Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show
Speaker 1: where we explore the stories behind the stories in the news.
Speaker 1: The world is full of books proposing counterintuitive claims about
Speaker 1: the way things are. You could even say books like
Speaker 1: that are a dime a dozen, But doctor Carl Hart's
Speaker 1: book Drug Used for Grown Ups is exceptional, and I
Speaker 1: might even call it unique. You may have heard about
Speaker 1: it in the press recently. Doctor Hart provocatively argues that drugs,
Speaker 1: including drugs like heroin, are much safer physiologically than we
Speaker 1: ordinarily think, and that the major dangers, including the dangers
Speaker 1: of addiction, come from comorbidities, risks that people have associated
Speaker 1: with mental illness and poverty, and not from the physiological
Speaker 1: substrate of these drugs themselves. He goes further than that,
Speaker 1: suggesting that we need a radical reform in light of
Speaker 1: a new understanding of drugs as having far fewer negative
Speaker 1: effects than we believe and far more positive effects associated
Speaker 1: with the altering of consciousness than we usually consider. Doctor
Speaker 1: Hart is a professor of neuroscience and psychology at Columbia University,
Speaker 1: where he's been chair of his department, and his research
Speaker 1: focuses on the physiological and behavioral effects of psychoactive drugs.
Speaker 1: The book is heavily deeply footnoted, as I learned by
Speaker 1: reading it closely and going into the footnotes. At the
Speaker 1: same time, it's a highly accessible and indeed personalized account
Speaker 1: of a serious and complex set of issues with major
Speaker 1: consequences for how power is distributed in our society, including
Speaker 1: an in particular on the basis of race and racialized hierarchies.
Speaker 1: Drug Use for Grownups is one of the most thought
Speaker 1: provoking books I've read this year, and I had to
Speaker 1: have doctor Hart on the show. Doctor Hart, welcome to
Speaker 1: deep background. Let's dive in by starting with a crucial
Speaker 1: definition that you provide at the beginning of the book
Speaker 1: that really follows us all the way through, and that
Speaker 1: is the definition of the word addiction. And you say
Speaker 1: in the book that you're going to use the definition
Speaker 1: of addiction borrowed from the DSM, the Diagnostic and Statistical
Speaker 1: manual that psychologists use, and that that definition of addiction
Speaker 1: entails not just that you are using a substance regularly,
Speaker 1: but that it is negatively affecting a major life activity
Speaker 1: and that it's causing distress to the user. And under
Speaker 1: that definition if someone drings coffee every morning but negatively
Speaker 1: affect the person. Even though you know, if I don't
Speaker 1: get my coffee, i have headaches or I'm cranky, I'm
Speaker 1: not addicted. Right, that's right. I mean you can imagine
Speaker 1: people who drink coffee, people who drink alcohol or other substances,
Speaker 1: and their life is not impacted. They're able to meet
Speaker 1: all of the obligations. Why would we say that they
Speaker 1: have an addiction problem. Like in this culture, we have
Speaker 1: this popular saying of functional adding. There is no such thing.
Speaker 1: That's a Nazi mourn by definition of addiction, that means
Speaker 1: you're not functional, you're not meeting your obligations. And so
Speaker 1: simply based on what people put in their body or
Speaker 1: what they're using, if you use that as a definition
Speaker 1: of addiction, everybody would be labeled an adding I think
Speaker 1: the thing that I was so fascinated about in your
Speaker 1: clarity about pointing this out about addiction is that you're
Speaker 1: a neuroscientist. So at least in principle, you're supposed to
Speaker 1: be a physiology guy. But that definition is way bigger
Speaker 1: than the physiological definition. Right, No, that's right. So you
Speaker 1: know the goal of neuroscience is to try to explain
Speaker 1: human behavior. And if you're going to explain human behavior,
Speaker 1: you can only look at the brain. You have to
Speaker 1: understand the animal of the human in its social context.
Speaker 1: Without the context, you will make some mistakes about what's
Speaker 1: going on without understanding the context. And so I think
Speaker 1: most of us who understand anything about human behavior know
Speaker 1: that we need to understand the social contact and under
Speaker 1: which the behavior happens, because you can imagine some behavior
Speaker 1: happening in one context maybe inappropriate, whereas it's entirely appropriate
Speaker 1: in another. Let's say somebody physically assaults somebody and that's
Speaker 1: all you know, and it turns out the person who
Speaker 1: physically assaulted the other person was a defensive end for
Speaker 1: the Tampa Bay Buccaneers, and he physically assaulted the quarterback
Speaker 1: for Kansas City. On the field, that's entire appropriate, But
Speaker 1: off of the field that's not appropriate. So context is everything.
Speaker 1: It sure is, And that's a great example. Let's move
Speaker 1: on to another really important topic for you, and that
Speaker 1: is you condemn the language of harm reduction that tends
Speaker 1: to surround our discussions about drugs. Say more about that,
Speaker 1: because on the surface, harm reduction sounds like the most
Speaker 1: who could argue with it, you know, idea in the world,
Speaker 1: and yet in your view that framing of harm reduction
Speaker 1: has had disastrous consequences. Yeah, I just want to be clear.
Speaker 1: You know, in principle, what people do with harm reduction,
Speaker 1: they try to help folks who are in need of help.
Speaker 1: I support that. The thing that I had took issue with,
Speaker 1: it's just the term harm reduction. We do harm reduction
Speaker 1: when we brush our teeth in the morning, we want
Speaker 1: to avoid cavities, we put on our seatbelt, we want
Speaker 1: to avoid any sort of harm that might come if
Speaker 1: we had a car crash. But we don't call that
Speaker 1: harm reduction, and we reserve the term harm reduction only
Speaker 1: for drugs. And when you do that, you pair the
Speaker 1: word harm with drugs over and over in our language,
Speaker 1: shapes how we behave, how we think. So I'm asking
Speaker 1: folks maybe reconsider another term, like we're really trying to
Speaker 1: enhance the health and happiness and safety of folks, and
Speaker 1: so maybe health and happiness, But to focus exclusively on
Speaker 1: harms associated with drugs seems shortsighted. Most people are using
Speaker 1: drugs to enhance the pleasure to have a good time
Speaker 1: to alter their consciousness. We're not thinking about harm so much,
Speaker 1: but this term harm reduction forces us in this sort
Speaker 1: of unique dimensional space, as if harms are the only
Speaker 1: things that happen when you take drugs. I think the
Speaker 1: reason that point that you're making was so powerful for
Speaker 1: me and reading the book is that, like a lot
Speaker 1: of what you do in the book, it just challenges
Speaker 1: the reader to say, start somewhere different. You know. I
Speaker 1: get the sense again and again reading your book that
Speaker 1: what you're fighting against is preconceptions that have been kind
Speaker 1: of drilled into our heads, and not by accident. It's
Speaker 1: not just they're out there in the culture. They've been
Speaker 1: created by the television that we've watched, the PSAs that
Speaker 1: we've been seeing. If you're in our generation since we
Speaker 1: were kids, and that the next generation is still getting
Speaker 1: it's a full you know, I guess it's what the
Speaker 1: sociologists would call a full discourse, you know, a full
Speaker 1: set of ideas and language and beliefs that have been
Speaker 1: created in a very self conscious way. Am I getting
Speaker 1: you that you're trying to start us off by saying, hey, everybody,
Speaker 1: take a deep breath and realize that you're in the
Speaker 1: grips of these ideas and just question them. Doesn't mean
Speaker 1: you have to reject them at the end, but start
Speaker 1: by putting a question mark in front of them. That's
Speaker 1: exactly right. In our culture, we've been inundated with these
Speaker 1: messages about drugs that are largely inactress. And we've been
Speaker 1: innovated with these messages because it facilitates some sort of
Speaker 1: argument or some sort of position of the person who's
Speaker 1: producing the messages. And it's really easy to say that
Speaker 1: anybody who uses crack cocaine will become addicted, and we
Speaker 1: all believe it. It's really easy to say one hit
Speaker 1: of heroin and then you're addicted. And I'm asking people
Speaker 1: to just reconsider this with the evidence, and I'm trying
Speaker 1: to present evidence throughout the book that I hope people
Speaker 1: will look at, consider and reconsider their starting point. Those
Speaker 1: stories are so powerful. You know, I'm from Boston and
Speaker 1: grew up as a big Celtics fan, and i remember
Speaker 1: very very vividly as a kid when Len Bias died
Speaker 1: of a cocaine overdose, or at least so it was reported,
Speaker 1: and you know, the takeaway for kids, and I was
Speaker 1: a kid was supposed to be you could die from
Speaker 1: one use of cocaine. There was no serious analysis of
Speaker 1: the history, the context, any of it. And I don't
Speaker 1: actually know the facts of it except that, boy, did
Speaker 1: it make a central impression on me as a kid.
Speaker 1: You know, this was a terrifying, terrifying drug and you
Speaker 1: should avoid it at all costs. Yeah, same here. I
Speaker 1: came of age about that time. Not only did Lin
Speaker 1: Baias die, a week later, Don Rogers died from the
Speaker 1: Cleveland Browns, And so the message was this drug is
Speaker 1: so unpredictable. Even one hit can take out the most
Speaker 1: fit person in our society. That's just the overly simplistic message.
Speaker 1: Nearly every day before COVID, at least at our institution
Speaker 1: at Columnia University, we give cocaine to research subjects and
Speaker 1: never have we seen such a thing like that. But
Speaker 1: you know, it's in a controlled environment, in a medical setting.
Speaker 1: But limbaias experience as the way it was reported in
Speaker 1: the media just seemed to be an extreme aberration. But
Speaker 1: that was the standard that was presented as if it
Speaker 1: was the standard. The real troubling thing about the media's
Speaker 1: approach to drugs is that the approach is done to
Speaker 1: the sensationalized event and almost never done to actually help people,
Speaker 1: help people who may be using a drug, or help
Speaker 1: people who want a deeper understanding about these things. And
Speaker 1: as a result, it shapes what we think, it shapes
Speaker 1: our policies, and it contributes to the restricting of civil
Speaker 1: liberties and a number of sort of things. And that's
Speaker 1: the real concern that I have about the way that
Speaker 1: the media covers drugs. And more importantly, you can be
Speaker 1: completely wrong in your coverage of drugs and it's okay.
Speaker 1: You don't have to be complete, and you can be
Speaker 1: praised as a reporter in the media. And I wonder
Speaker 1: if that maybe has connected all sort of harm reduction,
Speaker 1: because if you said to a reporter or later on, well, gee,
Speaker 1: you overstated the risk, the reporter will say, well, that
Speaker 1: might be true, but we were reducing harm overall. If
Speaker 1: people are more scared of drugs rather than less scared
Speaker 1: of drugs, that's a good thing, because less drugs means
Speaker 1: less harm. Yeah, you know, I think we even take
Speaker 1: that approach in science. It's it's better to air on
Speaker 1: the side of caution, and then that way, fewer people
Speaker 1: will use it's like that would be okay if there
Speaker 1: was not a price to pay. There is a big price,
Speaker 1: but airing on the side of caution when you are incorrect.
Speaker 1: For example, this past summer, we had a lot of
Speaker 1: protests related to Black Lives Matter, the killing of George Floyd.
Speaker 1: The killing of George Floyd is a good example because
Speaker 1: we all saw Derek Schoulbin put his knee on George
Speaker 1: Floyd's next for eight minutes and forty six seconds. We
Speaker 1: all saw it. But George Floyd had some drugs in
Speaker 1: his system, and now the story becomes, oh, the drugs
Speaker 1: did it, even though we saw with our own eyes
Speaker 1: what happened. But people are sensitized to believe anything about
Speaker 1: drugs that's negative, and then we miss some important sort
Speaker 1: of facts like that was a horrible act by this
Speaker 1: police officer or other police officers. When they say something
Speaker 1: like oh, they had PCP in their system. The public
Speaker 1: has been sensitized to believe that PCP causes a superhuman strength,
Speaker 1: causes people to have superhuman strength, which is nonsense. But
Speaker 1: that's the price that we pay in that the police
Speaker 1: can get away with harming people, killing people as long
Speaker 1: as they scapegoat drugs in the process. That's the price
Speaker 1: that we pay as a society for erroring on the
Speaker 1: side of caution. People are susceptible to believe nonsense about drugs,
Speaker 1: even when some abhorrent act has occurred against the person
Speaker 1: who might have drugs in their system. I just want
Speaker 1: to pause for a second to underscore the power of
Speaker 1: the point you're making, because it goes to something really
Speaker 1: subtle about your book that's actually really different from almost
Speaker 1: all the other books that I've read on the topic.
Speaker 1: You are making a very powerful point about the real world,
Speaker 1: hierarchical and race based social impact of not only drug
Speaker 1: enforcement but drug ideology, if I could call it that.
Speaker 1: And you make that point again and again and again,
Speaker 1: and very very successfully and powerfully, so much so that
Speaker 1: when I was describing the book to friends because I've
Speaker 1: been very excited having read it, several people said to
Speaker 1: me who hadn't read the book yet. So, is this
Speaker 1: a version of the familiar argument that we've now been
Speaker 1: hearing off and on for the last five or ten
Speaker 1: years about how the war on drugs has been effectively
Speaker 1: a tool for racial hierarchy in the United States? And
Speaker 1: what I kept on saying people is yes, heart makes
Speaker 1: that argument, but that's not all the book is. The
Speaker 1: book is also adding a separate argument that is analytically
Speaker 1: distinct about the scientific reality underlying the assumptions that go
Speaker 1: into the war on drugs. And what I was saying
Speaker 1: was the book is trying to make both arguments in
Speaker 1: relationship to each other. Yeah, that's one of the things
Speaker 1: that motivated me to write this book. Putting together, for example,
Speaker 1: the people who had been killed by police and they've
Speaker 1: had drugs in their system, and that kind of stops
Speaker 1: any sort of analysis about what actually happened. That's a
Speaker 1: real concern because an injustice may have occurred and we
Speaker 1: say it's okay because they had a drug in their system.
Speaker 1: Can you imagine the millions of Americans who may have
Speaker 1: some metabolite, that is some byproduct of a drug in
Speaker 1: their system and they happen to have some interaction with
Speaker 1: someone and they're killed, and because they had a substance
Speaker 1: in their system, their death is excused or disregarded because
Speaker 1: of the fact that they had a substance in their system.
Speaker 1: That would be a horrible injustice. And that's what I'm
Speaker 1: trying to get Americans to look at so we avoid
Speaker 1: anymore injustices. Let's talk science for a bit, and I
Speaker 1: want to start with one of the most fascinating and
Speaker 1: controversial claims in the book, which has to do with
Speaker 1: calling on us to rethink the opioid crisis or opioid epidemic.
Speaker 1: And I think you're making a bunch of different arguments here,
Speaker 1: and I want to tease them all out so that
Speaker 1: the listeners can really get a sense of them. So
Speaker 1: the first one I think is that what we hear
Speaker 1: about the increasing number of opioid deaths or opioid related deaths,
Speaker 1: that some of that apparent increase may be a product
Speaker 1: of reporting, that there's better reporting, or more reporting, or
Speaker 1: maybe overreporting compared to what there was previously. That's just
Speaker 1: the first of several claims. And the first thing I
Speaker 1: want to ask you is what's the social scientific basis
Speaker 1: for thinking that that might be the case. Yeah, if
Speaker 1: we think about this, we think about who does death investigations.
Speaker 1: In the United States, most death investigations are carried out
Speaker 1: by corners. Corners and medical examiners both death investigations, but
Speaker 1: corners do most. And we think about what are the
Speaker 1: skill sets of corners. In order to be a corner,
Speaker 1: all you need is a high school diploma in most
Speaker 1: cases and a few hours of a death investigation course.
Speaker 1: So the skill levels of corners are not that high
Speaker 1: compared to a medical examiner, who is a physician who
Speaker 1: generally has training in forensic pathology. And so now we
Speaker 1: have these death investigations that are being happening all around
Speaker 1: the country, and they're not uniform, that is, they're not
Speaker 1: carried out in the same way. In some cases, we
Speaker 1: don't even have biological confirmation of what drugs the person
Speaker 1: actually had in their system number one. In other cases,
Speaker 1: the person may have had multiple drugs. This is the
Speaker 1: case for most overdose They have multiple drugs in their system,
Speaker 1: including medications that they were prescribed. And also with a
Speaker 1: number of deaths, people commit suicide intentionally. When you add
Speaker 1: all of this to this sort of this mix, it's
Speaker 1: really hard to tease a part what was the culprit
Speaker 1: the cause of the person's death, because when multiple drugs
Speaker 1: are involved, rarely does anyone bother to look at what
Speaker 1: drug actually caused the death or did the combination cause
Speaker 1: the death. And so when we say like these drug
Speaker 1: related overdoses. We tend to focus on the opioids because
Speaker 1: those are the drugs of the moment, but it doesn't
Speaker 1: mean that the opioid actually caused the death. Added to
Speaker 1: that the fact that many people when they do street drugs,
Speaker 1: may get tainted drugs, and so the drugs may be
Speaker 1: tainted with other things that are more dangerous than the
Speaker 1: drug that they were seeking. For example, if someone was
Speaker 1: seeking heroin and they got analog, that analog can be
Speaker 1: a lot more potent than heroin, therefore more unlikely to
Speaker 1: cause overdose in an unsuspecting user. And so all of
Speaker 1: this adds complexity to this overdose mix that is rarely
Speaker 1: tease the part when we document the cause of death.
Speaker 1: We'll be back in a moment. I take the point
Speaker 1: that our statistics are kind of problematic for all of
Speaker 1: those reasons. And by the way, I had no idea
Speaker 1: that most deathIn nittates are investigated by partners who don't
Speaker 1: have medical training. I guess I'm a product of the
Speaker 1: television age, and I always imagine a medical examiner involved.
Speaker 1: So that's a totally fascinating fact that I had no
Speaker 1: idea of. But let's imagine that we were able to
Speaker 1: tease a part the data. Don't you think there would
Speaker 1: be a rise in the number of deaths where opioids
Speaker 1: were at least involved, even if the cause of the
Speaker 1: death was the interaction between opioids and something else, or
Speaker 1: tainted drugs, or a fentonyl based drug that was way
Speaker 1: more powerful than the person who ended up using the
Speaker 1: drug ever knew. I mean, you're not suggesting, are you
Speaker 1: that the idea that there's a lot more opioids out
Speaker 1: there and that there are a lot more deaths than
Speaker 1: their word is not true, but rather that their connection
Speaker 1: between those things, between the number of opoids and the
Speaker 1: number of deaths hasn't been sufficiently substantiated. Yeah, I think
Speaker 1: that we have to think about what changed, what changed
Speaker 1: in this period where we see this increase. One of
Speaker 1: the things that changed is that we now have more
Speaker 1: phintonyl analogs or opioid synthetic opioids that are more potent
Speaker 1: than heroin and these other sort of opioids of the
Speaker 1: path that changed, and so it will be nice to
Speaker 1: tease the part to see whether or not those are
Speaker 1: the culprits of any increase that we see, and in
Speaker 1: that way, If that's the case, we can approach this
Speaker 1: problem by simply doing as some of the other countries
Speaker 1: have done, implementing drug checking facilities where people can test
Speaker 1: their substance to see if they contain adulterants that might
Speaker 1: be potentially dangerous. And so, I don't really know what's
Speaker 1: going on, but I know one of the things that
Speaker 1: we can do is be more careful in discerning what
Speaker 1: is happening so we can better protect our public. Part
Speaker 1: of the reason that this part of your book is
Speaker 1: so counterintuitive is that we have this narrative, which is
Speaker 1: a new narrative associated with the opioids. It's different than
Speaker 1: the narratives about cocaine or crack cocaine of the eighties,
Speaker 1: and it's a narrative that big pharma, acting quote unquote
Speaker 1: within the bounds of the law, pushed physicians to prescribe
Speaker 1: lots of opioids that were themselves. Those opioids themselves were,
Speaker 1: as it were regulated, they were legal drugs in the
Speaker 1: sense that they were legal if they were prescribed. You
Speaker 1: had physicians being under a lot of pressure and a
Speaker 1: lot of incentive to prescribe them. And then the way
Speaker 1: this narrative runs, people got addicted after having genuine, real
Speaker 1: pain that was medically diagnosed, treated by opioids that were
Speaker 1: medically prescribed, and then couldn't get off of those opioids,
Speaker 1: and then that led them to illegal forms or other
Speaker 1: forms of the drug that may have caused the actual death.
Speaker 1: And I don't think you talk so much in the
Speaker 1: book about the big Farma part of that story, and
Speaker 1: so I really wanted to ask you, do you buy
Speaker 1: that story? I mean, we're hearing it all the time.
Speaker 1: I suppose big Pharma at one point they wanted to
Speaker 1: deny the story. At this point they've changed strategies, right,
Speaker 1: They've given up and realize their best bet is to
Speaker 1: say we're sorry, that the companies who did the most
Speaker 1: of this will pay large settlements. That the companies who
Speaker 1: advise them were participating it will also take a hit
Speaker 1: and pay large settlements, and they'll do what big companies
Speaker 1: always do to try to move on to the next thing.
Speaker 1: But the reason I think this is significant is that
Speaker 1: it's a different story than the story of a new
Speaker 1: drug came from the streets. This is a story of
Speaker 1: a new set of drugs came from corporate America. And
Speaker 1: I think it makes a lot of people skeptical about
Speaker 1: arguments for legalization because this looks like a story of
Speaker 1: what happens when a big corporation gets involved. The big
Speaker 1: corporation turns into the drug pusher, according to this narrative,
Speaker 1: and is way better at it in terms of quantity
Speaker 1: than any number of street pushers could be, and the
Speaker 1: consequences turn out to be really bad. Well, don't make
Speaker 1: me defend the pharmaceutical industry. I have some contempt for
Speaker 1: the industry, just like most Americans, whether it's opioids or
Speaker 1: some other drug there. But that's part of capitalism. They're
Speaker 1: in it to make money. The point here is that
Speaker 1: the pharmaceutical company downplayed the addictive potential of something like oxycodo.
Speaker 1: They downplayed that's a mistake and they should pay for that.
Speaker 1: Now this narrative, they pushed the drugs onto people, and
Speaker 1: these poor people got addicted as a result. That is
Speaker 1: a little troubling because as a patient, as a person,
Speaker 1: if you see yourself getting in trouble with something, you
Speaker 1: bear some responsibility. And now this isn't to stay that
Speaker 1: people shouldn't listen to their doctor, But if you're having problems,
Speaker 1: if you're concerned that you are going to have some
Speaker 1: withdrawal symptoms or something of that nature, you can not
Speaker 1: take it. That's your responsibility too. I'm just trouble that
Speaker 1: we think that it's okay to just completely absolve adults
Speaker 1: responsibility in their own care. That will potentially lead us
Speaker 1: down a horrible path. Let's dive into that a little bit,
Speaker 1: because it's very provocative in the following way. We live
Speaker 1: in a society where we're really unsure about personal agency
Speaker 1: and responsibility in some zones, and addiction is one of
Speaker 1: those zones, right. I mean, for a long time, the
Speaker 1: society did have the view that someone who's a drug
Speaker 1: addict it's his fault or her fault, and the society
Speaker 1: assigned a lot of blame for that and was happy
Speaker 1: to punish people. In recent years, it seems like there's
Speaker 1: been a bit of a shift, and there's a lot
Speaker 1: of talk about whether the shift is driven by the
Speaker 1: largely white nature of the opioid crisis, and that may
Speaker 1: well be the case, but regardless of the whether the
Speaker 1: underlying cause is race driven, there has been a shift
Speaker 1: to talking about people who have drug addictions as less
Speaker 1: responsible and as less culpable, and that's usually associated that
Speaker 1: shift is usually associated with reformist approaches. And so it's
Speaker 1: interesting to hear you in the context of an argument
Speaker 1: that's radically reformist, still making an argument for personal responsibility.
Speaker 1: And I just wonder if you'd say more about that. No, see,
Speaker 1: please understand you can hold two things in your hand
Speaker 1: at month, right, and so that's this is a nuanced argument.
Speaker 1: First of all, addiction has almost nothing to do with
Speaker 1: the drug itself. That's a that's a myth. The vast
Speaker 1: majority of people who are prescribed opioid pain pills, We're
Speaker 1: talking ninety to ninety nine percent of those people never
Speaker 1: become addicted. So the vast majority, so let's just be
Speaker 1: clear about that. Now, that tells you this has little
Speaker 1: to do with the drug. But we also know that
Speaker 1: addiction has a lot to do with people who have,
Speaker 1: for example, co occurring psychiatric illnesses depression, schizophrenia, anxiety. All
Speaker 1: of those sorts of things increase the likelihood of someone
Speaker 1: becoming addicted. So if that's the case, make sure people
Speaker 1: co occurring psychiatric illnesses are treated. We also know that
Speaker 1: addiction is much more likely in people who, for example,
Speaker 1: who are under employed, unemployed, particularly those individuals who once
Speaker 1: had middle class paying jobs, and now those jobs are gone,
Speaker 1: and those people now do not have the status in
Speaker 1: their community, in their home that they once had. Those
Speaker 1: people are much more likely to become addicted to someone
Speaker 1: who have not have to face that sort of thing.
Speaker 1: And so how about we make sure people are gainfully employed.
Speaker 1: All of these sorts of things can be done to
Speaker 1: make sure that we take care of our people and
Speaker 1: ensure that they have a less likelihood of becoming addicted
Speaker 1: or any other problems. Now that puts it on us
Speaker 1: too as a society, But me, as a person, I
Speaker 1: have responsibility in making sure that I notice when something
Speaker 1: is going wrong. To be an adult means that you
Speaker 1: do bear some responsible but it does not absolve the
Speaker 1: state of its responsibility. I think that was very powerfully put.
Speaker 1: It does make me think that you could imagine someone
Speaker 1: who's a sympathetic reader saying something like this. Listen, you know,
Speaker 1: doctor Hart, I've read your book, and I accept every
Speaker 1: argument you make in there on the facts. But I
Speaker 1: look at a statistic that says somewhere between ninety and
Speaker 1: nine percent if people prescribe opioids don't get addicted, and
Speaker 1: I say, okay, let's imagine that it's ten percent who do.
Speaker 1: Then let's look break down the data and look at
Speaker 1: who those ten percent are. And some of them are
Speaker 1: people who, as you say, have mental illness or depression,
Speaker 1: or alternatively, they're people whose risk factor is there fact
Speaker 1: that they're poor because they've lost their jobs. So that's
Speaker 1: not distributed fairly or justly across the society. So then
Speaker 1: I might conclude if all that's true, and that say
Speaker 1: ten percent are people who are particularly vulnerable, and whose
Speaker 1: vulnerabilities are a product not of randomness but of structural
Speaker 1: racism and other features, that's enough to end up with
Speaker 1: a policy of strong prohibition. Even if it were the
Speaker 1: case that there are stable, mentally healthy middle and upper
Speaker 1: middle class people who could take opioids or other drugs
Speaker 1: and be totally fine, and then to you know, to
Speaker 1: conclude that even a little more strongly. You know, one
Speaker 1: of the things that you talk about in your book
Speaker 1: is that it's totally reasonable for people who have good
Speaker 1: jobs and are you well adjusted to take drugs and well,
Speaker 1: they're pretty much certainly couldn't be fine. But maybe that's
Speaker 1: not where we should be focused. You know, maybe the
Speaker 1: upside for those folks doesn't outweigh the downside for people
Speaker 1: who are more vulnerable. How would you respond to that.
Speaker 1: I would call it a sympathetic reading coupled with a
Speaker 1: disagreement with your conclusion. Yeah, well, we would have the
Speaker 1: ban alcohol of that, But we tried, right, I mean,
Speaker 1: I think a lot of people thought we should ban alcohol.
Speaker 1: We did ban alcohol, and then it went south and
Speaker 1: we ended up unbanning it. But I mean, you know,
Speaker 1: as a moral principle, I don't think you could be
Speaker 1: wrong about that. I mean, I don't think prohibition was irrational.
Speaker 1: Prohibition was highly rational. There was huge harm that was
Speaker 1: being caused by alcohol, and it's just that the society
Speaker 1: was unwilling to tolerate the social cost. Ultimately. Well, I
Speaker 1: don't know, I think that's naive. We think about automobiles.
Speaker 1: Every year we lose forty thousand Americans on the highway
Speaker 1: because of car accidents. Well, we should probably think about
Speaker 1: banning cars, and we can think about other activities that
Speaker 1: people die in. People humans should understand that life is
Speaker 1: not without risk. But you know, when we think about
Speaker 1: restricting these things, first of all, the people who had
Speaker 1: the means are still going to get their substances, and
Speaker 1: we have these laws that ban these substances, and that
Speaker 1: means that these laws will primarily affect those people who
Speaker 1: don't have means. So those individuals will probably pay an
Speaker 1: even higher price if we ban these substances, while the
Speaker 1: people of means they're always going to be okay. They're
Speaker 1: always going to get their substances because they can circummit
Speaker 1: the laws in ways that the folks without means cannot.
Speaker 1: There's a fascinating chapter in your book, Carl, about psychedelics,
Speaker 1: where you begin by saying that, unlike lots of other drugs,
Speaker 1: which you have experimented with in various ways are used,
Speaker 1: you haven't done so much in the way of psychedelics.
Speaker 1: But you observe that the mostly white, mostly upper middle
Speaker 1: class people who are into psychedelics and it's a big
Speaker 1: cultural movement these days, are at pains to differentiate themselves
Speaker 1: from users from other drugs which are coded as less white,
Speaker 1: and you have a sort of call for people to
Speaker 1: be a little more open mind about this. Do you
Speaker 1: want to say more about whether the movement towards legalizing psychedelics,
Speaker 1: which does seem to be making progress is a useful
Speaker 1: thing from your perspective insofar as it could be leverage
Speaker 1: to achieve the social goals that you're looking for, or
Speaker 1: whether you see it as actually part of the problem,
Speaker 1: because it does rest to some extent, as you argue,
Speaker 1: I think very convincingly on a kind of hierarchy of
Speaker 1: good drugs versus bad drugs. Yeah, it troubles me if
Speaker 1: someone says, oh, I use some ayahuasca or psilocybin to
Speaker 1: achieve some spiritual enlightenment or to be one with the universe,
Speaker 1: or to heal some problem I had, it's totally acceptable
Speaker 1: at it in this day and age. Now if someone
Speaker 1: says that I took her one and I felt great,
Speaker 1: that person it's vilified. And when in fact the two
Speaker 1: individuals are doing exactly the same thing. They are choosing
Speaker 1: to alter their consciousness, They're doing exactly the same thing oftentimes.
Speaker 1: And my point is that we're all doing the same thing.
Speaker 1: So why not come and stand on behalf of those
Speaker 1: people who have been vilified for doing exactly what you're doing?
Speaker 1: I know why not? Because the sort of folks who
Speaker 1: are enthusiasts of psychledelics don't really want to be associated
Speaker 1: with those other drugs because of the baggage that those
Speaker 1: other drugs carry, including the perception of the users being
Speaker 1: predominantly non white. I get it. I understand that that's
Speaker 1: why it happens. What I'm pointing out is that it's
Speaker 1: wrong because those people who have been persecuted for using
Speaker 1: heroin or cocaine there the penalties that they have faced
Speaker 1: are very real, while these other folks face no penal
Speaker 1: lease and not that they should face, but they should
Speaker 1: stand up on behalf of those other people. And I'm
Speaker 1: asking them to do this very thing. Speaking of baggage,
Speaker 1: I intentionally waited till the end of the interview to
Speaker 1: ask you about this, but it's been upfront in reviews
Speaker 1: of your book, and you talk about it very frankly
Speaker 1: in the book, and that is your own willingness to say.
Speaker 1: You know for the record that for a few years
Speaker 1: you've used heroin in a controlled setting, with controlled dosage.
Speaker 1: You even describe in the book deciding to get off
Speaker 1: of it and going through the withdrawal symptoms and how
Speaker 1: you manage that, and then deciding to use it again.
Speaker 1: And that grabs the attention to the media, and it
Speaker 1: gets people to sit up and take notice when they're
Speaker 1: reading the book review and say, oh, I'm going to
Speaker 1: go out and buy this book because this is remarkable.
Speaker 1: This is unusual someone would say this. When you think
Speaker 1: deeply about how your decision came about to put it
Speaker 1: in the book, did you weigh this issue. Did you
Speaker 1: think to yourself, man, on the one hand, people are
Speaker 1: really going to folk on this and the whole conversation
Speaker 1: could end up being about that. But on the other hand,
Speaker 1: it'll get more people to hear my message. Or did
Speaker 1: you just think no, I just want to be honest
Speaker 1: and damn the consequences. Oh, yeah, of course I thought
Speaker 1: about this. I thought that people would read the book,
Speaker 1: and I really cared about the people who are being
Speaker 1: persecuted for having being identified as a heroin user or
Speaker 1: some other vilified drug. So I thought about that group first,
Speaker 1: and I thought that, you know, I know more about
Speaker 1: drugs than most people, and so if anybody takes the
Speaker 1: arrows and shots, let it be meet on behalf of
Speaker 1: those people. That's what I thought. But frankly, I didn't
Speaker 1: think that folks would lose their mind as some have,
Speaker 1: for example, saying that you use heroin occasionally but regularly,
Speaker 1: or something that that means that you're an addict. That
Speaker 1: means that you have no control, you need help. Nobody's
Speaker 1: stops to look at things like, oh, you just published
Speaker 1: this book, which is really hard to do. You published
Speaker 1: I published another book this year, It's really hard to do.
Speaker 1: I have hundreds of scientific articles. Nobody stops to look
Speaker 1: at things like my kids graduated from Ivy League institution,
Speaker 1: all of these sorts of things. And so I wasn't
Speaker 1: really I didn't think that would happen. I didn't think
Speaker 1: the message would get to start it so badly. But
Speaker 1: even still, even if I knew that, I wouldn't change
Speaker 1: my mind, because it's the right thing to do. I'm
Speaker 1: trying to get people to focus on not the drug itself,
Speaker 1: but the individual's behavior. Is that person meeting their obligation?
Speaker 1: Are they good people? All of these sorts of things
Speaker 1: I'm trying to get people to focus on. But the
Speaker 1: sort of current media frenzy about this is really just
Speaker 1: proving my point. The vast majority of people have read
Speaker 1: the book and understood this like you have. And that's
Speaker 1: what I'm really happy about. Your comparison to religion I
Speaker 1: think is exactly on point. And I always say to people,
Speaker 1: you know, when you're in a supposedly secular context and
Speaker 1: you see that a religious metaphor explains everyone's behavior as
Speaker 1: it does here, you know you're in the presence of orthodoxy.
Speaker 1: You know you're in the presence of a deep community
Speaker 1: commitment to a set of beliefs that it's very costly
Speaker 1: for anybody to dissent from because of the fear that
Speaker 1: if one person speaks out and says, hey, this is
Speaker 1: not true, the whole edifice, the whole structure of beliefs, customs, practices, interests,
Speaker 1: power is in danger of being corroded. And I just
Speaker 1: want to give you all the respect that I know
Speaker 1: how to give for being someone who's willing to break
Speaker 1: out of that and to provide detailed, analytic, scientific arguments
Speaker 1: which I think are just tremendously important, and whether people
Speaker 1: agree with them or whether they disagree with them, people
Speaker 1: should engage them. And I think you made a huge
Speaker 1: contribution to intellectual discourse around this very difficult set of
Speaker 1: issues by doing that. So I just want, I really
Speaker 1: want to say thank you for that. And I you
Speaker 1: know what, I could talk to you all day about this,
Speaker 1: and maybe in the future, when you're out from book publicity,
Speaker 1: we come back and we'll have a more relaxed and
Speaker 1: lengthy conversation about associated issues too. It's just great to
Speaker 1: have you here. Thank you, Thank you so much for
Speaker 1: reading the book and taking the arguments seriously. That's all
Speaker 1: I ask. I really appreciate it. I can't tell you
Speaker 1: how much I appreciate it, particularly in this moment, So
Speaker 1: thank you so much. When I read a book that
Speaker 1: really gets me thinking, I am always incredibly excited if
Speaker 1: I get the chance to talk to the author, And
Speaker 1: in fact, for me, one of the great pleasures of
Speaker 1: deep background is that I have an excuse to call
Speaker 1: up the authors of new books and say, pardon me,
Speaker 1: would you be willing to have a conversation with me
Speaker 1: about this thing you've written. My interview with doctor Carl
Speaker 1: Hart fit that bill for me. His book Drug Use
Speaker 1: for Grown Ups is a book that basically demands that
Speaker 1: you think anew about something that you thought you understood before.
Speaker 1: Not every argument in the book necessarily will convince every reader,
Speaker 1: and I don't think that every argument in the book
Speaker 1: necessarily convinced me. But what the book did is the
Speaker 1: thing that I feel. Nonfiction books often do it. They're
Speaker 1: most powerful upset my fixed expectations, change my ideas, and
Speaker 1: the book does so by drawing attention to two different
Speaker 1: dimensions of our One is an argument about power in
Speaker 1: the world and about the effects of our drug policies
Speaker 1: on ordinary people, especially people of color and people who
Speaker 1: have less money. The other is to make us reconsider
Speaker 1: what we take to be scientific evidence of propositions that
Speaker 1: seem to have common sense weight and value, and it
Speaker 1: requires us to ask ourselves whether the science supports what
Speaker 1: the public discourse entails. Through that, we can then ask
Speaker 1: ourselves whether the discourse that we've been hearing all of
Speaker 1: our lives around drugs is accurate or not. The point
Speaker 1: of intellectual work that makes us question all of our assumptions.
Speaker 1: Isn't that every time we read something like that, we
Speaker 1: throw away everything we thought we knew. That's not how
Speaker 1: the brain works, and it's not how the brain should work.
Speaker 1: We always need to build on what we've learned, We
Speaker 1: always need to update what we know in light of
Speaker 1: new data and new information. What's most exciting for me, however,
Speaker 1: is that by challenging what we think, we know we
Speaker 1: have a chance, just a chance to start afresh, and
Speaker 1: without fresh starts, we never change the world around us.
Speaker 1: There's nothing more thrilling for me than seeing things differently
Speaker 1: and in the real world. There's nothing that gives us
Speaker 1: greater reason for possibility of change and optimism than taking
Speaker 1: on board ideas that, if followed, would change the way
Speaker 1: power is configured in our society and change the way
Speaker 1: the world really operates. I look very much forward to
Speaker 1: hearing how all of you think about Doctor Hart's interview
Speaker 1: and his book, And until the next time I speak
Speaker 1: to you, be careful, be safe, and be well. Deep
Speaker 1: background is brought to you by Pushkin Industries. Our producer
Speaker 1: is mo La Board, our engineer is Martin Gonzales, and
Speaker 1: our shore runner is Sophie Crane mckibbon. Editorial support from
Speaker 1: noahm Osband. Theme music by Luis Gera at Pushkin. Thanks
Speaker 1: to Mia Lobell, Julia Barton, Lydia Jean Cott, Heather Faine,
Speaker 1: Carle Binggliori, Maggie Taylor, Eric Sandler, and Jacob Weisberg. You
Speaker 1: can find me on Twitter at Noah R. Feldman. I
Speaker 1: also write a column for Bloomberg opinion, which you can
Speaker 1: find at bloomberg dot com slash Feldman. To discover Bloomberg's
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Speaker 1: background