Drug Use for Grown Ups by Dr. Carl L Hart

“I am an unapologetic drug user. I take drugs as part of my pursuit of happiness and they work” begins Dr. Carl Hart’s newly released book, Drug Use for Grown Ups: Chasing Liberty in the Land of Fear.

Dr. Carl Hart is a professor of Psychology at Columbia University and the former the Psychology Department Chair. He is a research scientist that focuses his efforts on understanding drug use and drug addiction. His personal journey took him from being a supporter of strict drug laws with harsh penalties to being an advocate of legalization and science-based public policies.

His new book, Drug Use for Grown Ups, explains why drug policies in the United States are deeply flawed, often propped up by racist appeals and unsupported by science. Dr. Hart’s personal story is also compelling and he effectively weaves his own narrative throughout the book, providing a fresh perspective on the issues.

Dr. Hart grew up in a poor neighborhood. He used and sold drugs and kept a gun in his car. After completing high school he joined the Air Force, which started him on the path of higher education. Ultimately he earned a Ph.D in neuroscience, in large part because he wanted to solve the issue of addiction, which he blamed for many of the problems his childhood neighborhood faced.

As his knowledge grew, his perspective changed. He began to see drug abuse as a symptom of a problem, rather than its cause. Unemployment, racism, classism, poverty, and boredom contribute to drug abuse. In contrast, he recognized that physically and mentally healthy people may choose to use drugs to increase their personal happiness, without imposing any cost on society and little or no harm to themselves. Recreationally he has used, and in some cases continues to use drugs to improve his life. Among the drugs he has used are heroin, MDMA and cannabis.

Drug Use for Grown Ups has been released at a perfect time. Decriminalization of cannabis has lead to a broader reconsideration of drug policies. The voters of Oregon recently voted to decriminalize all drugs, and focus resources on treating those who experience troubles. In the coming years our social policies toward drugs and their users will be reconsidered, and Dr. Hart’s message needs to be heard loud and clear in any debate.

Let’s take a moment to review some of the themes Dr. Hart touches upon.

the War on Drugs

The foundation of American drug policy has never been the public’s good health. Instead, it has been a tool used by politicians and law enforcement to consolidate power and advance personal objectives. The War on Drugs has been and always will be a war on the poor and people of color. It has been used to stoke fear in middle America, often using deeply racist rhetoric. The prize is large: A $35 billion industry. An industry that relies on one drug crisis after another to sustain it.

A now familiar refrain began in earnest over 100 years ago, when white America was first warned of the pending dangers of drug abuse. In 1914, a New York Times article announced “Negro Cocaine ‘Fiends’ Are a New Southern Menace.” (See insert). The author, an accomplished physician, warned of the “Negro fiend’s'“ homicidal propensities, and super human abilities: “[T]he deadly accuracy of the cocaine user has become axiomatic in Southern police circles…. the record of the ‘cocaine nigger’ near Asheville who dropped five men dead in their tracks using only one cartridge for each, offers evidence that is sufficiently convincing.” [FN]

But we need not look back 100 years to see this same rhetoric. The crazed super-human negro theme appeared in 1991, when Rodney King was badly beaten by Los Angeles police. The assault was justified initially by the claim King was on PCP at the time of the beating, and the use of PCP, it was reported, can give super human strength.[FN] When toxicology showed no traces of PCP, the argument became that it was reasonable for the officers to use overwhelming force because they believe King was on PCP. [FN] Missing from news reports is the demonstrated fact that PCP does nothing to increase human strength, although it can reduce the perception of pain as one is badly beaten.

When Trayvon Martin was shot to death by George Zimmerman in 2012, Zimmerman’s lawyer argued that Mr. Martin’s drug use could have made him aggressive and paranoid [FN]. While barring testimony that Martin regularly used marijuana, the judge admitted into evidence a toxicology report that showed trace amounts of THC in his body. The amounts were well below the threshold for any type of intoxication, and suggest that he had not used marijuana for at least twenty-four hours.[FN] As Dr. Hart notes, Zimmerman’s “[defense team] reverted to the familiar and tired marijuana-crazed Negro script, illustrating the enduring persuasive power of this myth.”

And in 2014, while peacocking his proposed harsh drug legislation, Maine Governor Paul LePage sounds the familiar tune of the negro menace coming to town, leaving in their wake a trail of impregnated white girls.

Wait, what? Impregnated white girls? Yup, read on (or better yet, watch the video):

I’ve got a bill into the legislature right now to take the traffickers….these are not the people who take drugs….These are guys with the name D-Money, Smoothie, Shifty. These types of guys, they come from Connecticut and New York. They come up here, they sell their heroin, then they go back home. Incidentally, half the time they impregnate a young, white girl before they leave, which is a real sad thing because then we have another issue that we got to deal with down the road.

A racist dog whistle through a bullhorn, cynically used by the Governor of one of the whitest states in the nation to stoke white fear of the black man and the drugs he peddles.

These drug laws, enacted via race-based fear mongering, are often drafted to primarily impact poor and BIPOC communities. Selective enforcement further leverages their impact on vulnerable populations. Dr. Hart notes, for example, that the infamous 1973 Rockefeller drug laws in New York State created mandatory 15 years to life sentences for the possession of small amounts of heroine or other drugs, and “More than 90 percent of those convicted under the Rockefeller laws were black or Latino, even though they represented a minority of drug users.” And one should not forget the crack cocaine laws, which provided penalties of 100 times that of powdered cocaine, despite there being little difference between the two compounds other than the manner in which they are ingested (smoking vs. snorting), and the population perceived to be using them (black vs. white).

The TROUBLED Science of Drug Abuse Policy

“There are virtually no data on humans indicating that responsible recreational drug use causes brain abnormalities in otherwise healthy individuals. ”

As a research scientist, Dr. Hart is able to go beyond reviewing the contemptible motivations and tactics of some of the anti-drug crusaders, and addresses head on the science of drug use. Drug policy should be routed in public health concerns, not in political power grabs. U.S. government action should be designed to promote those values articulated in our Declaration of Independence, which guarantees our citizens the birthrights of “life, liberty and the pursuit of happiness.” Dr. Hart correctly notes that the Declaration of Independence “proclaims each person’s right to live as they see fit, as long as they do not interfere with others’ ability to do the same. And it declares that governments are created ‘to secure these rights,’ not to restrict them.”

A common sense approach to drug regulation is for the government to balance public health concerns and an individual’s pursuit of personal happiness, using scientific data to weigh the costs and benefits of restricting individual freedom. The first step in this process is to look at objective, peer-reviewed scientific studies of drug use. It turns out this isn’t as easy as it should be.

First, studies often show the harm from drugs isn’t particularly high. For example, in 1972, Richard Nixon declared drugs to be “Enemy Number One”, and the phrase “The War on Drugs” became popularized. Also in 1972, Nixon’s own Shafer Commission released its finding, following a comprehensive, science-based analysis of the issue of marijuana use in the United States. It found “No significant physical, biochemical, or mental abnormalities could be attributed solely to their marihuana smoking” and recommended decriminalization of its possession.[FN] Rather than following the science-based findings, Nixon doubled down, with nearly weekly anti-drug assaults. It’s no surprise that one of Nixon’s closest aids later told a journalist that the War on Drugs was a war on the “antiwar left and black people”[FN]

“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.”

But what about studies that do find drugs to create some type of harm? As Dr. Hart developed his professional expertise he came to a troubling conclusion: “I came to realize that drug-abuse scientists, especially government-funded ones, focus almost exclusively on the detrimental effects of drugs, even though these are, in fact, a minority of effects.” And concluded, “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.”

Dr. Hart calls out bias at National Institute of Drug Addiction, and in particular, the roll of Dr. Nora Vokow, NIDA’s director. NIDA is a government agency, with an annual budget in excess of $1 billion. Many scientists rely on NIDA grant money to do their studies. While recognizing Dr. Vokow as an accomplished researcher, Dr. Hart also paints a picture of a bully, who overstates the negative impact that recreational drugs have on the brain, while essentially ignoring any benefits. Many scientists don’t publicly share any views that don’t follow the party line for fear of repercussion, including the loss of critical funding from the NIDA. In short, “it is difficult to disentangle politics from science when dealing with a federal organization such and NIDA.” I doubt that a research agency that names itself “National Institute of Drug Addiction” rather than the “National Institute of Drug Health” is likely to produce unbiased analysis anytime soon.

Unfortunately, the issue goes beyond the almost inevitable bias in U.S. government funded studies. Even when a scientific study is well designed, researchers can interpret the results to support their own pre-conceived notions, an issue Dr. Hart provides evidence of. The press can then take the study and further distort findings with sensational headlines. Dr. Hart takes the time to walk through several examples where these distortion have occurred as well. He also provides a basic framework for the general public on how to read studies, and to interpret their results. He even spends a fair amount of pages criticizing his own early work, which reflected a lack of working knowledge of the substances being studied, resulting in flawed study design.

Finally, the government can then selectively pick studies to support whatever policy they wish to pursue, typically those studies that will require more government and more funding for law enforcement. We have already seen how the Nixon administration ignored its own committee’s findings to pursue an anti-drug agenda. The prohibition of LSD and psilocybin was also driven almost entirely by politics, with barely a fig leaf of scientific data to support it, and only after over fifty years of active repression of scientific research is the therapeutic value of these substances once again being documented in double blind studies.

For MDMA, a drug that has always shown significant promise for treating psychiatric conditions, the DEA effectively shut down research into its benefits in 1985, arguing MDMA need not have caused any actual harm to be placed in Schedule I, and that a potential for abuse was sufficient. [FN] Today, both psilocybin and MDMA are on the verge of being available for legal use under medical supervision. Even Peter Jennings and ABC News took our politicians to task for their treatment of MDMA in a 2004 special news report. (See insert).

The hypocrisy and personal greed of politicians who promote the War on Drugs is clear. But perhaps no clearer than in the case of John Boehner, the former Republican Speaker of the House, who opposed cannabis during his three decades of government service. He retired in 2015 and three years later did a complete about-face from his prior thirty years in government by supported cannabis legalization. Why the quick change? He joined the board of Acreage Holdings, a Canadian firm that is the largest multi-state owner of cannabis licenses and assets in the United States. Shockingly, when asked about regrets in promoting an anti-Cannabis that resulted in mass incarceration, he noted “I don’t have any regrets at all” and when pressed elaborated “The whole criminal justice part of this, frankly, it never crossed my mind”.[FN] As Dr. Hart notes, Boehner doesn’t “seem to give one fuck about the extensive harms caused by the prohibitory policies he once supported.”

Stigmatization and The path to effective policy

We’ve already reviewed the tainted motivation of politicians and the challenges of bunk science, but a third factor really colors everything. The stigmatization of drug users.

A few years back, when Trippingly.net was suddenly gaining unexpected media attention, an interviewer asked why I had started a “harm prevention website”. Irritated, I shot back that Trippingly was not a harm reduction website. The confused and well-intentioned interviewer asked me what Trippingly was, if not focused on harm reduction. I stumbled at bit, before clumsily declaring it to be an “awesomeness enhancing website”.

It wasn’t an unfair question really. At the time, virtually every website that discussed the recreational use of drugs wrote disclaimers that they didn’t advocate the use of drugs, and hid behind the veil of “harm reduction.” I didn’t even immediately understand my own frustration at the question, but underlying my emotional outburst was frustration over the very premise of the question; the assumption that any website that focuses on drug use must be dedicated to reducing some type of harm, despite almost all Trippingly’s content being focused on the positives I perceived associated with the use of psychedelics and many other drugs.

Dr. Hart also bristles at phrase “harm reduction”. For him, “It doesn’t capture the complexities associated with grown-up activities such as love or war or drug use. Instead, it preoccupies us with drug-related harms. And the connection between harms and drug use is reinforced repeatedly through our speech.” Maximizing the safety of any activity, whether it be driving a new car, engaging in a new workout regime, or embarking on drug use has safety as an element, but not the primary focus. Dr. Hart suggests a better phrase would be “Health and Happiness”, which focuses on both using compounds safely, and using them in a manner that promotes personal happiness.

Again, effective public policy is one that balances the health of the user (and any concurrent costs to society) and the user’s happiness and personal freedom. The current prohibition culture fails society and users alike by creating more problems than it solves.

The use of virtually any recreational drug in an appropriate setting by a healthy user is likely to be safe at a proper dose. Troubles begin when a user takes a drug in an unsafe environment, at an inappropriate dose or when the drug has been adulterated. The criminalization of drug use has made each of these problems worse, not better.

The first step in safe drug use is education and information. A drug user should have access to clear, science-based information on how and where to take a drug, along with proper dosing. And the drug user should have access to pharmaceutical grade compounds. The quickest route to achieving this, of course, is legalization of all drugs, including the legalization of the sale and distribution of pharmaceutical grade drugs. Until that day, providing education to drug users about the effects, dosages and risks coupled with inexpensive and anonymous testing of psychoactive compounds would go a long way toward true harm reduction.

Let’s consider this proposition by examining one of the most controversial drugs, heroin. Remember, Dr. Hart has noted that he has used heroin for years, without creating any social harm, and suffering no apparent adverse medical effects. At one point he even used heroin repeatedly to develop a dependency so he could better understand withdrawal (very unpleasant, but manageable).

We have all been bombarded with news of the latest drug crisis, “the Opioid Crisis”. When we dig down a bit, the crisis is not quite what it seems. Let’s take heroin as an example. Heroin presents risks to the user. But Dr. Hart introduces us to Barbara Broers, a professor at the University of Geneva, who notes (in a quiet, and matter-of-fact tone), “Heroin is one of the safest drugs.” Dr. Hart initial reaction to hearing this likely reflects most people’s response: “I’m not exactly sure what I said or if I even said anything, but I am certain that the incredulous look on my face communicated, ‘Get the fuck out of here!’”

Dr. Hart next systematically walks through the risks and statistics associated with opioid use: most heroin users do not become addicted, but risks increase if you are young, unemployed or have co-occurring psychiatric disorders. Perhaps more importantly for public policy, the real concern is adulterants in heroin. The presence of fentanyl when a user is expected heroin can kill. The issue isn’t that fentanyl is so inherently dangerous. It’s that the effective dose of heroin is much larger than that of fentanyl, and the unexpected substitution can easily cause a user to overdose.

The unpredictability of the heroin supply has driven many users to take prescription pills, such as Percocet or Vicodin, however, these drugs contain only a small amount of opioid and a larger dose of acetaminophen. So a user chasing a opioid high might be tempted to take several pills to achieve their goal, but in doing so risk liver damage from the acetaminophen. Similarly, users that combine opioid and a sedative, such as alcohol, greatly increase their risk.

Note, that none of these issues are inherent in the use of heroin. They are caused by the prohibition of heroin, which creates both an unreliable underground market and an information gap for would be users. Dr. Hart aptly concludes: “People are not dying because of opioids; they are dying because of ignorance.”

The same argument can be made with almost all drugs that are subject to the prohibition. For example, next time you read about an overdose death on MDMA, in all probability the death is the result of the drug’s true content or strength being misrepresented to users, or the drug being mixed by the user with other drugs.

A Note on Drug Exceptionalism

Not all reform efforts rest at the feet of politicians. We all share responsibility to move the ball forward. Most readers of Trippingly are seeking information about psychedelics. The psychedelic community historically is unusually well educated, financially stable and predominantly white, although for the past few years I have witnessed a rapid and welcomed demographic diversification. Nonetheless, even with the shifting demographics, one will quickly encounter drug exceptionalism in our community.

Dr. Hart recounts being approached by a middle-aged white military veteran who shared his experience with “plant medicines” he used not to “get high” but to facilitate his “spiritual journey”. Dr. Hart felt some contempt, not anger at the man personally, but a general annoyance “with the mental gymnastics that some psychedelic users perform in order to distance themselves from other drug users.”

I have always advocated for the recreational use of drugs, along with their use for personal growth and healing. In many ways I believe the lines people draw between these categories are arbitrary and almost always self-serving. As a frequent public speaker, I often encounter drug exceptionalism. Almost always certain drugs are viewed in a favorable light, while others viewed negatively. Tellingly, which drugs belong in which bucket varies predictably depending on my median age and race of my audience.

My first observation speaking to groups is that once I declare myself as a strong proponent of the recreational use of drugs, including the recreational use of psychedelics, I find most of the audience seems to breath a collective sigh of relief. Yes, it’s ok to have a good time on psychedelics and not have to always deal with heavy stuff. Here’s your permission slip. Enjoy.

But then things get tricky. I don’t view the use of psychedelics as being in any way morally superior to the use of any other compound. I do believe (with certainty) that certain drugs require a higher experience level and diligence than others. Some drugs are plain simple to use. Others are not. However, in the psychedelic world there is a common hierarchy of drugs, which might look a little like this: Ayahuasca> mushrooms/LSD> MDMA> Adderall> crystal meth> heroin. I suspect that almost everyone in an average psychedelic discussion group would agree with this ranking if they were entitled to switch only one ranking. Dr. Hart takes this thinking to task.

First, he notes that the distinction between having “a good time” and healing or spiritual enlightenment is often difficult to parse. “Sacred experiences that positively affect one’s self-perception, worldview, goals, and ability to transcend one’s difficulties are hard to separate from one’s feelings of pleasure or happiness.” What’s more, he notes he has experienced all these effects after taking non-psychedelic drugs.

Dr. Hart goes on to note that he wouldn’t classify MDMA as a psychedelic. “It is an amphetamine, period.” And of course he is right. MDMA creates an experience that is distinct from many other amphetamines, but its chemical composition makes it an amphetamine. Moreover, the subjective experience of ecstasy is far more closely aligned with other stimulants than any classic psychedelic. Nonetheless, Dr. Hart is undoubtedly correct in his conclusion that “MDMA is categorized as a psychedelic by respectable, middle-class white folk because they use and enjoy it.”

We owe it ourselves and others to look beyond this type of elitism. Choose your own intention but abandon any pretense of superiority when it comes to our substance of choices.

Closing Thoughts

While Drug Use for Grown-Ups is an important book, it is also an enjoyable read. Some of Dr. Hart’s most moving material only relates tangentially to drugs. His relationship with his wife and son and the racism they encounter are powerful. The risk associated with vulnerability Dr. Hart describes is heart breaking, and an important read for anyone who has not experienced systemic racism. Hart’s own struggle to be open about his drug use, and his call for others in positions of power (and privilege) are important messages to the growing mass of middle and upper class people who have discovered drug use to be a powerful way to improve their quality of life.

A new War on Drugs is starting. It is a cultural war, in which we can no longer afford to allow half truths and outright lies be told. And war in which we must not allow people to be marginalized because their choice of drug is not our choice of drug.

Note: We received no revenue associated with the publication of any review. There are no affiliate links in this review. We paid the full purchase price for all copies of the book.