The addiction researcher Carl Hart argues against the distinction between hard and soft drugs.
In 2013, the Columbia psychologist and drug-addiction researcher Carl Hart published a book that was a specific kind of success: it made him into a public character. The book, “High Price,” is in part a memoir of Hart’s adolescence in a poor Miami neighborhood, documenting the arrival of cocaine there in the eighties. Two cousins, whom as a child he’d looked up to, are exiled from their mother’s house for using cocaine, move into a shed in her back yard, and steal her washer and dryer to pay for drugs. The narrative of Hart’s ascent, to the Air Force, graduate school in neuroscience, and, eventually, Ivy League tenure, is interspersed with evidence from his career as an addiction researcher, in which he spent years paying volunteers to use drugs in a controlled hospital setting and observing the results. Hart argues that the violence and despair that defined the crack epidemic had more to do with the social conditions of Black America than they did with the physical pull of drugs. The book begins with his father beating his mother with a hammer after drinking. Hart’s view is that the attack was not about alcohol. “As we now know from experience with alcohol, drinking itself isn’t a problem for most people who do it,” Hart wrote. “The same is true of illegal drugs, even those we have learned to fear, like heroin and crack cocaine.”
Hart, who was one of the first Black scientists to attain tenure at Columbia, cut a charismatic figure. He had an easy authority in talking about the human and pharmacological experience of drug use, describing it in a way that turned an audience’s expectations on its head. Recounting the Rat Park experiments of the seventies, which allowed rats to press a lever for a drug, Hart explained that rats raised and kept in isolation consumed greater quantities of the drug than those that were held in a stimulating environment. “The key factor is the environment, whether you’re talking about humans or rats,” he said. In the late Obama years, most everyone, but especially most evidence-minded liberals, had lost faith in the war on drugs, and Hart became the scientist who said that pharmacology was a weaker force than we’d been led to think.
To promote the book, and this idea, Hart travelled overseas. During those trips, he said that he favored decriminalization and the regulation of all drugs from a perspective of harm reduction, positions that put him on the far left of the American debate. Still, he was sometimes challenged by audience members who thought these positions condescended to users. At an event in Vancouver, a man in the audience raised his hand and explained that he was a heroin user. “Canadians are more polite than New Yorkers, but essentially he said, ‘Who are you to tell me how to live my life?’ ” Hart recalled. The man was smart and clear, and he knew things about heroin that Hart did not. Hart said the conversation made him feel that he had been “paternalistic, pedantic, all those things. I thought I was, I don’t know, some enlightened scientist, and it just came down to, I had no right.”
In Geneva, he met a physician who invited him to visit a heroin-maintenance clinic with which she was affiliated. Hart spent several months there in 2015, watching heroin users behave as efficiently and functionally as the weighted gears in a watch. Patients checked in twice a day for injections, during one period that began at seven in the morning and another at five in the afternoon. In between, many of them went to work. The patients were each assigned a cubby to stash their respective belongings, and often one would leave a beer there, to drink after injection. Hart noticed that though American doctors worried endlessly over the harms of mixing booze and opioids, it didn’t seem a very big deal to the Swiss users, maybe because they knew the exact dose of heroin they were getting and could trust its purity. When one patient had to attend a wedding in less enlightened England, utterly lacking in injection clinics, she carefully planned out her doses and travel arrangements so she could make the trip. When Hart told me about the Geneva injection clinic, he spoke about it in the way that liberal parents speak about Montessori schools—as a fanatically engineered expression of trust. Of the users, Hart said, “They were always on time.”
Shortly after visiting the clinic, Hart began regularly snorting heroin, as he recounts in a new book, “Drug Use for Grown-Ups.” His description of how he started is deliberately simple, suggesting how many of his boundaries had fallen away: a friend said that she’d never used heroin before but was interested in doing so. “Same here. So one Friday evening we did.” He describes using heroin in carefully managed doses, with product he trusts, in the company of friends, at times when being in an altered state does not interfere with his life, and achieving “a dreamy light sedation, free of stress.” Hart says that he used on “no more than about ten consecutive days at a time,” with a frequency roughly similar to his use of alcohol. He writes, “Like vacation, sex, and the arts, heroin is one of the tools I use to maintain my work-life balance.” There are libertarian strains in Hart’s extreme vision of a responsible individual user—but he also sometimes describes his use in the context of a shared racial identity. “I am frequently in a state of hypervigilance in an effort to prevent or minimize the damage caused by living in my own skin,” he writes. “When heroin binds to mu opioid receptors in my brain, I ‘lay down my burden’ as well as ‘my sword and shield’ just as described in the Negro spiritual ‘Down by the Riverside.’ ”
Last summer, during the nationwide protests after a Minneapolis police officer killed George Floyd, Hart published an attention-getting Op-Ed in the Times, analyzing Floyd’s toxicology report and concluding that traces of fentanyl and methamphetamine found in Floyd’s system had played no part in his death, nor could they have made him “crazed,” as some backers of police had alleged. Shortly thereafter, he was interviewed extensively by the MSNBC host Chris Hayes. But if liberals found themselves moving toward his point of view, Hart was moving away from theirs. This evolution becomes plain in “Drug Use for Grown-Ups,” which makes the case that even the hardest drugs can serve as tools for a more balanced life. Hart is sharply critical of the distinctions that liberals often draw between hard and soft drugs: he quotes Bernie Sanders’s claim that marijuana is different from “killer drugs” and calls that view “ignorant.” Hart agrees with the scientific consensus that heroin is more likely to create a physical dependence than psychedelics or marijuana, but he does not believe that a heroin user is less likely to be functional than a user of “soft” drugs, a position that puts him outside the mainstream. He writes, “Neither heroin nor marijuana is inherently more evil than the other.”
It’s difficult not to notice that Hart is also experimenting with a different public character—one that is more pugnacious and extreme. Having so recently been broadly celebrated, he has now made himself a case study—of whether liberals, presented with an apparently exemplary heroin user, might be willing to see drug policy from his perspective. In so doing, he had also remade himself as one of scientific liberalism’s discontents. Hart told me recently, “In ‘High Price,’ I’m clearly on the left, I’m clearly a good Democrat. And I also subscribe to that ‘up from slavery’ narrative. And I think that’s what a lot of liberals really like. And life is not that neat, obviously.”
To some extent, Hart’s argument is simply that the public-health establishment is infantilizing Americans, and that the more enlightened approach would be to allow them their own preferences. This past year has been a remarkable one in which to make that case. If, during the Obama years, liberals were inclined to follow the teachings of behavioral economics, which gently “nudge” the population toward self-interested compliance, the covid-19 emergency has enforced a stricter regime: six feet apart, masks over the nose, and apps to tick down fourteen-day quarantine timetables. This year, anti-paternalism has been the right’s animating cause. Its complaint, echoing Hart, has been that liberals are working from faux, politically motivated science rather than the real thing. The movement against masking and against paternalism has seemed to grow only more intense as mass vaccination advances: this week, Tucker Carlson told his audience that if they saw a child wearing a mask outside they were to call Child Protective Services (a weird combination of anti-paternalism and straightforward paternalism). Hart was sometimes caught in the red-blue crossfire. He told me, “People have actually assumed that I’m an anti-vaxxer, and I’m, like, ‘Where did you get that from?’ ”
The rollout for Hart’s second book has been less successful than the one for “High Price.” An interview in the Times opened with the question of whether Hart was high. (No, he said, with some indignation.) Hart told journalists that his grants from the National Institute on Drug Abuse had dried up, because he was no longer focussed solely on the negative consequences of drug use on the brain. (The institute said that it does not comment on the grant decision-making process for individual applications.) He told me that a university had asked if he could give a scheduled book talk on “High Price” instead.
When his audiences were not mostly white, the skepticism didn’t really evaporate. On “The Breakfast Club,” the nationally syndicated radio program hosted by Charlamagne tha God, a co-host, Angela Yee, asked Hart about a line she often heard from users, that they were chasing their first high—was there anything to that? Patiently, even Socratically, Hart analogized it to sex: most people really enjoyed their first orgasm, but did that mean in every sexual encounter afterward they were chasing their first orgasm? Hart said, “Of course not.”
“Yes,” the co-host DJ Envy cut in, and added, “an orgasm can’t kill you, though.”
If the media seemed hesitant about Hart’s arguments, that was probably because many scientists and clinicians were, too. “The specific drug matters,” Andrew Kolodny, an addiction specialist and the medical director of the Opioid Policy Research Collaborative, at Brandeis’s Heller School for Social Policy and Management, told me. I heard a note of slight disbelief in his voice, that he was really being asked to explain why heroin caused more physical dependence and human suffering than other drugs. “With alcohol, most of the population can be repeatedly exposed to it and doesn’t develop addiction to it,” he said. With other drugs, like nicotine, heroin, and oxycodone, “it’s a different story. If you’re using those drugs regularly, you’re going to be at very high risk for becoming addicted.”
Bertha K. Madras, a professor of psychobiology at Harvard, argued that the U.S. had just run this experiment, and it had ended very badly. “What we have learned from the current opioid crisis is that it is very easy to promote a drug as safe and effective and harmless, as was done with prescription opioids,” she said. “The end result was that we had millions of people misusing opioids.” According to the Centers for Disease Control and Prevention, nearly half a million people have died from opioid overdoses in the past two decades.
I spoke with Hart on Zoom earlier this month, and when he appeared on my screen—a slim, intense man in his early fifties, with dreadlocks he’s worn long for years and a little gray in his mustache and hair—he sounded like he’d accepted the reaction to the book, even if it frustrated him. “One of the things that has been interesting as I go through the interviews and I talk to liberals—Black, white, whatever, just liberals—and I talk about giving people the right to make decisions when it comes to drugs, they say, ‘I’m just concerned about the vulnerable.’ That’s the buzzword. And then I say, ‘Well, if I hear you right, you’re saying that some people can handle this and others can’t.’ ‘Yeah, exactly.’ ” It seemed to Hart that what the liberals were saying was that “some people can’t think for themselves, and so they shouldn’t have this decision. That’s where you get to the crux of this. People back away from that, but that’s what they really mean.” Hart told me that he hadn’t come lightly to the choice to publish a book saying he was a heroin user. “But now that I’ve done it, I’m so happy that I’ve done it, because I get a little taste of what people get who are vilified, who don’t have a middle-class life,” he said. “I feel more aligned with people who’ve been vilified for their drug use than ever before.”
The drug war has shown an unusual tenacity, of late. The Democrats who run cities often reject its precepts, a wave of progressive prosecutors has been elected, referendums to decriminalize marijuana have been successful. And yet the basic operational pattern, of a very active police presence and vast numbers of arrests for drug possession and other minor infractions, has proved resistant to change. Hart told me that he differed from the rest of the addiction field in that he drew a more direct connection between the work that scientists did emphasizing the toxicity of drugs and the deaths of George Floyd and Breonna Taylor. In his view, the casualties of policing are unlikely to change unless the public comes to view heroin and cocaine in something like the way it now views marijuana and psychedelics. Hart writes that he hopes to encourage other users to “come out of the closet,” and to show how functional even heroin users could be.
If there is to be a wave of professional heroin users coming out of the closet, it has not yet begun. It seemed to me that Hart might have underestimated how unusual he is, as a case study, and how hard an act to follow. Few closeted users could be so sure as he that they are estimating the effects of the drugs correctly, that they are dosing accurately, that using heroin for ten consecutive days is responsible and defensible but using for, say, twenty is not. He is using heroin not just like a grownup but like a scientist.
Hart may be right that there is a large population of quietly functional, closeted heroin users and wrong about their motivations, which might include not just fear but doubt: that they are actually being as safe and functional as they might like to imagine, that the kind of liberties they are taking themselves would also be wise for others to take, that the benefits to broadcasting their use would outweigh the risks. This kind of drug use might not be as brave or unfettered as Hart’s. But, in its own way, it is a very grownup choice, too.
No comments:
Post a Comment