A Neuroscientist’s Case for Legalizing All Drugs
A Neuroscientist’s Case for
Legalizing All Drugs
We’ve assigned moral values—usually with racial and class implications—to most drugs. Those moral values are often not grounded in science or reality, but they play a starring role in how we think about, legislate around, and prosecute the use of any particular drug. Carl Hart, PhD, is trying to change that. Hart is the psychology department chair at Columbia University, and for decades, he’s been studying the effects of drug use on the brains of both animals and humans.
When he got into the field in the ’80s, he believed drugs like crack cocaine were destroying communities like the one he came from. He thought that if he could understand how drugs affect the brain to cause addiction, he could start to address the effects they have on society. But the more Hart ran experiments in the lab—and experimented personally—the more his position evolved.
Reading Hart’s newest book, Drug Use for Grown-Ups is enlightening: He covers the effects of responsible drug use, drawing on history, scientific research, and personal experience, as he makes the case for the legalization and regulation of all drugs. Even if you have warmed to the conversation around psychedelics, the ideas in this book—and in this Q&A with Hart—will almost certainly challenge you. Which is why they’re worth reading: Our country has a drug problem that’s entirely separate from the drugs themselves.
A Q&A with Carl Hart, PhD
This book is about the legal regulation of drugs, and it’s based on a simple concept: liberty. As I’ve taken a deep dive into writing this book, it’s remarkable to me that I’m only recently coming to this position. We hear all the time that we are the freest country and the freest people in the world, but at the same time, the government can tell you what you can and can’t do with your own body and your own consciousness. I don’t know how responsible adults are okay with that. I certainly am not.
This book talks about drug use for responsible adults—the key word here being “responsible.” Responsibility is a lot of work. You have to be reflective. You have to think about the impact of your actions on others, and you have to make sure that in the process of pursuing your own freedom and happiness, you are not somehow impeding someone else’s right to pursue freedom and happiness. Responsible adults take care of themselves. They eat well. They sleep well. They look after their families. They contribute to their communities. If I am a responsible adult who does all of these things, why is somebody who is less informed than me going to decide what I can choose to put in my body—how I should pursue happiness and pleasure? That doesn’t sit right with me.
People have discovered that chemical agents allow them to alter their consciousness to their level of satisfaction. Alcohol, tobacco, and caffeine are all drugs that are legal and regulated. They can all alter your behavior. They’re all more or less socially acceptable to use, and they can all cause harm if used irresponsibly. But we have systems in place to regulate these drugs and educate people to use them responsibly. With alcohol, for example, we have a lot of public knowledge and accessible information as well as cultural education available through movies and other media.
We’ve started to build this structure and knowledge with marijuana and psychedelics, although they are not yet federally legal. But with drugs like heroin and even cocaine, we haven’t done that sort of thing.
We’ve developed this hierarchy of drugs and drug users that doesn’t make sense: If you use psychedelics, that’s okay, but if you use heroin, that’s not okay. It has a lot to do with who the perceived users of a particular drug are in the public mind.
Psychedelics are a big part of the current conversation around drug legalization, and while they are not yet legal, it is becoming more mainstream to use them and talk about using them. Many of the folks who are using psychedelics are middle-class White folks, and they don’t want to be associated with drugs used by poor Black and Brown people. So these folks may feel comfortable talking about their use of drugs like psilocybin and ketamine for exploring altered states of consciousness. Then consider phencyclidine, or PCP, which is more visibly used by Black people: PCP is chemically similar to ketamine, but this same group of people who use psychedelics would likely never put PCP in the same moral category of drugs or ever admit to using PCP.
That’s in part because of the stories and propaganda that have been associated with PCP. Police have said somebody who’s on PCP has superhuman strength and requires excessive force to control or can be shot twenty-eight times and still be coming at them—all of which is simply not true. It’s an urban legend perpetuated by racism and irresponsible reporting. But because of that negative association, psychedelic users have abandoned ownership of PCP as a psychedelic. It’s also possible that many psychedelic users and advocates don’t know that PCP is a psychedelic at all.
Think about methamphetamine versus Adderall. Adderall contains d-amphetamine. That’s the primary agent in it, and the amphetamine and methamphetamine are the same drug here. They have a slight chemical modification: Methamphetamine has an additional methyl group. But they produce the same effects in humans. If you smoke Adderall, you get the same effects that we typically associate with meth. If you take methamphetamine by mouth, you get the same effects we associate with Adderall. We’ve done the studies to know that.
Yet the stories surrounding those drugs are wildly different. People think of methamphetamine as being this horrible drug associated with poor White folks, and it used to be associated with the gay community in disparaging ways. Whereas Adderall is something people take by prescription. The cultural story around Adderall use is completely different. It’s fine; it’s acceptable. But the methamphetamine story is that it’s not acceptable, and that story ultimately comes from the drug being associated with people we don’t particularly like.
The same is true with other analogous drugs. Take crack versus powder cocaine: Crack has been associated with poor Black folks, whereas powder cocaine is largely associated with wealthy White people. Even though they’re the same drug—they produce the same effects—the stories around them are wildly different, and those stories being different allows us to continue to vilify people we don’t like. The same is true with heroin and morphine. Heroine and morphine are essentially the same drug, but the stories surrounding them are wildly different. All of these narratives are maintained in the service of manipulating the public and continuing our subjugation of specific groups.
One of the greatest myths is that most people who use drugs like crack cocaine and heroin are addicted. That’s simply not true. The vast majority of people who use any drug don’t become addicts. Another myth is that recreational drug use causes irrevocable brain damage, meaning neuron injury or death. But the drugs that people take in recreational doses have not been shown to cause damage to the brain. The evidence to support that supposition is weak and overstated, and it has serious implications for how we make and enforce harmful drug policies.
One major myth I want to address is specific to opioids. People think that folks are dying because of opioid use, period. And the truth is that folks who die with opioids in their system usually die because of ignorance. Let me break that down for you: When people die with an opioid in their system, we count that as an opioid death, but the vast majority of these people have multiple drugs in their systems. And so we often don’t know which agent caused the death.
Mixing opioids with other powerful sedatives, like antihistamines or large amounts of alcohol, becomes dangerous and sometimes deadly. We could do a better job at informing people that if you’re going to be taking sedatives like opioids, don’t mix them, especially if you don’t have much experience with sedatives. Because when you mix sedatives, it increases the potential for respiratory depression and, ultimately, death.
When we think about prescription opioids—something like Percocet or Vicodin—those medications contain a low dose of opioid and a large amount of acetaminophen, or Tylenol. These medications contain about five to ten milligrams of an opioid in a pill. A regular opioid user can typically take 50 or 100 milligrams of an opioid and be fine. But then the medication may also contain 325 milligrams or so of acetaminophen per pill. If they’re taking enough for an opioid effect, that takes them up to about four to five grams of acetaminophen. And that dose of acetaminophen over several consecutive days can cause liver toxicity. In fact, acetaminophen poisoning is the number one reason for liver toxicity. These are things that the general public, including many opioid users, just doesn’t know. That’s how people die because of ignorance. We can easily deal with this if we’re willing to have honest conversations and education about drugs.
Death by opioids alone is a rare sort of death unless it follows a long period of abstinence, when the individual might be more susceptible to overdose, or if they take something like fentanyl. Oftentimes, people take fentanyl unbeknownst to them in place of what they thought was heroin, and they take that fentanyl in the same dose as they would take the heroin they thought they were taking. That can be fatal.
The solve for all of these problems—and for the fentanyl problem specifically—is drug testing, in which people can submit small amounts of their drug and get back an analysis of the chemical composition of that substance. If they submit heroin and it contains something like fentanyl or some other impurity, they can choose not to take it or to take smaller doses of it. These drug-checking facilities are not expensive. If we really cared about our population, we could do that to lessen people’s ignorance about what they are taking.
Back in the mid-’80s, we were spending about $1 billion a year on antidrug efforts. Today we’re spending over $35 billion a year on this “war on drugs”—I don’t like that language, but that’s what people use. Now keep in mind that rates of drug use haven’t changed in that time. We say we’re fighting this war to decrease drug use, but it’s clearly not working. The war on drugs has another use to us, though, and that’s to make sure that we continue to fund various groups in our society.
Like law enforcement: Law enforcement gets somewhere between two thirds and three fourths of that $35 billion antidrug budget. The whole economy of prisons is reliant on the funds from the war on drugs. That’s why it would be a difficult thing to change. This past summer, we’ve heard people advocate to defund the police across the country. People who study drugs have been calling for this forever; we saw the abuses of this system. It got so bad that police organizations didn’t even have to prove that you were guilty of a crime if drugs were involved. They could take your property, and they could take your children.
When we think about who is targeted by these antidrug efforts, we come back to who is considered unacceptable in America: largely Black people and specific Latino groups, like Puerto Ricans in New York and Mexicans in California and Texas. This situation we think is a war on drugs is just another mechanism by which we exert White supremacy and the subjugation of these various racial, ethnic, and socioeconomic groups.
When we look at the political landscape around drugs the United States, we can see how the path from demonization to legalization has worked up until now. In 1992, when Bill Clinton was running for president, he couldn’t even admit that he had smoked marijuana, right? In 1992, you could lie to people about the purported horrors of smoking marijuana. Today, it’s a bit more difficult to lie to folks—you won’t be entirely believed. Now sixteen states have legalized recreational marijuana, and there is a push for legalization at the federal level.
This shift is driven by two things happening at the same time: Better education about drugs, which we’ve talked about, and drug users coming out of the closet about their drug use. The reason it’s important for responsible people to talk openly about their drug use is that if they don’t, it’s easy to pigeonhole drug users as irresponsible derelicts, a menace to society, and people who are easy to look down upon. And that image is just inconsistent with reality. While there are certainly irresponsible people who use drugs, it’s not the majority of folks. If we have only that undesirable image of irresponsible drug users, our approach to drug legalization and regulation will not change. We have to get people out of the closet. And we have to educate people on the real science of drugs.
Carl Hart, PhD, is the author of Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear. Hart is the chair of the Department of Psychology and the Ziff Professor of Psychology at Columbia University. He has published extensively on neuropsychopharmacology and drug policy, and he coauthored the textbook Drugs, Society, and Human Behavior with neuroscientist Charles Ksir. He is an advocate for rational drug policy.
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