The Silenced Nuances of the Opioid Crisis: A Conversation with Carl L. Hart

The major thing is, legalization gives us the opportunity to control the unit dose; that is, how much substance is in each dose. What I want people to come away understanding is that our country has promised these birthrights [life, liberty, and the pursuit of happiness]. “Immediately, we detected the nice, characteristic opioid effects, including a dreamy light sedation, free of stress. That’s a consequence. The thing that is really different is the narratives that we have built up around these drugs. But the main message that I want people to take away from the book is that they have willingly sacrificed their liberty [by consenting, if tacitly, to live under prohibition and allow for the War on Drugs], for no good reason. But this woman is still trying to figure out how her son died. Can you explain what legalization means? What are the benefits of cocaine and heroin? People think that folks are dying from heroin overdoses. For example, hard drugs like cocaine and heroin? And so I don’t know. So that they can see that the use of drugs, responsibly, can enrich their lives. We can do the same with heroin. Growing up and really understanding what liberty and freedom mean, it forced me to look in the mirror and think about what I do, what I have been doing in the closet, and then about the people who have been persecuted for doing exactly the same thing but who have less privilege. And the level of cocaine in his system was five times lower than what we typically give in the lab [during studies at Columbia University]. MARCH 6, 2021

CARL HART DESCRIBES the first time that he used heroin as “deliberate,” “dreamy,” and “unremarkable.”
“We each snorted a short, thin line,” Hart writes. But maybe we have additional requirements before someone can purchase it … Drug regulation can look any number of ways, depending on the substance. In Drug Use for Grown-Ups, you, for the first time, write openly about using illegal drugs, including cocaine and heroin. Not to my face. But the important thing to remember is, this is not complicated. We put a man on the Moon, and this pales by comparison. That made it really simple. And I do. Instead, you dilute it and make it a certain proof, depending on what sort of bottle of alcohol you want.   ¤
Travis Lupick, a journalist based in Vancouver, is the author of Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction (2018). They’re okay just blaming opioids. (Hart recounts that story in his first book, High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society.) Now, with Drug Use for Grown-Ups, the author is begging the United States to better understand that science and use it to bring sanity to the country’s laws and policies governing drug use. Because I believe that this is the right thing to do. Being more generous and open and magnanimous, those are the benefits of heroin. And then, in the book, you argue that the benefits of illicit drugs outweigh the potential risks and adverse consequences. This book is a radically different vision for people. And, frankly, I can’t be concerned about that. In his new book, Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear, the author argues that it is time for Americans to strip illegal drugs of the hysteria around them, acknowledge what the scientific research actually says, and discuss these substances and the laws prohibiting them as, well, grown-ups. Let’s start with something like heroin. I don’t know what people say behind my back. Dr. On a personal level, what do you feel drugs add to your life? HART: That drugs are just chemicals. Also, I wanted to remind the public that no benevolent government should forbid autonomous adults from altering their consciousness.” 
In addition to discarding the stereotype of a disheveled junkie, Drug Use for Grown-Ups corrects a different misconception about illicit drugs on seemingly every page. You acknowledge that for a minority of users, drugs involve a risk of addiction and, for some, a risk of fatal overdose. And I think that, regardless, history will exonerate me. I was going to try to live like the man that I think that I am. Things happen with whispering campaigns and innuendo. And nobody seems to be troubled by this. And so, how could I call those people my heroes when I didn’t do the same thing when faced with a similar situation? She sent me the toxicology report and fentanyl was in his system and cocaine was in his system. What do you want people to know about illicit drugs? Regular but responsible drug use does not cause brain damage, Hart insists, backing that claim with the neuroscience that supports it; the opioid epidemic — which is projected to have killed a record 80,000 people in 2020 — is not really about opioids at all, or at least not exclusively; and the War on Drugs is harming, not helping, authorities’ efforts to reduce illicit drug use. In addition to mainstream misunderstandings of illicit drugs in general, you argue that the opioid epidemic or the overdose crisis, specifically, is misrepresented and misunderstood. “Like vacation, sex, and the arts, heroin is one of the tools that I use to maintain my work-life balance.”
While the book frames Hart’s occasional drug use as not such a big deal, his admission of using drugs is. Anything short of that is un-American, because it violates the principles of the Declaration of Independence, of which we so proudly claim to be proponents. People are also combining opioids with other sedatives, like older antihistamines, benzodiazepines, alcohol, and the like. But what about drugs like cocaine and heroin? What it would change and accomplish? If you’ve ever gone to a show where a band is playing, I submit to you that they will often be on a stimulant, maybe cocaine or amphetamines. That’s a big question. What is the truth of what people call the opioid epidemic? These substances are legally regulated, there is quality control, and then there are also requirements to obtain these substances. (Not all misconceptions Hart tackles align with the views of advocates for drug-policy reform; Hart also notes there is still no evidence to suggest that the Silicon Valley fad of microdosing hallucinogens like LSD and psilocybin in any way improves performance outcomes.) 
Hart has come a long way to write this book. “My heroin use is as rationale as my alcohol use,” Hart continues in the book. We’ve been together for 28 or 29 years and, over time, you go through stuff, like every relationship. But in practice, we haven’t lived up to that promise. — they stood up in the face of people’s liberties being taken away. Is there anything else that you want grown-ups to know about drugs? What are the consequences of this misunderstanding of the increase in overdose deaths in the United States? We talked, reminisced, laughed, exchanged ideas, and carefully documented our drug effects. Follow him on Twitter: @tlupick. But again, that is the point. That’s why people take cocaine. Hart is a tenured professor of neuroscience at Columbia University and from 2016 to 2019 served as the school’s department chair of psychology. “I wrote this book to present a more realistic image of the typical drug user,” he writes. Heroin is not that different from alcohol. Carl Hart recently spoke to me about his new book, why he chose now to disclose his drug use, and what Americans’ misperceptions of illegal drugs mean for the people who use them. The user has to be a certain age, and so there is a sort of legal regulation … I see things like cocaine and heroin legally regulated just like we do alcohol, tobacco, and cannabis. I don’t want to dwell on this because that would go against the ethos of your book (that illicit drug use is not always the big deal that most people believe it is). In addition to presenting evidence-based information about illicit drugs, this book stands as an argument for legalization. When I talk about my drug use — which, you point out, rightly so, that my drug use is not the point of this book — but when I talk about it, I need to make sure that people clearly understand, I’m talking about taking drugs with my wife. Can you discuss those benefits? That’s one of the messages that I want people to take away from the book. And it [MDMA] is really helpful there … Another one of the things that my drug use helps me with is it helps me to be more magnanimous and forgiving, and to think about other people, to think about things from their perspective … Those are some of the beneficial effects that I get from drugs. But to die from a heroin overdose is actually quite difficult … The reasons why folks are dying is contaminated drugs: drugs contaminated with something like a more potent opioid, like a fentanyl analog, for example, or something else. With cocaine, the benefits of cocaine are that you are more euphoric … It’s a great social lubricant. CARL L. And in the process, what they’ve done is sacrifice my liberty, too. I thought, “What kind of a man am I if I don’t stand with folks who are vilified unjustly?” My heroes — people like Rosa Parks and Martin Luther King Jr. ¤
TRAVIS LUPICK: The title of the book is Drug Use for Grown-Ups. Because we don’t know how these people are dying; therefore, we can’t tell them how to avoid this potential consequence [a fatal overdose]. In academia, people aren’t always direct. Let’s make it simple. There are all kinds of benefits to cocaine. Maybe there was something else in this guy’s system that was at toxic levels that they didn’t measure for. He has spent the last two decades researching drugs’ neuropharmacological effects and humans’ behavior on them. There is less honor in academia than there is on the streets. He’s what most people regard as a so-called important person — someone who makes a decent salary and carries the responsibilities that come with it, who people listen to, and who also has a lot to lose should authorities (or colleagues) learn he is doing something illegal. 
And so by discussing his use of heroin, cocaine, and other drugs in a book that is likely to land on best-seller lists across the country, Hart has taken risks. They don’t have the right to do that. “A responsible professional who happens to use drugs in his pursuit of happiness. These two things — contaminated drugs and the combining of opioids with other sedatives — increase the likelihood of people dying … So I think that we are doing this country a great disservice [by focusing exclusively on opioids]. Has there been much of a reaction to this disclosure? What risks did you feel it would entail? Maybe it will look slightly different for each of those substances. After they had worn off, we called it an evening and went home.” 
The experience was rather mundane, which is one of Hart’s reasons for sharing it. So neither of those drugs reached levels that would be potentially toxic to someone. For example, you don’t want to put so much alcohol in a bottle that it is likely to kill you. Last week, for example, I got a phone call from a woman whose son died — a drug-related death. But I want to ask, how did you arrive at the decision to speak openly about using drugs? But the level of fentanyl in his system was something like two nanograms per milliliter, which is nothing, which is very low. And talking about us connecting, taking something like MDMA [commonly known as ecstasy or molly], for example, where that drug is really good at facilitating empathy, openness, caring, patience — all of those kinds of things that are really good for a relationship. Legalization is basically what we do with tobacco and alcohol. And I’m upset about that … When we talk about liberty, it means that you have the right to live free and to live as you see fit … I’m asking people to not sacrifice my liberty. But they called this a cocaine-fentanyl death, even though there is no evidence for that based on what they had … They didn’t do an autopsy because they figured he was a drug user and the toxicology [screen] showed that drugs were in his system, so they thought they were done. There’s an increasing number of reputable research institutes looking at the therapeutic applications of MDMA, and so I think people are beginning to understand that there are potential benefits associated with that drug. And so I had to decide whether or not I believed in this strongly enough to go to jail.