Drug Use for Grown Ups

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0:00:07.2 Trevor Burrus: Welcome to Free Thoughts. I’m Trevor Burrus.

0:00:09.2 Aaron Powell: And I’m Aaron Powell.

0:00:10.7 Trevor Burrus: Joining us today is Dr. Carl L. Hart, the Ziff Professor of Psychology in the Departments of Psychology and Psychiatry at Columbia University. His new book is Drug Use for Grown-​Ups: Chasing Liberty in the Land of Fear. Welcome to Free Thoughts, Dr. Hart.

0:00:24.7 Carl Hart: Thank you for having me, Trevor and Aaron.

0:00:27.4 Trevor Burrus: I’d like to start with a question that I pose to audiences when I give talks on drug policy, which is, why do heroin addicts get cages and alcoholics get treatment?

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0:00:43.0 Carl Hart: I don’t know how to answer that. That’s a loaded question. There’s a lot of shit in that question. I don’t know, you know? It all depends just in terms of how we treat addiction in this country, it’s not very progressive or even humane or not even good medicine. Maybe it has something to do with our limited skill set or knowledge in medicine, not that the knowledge isn’t out there, but our unwillingness to accept good knowledge and good science, maybe that’s what it has to do with.

0:01:17.8 Trevor Burrus: But historically too, this question, you get into it a bit in your book, that the way the users of each of those drugs are perceived seems to be a crucial, crucial thing and that historically, we have not been very kind to the image of heroin users.

0:01:35.0 Carl Hart: Yeah, no, that’s right. One of the things that we have done with drugs is that we’ve used it as a tool, particularly some drugs as a tool to vilify certain people in our society, certain groups that we don’t like. We used alcohol to vilify the Germans. We did do that the First World War, and heroin’s vilification of issues, just has been long-​lasting. So yeah, that’s why. That’s one of the reasons, yeah.

0:02:03.0 Aaron Powell: We are in the middle of an opioid epidemic. It’s striking driving through the states around Virginia and seeing them just filled with billboards for opioid addiction hotlines that I don’t ever remember seeing, and we’re hearing constant stories. And so, is it the wrong time to be talking about the question of legalizing opioids?

0:02:29.6 Carl Hart: Let’s take West Virginia for an example. West Virginia has some real problems, economic problems, environmental problems, real problems, and one way to sweep those problems under the carpet is to blame opioids and heroin and the rest of these drugs. Like you said, we’re having an opioid epidemic. I don’t know how you’re defining opioid epidemic. It is true that some people die from drug-​related overdoses, but rarely do people die from a single opioid alone. That rarely happens, and we also know that people get in trouble with opioids or they’re more likely to get in trouble with opioids when they have things like loss of income, especially when their income was supporting a family, also securing their role in that community. Now that’s gone.

0:03:23.7 Carl Hart: So let’s just think about DuPont and all the damage that corporation did to that community. We don’t blame DuPont, we blame heroin or some other drug. So these drugs, opioids just become a scapegoat for those corporations that really should be blamed for the carnage that is going on in places like West Virginia, Michigan, Ohio. All of these corporations who have poisoned the land, taken away the jobs, and then we say, “Look at those opioids, let’s go after those opioids.” And so I’m trying to help people in those places understand, it ain’t the opioids, it’s these other things, and if anything, the opioids provide some relief from the horrible conditions under which you find yourself these days.

0:04:14.3 Trevor Burrus: Your own history, getting into drug research, you talk about it more in your previous book, High Price, but when you first got into drug research, you had a very different image of drugs and what they did to people, correct?

0:04:30.6 Carl Hart: That’s true. I was like those people of West Virginia. I thought that at the time, crack cocaine had destroyed communities like the one from which I came, and so I blamed crack, I blamed all these other drugs, but then when I started to look at the evidence, the more closely I started to see that, “Wait a second, something doesn’t fit.” To give you one example, we blamed crack for high unemployment rates. The highest unemployment rates in the United States was in 1982 when our community certainly felt that. Crack didn’t appear in places like Miami, like where I’m from, until late 1985, early 1986 but yet, we blame crack for the high unemployment rates that were already there.

0:05:15.1 Carl Hart: So that’s just one example how the data just doesn’t fit, and now there isn’t this big concern about crack, but the unemployment is still there and many of the problems are still there. So it lets you know that it ain’t the drugs, it’s something else. The drugs are just convenient scapegoats for politicians to point to and for them to look like they’re heroes because it’s like all they have to say is, “We’re gonna put more cops on the street to remove those drugs out of your community.” There, they immediately, they increase some jobs for select groups of people and those jobs are dependent upon locking up other people in that community. And so, politicians are good for four years, another four years, whereas the real problems, they still remain.

0:06:08.4 Aaron Powell: When you say that we’re placing too much emphasis on the harm of the drugs, do you mean in comparison to other things or that we are… I mean, we’re doing both of these simultaneously, that we are overstating the actual, say, physical and addictive harmfulness of the drugs?

0:06:28.3 Carl Hart: Yeah, so let’s just think about this for a second. If we take any drug, from heroin to marijuana to cocaine, whatever the drug, the vast majority of the users of that drug, they don’t have a problem, they are responsible people taking care of their families, they’re doing all the things that we expect adults to do in a society. If that’s the case, if you’ve got the vast majority of any drug, vast majority user of any drugs, they’re okay, you don’t have these problems, then it tells you that it’s not the drug, it’s something else.

0:07:07.4 Carl Hart: We can look at the individuals, we can look at the conditions, and we start to look at the conditions and individual, we start to really start to see some clues about what’s going on. We know that people who have co-​occurring illnesses, whether it’s like a pain problem or whether it’s a psychiatric problem like depression, anxiety, those people are more likely to have problems with opioids and other things. They are also more likely to have problems with paying their bills. And so, if you treat those co-​occurring illnesses, now you deal with some of the things that you have attributed to opioids or some other drug.

0:07:45.3 Carl Hart: And then we can think about those people who they once were pillars of their community, they had good jobs, they were middle class, GM, the factory left, went to Mexico. Now, that person doesn’t have that well-​paying job, that person is not respected as much in that community, their sense of somebody has been diminished, and the impact of that, is that it can be tremendous. But we fail to get at those issues when we say the problem is heroin, or the problem is something else or some other drug, as opposed to focusing on let’s make sure people are treated like people, like humans. Let’s make sure adults have gainful employment.

0:08:29.8 Trevor Burrus: Now, I’m a product of Drug Abuse Resistance Education, the DARE program, which taught me a lot of things about drugs. It taught me that you could get addicted to heroin if you take it once. Also crack, I think that, especially in the ’80s, the discussion of being addicted to crack, and that sounds a little bit hyperbolic, but there’s got to be something about heroin rather than, say, aspirin that would cause addiction. It does give you happy feelings. Opiates always make me nauseous, but I know for some people, they give them happy feelings, so we can’t discard the drug and heroin itself seems to be extremely… More intense feelings than morphine, which gives more intense feelings than just regular opium, and fentanyl gives more intense feelings. So there’s something going on there, right?

0:09:19.3 Carl Hart: Yeah, there is. Heroin is good at producing euphoria, like you nicely described. But please understand that heroin and morphine are essentially the same drug. In fact, their actions on the brain, they’re the same. The Bayer aspirin company in 1874 put two acid groups on morphine and then voila, that’s heroin. Although the acid group, they don’t have any effects, not on the brain or anything. So heroin is morphine. Now, it’s true that heroin and morphine can produce euphoria, so that means that people might want it more and that means that they might go to some great lengths to get it.

0:10:03.1 Carl Hart: But, please understand, having an orgasm is a lovely thing and that’s still like one of the best things, and people will go to some great lengths to experience that. And some people get in trouble with that sort of thing. But the vast majority of people don’t, and the same is true with heroin. Heroin is not like some pleasure that is so overwhelming that you’ll do anything to get it, that’s just nonsense. I know that’s how people show it in films, in the media, but that’s just nonsense. It’s just like, we think about alcohol.

0:10:40.5 Trevor Burrus: Alcohol produces a lot of pleasure for some people, but there’s a time and place for it. And we don’t have to go to great lengths to get alcohol because it’s legal, because we can go and get it if we are a certain age, and all of these sorts of things. The same could be said if we legalized heroin, but it’s not overwhelmingly positive, such that you are going to knock over the head of your parent or someone, someone who is not likely to do that, is not going to do that. But it’s true, there are people who use heroin and they committed some crimes. They would have committed those crimes whether they use heroin or not, and to blame heroin is short-​sighted, naive and adolescent. Like, that’s what we do in this country. We have drug discussions, we’re adolescents, and it’s insulting to somebody who has been trying to grow up.

0:11:43.3 Aaron Powell: So if I understand correctly, then, what you’re saying is, we’re essentially getting the lines of causation wrong or the direction of causation wrong in terms of the destructiveness of what we perceive to be illegal drug use. The story we get told, the story we hear in DARE or in the very special episodes of sitcoms and so on is that you have the good kid who then has a run-​in in a back alley with some bad kids who maybe have cool jean jackets or something, and they talk him into taking a hit, and then his life is destroyed, and we watch the life spin out, whether it’s like the reefer madness, driving your car too fast or he stops doing his homework or something. And the drug is the thing that’s directly causing it.

0:12:33.9 Aaron Powell: But if I understand what you’re saying, you think, the actual story, maybe not all of the time, but the actual story more of the time is that there are bad things in people’s lives, things that have made them unhappy, and the drugs are a way out of that, and so the destructiveness, but is there a feedback loop? Once you start using the drugs, to get out, the addictive and physical properties of the drugs make it harder to get out.

0:13:05.3 Carl Hart: So I liked to what you said. So I don’t wanna screw that up too much ’cause it was comical, actually, but I don’t wanna screw it up, but if I can, please, I like to separate physical dependence from just this thing we call substance use disorder. That’s addiction, according to the DSM, that’s a Diagnostic Statistical Manual of the American Psychiatric Association. So physical dependence is when you take a drug for some extended period of time, and then if you abruptly discontinue the use of that drugs, your body reacts with these symptoms. Like with heroin be like a flu-​like symptoms. You might vomit. You might have diarrhea. You might have muscle aches. You might have some symptoms that make you feel unpleasant. That’s physical dependence.

0:14:03.8 Carl Hart: You can see that with something like an antidepressant. If someone has been taking an antidepressant for an extended period of time, and then abruptly discontinue, you can see some withdrawal symptoms. You can see that with nicotine. You can see that with a number of drugs, but that’s not what we call addiction. That’s not substance use disorder. That’s just the body having a normal response. You certainly get that with heroin, but when you get that with something like alcohol, it can be life-​threatening. So alcohol withdrawal can kill you. Heroin withdrawal, rarely, or it’s hard to die from a heroin withdrawal, and so I wanna separate that.

0:14:44.0 Carl Hart: Now, if we think about heroin use disorder, addiction, if you will, it’s certainly possible, but the vast majority of people who use heroin do not meet criteria for heroin addiction, and this notion that one hit and then you’re hooked is nonsense, because addiction by definition means that you have to put it to work. It requires work. You have to do it multiple times, several times, and you’ve repeated unsuccessful attempts at quitting and those sorts of things, and you have this disruption of your life function. Now, given that the majority of the users who use heroin don’t become addicted, it tells us that we have to look beyond the drug, and let’s look in that person’s environment. Let’s look at the individual, what’s going on, and now that might provide some clues about why that person is addicted to heroin or anything else.

0:15:44.8 Carl Hart: And so to uniquely blame heroin would be short-​sighted and inaccurate if people do that. So in other words, addiction has almost nothing to do with the drug, almost nothing to do with the drug, but all of our focus is on the drugs, and our focus is on the drug because the majority of people in America haven’t used heroin. So we can say some crazy stuff about heroin and be believed, just like we said some crazy stuff about marijuana, like marijuana use leads to matricide. You’ll kill your mother. We said all of these things and we were believed, but you can’t do that today ’cause more than half of American adults have used marijuana, and so you can’t tell that lie anymore and be believed, but you can tell a lie that heroin is so addictive, you won’t want anything else in your life. I mean, you’re talking to somebody who is identified, me, as a heroin user, and I can take it or leave it. And that’s how life is.

0:16:50.6 Trevor Burrus: The part of your book that is just coming out essentially as a heroin user is that one of the big, important parts of it where, and it’s something that I’ve said a lot to different audiences, where it’s interesting how we treat a certain story about using a drug. I could come in and be like, “Oh, man, I’m feeling sick ’cause this weekend I got really drunk and I passed out in the street and then woke up and I apparently had ordered a pizza and banged my knee somewhere.” And people tell those stories and say, “Okay, that’s a… You really had a good one.” But if I said the same thing where I was like, “What’d you do this weekend?” And I said, “Well, you know, I did a bunch of heroin and then passed out in the street and banged my knee and woke up and had a bunch of pizzas,” then they’re gonna be looking at you and saying, “What’s wrong with this guy? This guy is clearly a bad person because I’ve learned about heroin and there’s no good that comes from it.” And so you’re here to say there is positives to even heroin use, correct?

0:17:42.9 Carl Hart: Absolutely. Look, if there weren’t positive to heroin use, I assure you, nobody would continue to do it. But heroin use, the majority effects associated with heroin use are positive, even though we have banned the substance, and then you have these increased likelihoods of negative effects like your interactions with law enforcement, you might get arrested, you have to hide, and you might get tainted heroin, all of those sort of… Even in the face of those things, folks who manage to get heroin, good heroin, can have a tremendous amount of positive effects, namely subjective effects, like one might become with a nice dose of heroin, become more magnanimous, more forgiving, and you are more tolerant of a society that treats you like a pariah, even though you know that you’re a good person.

0:18:44.5 Carl Hart: And you are only seeking to be the best person you can be, but the society has vilified you, unjustly so. And you are able to overlook that and be forgiving and be caring, be more empathetic. All of these sorts of things are things that we claim to value in this society, and certainly someone who is using heroin certainly taps into these things, particularly if they have been thinking about these things, trying to develop as a person. Oh, it can be a beautiful thing.

0:19:22.0 Aaron Powell: It seems then, I can imagine a cultural change way out of this, then, that if we take the story of alcohol, we take the story of marijuana and now of heroin, that what you’re saying is, alcohol is actually pretty bad, marijuana, there’s not much bad about it at all, but we were told all these lies and then enough people used it, that we became convinced the lies were in fact lies, and then the kind of cultural and then legal change followed on from that. And it also seems like there’s always going to be people who… There’s a lot of people who would not take what you’re saying to heart and go out and try heroin because it is… They’re either scared or it’s illegal, they don’t know how to get it, they’re afraid of the repercussions and so on. But there’s always going to be people who are willing to do that.

0:20:08.8 Carl Hart: Let’s be clear, I don’t want anybody to take what I’m saying and go out and do heroin, based on that, that would be stupid. That would be like somebody saying, “I’m saying flying is great. Oh, I’m gonna go out and get an airplane and fly,” that’s some stupid shit. So we are having an adult conversation and we expect people to behave as such. So what we’re saying is, we’re having the conversation to open people’s mind, to look into this further, to learn about it, to the point where you can make an informed decision. That’s what we’re doing. How we go to the frame of this conversation leads to people using drugs, that’s some American adolescent bullshit. And that’s not what we’re here to do, right?

0:20:53.3 Aaron Powell: Right, I’m not saying that’s what we’re doing, what I’m saying is that there’s this cultural fear, and there’s also… So there are people who already would be interested in trying it, but there’s external factors that kind of prevent them from doing it in a way that 10 years ago, before marijuana was legalized in a lot of places, people were less worried about trying that, because they knew that how it was easier and there were less repercussions and so on. And so it seems like then, if the marijuana story just repeats, that people start trying other things as well, that the marijuana story repeats for heroin, heroin seems like in most people’s minds, the hard drug, that’s the one, when we at the Cato Institute talk about legalizing drugs, the response is like, “Oh, you wanna legalize heroin?” And maybe there are a handful, like PCP or something that people might be more scared of, but heroin, it feels like if we can get to the point where people are thinking about heroin specifically the way they think about marijuana, then the war on drugs is done.

0:21:55.6 Carl Hart: Yeah, thank you. That’s a great, great point. So let’s just be clear, one of the things you said about alcohol, alcohol is bad. Let’s be clear, none of these drugs are bad or good, that’s not the way to look at it. Alcohol is an excellent drug, under some conditions, alcohol’s the only one of these drugs that we’re talking about that you can take it orally and dose yourself and titrate, you have this level that you feel comfortable with, because alcohol’s chemical properties are such that, it’s such a small molecule, there is essentially no blood-​brain barrier. So that means that what’s in the blood… You’re drinking, and what’s in the blood, is in the brain immediately. There’s no other drug, recreational drug, that’s like that. So its properties are ideal for recreational oral use. In that sense, it’s good.

0:22:48.9 Carl Hart: As we get older, we start to worry about our liver, we start to worry about a number of things, we might have to shift our drug use to something that’s not as potentially toxic to the liver, away from alcohol to something else. And so, we have to be smart about these things. We can think about, when we were younger, we played athletics, some athletic sport. Now we can’t play it. We have to coach it. It’s the same sort of thing. We’re making these transitions as we get older, with our drug use, just like we do with anything else in our society. So heroin can be ideal in certain situations if only we packaged it right, provided the right amount of education, such that we use the appropriate route of administration for that drug.

0:23:36.1 Carl Hart: And for many of us, it would not be intravenous, it would be something like intranasal, it would be something else. The reason why people use intravenous, in part because the varying quality of the drug, and you know you wanna get the biggest bang for your buck. And that sort of pressure, that pressure brought on by the restricting or the forbidding of heroin, actually increases the dangers of the drug. And so all of these things need to be taken into consideration, and then when we do that, we start to realize, a drug isn’t good or bad, we can enhance the positive effects and decrease or minimize the negative effects, based on what we do.

0:24:27.4 Trevor Burrus: One of the more interesting chapters of your book, when you discuss the National Institute on Drug Abuse, and you are a prominent professor at a prominent American university, saying things that I think might make them mad, maybe at least the director, Nora Volkow. But how has the National Institute on Drug Abuse contributed to this unified view of drugs and how we have to approach them? And how has been your relationship with them in the past?

0:25:00.6 Carl Hart: Yeah, you can imagine. The National Institute on Drug Abuse’s mission used to be, until a year or two ago, it was to bring to bear the nation’s scientific resources to focus on drug addiction and drug abuse, so the negative effects. If the vast majority of effects that occur after these drugs are positive and you’re only focused on the negative, you can see how that will skew the scientific literature and therefore our perspective as a society. And that’s what the National Institute on Drug Abuse has done, and knowingly and willingly done, because they were incentivized to do as such.

0:25:42.8 Carl Hart: And that’s the thing that I found most abhorrent as a scientist. When we start to bring this to the attention of other scientists at the National Institute on Drug Abuse, they ignore it and say, “Well, that’s not our mission.” And say, “Well, we’re doing potentially more harm by going through this path, than actually looking at all of the totality of the data.” And so they changed their mission recently, I think, because of this pressure we brought on them, but it would be interesting to see if the behavior changes.

0:26:19.1 Trevor Burrus: You discuss the… At least the way the… I was gonna say scientific mistakes, but they’re not, they’re just the way that the papers are done, and some of these examples where the way the headlines work, this idea that marijuana permanently affects your brain, or meth amphetamine or something… In the [0:26:39.6] ____ version, those are things that we should always be skeptical of, it sounds like, in the popular science viewpoint, unless they’re a really good study which actually deals with the different ins and outs. So how do those things come together, and why are people so flippant about putting these things out that don’t actually even say what they claim to be said, or what journalists say about it?

0:27:01.7 Carl Hart: As long as you are holding the party line, and the party line is that drugs are bad, and if you or your verbal behavior is consistent with the party line, you have less likelihood of someone challenging that perspective. But when you’re going against the party line, as I am, and now you open yourself up to be challenged. And so you have to be prepared to deal with the challenges, and that’s not necessarily pleasant, particularly for somebody who is just trying to have a career, trying to go about their life and trying to publish papers, trying to get promoted and tenured and all of these things. So scientists by nature are risk averse, and so I think that’s what has happened. People have just decided that, “Look, it’s easier just to go along and you’re rewarded and you don’t stand out.” I think the Japanese have this saying that the nail that sticks up gets whacked, and so that’s how I think science or scientists have been thinking about it.

0:28:11.8 Carl Hart: But if we can, for a second, please, think about… The thing that really clued me in is when I started to re-​read American history as an adult, not like the kids, they make you learn the Declaration of Independence and those things, but as an adult, when I looked at this, it’s some profound stuff that the Founding Fathers produced, this notion of we all have these three birth rights at least: Life, liberty and the pursuit of happiness. So long as you don’t disrupt anybody else’s ability to do the same. That’s some profound stuff, and it means that you can live your life how you see fit. It’s like, that’s all we want as adults, we just wanna live how we see fit. We just wanna be left alone to our own devices, and as long as we’re not bothering anyone else, I participate in my community, I contribute, I do all of these things to help other folks, and now some person who knows less than pharmacology than I do is going to tell me I can’t alter my consciousness with my wife or whatever I decide to do. It’s insulting.

0:29:30.6 Carl Hart: I think every American should be insulted. And so I was so shocked as I read deeper at how willingly Americans gave up these rights, and it’s like, “Well, you can give up your rights, but you have no right to sacrifice mine.” And that’s why I wrote this book, and why I am out here, because I want my rights.

0:29:56.7 Aaron Powell: Do scientists working in this area… The threats to career, to prestige, to reputation and all of that… Are they… And so when you talk to other scientists who are working in this area, doing this kind of research, do you get from them like, “I wish I could be saying different. I wish I could be giving a more nuanced view on drug use or effects and so on, but I fear for this”? Or is it more that there’s a selection effect so that the people who get into this stuff are the ones who’ve been filtered through and kind of already believe the line that we all grew up with in school.

0:30:37.9 Carl Hart: So, as you might imagine, there are a variety of folks. There is a large number of people who use drugs, who use these drugs, and they toe the party line, and they believe in exceptionalism, like, “I’m special, and so I can do this, but not for the masses.” And that’s really insulting, but a lot of people believe that, and so you have the exceptionalism. And then you have a faction that believes that, “Well, it’s better to err on the side of caution. We never know what’s gonna happen in the future, so you err on the side of caution.” That’s okay if there are not potential negative outcomes that outweigh that approach, and there are far more potential negative outcomes by erring on the side of caution. One of the things we’ve done is that we have completely vilified these drugs such that we vilify the people who use them, and we increase the likelihood that we facilitate those people coming under criminal justice control, and so the costs to them are incalculable.

0:31:54.2 Carl Hart: And so the scientists don’t have to think about that sort of thing, and that’s one of the things that I have to think about, particularly when I see that kind of carnage all around me from my neighborhoods and that sort of thing. So there are a variety of positions in science. Some people come to me and say, “You know, I agree with you, and I don’t know how to step out,” and so they’re struggling with stepping out, and so hopefully they figure it out, hopefully. I’m encouraged by that, but I don’t really look for my salvation among scientists. I look for my salvation among the American people. And you present it to the American people, and they will do what they will. And then that’s all I can do. That’s all I’m trying to do.

0:32:48.8 Trevor Burrus: One of the realizations I’ve had as I’ve studied drug policy over the years is that if you drill down deep enough into the issues, why are these substances prohibited versus these substances that are allowed, if you drill down into it, you end up kind of at a strange question, which is, what is the difference between a drug, as in an illicit drug, and medicine, and who decides that question. And you mentioned earlier, antidepressants and things like benzodiazepines, for example, which are highly, highly chemical-​dependent inducing substances, and they’re also happy pills, people casually reference their happy pills, and they use them compulsively to make their life better. That’s okay.

0:33:33.5 Trevor Burrus: But if you do that with other drugs that are illegal, it’s not okay. Has that ever struck you as the irony there, too? ‘Cause almost everything applies to those drugs that a person in a white coat tells you to use, and why couldn’t we get to a point where a person in a white coat says, “Here’s a pill of opium, take as needed, as anxiety develops,” which is what they say about Xanax.

0:33:56.7 Carl Hart: Oh, trust me, those people, the people who are privileged in our society, they have their white coat people, and they are getting these drugs, whether they’re amphetamines, whether they’re opioids, whether they are benzodiazepines, whatever they are, people, they have access, and that’s how we’ve had throughout our history. And so, yeah, it struck me as strange a long time ago, but today it’s what we do. We privileged people have access, other people don’t. And I’m trying to help people to see that that’s not right.

0:34:36.6 Carl Hart: But we could think about our presidents, we have a protocol for presidents and their drug use, they have stimulants in the day to wake up and sedatives at night to go to bed. I don’t know if you guys remember back in the late ’80s, early ’90s, George Bush I came under attack for his sleeping med. Yeah, he was on a benzo called triazolam, which is Halcion. Halcion had got, started to get a bad reputation, like all sleeping pills do, and it’s not the pills, it’s the folks and the conditions, but once they are touted as, “Oh, they are miracle drugs,” and then you can be sure that they’re gonna be vilified, and Halcion was vilified.

0:35:23.1 Carl Hart: George Bush, President Bush had been taking this Halcion for a number of years without problems, and he was happy with it. And the press was starting to dog him about him using Halcion, and he was like, “Why should I change my medication that works?” And he was right. We know that presidents and people who are movers and shakers in our society, they use substances to produce better, to be alert, to go to sleep. If you’ve ever gone to a concert, you’ve ever gone to a show, have a performer, I assure you, they are psychoactively altered in some way or another, and you want them to be psychoactively altered so they can be alert and present for your show.

0:36:11.3 Carl Hart: It’s like this person is on tour, they’ve been in all of these cities over this short period of time, their body is saying, “You need to sleep,” but you are saying, “I paid for a ticket.” And so it’s like, “You take that amphetamine, you take that cocaine so you can perform for me.” But we don’t wanna deal with that as a society, but that’s how it works.

0:36:31.2 Trevor Burrus: What’s wrong with the term? This chapter was very interesting, because I’ve worked in the harm reduction sphere to an extent, filed briefs and cases about safe injection sites. I’m a lawyer personally but do drug policy and also hold conferences on harm reduction, which was the big kind of, over the last decade, 20 years, growth in how we talk about this, but you criticize the concept of at least saying harm reduction.

0:36:56.2 Carl Hart: Yeah. I just wanted people to think about using that term, and the term, just what we do in harm reduction, it’s just common sense, and so it’s just basic education or it’s just providing services to people in need. But we marry the term harm reduction to drugs, so like our number one goal is to reduce harm, that’s not our number one goal when we’re talking about drugs. I know when I think about using drugs, my number one goal is to alter my consciousness to enhance pleasure and not to reduce harm, that’s not the number one goal, and that’s not the only thing that’s associated with this. The harm, it’s one of those minor or one of those relatively rare things, but by using the term harm reduction, we bring the harms up to a prominent position and we pair it with drugs repeatedly, and that shapes how we think and act and behave around drugs.

0:37:58.0 Carl Hart: And so that’s what I’m just trying to get the community to think about. And then also when we think about supervised injection facilities or consumption facilities, the people in the field, harm reduction field, they feel as though that this is progressive and they’re doing something good. And I’m trying to say to folks is like, it’s not. And it’s not related to drugs, it’s like… ‘Cause if you have somebody who’s using drugs, any of us, and I know I don’t wanna go to a public space to use my drugs. If I had a home, I would go to my home. So how about we work on getting these people homes and then if you get… That’s the problem, their housing is a problem, not their drug use, but we pretend the drug use is the problem. And when you do that, now you have castigated all of us who use drugs as if that’s a thing, and it’s like, no, focus on what the issue is. This person doesn’t have a home. This person doesn’t have healthcare. This person doesn’t have all of these things, but we’re calling it a drug problem. That’s part of the problem.

0:39:09.1 Aaron Powell: How much of the continued embrace of the war on drugs, locking people up, preventing research into this stuff and so on, is class and race-​based, othering and discrimination? You hear the line like, “The cops can bust a whole bunch of people, harass a whole bunch of people in the street for using, buying, selling drugs in Anacostia, DC, but if they started doing the same thing in Georgetown, opinions would change really quickly,” and that seems to be this kind of constant thing is… And the opioid crisis became national news when it was white communities that were getting hit, but there was less interest when black communities and so on. Is a lot of this simply that we just can’t look past these class and race differences, and so we want to just punish people who we think are different than us or lower status or so on?

0:40:05.8 Carl Hart: Yeah, so if we could go back a little bit to the Rust Belt, like the West Virginia and Michigan, Ohio, we think about all of those jobs that left, and what are we going to do? One of the things that we have agreed to do is to make the war on drugs a jobs program, so that. So the war on drugs is a jobs program, and if we think about it as a jobs program, so we’re thinking about… What do you mean jobs? Well, we created jobs in law enforcement, law enforcement primarily for white folks who were less well-​educated in some cases, but it’s also a jobs program for the prison industry, the industries that have been propped up around prisons like hotels, restaurants, all of those. It’s this jobs program.

0:40:58.5 Carl Hart: And now we think about it from that perspective, we know that it’s incumbent upon us to make sure that the commodities in which this sort of industry is built on, bodies behind bars are primarily black and brown, because you can do that, you can put black and brown bodies behind bars without too much of a fuss from the broader society, because the broader society is already susceptible in believing that those people are somehow less moral, somehow less than we are. And so we can get away with that for some period of time, and we have gotten away with it for some period of time.

0:41:45.6 Carl Hart: Now the society is now being forced to kind of rethink this and re-​evaluate this, but we haven’t really made many changes, we have tinkered around the edges, but that means that the society still has time to figure out how do you shift those jobs? How do you make sure people stay employed who are in this sort of jobs program without being too inconsistent with this notion that we live in a democracy and we care about our people? And that’s what we’re struggling with now. So you have people on the left, the right, oh, they’re all talking about criminal justice reform. There’s really nothing to discuss, but we’re talking about it because we still haven’t figured out how to replace those jobs or how do we redirect the efforts of the people who have benefited, ’cause we talk about the war on drugs like it’s been a failure when in fact, it’s been a huge success for a number of people.

0:42:43.0 Carl Hart: I mean, you wouldn’t be talking to me if it was not for the war on drugs. My career is predicated on the war on drugs. I got paid essentially to get a PhD to study drugs all because of the war on drugs. And so many of us, we’ve benefited handsomely. And so the question is, how do you replace those jobs? How do you shift the focus of those individuals who is working in this job program?

0:43:11.7 Trevor Burrus: In 1938, a man named Henry Smith Williams wrote a book that you might be familiar with called Drug Addicts are Human Beings, which is a remarkable book.

0:43:20.5 Carl Hart: I’m afraid I don’t know it, thank you for saying that.

0:43:22.9 Trevor Burrus: Well, I’ll have to send you, it’s available digitally, but your book kind of reminds me of almost an updated version to some extent of what his book was about. Ultimately, is that the goal, to make people realize that drug users, drug addicts are human beings, and to get people to come out of the closet and say, “I use these drugs, I do it responsibly”? It seems at the end of the day, that’s what we’re looking for. These people are human beings.

0:43:53.8 Carl Hart: Yeah, ultimately for me, man, I really got a profound appreciation for our founding documents and what these folks were trying to produce here, and with the understanding that we are not there, and they knew we weren’t there, they had their own flaws, those guys themselves and society… Just give society something to aim for, and I’m trying to… I’m an expert on drugs, so I’m trying to make sure that my area is consistent with the promise, the practice of my area is consistent with the promise that… To American citizens. That’s what I’m trying to do there. The notion of people getting… Or my ask that people get out of the closet, particularly middle class privileged people get out of the closet, that ask is based on the fact that many people come up and say, “What can I do?” And so I wanted to give them something simple that they can do at Thanksgiving with their family, come out of the closet in their small circle, on a bigger scale, but it’s something that everyone can do.

0:45:03.1 Carl Hart: And we’re all participating and you don’t have to know how to write, you don’t have to be the most charismatic person, you don’t have to do any of those things. All you have to do is just say, “Hey, I’m one of those people.” So hopefully, your circle is less likely to vilify somebody for simply using a certain substance.

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0:45:39.5 Aaron Powell: Thank you for listening. If you enjoy Free Thoughts, make sure to rate and review us in Apple Podcasts or in your favorite podcast app. Free Thoughts is produced by Landry Ayres. If you’d like to learn more about libertarianism, visit on the web at www​.lib​er​tar​i​an​ism​.org.