A Columbia professor argues against our drug puritanism

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Exploring the promise — and blind spots — of Carl Hart’s “Drug Use for Grown-Ups.”

It’s not often that I read a book and find myself torn over its thesis, but that’s what happened when I picked up Carl L. Hart’s Drug Use for Grown-Ups.

Hart is a neuroscientist and a professor of psychology at Columbia University. For roughly two decades, he has studied the behavioral and neuropharmacological effects of drugs on human subjects.

But his work — and this book in particular — pushes the boundaries, both within his field of research and within the public discourse more generally. Part of Hart’s argument is uncontroversial: America’s drug regime is a failure. The drug war has done almost nothing to curb drug use and has instead subsidized a sprawling prison-industrial complex and helped militarize police departments across the country. This is now so obvious that it’s practically become bipartisan conventional wisdom.

But Hart goes further than this. He believes our entire way of talking about drugs and addiction is not just wrong — it’s actively blocking the way to a society that lives up to its ideals of liberty and the pursuit of happiness. All drugs, he argues, should be fully legalized, and instead of punishing or shaming people for drug use, we should focus on helping them use drugs as wisely as possible.

As you can imagine, Hart’s research has its share of critics, even as mainstream attention to his work has grown. He makes some categorical claims that threaten years of consensus, offers data points that critics say are based on selective misreadings of the scientific evidence, and is fairly unsparing in his criticism of those who disagree with him. He occupies a unique position in the discourse on drugs — an academic with an activist’s zeal for his cause — and I thought a conversation with him about “responsible drug use” and the points of tension in his research would be illuminating.

I should say up front that my life has been improved by the use of drugs, particularly psychedelics. And I believe that people should be able to experiment with their own consciousness however they want, as long as they’re not harming other people. But when we’re thinking about drugs at the societal level, things get more complicated.

All of which is to say this is a difficult conversation. Some — not all — of my reservations about Hart’s thesis faded the more we spoke. And while I still don’t buy his claim that it’s “misleading” to argue that a drug like LSD is less addictive than, say, heroin, he still has some worthwhile insights into drugs and their role in human life.

A lightly edited transcript of our conversation follows.

Sean Illing

You wrote this book for lots of reasons, but one of them is that you’re very unhappy with the way we talk about drugs and addiction in this country. What would you say is your biggest complaint on this front?

Carl Hart

The way you ask the question captures the problem: Drugs and addiction have nothing to do with each other, but we always marry them. That’s probably my biggest gripe. My question is always, when are we allowed to grow up in this country? You and I both served our country in the military. We both did our part. I contribute to my community. I don’t want anyone telling me what to do as long as I’m not hurting anyone else.

I wrote this book because I want people to think harder about their own liberty and what it really means to be an American. We talk a lot about life, liberty, and the pursuit of happiness, but do we really know what it means? And I’m writing about liberty and drugs because it’s the thing about which I know the most. If I was an expert in some other area or issue, I’d interrogate that as an issue of liberty.

Sean Illing

Separating drugs from addiction is a complicated concept, and I’m not quite sure I understand it, but I’ll come back to that. When you started researching drugs, you were very much on the other side of this debate. Which is to say, you bought all the anti-drug propaganda from the ’80s and ’90s.

So how did your work transform your views?

Carl Hart

Like you said, I was down with the whole “just say no” thing. I thought drugs were the cause of all these problems in my community and other communities. But over time, I noticed discrepancies. We had one of the highest unemployment rates in 1982, for example, and people were blaming crack. Yet crack didn’t show up on the scene until 1985 or 1986, so the numbers didn’t fit.

And in the research I was doing, I began to realize that the stories I was told about drugs just didn’t make sense. It didn’t fit the data. For example, we bring people into the lab and we give them the very drugs that we have vilified, and we give them thousands of doses every year. And you don’t see any of these negative effects that we see reported in the media, that we see in documentary films or in popular culture. Even the rationales I often saw in the world of science didn’t square with the actual evidence we were gathering in the lab.

There was just a ton of dissonance between what I had always heard and what I was seeing with my own eyes. The reality is that the predominant effects of drugs on the subjects we studied were positive. And the reality is that the overwhelming majority of people who use drugs do not get addicted. This is true whether we’re talking about heroin or cocaine or marijuana or you name it. So there were all these inconsistencies and eventually I had to look at the information in front of me and reevaluate my own beliefs.

Sean Illing

So let’s talk about what you consider the confusion around drugs. People often — and I’ve done this in my own reporting — draw distinctions between different drugs. We’ll put drugs like heroin or meth in one box and we’ll put something like psilocybin or other psychedelics in another box, and the conventional wisdom is that the latter class of drugs are safer (less addictive) and therefore fundamentally different from the former class of drugs.

You say this is a bullshit move, and there’s no evidence to justify it. Can you explain why?

Carl Hart

When people take psilocybin, they are seeking to alter their consciousness some way for some purpose. Typically, the users of psilocybin are middle-class or higher, they’re well-educated, and their use of the English language is more sophisticated than the typical heroin user. And what you’ll often hear from psychedelic enthusiasts is a lot of lofty talk about seeking higher planes of consciousness or religious transcendence or whatever.

But here’s the thing: A person doing heroin is often doing the exact same thing; they just don’t have the same language to describe it. But ultimately it’s all about the pursuit of happiness, of pleasure, of greater well-being.

Now the folks who are advocating for psychedelics know how the American psyche thinks about heroin and crack, so they’ve worked really hard to separate themselves and these drugs from those people and those drugs. Because the image that is conjured up in your mind about the average heroin user is not desirable. And so you have to do whatever you can to separate yourself from that person because what you’re doing is different when in fact it’s the same shit.

Sean Illing

Most people don’t get addicted to drugs — probably far fewer than most of us realize — but it’s still true that lots of people do get addicted, right? Do you think that’s just something we should accept as the price of a free society? I mean, your own research suggests that 10 to 30 percent of people who use drugs become addicted. Even if we take the low end of that estimate, it’s not insignificant.

Carl Hart

Something like 40,000 Americans die every year in car accidents, and that’s been true for 30 years or so. Nobody’s talking about banning cars. Instead, what we do is we try to implement safety procedures or safeguards such that we decrease the likelihood of that happening. We put in speed limits, we make people wear seat belts, etc. We do our best to make it as safe as possible.

Why would we behave any differently when it comes to drugs? Does anyone even ask if drugs are uniquely more dangerous than, say, driving a car? Because the evidence is that they’re not, and that’s all I’m saying. I’m not saying that people are not going to get in trouble. Anything worth doing in life is not without risks. I don’t want anyone telling me what risks I can take and what risks I can’t, so long as I’m not hurting other people. It’s really that simple.

Sean Illing

Just looking at the data we have, it seems driving a car is less dangerous than using opioids, since way more people drive cars than use opioids and still thousands more die from opioids.

Carl Hart

I don’t know how you came to that conclusion, given that neither you nor I know how many people die from opioids. Knowing that a person had an opioid in their body at the time of their death doesn’t tell you that the opioid caused the death. This is particularly relevant in light of the fact that the majority of drug overdose victims have multiple drugs in their system.

In addition, a substantial proportion of these individuals ingested tainted drugs. The point is that we still have a responsibility to try to enhance the safety of all these activities. Banning an activity merely pushes it into the shadows, where the risks will undoubtedly increase.

Sean Illing

I’m thinking about this in the context of the opioid crisis, which you say has been covered terribly by most media outlets. Actually, before I say more, can you tell me why you object so strongly to the way the opioid story has been covered?

Carl Hart

It’s a fact that Americans have lost their lives as a result of opioids. But when you look at the numbers, you start to realize that the likelihood of dying from use of opioids alone is extremely low. So why are people dying? They’re dying because often they’re taking multiple drugs, they’re mixing opioids with other sedatives, which is incredibly dangerous. So the cause of death isn’t opioids in these cases, but that’s how it often gets reported. The focus is on opioids when in fact the risks of death result from combining opioids with other antihistamines or with alcohol or various other drugs. These details matter, and it would be helpful if that was made clearer.

And another reason people are dying is because they’re getting tainted drugs. This is probably the primary reason they’re dying now, from something like fentanyl [an extremely potent synthetic opioid used in legal settings to treat severe pain]. But we could solve that problem so easily just like they did in Spain, just like they’ve done in Austria, Switzerland, and the Netherlands. Just have drug-checking services that will allow people to understand the composition of their drug. All they have to do is submit anonymously small samples of their drugs, and they get a printout of what’s contained in that substance and some education about each of the agents in that substance. That would take care of so much of this thing that we’re calling a problem.

I get parents who email me all the time after their kid has died, and they want to know about the toxicology. And I look at the toxicology reports in these cases that are classified as “opioid deaths.” What I see time and again is various drugs in the system, some of which may be tainted, but the parents are told it’s an opioid death. And look, it’s horrible, just horrible. But the issue isn’t opioids — it’s tainted substances and mixing drugs and using drugs recklessly.

Sean Illing

You mentioned Spain, Austria, and a couple other countries, but have any of these places emulated fully the drug model you’d like to see in the US? If so, what were the results?

Carl Hart

At the moment, no country has legally regulated all of the drugs discussed in my book. I think several countries are on the right track, including Portugal and Switzerland. Ultimately, it would be ideal for countries to regulate the drugs people seek in a similar way that alcohol is regulated.

Sean Illing

So why do you think it’s so important to divorce addiction from drugs?

Carl Hart

Addiction has everything to do with concurrent illnesses. Someone may have pain issues not being treated, or schizophrenia, or anxiety, or depression. People with these conditions are far more likely to become addicted. They have to approach drug use very differently from people who do not have these conditions. So that’s one thing.

And another thing is how we talk about people in, say, the Rust Belt, where the opioid crisis has hit especially hard. So many of these people used to be employed in factories that have been shipped to other countries or scaled back. These were middle-class jobs and now they’re gone. So you have people who lost their role in society, whose life has been drained of meaning, and that’s what drives addiction, whether it’s alcohol or opioids.

And then you have people who just aren’t mature enough to use drugs responsibly. When I was younger, I did a lot of stupid shit and probably met the criteria for being an alcoholic. But as I developed and learned skills, that changed. So if we are concerned about drug addiction in general, we have to focus on the root causes. Marrying drugs and addiction leads to focusing on drugs and in turn hiring more cops who cannot deal with the underlying problems.

Sean Illing

I’m still confused about your argument against drawing any distinctions between drugs. I cover some of the emergent research on psychedelics and mental health, and what I hear over and over again is that psychedelics like psilocybin are “non-toxic” and “non-addictive” and that drugs like alcohol or heroin are toxic and highly addictive.

Is that just misleading?

Carl Hart

It’s misleading. So the way we model addiction is by studying rats. Rats will readily take cocaine. If you put an intravenous catheter in their cage and allow them to receive injections of cocaine, they’ll learn how to press a lever and take it. You have to deprive them of food and all kinds of things to get them to do it, but they’ll do it if you deprive them of certain things. Now if you take a drug like psilocybin or LSD, and you try and teach rats to self-administer, they won’t do it. We’ve worked hard to get a different result, but they just won’t do it.

So we look at these studies and we conclude that rats will take cocaine, but they won’t take these other drugs. That’s our model of addiction. Cocaine is more addictive than psilocybin.

Now, this falls apart when you really look at it carefully. Because you look at something like nicotine, rats won’t take it. It’s a toxic substance, and they won’t do it. But humans, it’s the most addictive drug that we have. But that’s never mentioned in a lot of these discussions. Rats won’t really take alcohol either, unless you make it really sweet and essentially trick them into taking it.

My point isn’t that all drugs are the same. It’s that we selectively present a lot of this data, which is why I call it misleading. The reality is that any drug can become addictive under the right conditions and any drug can be seen as non-addictive under the right conditions.

Sean Illing

Is it empirically accurate to say that some drugs are in fact more addictive than others?

Carl Hart

There’s not enough evidence to make that blanket statement, unless you’re merely talking about one component of addiction. If we’re talking, for example, about physical dependence, then we have to say that opioids produce a lot of physical dependence, whereas drugs like LSD do not.

[Author’s note: As reported here, there is considerable research on the comparative dangers of various drugs, and most researchers argue that the risks are not equivalent and that drugs like heroin or meth are more addictive than LSD or mushrooms.]

Sean Illing

The physical dependence component seems pretty significant, but I’ll just ask what’s the strongest argument you’ve heard on the other side of this debate?

Carl Hart

Damn, that’s a good question. Honestly, what I constantly hear is some variation of “Drugs are bad because we said so.” Drugs have been so stigmatized for so long, and we’ve been conditioned to think of them as inherently bad, that these narratives are just hardwired into us at this point. But I just haven’t heard an argument based on logic and evidence that makes me rethink my fundamental position. I’m not saying that argument doesn’t exist, but I am saying I haven’t heard it.

Sean Illing

What’s the biggest price we pay for the hysteria and stigmas around drugs?

Carl Hart

I think we pay a tremendous cost by curtailing people’s liberties. And it’s difficult to estimate or calculate that price.

There is a reason that we are required to learn Patrick Henry’s speech, “Give me Liberty or give me Death.” We also pay a great deal in terms of using drug hysteria to divert attention away from the real problems. Numerous preventable deaths occur each year by not providing drug-checking services, by not removing Tylenol from oxycodone formulations, by not educating people on the risk of specific drug combinations.

In general, the nation’s war on drugs pits its practice (restricting specific groups’ liberty) against its promise (life, liberty, and pursuit of happiness). The cost of this fundamental inconsistency is incalculable.