“If I’m going to a boring party, I should be able to take an amphetamine to stay awake. I know what I’m doing.”
The audience laughs, recognizing first the ordeal of a tedious social function, then the frankness of the statement.
Carl Hart means what he says. The Columbia University professor has spent decades studying how drugs affect behaviour and the brain. He entered the field of neuroscience hoping to solve addiction, believing it was the cause of the problems he saw at home in Miami. An epidemic of crack cocaine hysteria had broken out in the mid-1980s, and the drug took the blame for a variety of ills in black communities — violence, crime, poverty, crumbling families, a generation of “crack babies.”
But after years of investigating the effects of drug use, and reflecting on his own life, the evidence piled up before him: drugs weren’t the issue.
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About 300 people in Vancouver have come to hear Hart at a presentation organized by the Canadian Drug Policy Coalition. One of the first things he says is that he has used and sold drugs, and even carried a gun.
He’s one of few black people in the room, and stands out in a suit, with dreads so long he has them partly tied up. His highly readable and compelling memoir High Price details his remarkable journey from a childhood of entrenched poverty to a career as a world-class neuropsychopharmacologist. He writes that he resolved to lock his hair as “a way to show homage and respect,” and remind himself that he could be “a conscious spirit, no matter what other people might decide a scientist should look like.”
The book also undercuts prevailing ideas about drugs. Looking back on his youth, Hart describes his realization that the many social ills blamed on crack cocaine preceded the drug. His father physically assaulted his mother; his parents split up when he was seven, after which welfare became part of his family life; he grew up in the homes of different relatives; he witnessed gun violence; he and his friends engaged in theft; he watched family and friends struggle, with no opportunities for economic and social advancement. All of this was happening before the appearance of crack, the result of long-standing historical and political structures made worse by law enforcement and the drug war.
High Price is Hart’s attempt to disrupt the scientific community’s silence, one that remains ominously loud.
Distorted dangers, prices paid
What’s known in the labs hasn’t been shared with the public, says Hart. Scientists have acquired knowledge about drugs through studies funded by taxpayers, and “it seems as though we should give something back to them. We should tell them something about what we know.”
One of his key statistics is that 80 per cent of people who have used drugs do not have a problem. This number underscores that addiction develops for a minority of drug users and that drugs aren’t as potently addictive as we have been led to believe. “The majority … of the people who use drugs are like me,” says Hart. “They take care of their families. They are responsible members of our society. And in some cases, they even become president of the United States.”
The harmful effects of drugs have been exaggerated, he emphasizes, laying out his case with cocaine as an example. Though crack cocaine is typically perceived as a more dangerous and addictive drug, it is virtually the same as powder cocaine. The slight chemical difference between them means that powder cocaine can’t be smoked. (Its melting point is too high, so it just burns up.) Removing the hydrochloride lowers the melting point, and that’s how crack is made. But whether cocaine is injected or smoked, it produces the same intense effect.
The mythology that continues to surround illicit drugs, Hart argues, comes with severe consequences. In the United States, the law creates an artificial distinction between powder and crack cocaine. Despite an amendment in 2010 to reduce the sentencing disparity, jail terms for possession and sales of crack are still significantly longer than for powder cocaine. This is a strike against poor black communities, in which crack is favoured because it’s more affordable.
“Black people in the United States represent 80 per cent of those people arrested under the law, even though they don’t use cocaine at rates higher than white folks,” notes Hart. (In Canada, the law is the same for all forms of cocaine. However, Canadian jails also have distorted incarceration rates. Since 2003, the proportion of white prisoners has decreased, while the proportion of black, Asian, and Aboriginal prisoners has shot up. As well, mandatory minimum sentences, implemented under Prime Minister Stephen Harper, are associated with disproportionate punishment of racialized groups.)
Despite scientific knowledge since at least the early 1990s that powder and crack cocaine are nearly identical, the law “is still inappropriate. It’s still inconsistent with the science,” says Hart.
“Imagine someone saying that smoking marijuana was so much more dangerous than eating marijuana in your brownie. That is the equivalent of what we’re doing.”
“The most important lesson that I’ve learned about drugs is this: drug effects are predictable. When you hear people talk about the unpredictability of a drug effect, it is a licence to stop listening.”
This means a basic education in drugs could save lives. Hart gives his Vancouver audience a quick demonstration of what could be taught. “The dose is critically important. And so you want to tell young people, ‘If you are a novice, don’t start using drugs or smoking like a champion. Crawl before you can walk.”
Starting with lower doses helps build tolerance. “We talk about it as if it’s a bad thing,” says Hart, but “tolerance keeps people alive. It actually saves people.”
Make sure you’re in a safe and comfortable space, not “an anxiety-ridden environment.” And know that how a drug is taken affects the speed with which it acts. “If you’re taking marijuana orally, don’t expect the effects to happen within 15 minutes. Don’t put more in your gut, because if you do you’re going to have some horrifying effects.”
In an online post, Hart recalls picking up his teenage son from a party and wondering whether his son has used drugs. He asks what his son remembers from their discussions over the years, and it turns out his son has absorbed a lot about how to navigate drug use. “Like most parents, I have discouraged drug use among my children,” writes Hart, but “I am heartened to know that [my son] is equipped with these important lessons because they will decrease drug-related harms, and ultimately save his life if he does decide to experiment.”
These lessons aren’t part of school curricula or health campaigns. PSAs don’t outline the difference between smoking and eating drugs, or explain that heroin and alcohol don’t mix well.
Instead the public is inundated with scary stories based on little fact. Every few years, the media declare a new drug epidemic, a new worst addiction, says Hart. Time magazine obligingly made this point with its latest cover, which he puts up on a screen. This round, painkillers are America’s poison.
“Science has been complicit in this nonsense,” says Hart.
What we as a public might reasonably expect from both journalists and scientists strikes me as quite similar. As a minimum standard, each group should pursue truth, recognizing and mitigating biases to the fullest extent, working with a dedication to ethics and the public good, with an aim of gathering and sharing knowledge broadly.
But corporate imperatives dictate news coverage, impacting journalism in explicit and indirect ways. Likewise, following the money in science is revealing.
An astounding 90 per cent of the world’s research on drugs is funded by a U.S. government agency, the National Institute on Drug Abuse, says Hart. Its mission is “to lead the Nation in bringing the power of science to bear on drug abuse and addiction.”
“Their focus is almost exclusively on pathology,” says Hart. In other words, they want to know all the bad stuff about drugs. They don’t want to hear anything else. (Despite his views, Hart manages to sit on NIDA’s advisory council. “You can imagine what our meetings are like,” he remarks at one point.)
Drug researchers are at the mercy of NIDA for money to fund their studies. It’s easy to imagine how this shapes their grant applications, the research they pursue, and the way they interpret and present their findings.
In a 2011 journal article, one he says he’s proudest of, Hart reviewed the research on meth and cognition. A widely held view is that meth causes damage to the brain, impairing a person’s memory, attention, and learning. But when Hart looked closely at the data, he found that meth users’ cognitive functioning actually fell within a normal range. The researchers had drawn unsupported conclusions, showing “a propensity to interpret any difference, whether it’s a brain difference or whether it’s a cognitive difference, as something that is clinically abnormal.”
Scientists err on the side of caution, because they don’t want to be seen as condoning drug use. “And we do that as scientists as if there is no consequence to this behaviour,” says Hart, but it “has contributed to the environment where certain drugs are deemed evil and any use of these drugs is considered pathological. And then, in the case of the United States, we have this unrealistic focus on eliminating certain drugs at all costs or any costs, particularly for some groups.”
“What does that mean for what’s published in the scientific literature? What does that mean for what’s published in a textbook? In the popular press? In our movies? I don’t know if Breaking Bad has made it to Canada — you have those [kind of] TV shows. All those sorts of things perpetuate misinformation about drugs. But it all kind of starts with this biased focus of our major funder.”
“The spotlight is on pathology, and that’s where most of us are looking,” says Hart. “We’re missing an opportunity to actually contribute to the public education about drugs. We are missing the opportunity to help keep the public safe.”
‘From your urine to your deeds’: A new focus
Honesty in science could bring to light not only basic facts about illicit substances, but the racist histories attached to their illegality. About a century ago, Canada and the United States took a prohibitionist approach to particular drugs — those linked to racialized groups, including the Chinese (opium), blacks (cocaine), and Mexicans (marijuana). Prejudice and conceit underlie the vilification of illicit drugs. The scientific data doesn’t support the current thrust of drug education, addiction treatment, and law and policy. It doesn’t support our revulsion for others.
The stigmatization of drug use “allows us in society to target people we don’t like without explicitly saying so,” says Hart. “It also allows us as a society to avoid dealing with the real problems that marginalized and poor people face — unemployment, substandard education, poor mental health, poor nutrition.”
Media, politicians, law enforcement, treatment providers, and others are complicit in fuelling this stigma as part of what Hart calls the addiction industry. In fact, he says, people involved in the treatment and public health approach “are just as incompetent and ignorant about drugs as law enforcement personnel.”
The minority of drug users who become addicted don’t need treatment programs focused on pathologizing drug use, says Hart. They need individual assessments to see what’s going on in their lives. They need support to figure themselves out.
Whether someone is a good person is more important than their drug use. “I don’t care if they are using heroin or something else in the privacy of their home,” says Hart, advocating that “we move the focus away from your urine to your deeds.”
He lists ways to force change. Learn the science, but study in humanities, to develop the ability to think critically. Make people “play by the rules of evidence,” and hold researchers accountable. Call out racism even if it makes you uncomfortable — “otherwise what kind of adults are we?” Get out of the closet about your own drug use, and confront society’s limited view of what a drug user looks like.
Work to change the legal status of drugs. “We need to regulate the market just like we do with other potentially dangerous behaviours, like driving.” Because the effects of drugs can be predicted, the risk is in what they’re being cut with.
“This is a not a recipe for popularity,” warns Hart. “It’s lonely being out here saying the things that I say…. I have lost a lot of friends as a result of this. Certainly I’ve lost grant funding.”
“But history will judge you favourably, and that’s more important.”
Dr. Hart’s reading recommendations
- Michelle Alexander’s The New Jim Crow
- Anything by James Baldwin
- Nothing about neuroscience