Doctor Carl Hart is a Professor of Psychology, specialising in Neuroscience at Columbia University in New York. He is well-known for his research on drug abuse and addiction, which has been his passion for over 25 years. He opens his latest book, ¹Drug Use for Grown-Ups, with the lines:

“I am an unapologetic drug user. I take drugs as part of my pursuit of happiness, and they work. I am a happier and a better person because of them.”

As a means of better educating drug users and thereby facilitating their health and happiness, he suggests that people focus on four areas – Dose, Route of Administration, Set [individual user characteristics], and Setting [environment in which drug use occurs]. These four areas can greatly influence the user’s experience – whether it will veer more towards a beneficial or a negative one.

Early in the book, he highlights the complete failure the war on drugs has been by quoting the United States drug control budget of approximately $35 billion a year in taxpayer money; in 1981, the amount stood at $1.5 billion. This is a gargantuan budget increase, but traditionally-popular illegal drugs are as commonplace now, if not more so, than they were back then. Dr. Hart believes that one unstated aim of the drug war is to prop up the budgets of law enforcement and prison authorities, along with drug treatment centres and urine drug testers. Those in law enforcement receive the bulk of drug-war money according to the Professor, and more drug arrests mean more overtime, bigger budgets and stronger job security for those in law enforcement, while more prisoners keep prison authorities content. It’s worth noting that the U.S. has got the biggest prison population on the planet, at an astonishing ²2.12 million inmates. This system includes ³130 private prisons. It’s clear from the statistics that prison authorities are among those who benefit enormously from the war on drugs.

The Professor believes the term Harm Reduction is dated and should be gotten rid of, or replaced with a more nuanced term, because: “The language we use shapes how we think and behave”. Elaborating on this, he says: “We need to cut the bullshit and stop pretending drugs inevitably – and only – lead to undesired outcomes”. He doesn’t believe there should be a specific term for harm reduction, mentioning other existing phrases which could be used, such as: “common sense, prevention, education, and the like”. Dr. Hart emphatically states that “Drug abuse and addiction are a minority of the many effects produced by drugs…” Of his years spent researching drug use, he says: “More and more, I came to realise that drug-abuse scientists, especially government-funded ones, focus almost exclusively on the detrimental effects of drugs…” He says that addiction “represents a minority of drug effects, but it receives almost all the attention, certainly the media attention”, before asking: “Have you ever read a newspaper article or seen a film about heroin that didn’t focus on addiction?”

Other universally-accepted lifestyle choices involving calculated risk are listed, including flying and driving – two potentially dangerous activities, which statistically involve few injuries or deaths when engaged in correctly. The information that’s typically found about heroin is compared with a driving analogy: “Imagine if you were interested in learning more about cars or driving and could only find information about car crashes or information about how to repair a car after a crash”. Regarding the small fraction of users who suffer with addiction, he says there are a substantial proportion of addictions involving “co-occurring psychiatric disorders – such as excessive anxiety, depression, and schizophrenia – and socioeconomic factors – such as resource-deprived communities and under-employment”. The Professor stresses that there are no inherently “evil”, wholly-negative drugs, despite what we are told growing up. Regarding the age-old gateway drug myth about cannabis, he states that it “grossly overstates the evidence by confusing correlation with causation…the vast majority of pot smokers never go on to use so-called harder drugs.”

He discusses the alarmism of typical cannabis-focused headlines which often blame it for psychosis. The studies such claims are based on generally make bogus interpretations of their data. This is because weed-centred studies often highlight when volunteers have marked if they have ever experienced certain psychotic symptoms (something many people do at some point in their lives) on a questionnaire. Such studies then decide that those volunteers qualify for psychotic disorders, when in reality, determining if someone suffers with a psychotic disorder requires rigorous consulting with psychologists and psychiatrists. It is not simply a box-ticking exercise. Of similar note, the inaccurate reporting of the results of toxicology reports by authorities and the media is looked at. These results generally involve many complex factors and according to Dr. Hart, “one of the most important limitations of many recent analyses and reports on drug overdose deaths is that the co-occurrence of alcohol is ignored completely”. 

Brain imaging data is another area the Professor breaks down into basics – structural scans look at the size of brain structures, without telling you how they’re functioning. Functional scans provide brain activity information (i.e. specific neurotransmitter activity), but not brain structure information. According to Dr. Hart, these scans only capture a moment in time. This means it’s nearly impossible to determine if drug use caused any difference to the brain, or if that difference was there before the scan occurred. Multiple scans are needed at different times to gain a true understanding of whether drugs have affected the brain or not, so the result of what is a highly nuanced procedure often ends up becoming an alarmist ‘finding’ about brain deterioration. The ignoring of tobacco and alcohol’s effects on the brain are also common oversights. Toxicology reports and brain scans, so often misinterpreted and misrepresented by prohibitionists and the media, often make the aforementioned mistake of confusing correlation with causation.

Dr. Hart says that complicated socio-economic issues are often reduced to being the result of “drug problems” by the powers that be. This means that more resources end up being given to law enforcement, instead of community organisations who urgently require education programmes, employment and life-saving drug services. The Professor outlines the deep-rooted, historical racism which has been such an intrinsic part of the war on drugs, stemming mostly from the U.S and spreading throughout the world thereafter. Opium developed a negative reputation because of media fear mongering in relation to the opium dens of Chinese immigrants. Dr. Hart cites an 1882 report, which said that young, respectable white people were “being induced to visit the dens, where they were ruined morally and otherwise”. The marijuana term entered common use in English because American authorities and media co-opted it from the Mexican term marihuana, to give it an association with Mexican immigrants, who traditionally used the plant and in some cases brought it to the States.

Common use of this term helped to exploit the existing hatred or distrust many Americans had for Mexicans, giving weed a negative connotation via perceived association. Media stories emerged in the ‘30s claiming that cannabis use by blacks led to violent crimes. Then there were ridiculous stories about cocaine use causing black men to become unpredictable, dangerous, and even bulletproof, in certain cases! The Professor notes that all modern reports referring to zombies and users with superhuman strength are descendents of those old media falsehoods, existing as a sensationalist, dehumanising means of justifying discrimination and brutality. During weed regulation hearings in Congress in 1937, Harry J. Anslinger is quoted as having said: “Marijuana is the most violence-causing drug in the history of mankind”. But interestingly, Dr. Hart states that there has been public data proving the safety of cannabis since it was first banned. New York City Mayor Fiorello LaGuardia commissioned a study about its use and effects and the results ran contrary to Anslinger’s hysterical statement.

Report findings from 1944 concluded that concerns about catastrophic effects from smoking weed were unfounded. It said that those “who have been smoking marijuana for a period of years showed no mental or physical deterioration which may be attributed to the drug.” Further highlighting systemic racism, Dr. Hart quotes data from The U.S. Sentencing Commission in 2017, which states that over 80% of those convicted of heroin-dealing were black and latino, despite the fact that most dealers were white. He also mentions the fact that black men make up 40% of U.S. prisoners, despite only representing 6% of the country’s population. The horrendous police killings of many African Americans, such as Philando Castile, Sandra Bland, Trayvon Martin, Laquan McDonald and Tamir Rice (who was shot at the age of twelve) are discussed in the book, as are the distortions of what occurred in subsequent reports released surrounding their deaths. These police killings and others place a glaring emphasis on the very serious issue of systemic racism in America and how the war on drugs continues to enable it.

The way the media shapes our perceptions of the effects of drugs and who is using them where, is a crucial subject area of the book. The media frenzies sensationalising the crack cocaine crisis and in more recent years opioid use in the U.S. are covered by Dr. Hart in considerable detail. The common portrayal of crack mainly being used in poor black communities, when in fact it has been used primarily by white people, will likely be a revelation to many readers of the book. The author also discusses the mythology surrounding ‘crack babies’ and writes about troubling incidents in which pregnant women who were found to have cannabis in their system then had custody over their newborn babies removed.

Drug Use for Grown-Ups is a must-read book in a time where the war on drugs is increasingly put into question across the world. I would highly recommend this book to anybody with an interest in cannabis, drug policy, health, misinformation, corruption or racism. Dr. Carl Hart expertly argues the case for every adult’s right to the pursuit of happiness, as espoused in The U.S. Constitution. He believes that safe, informed drug use should be permitted as a part of that equation. He argues this while dismantling virtually all of the arguments that are found in favour of prohibition, with an expertise developed over years of hard graft. From being a young man fully invested in the war on drugs narrative to one who sees it for what it really is – an authoritative narrative built from racism, paranoia and notions of morality, rather than one based on logic and scientific data.

* The Green Lens would like to thank Doctor Carl Hart for providing us with a review copy of this book.

References

¹ Drug Use for Grown-Ups can be purchased via The Book Depository here –

https://bit.ly/3f01fMc 

² This figure is taken from the following page, which details global prison populations –

https://www.statista.com/statistics/262961/countries-with-the-most-prisoners/

³ For more information on U.S private prisons, see this link –

https://infotracer.com/resources/us-private-prisons-facts-statistics/