Doctor Carl Hart is a Ziff Professor of Psychology and Psychiatry at Columbia University and is recognized for his research in drug use, addiction and abuse. Devoted to debunking common myths concerning drugs, Hart has spent his career researching the impact drugs have on the body in order to identify the grounds that mediate drug use behaviours. As a guest speaker for TD Gino Kenny’s Case for Drug Decriminalisation in Ireland, Hart shares his views on the future of drug reform, the causes of addiction and what drug policy Ireland would need to adopt to facilitate such change. The following text has been adapted from the live stream for the purpose of clarity. The questions were posed by TD Gino Kenny.

I’m Carl Hart, I’m a Professor at Columbia University. I am also a Research Scientist at the New York State Psychiatric Institute. I do research where we study the effects of drugs like cocaine, marijuana, methamphetamine, the opioids on peoples’ behaviours, social interactions, their brains. And so I’ve been doing this type of work for about thirty years now and I’ve learned quite a bit. And I hope to be able to share today, some of the things that I’ve learned.

Is there a case for drug decriminalisation?

Of course there is. When we talk about drug decriminalisation, we’re basically talking about making sure no-one is being arrested for putting drugs in their bodies, or using drugs. For seeking pleasure. We’re just making sure that that’s the case. That’s quite low-level; any idiot will say: “Of course there’s a case for decriminalisation.” But it’s more complicated than that. Because when we think about drug decriminalisation, drug decriminalisation is good in that no-one should be arrested. But it doesn’t address issues related to, for example, a contaminated drug that people may buy on the streets. You may buy, I don’t know, some drug that you think is MDMA, when in fact it’s something else and it might be dangerous. And so, drug decriminalisation doesn’t do anything to protect the user, besides making sure they don’t go to jail, which is fine. 

Many wealthy people don’t have that problem. They don’t have to worry about going to jail anyway. It’s poor people, those people are the ones who have to worry about going to jail. So the notion that there should be a case for decriminalising drugs, that’s easy. Of course there should be a case. But when we have this conversation, these issues get conflated. For example, we see people who are struggling. People who may be resource-poor. They don’t have housing, they have limited education. And then we see the problems that they face and then we attribute those problems to drugs, which is nonsense. And it’s a way for politicians not to really address the issues that poor people face. Because we know that people of means don’t have those same problems when they use drugs.

When that happens, that tells you that it’s not the drug. You have to look beyond drugs. But when we have this conversation, people that are talking about changing drug policy, now you’re being asked to solve all of society’s problems and that’s unfair. And the conversation gets sidetracked onto something else. When we have this conversation, we should really think about liberty. Think about people who are allowed to drink alcohol. Alcohol’s a drug. Alcohol in some cases is more toxic than many of the other drugs. But this is not an argument to ban alcohol, because I think that alcohol of course should be legally available and regulated. We have quality control, we make sure the government inspects the alcohol so we know what we’re getting. The government controls the unit dose, how much is in a bottle. All of that enhances safety. 

We can do the same thing with other drugs, and so the question becomes: Why are we treating one chemical differently than the other? I understand that people say: “This particular chemical (heroin or something else) is far more dangerous than alcohol.” Well, that’s debatable and it’s probably not true under most conditions. So if we think about liberty and peoples’ right to alter their consciousness, to put what they want in their bodies if they are adults, what we’re doing with drug policy is silly. And also it impacts our liberty. But we have to ask, well, why are we doing this if it’s silly and if it’s limiting peoples’ liberty? Well, we’re doing it because prohibition actually does work. It works for a select group of people in our society. It works for the police. It works for the politicians who can say: “We’re going to solve the problems in your community. We’re gonna put more cops on the streets and we’re gonna get drugs out of your community.” And those politicians look like heroes. When in fact they’re zeroes and they are not heroes. 

So a number of people benefit from prohibition. And that’s why we continue prohibition. Because if it didn’t work, then we wouldn’t continue it. But so many people are benefiting and we have to talk about those people who are benefiting and the people who are suffering. The people who are suffering, for example, are those people who may get a drug that’s tainted with something else and that person dies or that person gets maimed or that person is really injured severely. Those people are not benefiting. And the people who go to jail for drug laws, they’re not benefiting. And most of us in society, we’re not benefiting because the money that supports the war on drugs, or prohibition, is coming from us. But we’re not benefiting from the money. But a number of other people are benefiting from the money. Whenever we have this conversation we have to make sure we discuss the folks who are benefiting from the current approach. Because if no-one was benefiting from the current approach, then it would stop. The fact is, a tremendous number of people are benefiting from the current approach. 

In your opinion, what is the root cause of addiction, particularly around drugs? And how can we have more harm reduction, in relation to drug policy, rather than locking people up? Okay, I’ll just say this quickly. Whenever we start to talk about addiction and drug policy, we’ve already lost. Because the focus is on addiction, when in fact the vast majority of people who do drugs are not addicted. Clearly, we need to help people who are addicted. But, we should not have policy be dictated by a small minority, as we do with drugs. Because we say: “We’re worried about addiction”. As if addiction has anything to do with drugs. The vast majority of users of any drug are not addicted and that vast majority tells us that we must look beyond the drug to try to figure out why people become addicted. People become addicted for a variety of reasons, there’s no one shoe fits all. Some people have co-occurring psychiatric illnesses, like depression, anxiety, schizophrenia that drives their drug addiction.

Other people have situations where they have unrealistic expectations heaped upon them and they can’t meet these expectations. That might contribute to their addiction. Other folks may have had living wages in the past, or jobs that paid a living wage. Now, that’s gone. They have lost standing in their communities. That could contribute to peoples’ addiction. A wide range of reasons can contribute to people’s addiction, but most of them have nothing to do with the drug itself. But we talk about addiction and drug policy like they are relevant, it’s not relevant. We do so, because it’s easy for us to pretend that we care about poor people that are catching hell. When in fact, the vast majority of people who use drugs are not poor. They are your middle class people.

And we need the middle class people to begin this conversation, getting out of the closet, standing up, saying that they are drug users so we can have policy that is more rational. So that we spend our money on services more wisely, to people who actually need the help. But, when we start to focus on poor people and we’re talking about drugs, what we are doing, basically, is continuing the vilification of those people. Because people are poor and you know what, many of them don’t even use drugs! But they still need our help. But we like to act like drug users… they’re poor and therefore that’s why they’re using drugs. That’s not necessarily the case, no. And so we need to stop misattributing the cause of poverty to drugs and things of that nature.

Or the cause of homelessness to drugs. People have problems because it’s a difficult world in which we live and that makes sense. Some of them use drugs but not all of ‘em. Most of the people who use drugs are middle class folks who are in the closet and are not saying that they use drugs. If they come out of the closet and advocate for more rational policy, we might actually get something done. But they’re in the closet and they are, in my opinion, less than courageous. And they are contributing to these awful policies.

Carl, on the rational policy. In your opinion, what would a rational policy look like? Decriminalisation is in the mix, but we need to go beyond decriminalisation. In your opinion, what would that rational policy be? 

I’ll tell you. Given that the United States has miseducated the world and we have exported our awful drug policy and our awful drug knowledge around the world, the world needs to be re-educated about drugs. So for me, the first thing that we do.. Yeah, we should decriminalise all drugs. That is, nobody’s going to jail for what they put in their body. That stops, that’s a policy. Now, we also implement drug checking facilities, such that people can submit small samples of their drug to some local facility in their community where it’s done anonymously and they can figure out what is contained in their substance. In this way, they are less likely to take some contaminants, some adulterant. And in this way, they’re more likely to have what they think they have and then we don’t have overdoses and those sorts of things. We will also need to have a corresponding amount of better education about what drugs actually do and what they don’t do. 

And so this notion that one drug is evil versus another drug.. That’s not a part of drug education. The education will help people to understand differences between routes of administration. When you take a drug orally, it takes longer to have an effect. And when you smoke it or you inject it…you help people to understand that. You make sure that people have clean injection equipment. You make sure people understand the importance of dose. The importance of setting. Where the drug is being taken. So you have honest, better education. All of this, with the goal of working towards legally regulating the drugs that people want. Just like we legally regulate alcohol. And that’s how I see us going. You allow adults to be adults, you allow adults to make their own decisions.

And sure, some people will get in trouble, because life is not without risk. Anybody who is looking for a life without risk, that’s a boring-ass life! Nobody wants life without risk. And so we figure out how to minimise the risk. That’s our job as public officials. But we have to first be honest that people use drugs to feel good, people like that feeling. It’s like people have an orgasm, because they like to feel good. There’s nothing wrong with that. We act as if you have to be pathological in order to want to experience euphoria from MDMA, or something of that nature. So we have to be honest and we have to be adults about this conversation. That’s where we start.

The phrase “the war on drugs” was coined by the Nixon administration. That’s nearly 50 years ago. We’re looking at the United States. Some of these States are legalising cannabis, which is very, very good. But is it going in the right direction? In your opinion, where’s the public mood in relation to this issue? The criminal justice system and the police, they will even admit that it’s not possible to police our way out of a situation where it’s demand and supply. And where that demand is met, if the criminal gangs will use that vacuum. So, where’s the public mood in all this? Yeah, so the war on drugs. The term was coined by Richard Nixon in ‘71, but please understand, we have had a war on drugs in the United States since the early 1900s. We passed our first federal drug laws in 1914, and that’s when the drug war really began.

So we have a long history of this drug war and we like it, that’s why it continues. When you ask about the public mood. I think some folks on the panel noted it. In the United States, it has a lot to do with race, but it also has a lot to do with class. It’s just that we don’t talk about class as much, because there are a lot of poor white people for example, suffering because of drug laws. I have yet to come to Ireland, but I certainly have been to Northern Ireland. And when I go to places like Belfast, it looks like a number of places in the United States, where poor white people are getting their asses kicked. Basically, because of our policies that are negatively impacting them. And so, we think about where we’re headed as a country, in terms of drug policy. (Senator Lynn Roane) beautifully pointed out that she has concerns about us separating marijuana. When we liberalise marijuana policy, it kind of pits other drug users against each other.

I absolutely, emphatically agree with her. That’s happening in the United States, where we are separating marijuana. Fifteen States have now legalised marijuana for adult consumption. But, this sort of change, or liberalising of marijuana policy, has not happened because we are doing the right thing. It has happened because people see the financial potential and the tax revenues generated from legal marijuana. In other words, in America, the dollar is the major motivating factor. And so I think we will see a continued liberalisation of marijuana policy, as long as States think that they can make more money from marijuana tax revenues than they can from arresting people. From the criminal justice system. So it will be interesting to see where we go. But please make no mistake. We are doing this, not because it’s the right thing to do. Not because we want to respect individuals’ autonomy, that’s not why we’re doing it. We’re doing it because we see that there is money to be made.

Gino, I really appreciate you inviting me and I’m so honoured to be on a panel with Gerard (Roe), Philly (McMahon), Lynn, yourself. I just wish I could be there in Dublin, in the country, so we could interact like humans are supposed to do. And once we get out of this lockdown, I promise to come to Dublin. Because I really dig what you’re trying to do and I support it wholeheartedly. And if I could be of any help, you know where I’m at Gino, so please reach out.

Carl, I’d love for you to come to Dublin. And I’ll buy you a few pints of Guinness, and we can go have a bit of an auld party. I love Guinness! It’s really nice to see you guys.

Thanks Carl, thanks very much for coming. 

* Doctor Carl Hart released Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear to critical acclaim. Check out our review at: https://greenlensblog.com/2021/05/13/drug-use-for-grown-ups-review/ 

** The online panel discussion, hosted by People Before Profit, can be viewed in full at this link: https://www.youtube.com/watch?v=iAgtPMDmZzQ