Carl Hart is a professor of psychology and a neuroscientist at Columbia University and opens the book by stating that he is an unapologetic recreational drug user. He has done years of research on the body’s behavioral and physiological responses to drug use, and in this book, discloses that he himself regularly uses many illegal drugs and that they have improved his life tremendously.
His views on drugs have evolved a lot. He grew up in a rough neighborhood near Miami (more details about his early life can be found in his first book, High Price). He blamed a lot of the problems of his neighborhood on drugs like crack cocaine and heroin. He actually started as a researcher trying to elucidate the dangers of recreational drug use, but his thinking changed over time as he saw that his notions were not supported by his findings.
He points out the glaring racial disparities in drug policing, saying:
“At the state level, black people are four times more likely to be arrested for marijuana than their white counterparts. At the federal level, Hispanics represent three-fourths of the individuals arrested for marijuana violations. This is despite the fact that blacks, Hispanics, and whites all use the drug at similar rates, and they all tend to purchase the drug from individuals within their racial groups.
He points out that as a society, we tolerate lots of risky activities in the name of personal autonomy, like driving cars (forty thousand Americans die in car accidents every year) and owning guns, and we take a harm-reduction approach instead of banning these activities outright. He thinks we should do the same for drugs. Incidentally, he hates the phrase “harm reduction” because he thinks it focuses too much on negative drug effects without acknowledging the positive ones that most people actually use the drugs for.
NIDA funds 90% of the WORLD’s drug research, and Hart believes academic drug research is deeply biased and functions largely to confirm people’s pre-existing intuition that recreational drug use is harmful to our health and to the brain. He points out some specific common mistakes made in the academic drug literature:
- Brain imaging studies usually compare users vs non-users of a given substance at a single time point, and thus can’t tease out if any differences are due to causal drug effects, or were preexisting differences between the two groups.
- More importantly, these differences often still place both groups within the normal range for their age. This is often true for cognitive outcomes measured as well. But that fact is entirely undiscussed in the studies in question.
- Studies rarely account for the influence of tobacco smoking and alcohol use on the findings
Hart writes about a visit to the Philippines where president Duterte was conducting a violent campaign to eradicate drug use in the country citing data like any meth use shrinks the brain. He asks the reader where Duterte may be getting this info, and answer that he wouldn’t have to look far, he only needs to see results from NIDA. He was publicly maligned in the country after giving his talk, including a political cartoon of him speaking to small-brained meth users who really liked what he was saying.
Hart writes about the much publicized case of Rudy Eugene, who attacked a police officer and caused severe injury to him by viciously biting his face. Media reporting at the time indicated that Eugene was on “bath salts” (synthetic cathinones, a stimulant similar to amphetamines and cocaine) and that this was the cause of his erratic behavior. Left out of the media reporting was that Eugene’s toxicology report came back negative for the drug, and the theory was just floated by a wildly speculating police officer not trained in pharmacology, possibly to draw attention away from the fact that Eugene, who was shot and killed, was black. NIDA’s page about synthetic cathinones states “Human users have reported that the drugs trigger intense, uncontrollable urges to use the drug again.”
Hart takes issue with the growing psychedelic movement as well. One objection is that:
“If your aim is to seek relief from an emotional or physical ailment or to achieve spiritual transcendence or to find your god, cool. But if you merely want to have a good time, not cool.”
He doesn’t think it’s fair that selected drugs like DMT, MDMA, and psilocybin are gaining credibility through mainstream use by powerful (often white) people, but drugs like PCP, heroin and methamphetamine are just as strongly maligned as they were decades ago.
Drug myths he tries to dispel:
- The idea of marijuana being a “gateway drug”:
“It’s true that most cocaine and heroin users started out using marijuana first. But the vast majority of pot smokers never go on to use so-called harder drugs. To say marijuana is a “gateway” to “harder” drugs is baseless”
- That using “hard drugs” usually leads to addiction:
“research shows repeatedly that such issues affect only 10 to 30 percent of those who use even the most stigmatized drugs, such as heroin and methamphetamine…regarding the relatively small percentage of individuals who do become addicted, co-occurring psychiatric disorders - such as excessive anxiety, depression, and schizophrenia - and socioeconomic factors - such as resource-deprived communities and un- and underemployment - account for a substantial proportion of these addictions.”
- That the war on drugs has been effective:
We now spend $35 billion per year on the war on drugs, compared to $1.5 billion in 1981, but drug use hasn’t decreased. Additionally, banning drugs like marijuana has led to an endless stream of unpredictably potent and adulterated mimic-substances.
- Opioids are inherently extremely dangerous drugs:
“It is certainly possible to die from an overdose of an opioid alone, but such overdoses account for a minority of the thousands of opioid-related deaths. Most are caused when people combine an opioid with alcohol, an anticonvulsant, an antihistamine, a benzodiazepine, or another sedative. People are not dying because of opioids; they are dying because of ignorance.” Hart actually put himself through opiate withdrawal and found the experience unpleasant but not dangerous.
Hart’s book didn’t come out in time to cover Oregon’s Measure 110 referendum in November of 2020, which decriminalized the possession of small amounts of any drug, including heroin, cocaine, methamphetamine and LSD. Oregon became the first state to pass such a measure, and Hart spoke out publicly in favor of it. In his book, he writes about Portugal’s experience with decriminalization, writing:
“the number of heroin users actually dropped from 100,000 to 25,000 after that country decriminalized all drugs. Portugal has the lowest rate of drug-induced death in Western Europe.”
However, in Oregon, opioid deaths increased 58% in the year after Measure 110 was passed compared to the year before that. Overdose deaths increased nationally as well, likely due to pandemic-related knock-on effects, but nationally deaths increased 17%. Only 1% of people cited with the $100 ticket for possession chose to enter treatment, since treatment is not mandated like it is in some other states like California. Oregon now has the highest national rate of illicit drug use disorders (as measured by self-report), which it didn’t have before Measure 110. It also ranks last in terms of ratio of people seeking drug treatment to people accepted in, due to understaffed and inadequate treatment programs. However, Measure 110 has also prevented the devastating effects of having a drug arrest on your record (loss of employment etc.). But overall, the issue seems a lot more complex than Hart imagines it to be.
Thought questions:
- Hart champions personal freedom in this book a lot, claiming drugs should be included under our Declaration of Independence right to pursue happiness. But Hart says this freedom isn’t for everyone:
“A point I need to emphasize here is that this is a book for grown-ups. By that I mean autonomous, responsible, well-functioning, healthy adults. These individuals meet their parental, occupational, and social responsibilities; their drug use is well planned in order to minimize any disruptions of life activities. They get ample sleep, eat nutritiously, and exercise regularly. They don’t put themselves or others in physically dangerous situations as a result of their drug use. These are all grown-up activities.”
Do you see this as a contradiction? Who gets to decide if someone is ready for this freedom or if they’re not a “grown-up”? Does his view seem moralistic to you?
- I thought it was brave for a scientist to write about how he changed his mind based on accumulating new evidence. What effect do you think it would have if more scientists did this? I thought that was as meaningful as his standing up as a responsible recreational drug user.
- Hart urges us not to blame drugs for poverty, homelessness, and other social issues tied to systemic inequalities, stating:
“Politicians get away with simply scapegoating the drug du jour in order to avoid addressing the real problems people face: poor education, an insufficient number of jobs paying a living wage, affordable housing, racial discrimination, and a lack of basic public services, to name just a few.”
I think Hart makes a great point that these social issues don’t stem from a single cause. But consider that two large studies (National Center on Domestic and Sexual Violence Report, 2007; Didenko and Pankratz, 2008) have found that addiction is the single biggest reason (about 2/3 of respondents) self reported by homeless adults as a primary cause of their homelessness. According to a 2013 survey by The Substance Abuse and Mental Health Services Group, 38% of homeless adults had an alcohol dependency, and a further 26% abused other drugs. What do think of this data in light of Hart’s perspective? Could there be an interaction effect between drug use and homelessness, for example? It’s kind of like saying don’t blame fast food for making people obese.
- Hart has a deep mistrust of academic drug research, and goes so far as to say “you can ignore the introduction and discussion sections of most scientific papers. They usually serve as propaganda instruments to promote the research and ideas of the authors.” Do you think that’s good advice?
- The National Institute on Drug Abuse (NIDA) is funded by the U.S. government with a mandate to better understand the underpinnings of addiction and how to prevent the negative consequences of drug abuse. Did you feel that given NIDA's Congressionally mandated focus on addiction and abuse, that Carl Hart was too critical of Nora Volkow's focus on negative consequences of drug use. Or do you think that Hart's criticism of bias was justified.
- How does the negative narrative of NIDA's research focus impact or prevent other avenues of funding for positive effects of recreational drug use? What would be a good solution to this problem?
- An interesting aspect of the criminalization of drug use is that it is much more difficult as a consumer to drive ethical behavior by producers through buying patterns. In modern times, large companies that prioritize profit are ethically constrained by law and by public sentiment. Because manufacturing of many recreational drugs is illegal, law cannot impact the production process and public sentiment can rarely impact criminal elements around production methods. Why do you think it is so rare to talk about the manufacturing side of things?
- Is drug dependence bad, or do we think that it is bad because of our negative associations with certain illegal drugs? Should there be more focus on the behavioral consequences of addiction rather than focusing on drug use and dependence? Ben says he is dependent on caffeine, for example. But that dependence has had a net positive impact on his life. The few withdrawal headaches and grumpiness he has experienced have not outweighed the cognitive sharpness and increased happiness he feels from caffeine effects.