Forgotten Drugs of Abuse I: T’s and Blues

Stop me if you’ve heard this one before.  It’s about a new drug, a killer, raging through a major American city filling ERs and morgues and leaving a trail of wrecked lives.  Just a year ago heroin was the big problem, but now this new scourge accounts for three-fourths of drug busts and a third of all addicts seeking treatment.  Experts are saying there’s no way the drug will stay in one city: “similar to an infectious process,” it will inevitably spread across the nation.  It’s already surfaced in a handful of cities, and who knows where it will strike next.

Scourge of Our Cities

The year is 1978, and the Talwin panic is in full swing.

Wait, you don’t remember the great Talwin terror of 1978?  Maybe haven’t even heard of Talwin?  Don’t feel bad.  Despite the promising start, the Talwin scare never really got off the ground.  There were a few headlines here and there, a TV documentary, and a day of testimony in Congress, but in the annals of anti-drug crusades it was small potatoes.

Why?  1978 was a great year for drug crusades, and this one seemed to have plenty going for it:  Talwin really was causing major public health problems in Chicago; it had a hip, media-friendly street name (“T’s and Blues”); and most of its abusers were nonwhite, urban poor—classic drug-war boogeymen.  More:  one of the largest sources of Talwin in Chicago was a Medicaid clinic, where, Congress was told, the drug was “handed out literally like M&Ms.”  The headlines could have written themselves.  “Hard Working Taxpayers’ Dollars Going to Give Dope to Junkies!”  And if that wasn’t enough, how about this sound bite from the Congressional hearings:

Thank you indeed!  “Grandmothers are buying Talwin on the street”:  does it get any better than that for an anti-drug crusader? It wasn’t supposed to end up like that for Talwin. 

Breakthrough!

The drug had been introduced in 1967 by Sterling-Winthrop as the medical holy grail:  a non-addicting substitute for morphine. (The oral form came 2 years later.)  And for once it wasn’t just the manufacturer and friendly journalists who said so.  It was also experts at the Addiction Research Center at Lexington, Kentucky, the AMA Council on Drugs, the World Health Organization’s committee on drug addiction, and pretty much everyone else who had taken a look at the drug.  Talwin wasn’t like Quaalude, which had slipped through with no testing for addictiveness.  Talwin was a narcotic and heir to decades of dashed dreams:  anything that eased pain like morphine, addicted like morphine.  So it got tested by teams of researchers with years of experience telling bad news to very powerful corporations.  But no matter how hard they looked, they found virtually no dependence, and they couldn’t get opiate addicts to desire it any more than placebo.  So when Sterling-Winthrop took out the wonder-drug trumpet, even the skeptics were ready to join the band.

Consecration!

Within a year or two, occasional and isolated accounts of dependence and/or abuse began to pop up.  They were rare enough that experts weren’t worried, however.  The DEA asked the FDA for permission to put Talwin on the Schedule of Controlled Substances, but after two years of study the FDA said no.

So how did this safe, non-euphoric, non-addicting drug come to be the scourge of Chicago?  Step one:  Turkey, responding to U.S. pressure, cut back its opium crops.  The price of heroin rose significantly.  Step two:  some enterprising drug user in Chicago remembered a long-gone drug fad from the 1950s called “Blue Velvet,” when addicts had used the antihistamine Pyribenzamine (tripelennamine—the pills were blue) to intensify the effects of morphine.  Lo and behold, the same trick worked with Talwin:  if you crushed the two together and injected them, you got a reasonable substitute for heroin.  Not quite as good, by all reports, but much, much cheaper, safer, and more reliable.  And since it wasn’t on the Schedule of Controlled Substances, it was relatively easy to get.

Thus was born the “Ts and Blues” boom, and then, a little later, the Talwin crackdown.  It was hardly panicky.  The story failed to catch in the media, and you couldn’t exactly call the policy response an overreaction (unless you were the manufacturer, of course).  Illinois and a few other hard-hit states quickly put Talwin on their Schedule II, a highly restrictive slot.  In 1978 the FDA agreed to place it on Schedule IV—the “Valium schedule”—which imposed very light controls and served primarily to warn physicians about possible risks.  And in 1983, Sterling-Winthrop reformulated Talwin to include naloxone, a morphine antagonist that is inactive if swallowed but which brings on withdrawal symptoms in addicts if injected.  These moves worked pretty well.  Abuse plummeted, and Talwin more or less disappeared from view.

A reasonable response, right?  At least, as reasonable as can be hoped for within the lunacies of the broader drug-war.  But that only begs the question:  why such reasonableness in a neck of the woods not known for subtlety and restraint?  It wasn’t just that Talwin had corporate backers.  The 1970s were a graveyard for a parade of well-defended drugs (see amphetamine, for example).  So what gives?

Always the Bridesmaid

One explanation has got to be where Talwin abuse was occurring, i.e., almost exclusively among heroin addicts.  In survey after survey, no addict ever listed Talwin as their first drug of abuse, you had to use it for awhile in order to come to prefer it—and even then, it seems to have been preferred only for what you might call market-based reasons of price, reliability, and the safety of a known brand name.  (Interesting side point:  for a century pharmaceutical companies had been defending their drugs by arguing that only addicts or “addiction-prone” people abused them.  Addiction, they argued, was a quality of people and subcultures, not of drugs.  Talwin was about as close as they came to being right, and it’s a useful boundary case for exploring how society and culture work with pharmacology to construct “addictiveness.”)

Given Talwin’s abuser base, quotes about grandmothers buying on the street were outliers.  Almost no one pulled out the “Talwin is coming to get us all” argument, and there were few tear-jerking stories of good girls and boys turned bad by a demon drug.  Instead you had headlines like “Hardcore Drug Addicts Turn to Mixture Similar to Heroin.”  No surprise, I guess, that these didn’t compete well with stories of housewives turned to junkies by Valium, or sweet hippie kids becoming speed freaks.

In a way, to get on board with this scare you had to care at least a little about poor, black heroin addicts.  And that, I finally figured out, was why it was so strange to read through the rhetoric in the Congressional testimony.  Here’s Chicago Congresswoman Cardiss Collins opening the day of hearings:

Not everyone sounded like Collins, not by a long shot, but addicts came off pretty sympathetically in the day’s testimony.  The only people given a hard time were representatives from Sterling-Winthrop, who were blamed for their supposedly inadequate response to the early isolated cases of dependence.  All told, not your usual drug-war theatrics.  Perhaps a reason why it never caught on, but also maybe a reason why it ended up looking more like a public health campaign than a war.

One last thought:  the Talwin episode seems to be a great example of Joe Spillane’s moral panic model, where behavior and response—drug use and drug panic—interact dynamically.  But it was also small enough, and effective enough, to drop out of sight right after it was over.  So it could also be one of those exceptions that prove the rule:  i.e., real panics earn their label honestly because they are much more disproportionate than this neat, almost clinically targeted affair.

Destination: a New Drug Policy

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  1. Pingback: Forgotten drugs of abuse, part 1: T's and Blues | Points: The Blog of … | HEROIN ABUSE INTERVENTION

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