Uppers

How I didn’t succeed in getting addicted to them.

I have tried to misuse uppers on many occasions, and it has always, invariably ended in disappointment. Each of the dozen or so times in the past that I have tried cocaine it had no effect whatsoever - even as my friends were exulting, “dude, this is the best coke ever.” They were smiling, laughing, and speaking rapidly for hours and I was… stone-cold sober, even bored. It is almost as if my baseline hypomanic personality is already naturally coked out and there is no extra capacity in my brain for the white powder to contribute.

Just after college, with close friends - those fellow Swarthmore Philosophy majors (who are now all physicians…) who are such a menace to society: we bought and tried to freebase some cocaine. For the record (and for once): THIS WAS NOT MY IDEA. Under the flame, the white blob started boiling on the aluminum foil and then… just melted away…as if it were a small, expensive chunk of Ivory soap. I calculated that if we had bought the entire bar of soap at that price it would have come to about $40,000 or, as much as did our vaunted Swarthmore educations.

My friends – suffused with the moral injustice of it all, as if some Kantian or Hegelian rule of the universe had been fundamentally violated - insisted on going back to the same drug dealer on the corner near my D.C. apartment. They gave him back the empty glycine baggie and demanded our $20 back based on mercantile fraud and misrepresentation. This didn’t go particularly well. He just said, in an unnervingly calm voice, “get the fuck away from me” and that was that. We complied in a hurry.

My next attempt transpired when I was visiting Peru during medical school with my now very, very ex-wife. Leaves of the coca plant were legal and readily purchased (though, unknown to me, are about one millionth the strength of powdered cocaine). Chewing these leaves, or brewing them into a gentle cup of tea, was a local custom and was thought to result in a mild calm euphoria. I attempted chewing enough coca leaves to, at least momentarily, alleviate the constant heartburn and agita that my then spouse’s high pitched, continuously berating voice gave me. I compulsively chewed acres upon and acres of these slightly bitter leaves.  Sadly, it had no effect except that I gave myself a vicious case of jaw pain, I’m guessing TMJ, which lasted for months. When we returned to the States, I could barely speak, no one could understand a word that I uttered. I walked around with icepacks on both sides of my jaw. Useless plant! Useless drug!

During my addicted years, when there wasn’t an opioid on Earth that I wouldn’t try to swallow or snort, I tried Ritalin and Adderall, as well as every potentially misusable drug I could get my hands on. These highly sought-after uppers – for ADHD, for performance enhancement, and for recreation - didn’t do anything for me except make me grind my teeth and stay up all night tossing in my bed. I already have enough dental problems from sheer sloth – I didn’t need any more. These psychostimulants also gave me anxiety, palpitations, nausea, and scattered, racing thoughts. I couldn’t for the life of me discern by people misuse these horrid substances. If this is fun, no thank you!

I’ll skip over the time I tried snorting Adderall – suffice it to say that I think my nostrils are still damaged and sclerotic, twenty years later.

There is just one upper on God’s Green Earth that I can use addictively, with good benefit, to give me energy (a.k.a. barely contained hypomania…), without risking legal jeopardy, TMJ, or frank psychosis. Namely…coffee! Why deal with a drug dealer, and face potential criminal charges, or fentanyl poisoning, when you can legally go into Starbucks and have a sanctioned drug dealer sell you a vastly overpriced cup of caffeinated battery acid? Just like the other drugs mentioned above, coffee also causes exploitation and pollution in the process of production and distribution – though it is inconvenient to think of such things. If there was such a thing as “Caffeine Use Disorder” I would lead the pack. I would win hands down.

For completeness, it is important to mention that there are many other commonly used and misused uppers, such as the ones that are sold over the counter, including Sudafed, which can cause insomnia, palpitations, and teeth grinding, in its own right. The reason one must show one’s I.D. in order to buy Sudafed at a pharmacy is that it takes just a few simple chemical steps to transform Sudafed into methamphetamine and the DEA wishes to hamper supply to underground chemists.

The Feds just took a different stimulant (phenylephrine) off the market because it is clinically ineffective as a decongestant, despite the fact that millions have been using it to placebo their congestion into nonexistence. Other uppers are available by prescription such as Provigil (modafinil) and phentermine. These stimulants have several important medical uses such as treating narcolepsy, excessive daytime sleepiness, and weight loss, as well as congestion and wheezing.  ­­

Indeed, our society has always been awash in uppers. My dad wrote two books about this, including his 1975 masterpiece, “The Speed Culture.” My father had a natural talent at homing in on, and blasting away at, the hypocrisy that has always underpinned our drug policies (in an exceeding controlled and academic manner). When this book came out, I was 9 years old. This was typical of my bedtime reading as I was growing up.

Indeed, our society has always been awash in uppers. My dad wrote two books about this, including his 1975 masterpiece, “The Speed Culture

Serious Harms

In truth, many people get severely addicted to uppers. According to one study,

Among U.S. adults in 2015-2016, 6.6% (annual average) used prescription stimulants overall: 4.5% used without misuse, 1.9% misused without use disorders, and 0.2% had use disorders. 

These numbers are astounding and rising. Two percent - one in fifty adults in the U.S. misuse stimulants in any given year. Surely we each know fifty people. According to the dictates of probability, at least one of them is tweaking.

The harms of upper misuse include anxiety, insomnia, arrhythmias, cardiac disease, psychosis, and overdose. An increasing proportion of opioid overdose deaths includes at least one type of stimulant. Our society is very accepting of some stimulants (e.g., Adderall, Concerta) and very critical of others (cocaine, methamphetamine) – even though they are very similar to each other chemically. As always (in my humble opinion…), the criminalization of any drug makes its use more dangerous.

Addicted to speed

Addictions to stimulants are exceedingly tough to get over. There is no Suboxone (which we use for opioid addiction) for an addiction to stimulants. There is no methadone. There is no Vivitrol or Antabuse (as we use for alcohol). We simply don’t (yet) have pharmacological treatments for stimulant use disorders. These addictions can be deadly.

The only treatment for stimulant addiction that has some evidence backing it is “contingency management.”  This basically rewards people with a monetary or other reward for having a “clean” urine. It is not a particularly scalable treatment. Who on Earth would pay for it? Surely not the health insurance companies.

The doctors I monitored with methamphetamine addictions (when I was an Associate Director of the Massachusetts Physician Health Service) had a particularly rough time. These addictions seemed almost impossible to get over. Some studies cite a success rate of around seven percent. One doctor who I worked with was found slumped over in the doctor’s lounge, mumbling word salad into a microphone, going through the motions of dictating a note, after having been up for five straight nights injecting meth and trying to have sex. At that point, to his viewpoint, everyone’s hair was purple. The medical board was not amused. Neither was the rest of his life.

---

In my experience, the adage from the A.A. wing of Addiction Psychiatry that “a drug is a drug is a drug” simply isn’t true. It just doesn’t make sense that addiction is a “one size fits all” type of problem.

I am not convinced that those of us who have been addicted to a particular category of drug, are thus defenseless for life against other types of drugs. Especially if the drugs do the opposite of what our drug of choice did. I am a case in point. I was addicted to opioids for a decade, as detailed in my memoir, “Free Refills”. My attempts at misusing uppers have been an unmitigated failure. This is not a coincidence. Everyone goes into an addiction with some mood imbalance that they are trying to rectify, some unpleasant feelings or trauma that they are trying to short-circuit. But, however dysfunctional, not all DIYWD (do it yourself with drugs) fixes are equal. Some people are vulnerable to some substances – if they resonate with what we are trying to obliterate. Others are vulnerable to different types of drugs.  All of us require treatment with understanding, skill, and empathy.