Near the beginning of Dr. Carl Hart’s new book, Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear, you learn that he has studied and worked as a “drug abuse scientist” for more than twenty-five years—and that he’s entering his fifth year as a “regular heroin user.”
Maybe not what you’d expect from a neuroscience Ph.D. and Columbia psychology professor. But that is, after all, what he’s getting at in his book. Many of the ideas we have about drugs are all wrong, he says. Hart had his own preconceptions when he began his job as a drug abuse researcher, but the harmful effects he expected to find never materialized.
“Here’s the bottom line: over my more than twenty-five-year career, I have discovered that most drug-use scenarios cause little or no harm and that some responsible drug-use scenarios are actually beneficial for human health and functioning,” he writes.
Many of our misguided fears about drugs, Dr. Hart argues, began largely as a result of American racism. Up until the early years of the twentieth century, “Americans were free to alter their consciousness with the substances of their choice.” Then, fear of intermingling between Chinese and white Americans in opium dens, and racist sensationalizing exaggerating the harms of cocaine, led to the 1914 Harrison Narcotics Tax Act. (Among the most odious and ridiculous of these assertions, Hart writes, was one that “prompted some southern police forces to switch to a larger .38-caliber weapon in order to deal with the mythical black, cocainized superhuman.”) The Harrison Act, and the racial rhetoric stoked to buoy its passage, would set the tone for America’s discriminatory drug policy and enforcement in the last century.
Because these attitudes have also shaped our societal beliefs about drugs, Dr. Hart argues, many of the behaviours we regularly attribute to substances—from the likelihood of addiction to the “notion that recreational drugs cause brain dysfunction”—in fact have other causes. Drugs, he writes, “are inert substances,” whose abuse is usually the result of co-occurring conditions, be those psychological or circumstantial. Their use, Hart believes, should be allowed for grown-ups—“by that I mean autonomous, responsible, well-functioning, healthy adults”—as part of the American right to life, liberty, and the pursuit of happiness.
Though it’s common these days to hear the argument that America’s approach to drugs is deeply racist, flawed, and overdue for correction, it’s also hard to imagine a world where we can all do drugs freely. So GQ asked Dr. Hart to help imagine what that world might look like, and how we can fix our drug problem—which is not a problem with drugs, he says, but with our ignorance about them.
GQ: What's wrong with the current and historical relationship to drugs in our society?
Dr. Carl Hart: We don't think of these drugs in rational terms. We think of these particular drugs as producing unique effects and it's just not true. But when you do that, when you think of these drugs as producing these unique effects, the response is not rational. When we think about when these drugs were banned, we can see this even more clearly.
When we think about cocaine, for example, we banned it for irrational reasons, for reasons of American racism. Same thing with opioids. We paired these drugs with the behaviour of groups we didn't like, and behaviour that we exaggerated, like crime, like Black men being with white women. So the drugs became more about these other issues that were sadly exaggerated. And so we're still doing that today.
We're looking at these drugs in unrealistic terms. And what I'm trying to do is to have a conversation, or to get people to think about the drugs from a rational, reasonable perspective. Like, cocaine does not produce superhuman strength, heroin does not cause you to be addicted after one or even a couple of hits. And it doesn't take over your life. When we say things like that, that's just simply not true.
That was one of the big revelations in the book to me, that according to the stats you lay out, it doesn't seem like addiction is maybe as inevitable a problem as it's portrayed. [In the book, Dr. Hart points out that most users—usually between 90 and 70 percent—of any drug will not become addicted.]
That's one of the biggest myths, that the majority of people who use something like heroin or crack cocaine or cocaine in general are addicted—it’s simply not true. It is true that people can become addicted. There are a certain percentage of people who become addicted. But even when they become addicted, the addiction has little to do with the drug itself, and has more to do with these other environmental, psychosocial, and personal factors. People may have co-occurring psychiatric illnesses, co-occurring pain, a wide range of things that's driving the addiction, if we look past the drug.
I think this is a point worth hanging on. You say in the book that these drugs are for people who have managed to grow up. Obviously, a lot of people don't set out doing drugs to disrupt their lives, but maybe that happens because of societal factors, or circumstance, or underlying mental health issues—
Or maturity issues. People say, I've done this since I was in my teens or twenties. Now I've been clean all these years. It's like, did anything happen in the intervening time? Did you grow up?
Totally. But what I’m getting at is that the problem with libertarianism, in some ways, is that there are a lot of people not mature or well enough to handle liberty.
Absolutely. Thank you for catching that.
So how do we address that?
In chapter two, I try to explain what liberty really is and what it entails. It entails a responsible person, somebody who is constantly evaluating their own behaviour to see how it's impacting other people, and someone who is updating their behaviour, particularly when they notice that their behaviour is negatively impacting others. That requires a lot of work. Freedom requires a lot of work.
That responsibility is not something that I take lightly. That's why I took some time in chapter two to make sure people understood that this ain’t some light thing. Like your fake-ass patriotism, like the jingoistic “I hang out a flag, I'm patriotic,” that’s not real patriotism. Real patriotism takes work! It takes an understanding of the Declaration of Independence. That means that people around you have the right to pursue life, liberty, and happiness, as long as they don't bother anyone else. Even if you don't like the behaviour. That's real patriotism.
So in your ideal world, what would healthy societal engagement with drugs look like?
In my ideal world, these things would be available, and our government would regulate their quality control, and dispensing, in terms of putting limits and requirements on individuals before they purchase them.
For example, in terms of the supply, the unit dose would be controlled, such that we won't put enough in one unit dose or one container that could kill people. You would do like we do with alcohol. We can put a lot more alcohol in that container of beer or in that glass of liquor, but we don't because we put an amount in there that we think will enhance your good time with the substance and decrease the likelihood of you dying from it. The same would be true with heroin—what's contained in the package would be enough to take you to the euphoric effects and not enough to kill you.
We have an age requirement for alcohol. We can have additional requirements for some of these things. We can make people take a test, just like we do with driving. We could do a better job in public service announcements with things like opioids. We make sure people understand that, okay, if you're going to be using an opioid, you can't combine it with other sedatives and here are sedatives: antihistamines, neuro pain medication. We put these in public service announcements. That would be my utopia, if we could do that.
So what is the science of addiction? My understanding of it, which is mostly based through mainstream media coverage, is that something like opioids is far more addictive than alcohol.
So when we think about addiction—still working in this idea of utopian society—we would make sure everyone had health care. Because that's the main problem when we have addiction. Right now, we have these addiction specialists and that's part of the problem, because at the moment they get money for addiction. And they focus on the drug, as opposed to focusing on the person and then trying to help the person with their entire life, their situation, like they do in Sweden and Switzerland. So our addiction industry would change such that the person would have a social worker, a psychologist, a psychiatrist, an internist, all of them would be a part of their treatment teams, when they meet criteria for addiction.
We would also teach people about routes of administration. When we think about something like heroin, heroin becomes addictive in large part because of its physiological dependence. If you shoot it intravenously, it increases the likelihood of the physiological dependence. We will make sure people have higher quality heroin so that they don't have to shoot. They can snort it, they can take it orally, because the quality would increase, and it’s not like the stuff that people get off the streets, which is so variable that many people shoot it because they don't want to lose any of it. So we would try to help people to understand the difference between shooting the drugs, taking the drug orally.
So physiological dependence on something like heroin certainly occurs, particularly if you take the drugs via intravenous route. But physiological dependence to heroin is a lot less dangerous than physiological dependence on alcohol. So we manage that in our society. With alcohol physiological dependence, one can die. But you can't die from heroin withdrawal, or physiological dependence. I think that won't be much of an issue, but it certainly will be one that we will have to have our education aimed at.
How would you feel about drugs being made legal for medical purposes, but not necessarily for recreational ones?
I don't want the medical community in control of anyone's liberty, or the ability to enjoy themselves. Imagine if we said, okay, we're going to make alcohol illegal, but only for the medical community. You have to go to your doctor to get a prescription for alcohol. It has this additional gatekeeper. And we know when we have these additional gatekeepers, we are excluding large numbers of people in our society, like people who don't have access to the doctor. We have this opportunity now for racism, which happens with opioids and other prescription medication. The medical community is on par with law enforcement. They, in essence, function as cops. I want those folks to have as limited a role as possible in my utopian society.
As far as you understand it, why do some people get addicted and others don't?
A large percentage of people who meet criteria for addiction have co-occurring psychiatric illnesses: depression, anxiety disorder, schizophrenia, a wide range of other psychiatric illnesses. A large percentage of them also have other illnesses. They may be pain patients. So that increases the likelihood of them becoming addicted.
And then, if we think about the factories that went away, that went to different countries—like GM and other factories in the Rust Belt—you have people in those communities who were making a middle-class living. When the factories went away in all of these places, those people's sense of worth went away. They may have gotten in trouble with various drugs like opioids. We can understand that it's important for people to have a sense of worth in life, and many of our addiction therapies don't deal with this major problem. This is a major problem in the United States. So that's one reason that people become addicted.
Another reason is that some people just have not developed responsibility skills. They haven't developed an ability to exercise inhibitory control. It's just one of these things that develops over time.
In your understanding, is a high functioning addict a real thing? Or, if you're high functioning, does that go against the definition of addiction?
You hit it on the head. Addiction, by definition, according to the DSM [Diagnostic and Statistical Manual of Mental Disorders], is that you have these disruptions in your functioning. That's what addiction is all about. And those disruptions cause you, the person, distress. And so you don't like this as a person. So when people say a functional addict, that's an oxymoron, there is no such thing.
I want to hang onto alcohol for a second. I certainly think that alcohol can be as dangerous as some other drugs. I know people who've taken illegal substances who aren't nearly as out of control as people who've over-consumed alcohol. But the government does have to draw the line somewhere. Almost like speed limits, right? They have to set it somewhere. (Well, not in Germany, I guess.) So how do you think about where we set the speed limit, if we set it at all?
Good question. So the reason that alcohol is available is not because of what you just said. The reason why alcohol is legal today is because Americans thought that the revenue generated from the alcohol tax would take care of our income tax, and then we would no longer have to pay an income tax. That's why alcohol is legal today. That's why we overturned the 18th Amendment with the 21st Amendment. Not because of these limits.
Now let's go back to those limits. You are absolutely right that the government has to set these limits to make sure everyone can pursue their life, liberty, and happiness. But with the speed limit for automobiles, we haven't banned automobiles. We haven't said, okay, we're not driving because every year 40,000 Americans lose their lives in car accidents. This has happened for 30 years.
But what we do is we have speed limits. We make sure people have their car inspected. We make sure people have insurance. We make sure people can drive a car by passing a driving exam. Those are the limits. So if we're talking about heroin, we make sure that you have a certain age requirement. We make sure that we control the unit dose. This is how the government can make sure they have some limits, so they enhance the safety of these activities, but not ban them.
The counter-argument that pops into my head is that cars might be more necessary to a functioning society than some of these illegal substances.
People would disagree. Look at New York City. Before COVID, we had this great public transportation system, but people still wanted their right to be American and drive their car. So when we think about drugs from that perspective, there are drugs that people need—in their minds, they think they need—for their life, liberty, and the pursuit of happiness. And it shouldn't be up to me or any government to decide.
The first quote of my prologue is Thomas Jefferson saying, “Those folks who allow the government to tell them what to do, their minds are under tyranny.” That quote is perfect for this situation. The government shouldn't tell you what to do. The government is involved in order to enhance the safety of these things. Not ban these things.
Yeah, I think it just goes back to, wow, the infrastructure we'd have to build to create the conditions that would allow for healthy drug use is extensive. Which doesn't mean we couldn't do it, but it just strikes me as a massive undertaking.
You think so? I think we have this in place already. We’re doing it with cannabis. It's not a massive undertaking. I think the system is going to get refined. We don't need all of this security that we have, and they're gouging the industry at the moment. But I think we’re going to iron out these things and the excess will gotten rid of. But this isn't that complicated. We have these various stores and quality control—that's a source for a lot of jobs. It could help the economy and people would be happier.
You give some great examples in the book of places, in Europe, like Boom Festival, that actually create a safe space for people who want to do drugs. What do you think is different about their mindset or their culture that allows them to do that?
Have you ever been to Burning Man?
I have not.
We do it at Burning Man, but we just don't talk about it. And the people who are doing it are largely middle- to upper-class white people. And we just keep that under wraps, you know? So in the United States, the mindset is we really don't want the “riff-raff” to be involved there. And so that's why we don't talk about it. So we do ease activities, but they are limited to our sort of privileged class.
I wanted to ask you about the psychedelic renaissance. From what you write about in the book, it seems like your feelings are maybe ambivalent.
I am really excited about the fact that people are able to get these psychedelic drugs and use them and they feel like they're better people for it. I'm really happy about that. The thing that concerns me is the language I see cropping up around the use of these things. So people are justifying their use by calling these things “plant medicine,” or saying that they're on some spiritual journey, or spiritual enlightenment, that's what they're seeking. They don't get high. What they are doing, in a sense, is they are distancing themselves from other people who may not use the same words to describe their experience, who may not use the middle-class lingo. What they're doing is drawing these boundaries between them and these other folks. When, in fact, they're all doing the same thing. So it's an exercise in exclusivity, and that's the thing that bothers me.
Do you feel like the way people are coming around on psychedelics could trickle down to other things that are potentially not as societally accepted because of this exclusionary language?
I think that's how some of these “psychonauts” are justifying their behaviour or their nod to exclusivity. I don't know if it'll trickle down. These things rarely do. Sometimes they do. My position is that we have to stand up on behalf of everyone. I have no right to exclude other people. I have no right. So that's where I'm trying to come at this from. I’m trying to show people that your ketamine is nearly identical to my PCP.
By you not standing up for that, you now give, for example, police officers this excuse to shoot and kill black people. So I've been trying to make these connections. Because we know the police excuse is just false. It doesn't comport with reality, it doesn't comport with the data. These psychonauts who are middle-class or privileged class people, they can bring with them the immediate attention to change the narrative, if they took an interest in other people.
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What If drugs aren't as bad as we've been told? – British GQ