The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture - Hardcover

DeGrandpre, Richard

Hardcover

ISBN 10: 0822338815 ISBN 13: 9780822338819

Publisher: Duke University Press, 2006

Synopsis

America had a radically different relationship with drugs a century ago. Drug prohibitions were few, and while alcohol was considered a menace, the public regularly consumed substances that are widely demonized today. Heroin was marketed by Bayer Pharmaceuticals, and marijuana was available as a tincture of cannabis sold by Parke Davis and Company.

Exploring how this rather benign relationship with psychoactive drugs was transformed into one of confusion and chaos, The Cult of Pharmacology tells the dramatic story of how, as one legal drug after another fell from grace, new pharmaceutical substances took their place. Whether Valium or OxyContin at the pharmacy, cocaine or meth purchased on the street, or alcohol and tobacco from the corner store, drugs and drug use proliferated in twentieth-century America despite an escalating war on “drugs.”

Richard DeGrandpre, a past fellow of the National Institute on Drug Abuse and author of the best-selling book Ritalin Nation, delivers a remarkably original interpretation of drugs by examining the seductive but ill-fated belief that they are chemically predestined to be either good or evil. He argues that the determination to treat the medically sanctioned use of drugs such as Miltown or Seconal separately from the illicit use of substances like heroin or ecstasy has blinded America to how drugs are transformed by the manner in which a culture deals with them.

Bringing forth a wealth of scientific research showing the powerful influence of social and psychological factors on how the brain is affected by drugs, DeGrandpre demonstrates that psychoactive substances are not angels or demons irrespective of why, how, or by whom they are used. The Cult of Pharmacology is a bold and necessary new account of America’s complex relationship with drugs.

About this title

About the Author

Richard DeGrandpre is an independent scholar of drugs and other “technologies of the self.” He has a doctorate in psychopharmacology and was a fellow of the National Institute on Drug Abuse. He is the author of Ritalin Nation: Rapid-Fire Culture and the Transformation of Human Consciousness and Digitopia: The Look of the New Digital You. He has also written numerous scientific, theoretical, and popular articles on drugs and is a former senior editor at Adbusters magazine.

From the Back Cover

""The Cult of Pharmacology" brings badly needed information, insight, and--above all--sanity to the emotionally charged debate over legal and illegal drugs in America, whether LSD, caffeine, or Prozac. This book should be required reading for those whose lives are touched by the war on drugs--which of course means all of us."--John Horgan, author of "The End of Science," "The Undiscovered Mind, " and "Rational Mysticism"

Reviews

Reviewed by Peter D. Kramer Why isn't Nicorette gum a street drug? The Food and Drug Administration considers nicotine highly addictive. Tobacco companies seem to share this view when they manipulate the level of nicotine in cigarettes. But the gum, which packs a goodly dose of nicotine, appeals to almost no one. While we're at it, if nicotine dependence is what stands in the way of quitting, why do patched smokers -- their brains well-supplied with the substance -- still crave the next drag?

If these questions have an answer, it is that addiction is not a simple matter of chemical and receptor. Habit, ritual, social context and the means of delivery all affect how the brain processes a drug and how we experience it. As a result, drug research is replete with paradox. Charles Schuster, a behavioral pharmacologist, demonstrated that if you pair a stimulus (such as a colored light) with the administration of morphine, a test animal may later respond to the stimulus alone as if it were getting the drug. Conversely, Schuster found that presenting methadone in an unexpected flavor of Kool-Aid causes some addicts to act as if they have been deprived of the drug. Just as context makes a drug seem to be present, context can make it seem to be absent.

In The Cult of Pharmacology, Richard DeGrandpre uses findings of this sort -- the experiments he cites are more complicated ones -- to make the case that, when it comes to drugs, symbol outweighs substance. Psychoactive compounds, he writes, function "as mere stimuli, with more or less the same, potentially great, powers as other stimuli one experiences and gives meaning to." DeGrandpre derides a set of beliefs that he groups under the infelicitous name "pharmacologicalism." This false ideology, he writes, holds that "drugs contain potentialities that lie within the drug's chemical structure . . . and when taken into the body, these potentialities take hold of and transform both brain and behavior." According to DeGrandpre, drugs do not work in any consistent, predictable way -- and we've been brainwashed if we think that they do.

The prevailing ideology, DeGrandpre argues, has another, equally insidious side. It causes us to attribute different powers to substances that are effectively identical. We demonize cocaine, a natural stimulant, but sanctify its synthetic counterpart, Ritalin. This benefits the "medicopharmaceutical industrial complex," which favors what can be patented and profited from. Ultimately, our confused beliefs lead to forms of social control, causing us to drug our children with stimulants while imprisoning consenting adults for taking nearly identical substances such as crystal meth.

DeGrandpre is dead serious when he calls pharmacologicalism a cult. In a scholarly article he wrote, "No more impressive ideological system emerged in the 20th century with such a penetration of state power and private institutional force, than pharmacologicalism." In the current book, he likens the cult to Nazism. In this "limited metaphor," prescribed pharmaceuticals play the role of the Aryan and street drugs that of the Jew. (Alcohol, like the British, is acceptable but suspect.) The attributions, Aryan versus Jew, extend from substance to person: medicated patient versus dope fiend. This disturbing trope may cause readers to wonder whether DeGrandpre is fighting an ideology or advancing one.

The problem with DeGrandpre's argument is that he, more than his imagined opponents, ignores context. The findings of behavioral pharmacology are not unique; in medicine, environment often modifies physiology. Interferon, a medication used to treat certain cancers, causes depression, but it does so less in people who have social supports and more in patients who have had past depressive episodes. To show that the response is multifactorial hardly invalidates the claim that the drug triggers mood disorders.

Expectancy is powerful. Acupuncture is effective in pain relief. But so is sham acupuncture -- using shallow needles inserted at random points. Pain responds to placebos. It does not follow that pain lacks anatomical roots or that the use of aspirin for pain management amounts to a conspiracy.

Our drug policies, arising from puritanical moralizing as much as from the needs of corporations, are often irrational. Still, not every choice is without foundation. Like cocaine, Ritalin modulates dopamine transport in the brain. But schoolchildren who take Ritalin by mouth generally experience no high and develop no craving, while snorting cocaine famously does cause a rush. And crystal meth's minor chemical distinction -- it is water soluble and therefore easy to inject -- makes a major practical, and addictive, difference. That we allow Ritalin to be prescribed suggests that, as a nation, we pay attention both to drugs' chemical properties and to their customary usage -- hardly a sign of ideological rigidity.

As for "mere stimuli," DeGrandpre himself cites a study demonstrating that you can get addicts to crave some psychoactive substances but not others. No surprise there. Medications are not mere symbols. Different substances have different effects. Meanwhile, when DeGrandpre critiques prescription drugs, he refers to reports that antidepressants can foment suicides. Accepting this evidence resembles the stance that DeGrandpre otherwise attacks, the belief that drugs take hold of people in forceful ways.

Because its foundations include science, medicine, as a profession, tends to be ecumenical. Data that indict Prozac inform the literature; so do data that suggest Prozac prevents many more deaths than it causes. The major journals repeatedly contend that drug companies wield too much power. And behavioral pharmacology is mainstream medicine. Charles Schuster, a psychologist DeGrandpre praises as a pioneer, championed methadone-maintenance programs, hardly the stance of a man who doubts the power of physiological addiction.

We need to develop a humane approach to street-drug use. We need more independent testing of prescription drugs. But to hold these views does not require the belief that America has been hijacked by a cabal of doctors, politicians and entrepreneurs. DeGrandpre's attack comes from a libertarian posture, anti-business but even more anti-government. There's an element of the personal hobby-horse here as well: Pharmacologicalism conveys state power more effectively than communism or national socialism? Isn't it likelier that -- the undeniable flaws of capitalism and democracy notwithstanding -- we're muddling along, trying to make what sense we can of medications, licit and banned, that are ever better attuned to the workings of those admittedly complex organs, our brains?

Reviewed by Peter D. Kramer
Copyright 2007, The Washington Post. All Rights Reserved.

Excerpt. © Reprinted by permission. All rights reserved.

The Cult of Pharmacology

How America Became the World's Most Troubled Drug CultureBy Richard DeGrandpre

Duke University Press

Copyright © 2006 Duke University Press
All right reserved.
ISBN: 978-0-8223-3881-9

Contents

Preface......................................................................................................vii1 MAMA COCA..................................................................................................32 CULT OF THE SSRI...........................................................................................343 THE EMPEROR'S NEW SMOKES...................................................................................644 THE PLACEBO TEXT...........................................................................................1035 AMERICA'S DOMESTIC DRUG AFFAIR.............................................................................1386 WAR........................................................................................................1707 THE DRUG REWARD............................................................................................1798 POSSESSED BY THE STIMULUS..................................................................................2089 IDEOLOGY...................................................................................................236Appendix ONE ESCALATION OF AMERICAN DRUG LAWS IN THE TWENTIETH CENTURY.......................................243Appendix Two U.S. REGULATIONS ALLOWING A WHITE MARKET FOR DRUGS IN THE TWENTIETH CENTURY.....................245Notes........................................................................................................247Selective Bibliography.......................................................................................283Index........................................................................................................287

Chapter One

Mama Coca

Ah, cocaine. Such an amusing drug, don't you think? -Princess Margaret of Great Britain

Imagine that a collective of South American nations had control over coffee and oil imports into the United States. Imagine also that the peoples of these countries were increasingly given to drinking American spirits, leading to an epidemic of alcoholism in rural Andean society. Imagine finally that representatives of this collective came to America with the following ultimatum: either the U.S. government cease all production of distilled spirits, for both domestic and foreign markets, or member states of the collective would be forced to indefinitely prohibit all coffee and oil exports to the United States.

As strange as this story might sound, it is one that requires no imagination when the table is turned. Beginning in the 1970s, the United States pressured various South American nations-Bolivia, Colombia, and Peru-to prohibit a common traditional practice, the chewing of coca, and to eradicate an indigenous psychoactive substance, the coca plant. The United States did this by linking billions of dollars in economic aid with the mandatory adoption of American-style drug attitudes and drug policies. As a result, more than thirty U.S. government agencies had situated themselves in the Andean region by 1990, including the Drug Enforcement Administration (DEA), U.S. Customs, the U.S. Information Agency, the Bureau for International Narcotic Matters, the Federal Bureau of Investigation (FBI), the Central Intelligence Agency (CIA), and the Agency for International Development. Never mind that Bolivia, Colombia, and Peru were sovereign nations; more important, never mind that the oral consumption of coca had a great deal in common with the oral consumption of one of late-twentieth-century America's most popular pharmaceutical drugs: Ritalin.

A report published in 1995 in the prestigious Archives of General Psychiatry explains: "Cocaine, which is one of the most reinforcing and addictive of the abused drugs, has pharmacological actions that are very similar to those of methylphenidate [Ritalin], which is the most commonly prescribed psychotropic medication for children in the United States." In the 1990s doctors annually wrote millions of Ritalin prescriptions for children of various ages, including growing numbers of toddlers and infants. During that decade, more American children were given Ritalin and other stimulants to modify their behavior than in the rest of the world combined. North America accounted for about 95 percent of worldwide Ritalin consumption in 1997, with Canada alone having a per-capita consumption comparable to that of the United States. In 1998 Canada consumed 1,000 times more Ritalin than did the more populated country of France.

The story of Ritalin in America, and how it befriended parents across the nation, began in the 1950s, when European scientists first synthesized the artificial angel. The story gained momentum in the 1970s, when the manufacturer of Ritalin hailed it as a panacea for such things as the so-called chronic fatigue syndrome. The story peaked at the end of the twentieth century, with Ritalin not only having been widely adopted as a panacea for child-behavior problems but also having taken on a second life as a popular drug of misuse.

Consider Gerald Smith, once a principal at Aspen Elementary School in the Mormon town of Orem, Utah. While serving there as "a very good school principal," according to a local school-district spokesperson, Mr. Smith was also doing something very strange for a person of his position: he was sneaking into the school safe and replacing students' Ritalin pills with calcium and antihistamine pills. Since Ritalin had by that time become a controversial drug, some might have assumed that Mr. Smith was swapping the pills as a moral act, that he felt, as many Christians do, that psychiatric drugs had usurped the role of family values in the American home. But this was not Mr. Smith's motivation: rather, he had secretly exchanged several hundred Ritalin pills because he wanted them for himself. The fifty-year-old man was stealing Ritalin for his own casual use.

This was the late 1990s, and Gerald Smith was not alone. In 1997 the Milwaukee police charged an elementary-school teacher with possession of Ritalin, which he had stolen from a school office. In 1999 police arrested a computer technician at a junior-high school in Traverse City, Michigan, after school officials caught him on videotape in the act of stealing Ritalin. The same year, Indiana authorities ordered a school nurse into treatment and fined her $1,300 after she admitted to stealing Ritalin and other prescription drugs. In Nashville in 1995 James Smith became the second teacher at Grassland Middle School to be arrested for stealing Ritalin. In 1987 authorities charged a physician in Orange County, California, with writing fraudulent prescriptions for Ritalin, which he used to obtain the drug for his own purposes.

These anecdotes are consistent with a host of DEA findings during the 1990s, a time when drug agents began careful monitoring of Ritalin misuse. From 1990 to 1995, they recorded 1,937 incidents of Ritalin theft. Most of these were night-time burglaries at pharmacies, but they also included a variety of armed robberies and employee thefts. Meanwhile, between 1987 and 1994, the Ohio Board of Pharmacy reported more than 100,000 Ritalin tablets stolen from Ohio pharmacies, with eighteen of the cases involving pharmacists. On one occasion, a store videotaped a pharmacist crushing Ritalin pills and snorting the powder. A similar study in Indiana described a physician who knowingly sold Ritalin prescriptions to members of a multistate drug-tracking ring.

From 1996 to 1998, about 700,000 Ritalin pills were reported missing from pharmacists and licensed handlers of the drug. In comparison, only 100,000 Ritalin pills were legally dispensed in all of France in 1998. Numerous states have identified scams in which a parent drags his or her child to multiple physicians in order to obtain several Ritalin prescriptions, some or all of which are used or sold by the adult. In a report summarizing these findings Gretchen Feussner of the DEA concluded that "the magnitude and significance of diversion and tracking of MPH [methylphenidate, or Ritalin] are comparable to those associated with pharmaceutical drugs of similar abuse potential and availability (e.g., morphine)."

Adults supervising the culturally sanctioned use of Ritalin were not the only ones to appropriate it for their own use or to sell. The DEA reported that children and adolescents also diverted Ritalin for recreational use. The following is a typical story.

Lauren was 13 when she began pilfering her brother's Ritalin pills, crushing a few at a time and snorting them. It wasn't really like taking drugs, she says, because lots of other teen-agers she knew either had prescriptions for the pills or knew someone who would share his or her supply. "I would take one pill in the morning, then snort one or two pills when I came home from school," says Lauren, now 17.... "Every once in a while, I'd take a whole bunch at once."

As with reports of illicit Ritalin use by adults, and as suggested by the confession of Lauren, various statistics demonstrated that the stimulant had achieved a niche among children and teens similar to that among adults. One national survey found that the number of high-school seniors who misused Ritalin had nearly tripled from 1994 to 1996. In a 1996 phone survey in Georgia, more than 1 percent of the participating adolescents reported using Ritalin to get high. When asked specifically about their misuse of Ritalin (versus stimulants or "drugs" generally), as they were in an Indiana survey in 1997, 7 percent of students reported having misused the drug in the previous year, and 2.5 percent reported using it on a monthly or more frequent basis. In a study published in the Journal of Developmental Behavioral Pediatrics in 1998, 16 percent of participating children reported having been approached at school to sell, trade, or give away their stimulant drugs. Meanwhile, Ritalin-related emergency-room visits among children between the ages of ten and fourteen totaled about twenty-five in 1991; in 1995 this number topped 400; in 1996 the number of such visits among children from the ages of ten to seventeen was 630; in 1998 the number surpassed the same statistic for cocaine, jumping to 1,725.

Recreational Ritalin use also began showing up on college campuses in the 1990s, including top universities like Harvard. One young woman there acknowledged, "In all honesty, I haven't written a paper without Ritalin since my junior year in high school." Another reported, "I knew a girl in the freshman class who actually stole a script pad from the health center and faked her own prescription. She's an unbelievably smart girl, got a 1600 on her sat, but is convinced she needs to snort Ritalin in order to do all her work. She's become an absolute speed freak-up all night and strung out all day. Ironically, she's failing two of her classes."

Such stories gave sociological expression to what researchers had already established, namely, that all else being equal, Ritalin is the closest pharmacological substitute for cocaine. Nora Volkow and her colleagues at Brookhaven National Laboratory in Upton, New York, reported in 1995 that Ritalin and cocaine have very similar pharmacological actions; furthermore, they showed two years later in the journal Nature that Ritalin could be substituted for cocaine in addiction research. Ritalin is "like cocaine," they wrote, in that it "increases synaptic dopamine by inhibiting dopamine reuptake, it has equivalent reinforcing effects to those of cocaine, and its intravenous administration induces a 'high' similar to that of cocaine."

Volkow was not the first to pull back the curtain to reveal the truth about Ritalin. A 1975 study conducted by two pioneers in the study of drugs and behavior, Chris Johanson and C. R. Schuster, allowed rhesus monkeys to choose between Ritalin and cocaine. Because these studies were intended to test the drugs' liability for misuse, drug administration was typically intravenous. The study revealed that when one response led to administration of the drug and a different response led to administration of a placebo, animals responded for the drug. Furthermore, higher doses of one drug were preferred over lower doses of the other, and, most importantly, when they were delivered in comparable doses, no preference was found. Other studies have replicated these findings in other species, showing that animals will respond in a similar or identical fashion to Ritalin and cocaine. In fact, by the end of the twentieth century, more than a dozen studies had documented the comparability of these two drugs.

The finding that animals in the laboratory do not prefer cocaine to Ritalin mirrors what animal "drug-discrimination studies" first showed in the 1970s. Animals in these studies were involuntarily administered both drugs and required to gives responses that identified which drug was which, with correct responses being rewarded with food; in other words, the animals relied on the drug's psychoactive effects to instruct them on which button to press to receive food. When trained in this way, animals are usually better "blind" discriminators of drug effects than humans. Drug-discrimination studies demonstrated, however, that animals cannot reliably differentiate the psychoactive effects of Ritalin, cocaine, and the amphetamines, although they can tell the difference between these stimulants and caffeine, as well as other drugs.

Beginning in the 1990s, Volkow and her colleagues worked to clarify these findings. Measuring the effects of Ritalin in the human brain, they found that Ritalin was more akin to cocaine than to amphetamines-a dramatic set of findings in light of the fact that media reports had almost always characterized Ritalin's misuse as a cheap thrill and Ritalin itself as no more addictive than, say, caffeine and certainly no more powerful than amphetamines. A reporter covering the elementary-school principal who stole his students' Ritalin, for example, noted, "Ritalin is a mild stimulant usually given to children with attention deficit hyperactivity disorder, said Charles Ralston, a University of Utah pediatrician." Another story noted, "According to medical texts, the drug is a more potent stimulant than caffeine and less potent than amphetamines." Even the New York Times likened Ritalin to a "mild stimulant," "roughly [equivalent to] a jolt of strong coffee." Ritalin's manufacturer claimed Ritalin to be a pharmacological middleweight, acting merely as "a mild central nervous system stimulant."

To understand why Ritalin is more akin to cocaine one needs to consider the actions of these two drugs in the brain in terms of pharmacokinetics and pharmacodynamics. Pharmacokinetics involves the study of processes that govern the fate of a drug once it is taken into the body, including its distribution, absorption, metabolism, and elimination. Once a drug enters the bloodstream, it is distributed more or less throughout the body and is absorbed into the body's tissues, where it is metabolized, or broken down so it can be expelled from the body. Pharmacokinetics differ for different drugs because of their varying chemical compositions. For instance, some drugs are readily absorbed into the brain, whereas others are excluded altogether. Among those that do have access, some will have longer-lasting effects than others, such as amphetamine versus cocaine. The bodily processes that govern these events also vary from person to person. Pharmacokinetics are thus determined by both the drug and individual physiology. The recommended dose of an over-the-counter analgesic will be by-and-large correct for most users, for example, but will be too low for some and too high for others.

Whether a drug has the capacity to enter the brain is a question of pharmacokinetics, but once it does, it enters the realm of pharmacodynamics. By definition, psychoactive drugs affect nerve cells in the brain to alter the ongoing processes of the central nervous system. As long as pharmacokinetic activities continue to distribute and redistribute a drug's molecules throughout the body (that is, until they are fully metabolized and eliminated), a portion of those molecules will permeate and act directly on the nervous system, including the brain, prompting pharmacodynamic processes regardless of whether or not enough drug remains in the body to produce its intended effects (relaxation, intoxication, anaesthesia, or analgesia).

The relationship between the chemistry of a drug and its pharmacodynamics is not a simple one. Whether naturally occurring or synthetic, any pharmacologically active substance has its own unique chemical structure. The antidepressant drugs Zoloft, Paxil, and Prozac are all selective serotonin reuptake inhibitors (SSRIs), but each has a more-or-less unique chemical structure-which is prerequisite for patenting a drug and getting it on the market. It is perhaps natural to assume that drugs with similar pharmacological actions will have similar chemical structures, and vice versa, but this is often not the case. Sometimes drugs of the same class do have similar structures, as is true of tricyclic antidepressants, benzodiazepines, and the amphetamines. But broader drug classes, such as antidepressants, stimulants, or hallucinogens, can include drugs with quite different structures; mescaline, lysergic acid (LSD), and psilocybin, for example, produce similar hallucinogenic effects in humans, all else being equal, but they are highly dissimilar in structure. Furthermore, drugs with similar structures will sometimes vary considerably in their effects. Amphetamine and tranylcypromine illustrate this, where a slight structural difference causes the latter to act not as a stimulant but as an antidepressant. Classifications based on chemical structure would therefore bear little relationship to classifications based on uses or effects.

Pharmacodynamics helps clarify why not all stimulants act on the brain in the same way. Caffeine, for example, acts on brain cells by affecting the metabolism within nerve cells (neurons). Ritalin, the amphetamines, and cocaine, by contrast, affect the release of neurochemicals between neurons; these central-nervous-system stimulants can also be grouped loosely together in that they directly promote the activity of two neurotransmitter systems, norepinephrine and dopamine, albeit not exactly in the same way or to the same degree.

(Continues...)

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Edition details

• Publisher: Duke University Press
• Publication date: 2006
• Language: English
• ISBN 10: 0822338815
• ISBN 13: 9780822338819
• Binding: Hardcover
• Edition number: 1
• Number of pages: 312