Legalizing All Drugs Is Just the Beginning of a Compassionate Drug Policy

Carl Hart

In a new book, neuroscientist Carl Hart shares stories of his own drug use to break down the stigma.
Carl Hart

President Joe Biden has shifted some of his positions on drug policy in recent years: He’s now against mandatory minimums for certain offenses. He’s open to commutations for people serving long drug sentences. And the Biden-Harris platform proclaimed, “No one should be incarcerated for drug use alone.”

However, peer a bit closer, and you’ll see that Biden’s drug policy approach still assumes there is something inherently wrong with illicit drugs and the people who use them. For example, the administration’s “solutions” regarding drug policy involve mandating treatment for people convicted of drug possession. This mandated treatment policy is coercive and illogical, given that most people who use drugs are not addicted to them, and even those with serious addictions are generally not helped by involuntary “treatment.”

Biden is hardly unique in this regard. Even as marijuana legalization gains momentum around the country, the U.S. has a deep and abiding problem when it comes to both policy and public consciousness around drugs. In order to approach drug policy rationally and compassionately, we must drop our assumptions and expand our imaginations. That’s what acclaimed neuroscientist Carl Hart does in his new book, Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear. Hart, a leading drug researcher and a professor of psychology and psychiatry at Columbia University, suggests a full-scale reframing: Don’t assume that drugs are bad. He recognizes that pretty much any drug can have benefits, including typically vilified drugs like heroin, cocaine and methamphetamines.

In his book, Hart courageously presents this new framing through the lens of his own experience. He regularly uses illicit drugs, and shares how heroin, methamphetamines, cocaine, MDMA and others have served useful purposes in his life — including just relaxing and having fun. Hart notes that addiction affects “only 10 percent to 30 percent of those who use even the most stigmatized drugs, such as heroin or methamphetamine.”

Yet most U.S. drug policies are constructed with addiction and harm as justifications. In practice, those policies play out as other forms of criminalization do, targeting Black, Brown, poor, trans and disabled people, and other marginalized groups. Meanwhile the real and tragic problem of drug overdose persists — and Hart shows how criminalization makes it impossible to confront that problem, too.

Hart urges us to not only decriminalize drugs but also to legalize them. There are many reasons for legalization — including that decriminalization still comes with fines, civil penalties and stigma. (It should be noted that legalizing drugs equitably would need to come with reparations for communities impacted by the drug war and significant opportunities for people who currently sell illicit drugs.)

But in addition to acknowledging the importance of curbing arrests and incarceration, Hart focuses on how legalization could substantively improve people’s lives by reducing the risk of overdose, reducing interventions of child protective services, and increasing safety and awareness for all.

I chatted with Carl Hart about his book — and about what a life-saving, life-affirming, freedom-affirming set of drug policies could look like in this country.

Maya Schenwar: For me, one of the most refreshing aspects of your book was your acknowledgment that not only aren’t we going to have a “drug-free America,” but also that we shouldn’t want one. You argue that it’s OK to take drugs for all kinds of purposes, including just the pursuit of happiness — and you talk about this through the lens of your own current drug use. Why did you decide to tell this story through such a personal lens?

Carl Hart: Well, one of the things I know is that, having published more than 100 papers in the scientific literature, nobody knows and nobody cares. Nobody reads that boring shit. I learned that you have to tell a narrative — stories people identify with. I have all of these inconsistencies that are part of my character. I thought — take advantage of this character to tell this story. And that’s what I did here.

You used to support decriminalization of drugs but not legalization. Many of us agree that drugs must not be criminalized: We should not be policing and incarcerating people for these things. But legalizing drugs is an additional step. Where did that change come from, for you?

I think about what the real concerns are, when it comes to drug overdoses. First, we start with the quality — knowing what you’re putting [into] your body is the most important thing. Decriminalization does not even address that issue. And so, people are getting toxins, adulterants, and then they don’t have a chance. With decriminalization, we’re not arresting people, which is really important. But if people are putting substances in their bodies, there should also be some quality control. That’s the main thing. When I realized that more of the dangers flow from the adulterants in substances, that’s when I realized that we need to do something about regulating the quality.

Yeah, this is what we’re seeing with fentanyl in heroin, which people don’t know is there…. In your book, you talk about how offering widespread drug-safety testing could save lives. [Drug-safety testing involves checking drugs to inform people about what’s in the substances they’re using.] But when you suggest drug-safety testing to politicians — including liberal politicians — it’s off-limits; they don’t even consider it. They want things like naloxone to treat overdoses after people are already in horrible peril, but they oppose safety-testing the drugs, which could prevent so many health crises from happening. To me, this way of thinking is actually killing people.

That’s exactly what we have to say. People are acting like these half-assed efforts should be praised when, in fact, they’re killing people.

Some liberals think they know what’s best, and you should be praising them simply because their hearts are in the right place. They think they know more about your experience than you do.

I speak about overdose potential. I separate that from addiction because the people who are overdosing, a lot of them are not addicted. The thing we can do immediately to wipe out a number of overdoses is — it’s simple — implement nationwide drug checking.

You talk about how there needs to be much more awareness and education around drug combinations, like the fact that combining heroin and alcohol is extremely dangerous. I was thinking about the drug “education” programs I went through as a child, and how they contained no useful information. In addition to the widespread drug awareness that’s needed for adults (for instance, around drug combinations), I was wondering if you could share a little bit about what you think a real useful drug education program could look like, for kids.

All the evidence, for decades, shows that the drugs that children under 17 or 18 years old are most likely to use are marijuana, alcohol and tobacco. That’s where my education would focus. With teaching about other drugs at that age, you are distracting them and using scare tactics with them. If you’re doing the education because you’re concerned about the health of the people who you’re talking to, then you’re talking about alcohol, tobacco and marijuana.

For marijuana, the major effect that young people have to worry about is taking too much of it [which can prompt paranoia and anxiety]. I would make sure I explained to them that the difference between the oral route and smoking in terms of onset, the effects and how long the effects will last, and make sure they understand all of that really, really well.

With alcohol, I’d make sure they understand the sedating effects of it when you have too much, too rapidly. I’d make sure they understand what it means to vomit, when you’ve been drinking … that’s telling you to stop, because now you’ve had enough. That’s your mechanism to let you know that it’s getting really serious now.

And with tobacco, I’d tell them about the data. The effects of tobacco are not so immediate — the ones that we’re concerned about, like cancer. At first, you might think you’re good, but then later in life, these things start to show up. As a young person, you might not see any of these effects. So we would warn about cancer and those sorts of things — young people rarely see those effects right away, and so I’d be real with them about that.

We’d have a short curriculum that’s easy and fool-proof.

The “opioid crisis” in this country has been portrayed as a crisis of white victims and Black or Brown sellers. Now we have a growing number of drug-induced homicide laws in which people are actually being prosecuted for murder based on giving or selling someone opioids. Could you talk about those types of laws, and what path they take us down?

Those laws first came into effect in the ‘80s, along with the 1986 crack-powder law [which established a 100-to-1 sentencing disparity between crack and powder cocaine]. These laws came into effect in part because they were going after the Black sellers, who were vilified. In the pictures they painted in the United States — and the media participated — the sellers were all Black people, even though we know that most sellers were white. We knew that, the DEA knew that. But the pictures that they painted were always showing the cats who were in cities like New York, on the corner…. Those are the people prosecuted under these laws. Even when they catch some middle-class white dealer, they still have the choice of whether to apply these laws to that person. And if that person has sufficient resources and speaks the language of the court, the person will probably not be charged under that law. That law is used to prosecute people they don’t like.

You specify that your book is not about addiction, but I thought it had some helpful things to say about addiction nonetheless. You talk about a clinic that’s been operating for decades in Geneva, Switzerland, for people who are addicted to heroin, where the treatment is actually giving people heroin — and that it’s had incredible results. No one has ever died while receiving heroin in the clinic, and blood-borne illnesses are way down…. How does this work?

People come to the clinic twice a day, every day. And sometimes they can take home doses, depending on life situations — like if you have to go to a funeral or wedding or something like that over the weekend. And many of the people who are in the clinic have been there for 20 years or so. They all have access to a psychiatrist, psychologist, nurse, social worker, all of these options if they want them…. They have all of these members of their treatment team, they have access to housing and employment if they want it. They come there twice a day, 7 o’clock in the morning and 5 o’clock in the evening. It’s an amazing thing. I learned so much from those folks.

You don’t like the term “harm reduction.” You talk instead about using language around safety and health and happiness. “Harm reduction” is obviously a term that’s in very wide use, including among people working to support drug users and challenge criminalization — including me! Could you talk a little bit about your critique of that phrase, “harm reduction”?

When we think about “education,” that phrase is neutral. “Intervention” is neutral. “Common sense” is neutral. Those phrases, they’re all doing the same thing that the folks that talk about harm reduction are trying to do.

But we say “harm reduction” — that this is our goal — when we’re talking about drug use.

Most of us who use drugs are using drugs to alter our consciousness, to enhance pleasure. We’re trying to have better experiences. “Reducing harm” is not the prominent thing we’re concerned with. But when a lot of people think about drug use, they just think of harm, and reducing harm — the idea of taking care of people who don’t know how to take care of themselves. I’m just asking people to get rid of the charged language. We should have a term that’s more accommodating of conflicting constructs.

You talk about the issue of “drug exceptionalism,” such as how white middle-class psychedelic users are set apart from other drug users. This is something we see throughout a lot of politics…. Policy makers will paint some criminalized people as innocent and others as evil. What do you see as the dangers of drug exceptionalism?

People are setting themselves apart from others — they are othering folks. We categorize people who use particular drugs, along with categorizing them by their race and class.

It’s really a way that we promulgate our classism and our racism.

I have a question about studies that are done on drug users. You talk about how the actual design of studies might be flawed because people are asked to take drugs in sterile labs with strangers…. For me, for example, MDMA has been a really life-changing drug. But I’ve only taken it at home. Who wants to take MDMA in a sterile lab, or mushrooms in a sterile lab, with strangers? So, given the fact that you’ve used so many of these drugs yourself, what are some of the ways that you think that scientific studies should change in relation to drugs?

One thing is that we need to do studies with couples. We allow couples, partners to partner up and be themselves – and design the studies with partners in mind. That area is completely unexplored.

And a lab can be anywhere. A lab can be in your house. The main thing is that you control the variables. As long as the environmental influences are kept to a minimum, it doesn’t matter where the lab is. You want a more real, naturalistic lab — as natural as possible. And you figure out what that is. Researchers need to be creative.

President Joe Biden said throughout his campaign that people shouldn’t be incarcerated for drug possession — they should be mandated to treatment. Of course, this sets off alarm bells for me. As you point out, most people who use drugs don’t want or need treatment.

Biden knows that this position is politically safe. So he’s not gonna deviate from that. But it’s not useful.

This policy is a joke — even Biden probably knows it’s a joke. But it’s still considered progressive.

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