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

March 6, 2021   •   By Travis Lupick

CARL HART DESCRIBES the first time that he used heroin as “deliberate,” “dreamy,” and “unremarkable.”

“We each snorted a short, thin line,” Hart writes. “Immediately, we detected the nice, characteristic opioid effects, including a dreamy light sedation, free of stress. We talked, reminisced, laughed, exchanged ideas, and carefully documented our drug effects. 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. 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.

“My heroin use is as rationale as my alcohol use,” Hart continues in the book. “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. Hart is a tenured professor of neuroscience at Columbia University and from 2016 to 2019 served as the school’s department chair of psychology. 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. But again, that is the point. “I wrote this book to present a more realistic image of the typical drug user,” he writes. “A responsible professional who happens to use drugs in his pursuit of happiness. 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. 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. (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. He has spent the last two decades researching drugs’ neuropharmacological effects and humans’ behavior on them. (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.

Dr. 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.

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TRAVIS LUPICK: The title of the book is Drug Use for Grown-Ups. What do you want people to know about illicit drugs? For example, hard drugs like cocaine and heroin?

CARL L. HART: That drugs are just chemicals. Heroin is not that different from alcohol. The thing that is really different is the narratives that we have built up around these drugs. That’s one of the messages that I want people to take away from the book. 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. And in the process, what they’ve done is sacrifice my liberty, too. 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. They don’t have the right to do that.

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. What is the truth of what people call the opioid epidemic?

That’s a big question. Let’s make it simple. Let’s start with something like heroin. People think that folks are dying from heroin overdoses. 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. People are also combining opioids with other sedatives, like older antihistamines, benzodiazepines, alcohol, and the like. 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]. 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]. And nobody seems to be troubled by this. They’re okay just blaming opioids.

What are the consequences of this misunderstanding of the increase in overdose deaths in the United States?

Last week, for example, I got a phone call from a woman whose son died — a drug-related death. She sent me the toxicology report and fentanyl was in his system and cocaine was in his system. But the level of fentanyl in his system was something like two nanograms per milliliter, which is nothing, which is very low. 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]. So neither of those drugs reached levels that would be potentially toxic to someone. Maybe there was something else in this guy’s system that was at toxic levels that they didn’t measure for. 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. But this woman is still trying to figure out how her son died. That’s a consequence.

In Drug Use for Grown-Ups, you, for the first time, write openly about using illegal drugs, including cocaine and heroin. 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). But I want to ask, how did you arrive at the decision to speak openly about using drugs? What risks did you feel it would entail?

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. 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. — they stood up in the face of people’s liberties being taken away. And so, how could I call those people my heroes when I didn’t do the same thing when faced with a similar situation? And so I had to decide whether or not I believed in this strongly enough to go to jail. And I do. That made it really simple. I was going to try to live like the man that I think that I am.

Has there been much of a reaction to this disclosure?

Not to my face. I don’t know what people say behind my back. In academia, people aren’t always direct. Things happen with whispering campaigns and innuendo. There is less honor in academia than there is on the streets. And so I don’t know. And, frankly, I can’t be concerned about that. Because I believe that this is the right thing to do. And I think that, regardless, history will exonerate me.

You acknowledge that for a minority of users, drugs involve a risk of addiction and, for some, a risk of fatal overdose. And then, in the book, you argue that the benefits of illicit drugs outweigh the potential risks and adverse consequences. Can you discuss those benefits? On a personal level, what do you feel drugs add to your life?

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. 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. We’ve been together for 28 or 29 years and, over time, you go through stuff, like every relationship. 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.

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. But what about drugs like cocaine and heroin? What are the benefits of cocaine and heroin?

Being more generous and open and magnanimous, those are the benefits of heroin. With cocaine, the benefits of cocaine are that you are more euphoric … It’s a great social lubricant. There are all kinds of benefits to cocaine. That’s why people take cocaine. 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.

In addition to presenting evidence-based information about illicit drugs, this book stands as an argument for legalization. Can you explain what legalization means? What it would change and accomplish?

Legalization is basically what we do with tobacco and alcohol. These substances are legally regulated, there is quality control, and then there are also requirements to obtain these substances. 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. Maybe it will look slightly different for each of those substances. The major thing is, legalization gives us the opportunity to control the unit dose; that is, how much substance is in each dose. For example, you don’t want to put so much alcohol in a bottle that it is likely to kill you. Instead, you dilute it and make it a certain proof, depending on what sort of bottle of alcohol you want. We can do the same with heroin. But maybe we have additional requirements before someone can purchase it … Drug regulation can look any number of ways, depending on the substance. But the important thing to remember is, this is not complicated. We put a man on the Moon, and this pales by comparison.

Is there anything else that you want grown-ups to know about drugs?

What I want people to come away understanding is that our country has promised these birthrights [life, liberty, and the pursuit of happiness]. But in practice, we haven’t lived up to that promise. This book is a radically different vision for people. So that they can see that the use of drugs, responsibly, can enrich their lives. 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.

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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). Follow him on Twitter: @tlupick.