. Those are only off-label prescriptions now. Here's what's left: amphetamine for narcolepsy and amphetamine for this other fringe case, a disorder called hyperkinetic disorder of childhood.

• 48:23PJ Vogt?

  These were children who were understood to be overactive, restless, and easily distracted. Kids like this had always existed, and psychiatrists over the decades had theorized that their brains might be different. At times, they'd even come up with names for different possible disorders that might describe these kids: abnormal defect of moral control, minimal brain damage, minimal brain dysfunction. You can sort of see why parents never rushed to get their kids any of these diagnoses. Actually, as far back as 1936, a man who ran a psychiatric institution for children, Charles Bradley, was thinking about these kids. He'd gotten a hold of some amphetamine, and he was testing it on some of his child patients.

• 49:05Speaker 01

  And he noticed that some of the students who were particularly unruly in the classes seemed to do better. But it didn't affect all of them in that way, and he was never able to pin down what kind of a problem student it was that he tried electroencephalograms and this kind of thing to figure out. What is it about these students who benefit from it as opposed to the others? He was never able to pin it down. Now, interestingly, that trial was not paid for by Smith, Klein & French, but Smith, Klein & French did fund and help design another trial at the same time on kids in an institution, very similar population, you know, problem kids in a reform school. And so... They thought that there might be a market here. They thought, let's encourage these orthopsychiatrists, they were called,

• 49:50Speaker 01

  child psychiatrists who dealt with learning disabilities and behavior disorders. Let's encourage them to try and find a use for this drug. Because, you know, it does seem to improve cognition. Now, I say seem with an underline under it because the drug company had already commissioned extremely thorough studies with the University of Pennsylvania Psychology Department that established that the drug does not, in fact, improve any cognitive ability, at least in the normal subjects that they use, okay? It only gave them this confidence and this feeling that it was making them do better. And if what you're not confident about is your learning ability, it might actually help you do better on a test. Not because it's changing the way you think, but by altering your mood.

• 50:30PJ Vogt?

  I want to pause here for a second because the questions about these drugs that science can't fully answer in the 1930s. Why exactly do these drugs change kids' behavior? And which kids should we give these drugs to? We're still arguing about the answers to those questions today. Today, we do have a lot more studies about what these drugs might be doing. While working on the story, our team read dozens of these studies. We talked to psychiatrists who prescribe or don't prescribe these drugs. And we just found less consensus on basic facts here than I would have expected. Broadly speaking, the skeptics of these drugs will point to studies suggesting that there is little reliable evidence that prescription stimulants meaningfully enhance cognition.

• 51:14PJ Vogt?

  Some of these skeptics also point out that stimulants may just increase your perception of your own performance, which could be one reason why they're so popular. They'll say, they're confidence pills. They're turbo placebos. Advocates for the drugs, broadly speaking, point to other studies that show how these drugs can help people be less impulsive, boost processing speed, and lengthen attention span. Or at least change how our attention works. So it's more like a focused flashlight and less daydreamy and lantern-like.

• 51:47PJ Vogt?

  Where we found the most consensus is the idea that the drugs help you concentrate and the idea that they elevate your mood. But what's funny is that we basically knew that in the 1930s. The pharmaceutical companies knew their drugs made kids peppy and alert and gave them a drive to accomplish, but they didn't chase that market. They didn't need to. They had other markets: depression, weight loss. In 1961, a new methylphenidate called Ritalin is approved for use in distracted children. At the time, some doctors were saying those kids might suffer from childhood hyperkinesis, but the consensus is that that should only describe a tiny percentage of America's rambunctious youth.

• 52:31PJ Vogt?

  And so in the 1970s, one of these hyperkinetic kids who was being prescribed speed to still, they would have been rare. Like, it wouldn't have been a thing that was in the pop culture.

• 52:41Speaker 01

  Oh, yeah. The estimates were like either thousands or tens of thousands of patients a year only.

• 52:47PJ Vogt?

  They undercounted.

• 52:49Speaker 01

  That's how rare the condition was.

• 52:53PJ Vogt?

  So why does that change? Well, remember, the 1970s Drug Control Act passes, which made both amphetamines and methylphenidates Schedule II drugs. In the wake of that law, hyperkinetic disorder of childhood becomes one of the few conditions that the FDA will still approve these drugs to treat. Once that decision's made, prescriptions for kids start to climb. In 1970, American psychiatrists identify 150,000 kids who need the medication. By 1980, that number more than triples to 500,000. The same year, the disorder is rebranded to Attention Deficit Disorder, which will later become ADHD. By 1990, around a million kids a year are being prescribed stimulants for ADHD.

• 53:35PJ Vogt?

  Today, 6 million kids have been diagnosed, and the diagnosis also now applies to adults. Last year, an estimated 14 million Americans of all ages received prescriptions for stimulants. From tens of thousands of cases in the 1960s to over 10 million cases today, that wave is remarkable. It's also remarkable that so many of these were found in America. Other countries have ADHD, other countries prescribe for it, but not at the rate that we do.

• 54:08PJ Vogt?

  So what's actually going on here? I don't know. You can tell this as a story about pharmaceutical marketing. I think that's part of it. But I also think it's a story about how society changes, and it changes you with it in ways that are powerful but sometimes hard to perceive, the same way the surf tugs you out to sea without you ever quite noticing. Back in 1999, in the Philly suburbs, before I was diagnosed, I was struggling with a problem in my mind that was very real for me. It was not invented by a drug company. I was doing poorly in school, not just academically, but socially. I didn't fit in. And so my parents took me to see this child psychiatrist, who gave me a neuropsychological exam. Two days of intense tests.

• 54:51PJ Vogt?

  She also interviewed my parents and my teachers. I remember this all pretty well, but I hadn't seen the report in years. I asked my mom to mail it to me while we were fact-checking the story. This was the first time I'd seen it as an adult. It begins with biography. PJ lives with his parents and three younger sisters. Mr. Vogt is a lawyer. Mrs. Vogt is a decorator. My parents hadn't split up yet. The report describes me as a kid having a hard time. When she asks me to interpret a picture of a kid holding a chair, I tell her, "Either he's smashing it out of anger because he doesn't fit in it, or he's smashing it out of joy because he has graduated school and the chair belongs to the school." As she runs her tests, what she finds is actually kind of bizarre.

• 55:36PJ Vogt?

  Verbal scores are unusually high, 99th percentile, which sounds great, except my performance IQ, which is a lot of what we actually consider smarts, organization, visual learning, the ability to read social cues of other people, that, in fact, is quite low. She says a discrepancy of this magnitude is found in something like 2% of the kids she tests. It's very strange to see a picture of your own mind at 13. It is stranger, 25 years later, to recognize it essentially as the mind you still have. A very smart, dumb person. A very dumb, smart person. I'm never sure which. The specialist tests me for ADHD on two different scales. I fit five of the criteria.

• 56:19PJ Vogt?

  I often fail to give close attention to details. I often don't follow through on instructions. I often have difficulty organizing tasks. I often lose things. I'm often forgetful in daily activities. If this sounds like you, or lots of people you know, if it sounds kind of surprising that I was diagnosed with ADHD based on just these five criteria, you should know, according to this report, I did not have ADHD. The test said I needed six criteria. I only hit five. The specialist did not recommend medication and said I did not have the disorder. I'm sorry to bury the lead, but I found this out in fact checking last week. October 2023 is when I found out the four letters I have used to describe myself,

• 57:03PJ Vogt?

  casually, self-deprecatingly, sometimes very seriously, for 25 years, ADHD, were not entirely accurate. Instead, this specialist had a bunch of great suggestions for how I might modify the way I studied, how the teachers at my school might accommodate my weird, not-quite-typical brain. One-on-one instruction, extra time on tests, permission to bring a laptop to class? The problem is, I don't think anybody at that very strict school was into making a bunch of accommodations for some annoying C student who it turned out didn't even have a disability.

• 57:40PJ Vogt?

  So I continued to struggle. And soon after, my parents sent me to another specialist. This was the doctor I described at the beginning of the episode. He took a lot less time. He gave me a survey, an analogy about glasses, and a diagnosis: ADHD. This story that would help explain me to myself and help me explain myself to other people. ADHD got me the accommodations I needed in school. It forced my teachers to be a bit gentler with me. And ADHD gave me an answer to a question people close to me sometimes asked: "Why do you take those pills?"

• 58:15PJ Vogt?

  ADHD, I'd answer. Not knowing the truth was a weirder, longer story. Not knowing these drugs had had a long life in America, before I was even born. So, speed's history. It has been used to treat stuffy noses, depression, combat fatigue, obesity, ADD. What do you think is next? Like, what do you think is the next disease the drug will find?

• 58:38Speaker 01

  Well, I think it's amazing that it found a disease after it was, you know, basically internationally banned. So, you know, there's no limit on the inventiveness of the pharmaceutical industry and its marketing endeavors. So I'm afraid I can't propose a new disease for it. And I wouldn't want to if I had an idea.

• 58:55PJ Vogt?

  You're not trying to help the genie get out of the bottle.

• 58:59Speaker 01

  Yeah, well, it's out of the bottle, but you know, attention deficit, I'm not saying that it's not a real disease. I'm saying that what makes it a real disease is the misfit between the symptoms and the signs of the condition and the expectations of society. Like, you don't have attention deficit in a place where repetitive work is not expected. Right? Attention is not a problem unless the enormous amount of attention is required.

• 59:26PJ Vogt?

  Today, I still do a job that requires an enormous amount of attention. And I do it without the drug I once took to improve my focus, and which also may have increased my confidence. Off the drug, I've noticed some things. I've noticed I spend less time feeling paranoid. I spend less time thinking things are a huge deal that often aren't. I believe that I've gotten a little more thoughtful. Mainly, what I noticed is I lost this feeling I'd had for years, which is that I often felt like I had the nervous system of a person who'd been stuck on a traffic-jammed freeway for several hours. So it's nice to be off the drugs. But I do have less confidence, a lot less. I notice it. This show you're listening to, making it fills me with self-doubt.

• 1:00:12PJ Vogt?

  And the self-doubt, just surviving it, is absolutely the hardest part of this job. It's actually what the job is, just sitting in a place of pressure and absorbing it without going to pieces. Everything else, the writing and the interviews and the camaraderie here, that's the reward. The pressure is the job. And without the pills, I have to do the job alone. I never learned before. It's not easy. And because confidence is such a bad measure of ability, I will never know if I'm actually objectively better at my job off the drug or if I'm worse. We don't get answers to every question. Some, we just learn to stop asking.

• 1:01:01PJ Vogt?

  Next week, we're going to tell you a different story, one that's not mine, somebody else's, but where prescription stimulants also star. This is the story of a brilliant doctor who, instead of wondering why she took stimulants for 20 years, wonders why it took 20 years for her to find them. Can you just tell me the story of your brain as you understand it?

• 1:01:20Speaker 05

  Sure. My story is a little bit different, I think, than a lot of people who may be listening to this. I had a brain tumor when I was eight. And my dad is the one who said, "You're going to have to have a little operation to take something out of your brain."

• 1:01:39PJ Vogt?

  That's next week on Search Engine.

• 1:01:53PJ Vogt?

  This episode of Search Engine is brought to you in part by VistaPrint. As a small business owner running a podcast, I'm always looking for authentic ways to connect with listeners, which makes VistaPrint such a valued expert partner for us. I was on their site the other day, brainstorming new things we could make for our show, and the creative momentum took over. I ended up designing Search Engine stickers, and I tried to make a sign for our office. When your physical branding looks this sharp and professional, it immediately communicates credibility and shows your audience that you mean business. VistaPrint truly helps every dollar go further, delivering premium quality and design support that make your company look established without breaking the bank. Whether you need your design tweaked or a total rebrand, VistaPrint has you covered with the expert service small businesses deserve.

• 1:02:38PJ Vogt?

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• 1:03:07PJ Vogt?

  Search Engine is a presentation of Odyssey Productions. It was created by me, PJ Vogt, and Trudy Pinamenei. This episode was produced by Garrett Graham and Noah John. Theme, original composition and mixing by Armin Bazarian. Backtracking by Sean Merchant. We have some special thanks, but we're going to list them all in part two. At Odyssey, our executive producer is Leah Reese-Dennis. And thanks to the rest of the team at Odyssey. Rob Morandi, Craig Cox, Eric Donnelly, Colin Gainer, Moira Curran, Josefina Francis, Kurt Courtney, and Hillary Schaaf. Our agent is Orin Rosenbaum at UTI. If you'd like to support our show and get ad-free episodes, zero reruns, and some additional bonus audio, please consider signing up for incognito mode. You can learn more at searchengine.show.

• 1:03:50PJ Vogt?

  Follow and listen to Search Engine for free on the Odyssey app or wherever you get your podcasts. Thanks for listening. We'll see you next week.