Carl Hart: Drug Use For Grownups, A Human Rights Perspective

I just put here on the slide some reasons why Americans have died in 2017 the auto mode the automobile and gun related deaths that those numbers haven't changed much they've been relatively stable so every year 40,000 Americans die from automobile related deaths now has a bit of movement to ban automobiles in the country it's my pleasure to introduce dr. Karl Hart who is the ZIF professor of psychology and psychiatry at Columbia University thank you very much for taking your time to be with us dr. Hart's an international thought leader on the neuroscience of psychoactive drug use and people importantly he is found in his scholarship and lived experience that social factors and biological factors must be integral to our policies related to abused drugs he's author of more than a hundred scientific articles and the textbook drugs society and human behavior as he shares some of his work with us tonight I expect our views towards drugs and drug users will be challenged and expanded we are really spoiled to have the opportunity for a long Q&A with you afterwards so invite you all to stick around attend and participate however you feel comfortable now would you please join me in welcoming dr. hurt I dressed appropriately for the occasion I see the the priest on the walls but I may talk about some things profane a little different and what the priest usually talk about I want to thank you all for coming out I know you could be doing something else I know recently Massachusetts legalized weed and you could be smoking and getting high or some but you instead you decided to come check me out so thank you I really appreciate it so what I like to do today have a conversation about a recent book I just finished actually I just turned over I think my last edits to the editor I think they were the last that is I certainly hope so the new book is called drug use for grownups and so in my way I will push to society as academics I think should do particularly academics with tenure and academics with who was concerned about their society now for this new book what are the things I did was I went on an intellectual journey it was both geographical as well as intellectual where I traveled all around the world five continents much of the stuff I'll talk about tonight or some of the stuff I'll talk about tonight what deals with my own research that's done in the laboratory where we bring people in the lab and we give them drugs and we study the effects of drugs in order to help with treatment and also to help understand what drugs do when they don't do because there are so much misinformation about drugs the drugs that I'm talking about of course I'm sexy ones cocaine heroin marijuana methamphetamine MDMA psilocybin all of those drugs that people take because they want to have a good time usually and so this journey that I went on I have to think about it in terms of one of my favorite authors James Baldwin when he said that you cannot know what you would discover on the journey what you will do with what you find or what you find will do to you it's a profound statement because that's exactly what happened with me on this journey you will see that know what I was going to find but it certainly it changed me it changed me in a profound way in a way that makes me want to leave this country actually and I'm gonna share some of those things with you all tonight some of the lessons that I learned and some of what I think we should do in this country so if you all would please come back with me on this journey and also by the way you know you can be you can laugh you can be engaged that you can talk you can say things and you can react okay it's alright I feel like I'm in church alright lesson 1 one of the first things that I learned on this journey this journey that's been more than 30 years now is that this is so obvious but I didn't know this I've been studying drugs thinking that I was doing good by my community by telling people for example to stay away from drugs drugs the story my community all of the same tropes that you all know but I discovered from my research and from just traveling around the world engaging with people who do drugs responsible people people who are college students college professors people who are captains of industry things that I discovered was that the predominant effects of drugs are positive but this is not what we're told in the popular press in our movies and documentary films and so forth you're not told that you're predominantly told these negative effects you know can you imagine if you were into automobiles which you can die from driving an automobile that's a fact but can you imagine as you go and do a Google search about automobiles and all the things that comes up are things about automobile accidents that would be that's what happens with drugs but when you look at the data the predominant effects are positive these are just a few studies that we have done this is a study comparing methamphetamine to MDMA MDMA of course is this drug called that the kids call today I think Molly do you although have you changed the name you know when I was coming up we used to call it ecstasy but now it's called Molly and MDMA and methamphetamine they are chemical cousins the only difference is on your right you can see the red circle that's a methylene dioxins and what we found was that both of the drugs increase euphoria produce all of these pleasant effects there were some divergent effects MDMA is a little better at producing empathy or some of those other things but by and large they produce overwhelmingly positive effects another study that we did this is one of the earlier studies where when I was studying crack cocaine in the 80s I thought crack cocaine was which was destroying the black community and so I was determined to do research that would come up with a cure for crack cocaine addiction but this is a simple study that we didn't where we gave people a choice between crack cocaine and five dollars in cash to see whether or not the the people who met crack criteria for crack cocaine use disorder whether or not they would take the drug on every occasion even when you have an alternative but when you have an alternative is low as $5 little as $5 you see that they take drug on about the same amount of time as they take the money which was surprising to me back in 1999 when I was running these studies because I thought that people who were addicted to crack would take crack on every occasion we followed this up with other studies by increasing the amount of money that we offered them compared to the hit when you increase the amount of money to something like $20 they almost never take crack cocaine or methamphetamine we did across different drugs and so one of the things that it told me was that I was ignorant I was believing anecdote and attending to principles that govern human behavior like when you have attractive alternatives people will take those alternatives but it told me that people even when they are so-called drug-addicted can and do make rational choices they overwhelmingly take the money when you increase the amount of money there we've done under studies with other alternatives as well now I know some of you all since we are at a university some of you all are saying well professor Hart maybe they just took the money in your lab but when they left your lab they went out I found their drug dealer and they use your money to buy drugs right could be you know these studies were done in the hospital and then once they finished they saved up their money and then they went found their drug dealer maybe so but if they did again it went against the normal narrative that was being told that drug that people who met criteria for drug addiction had difficulties engaging in executive cognitive functioning such that they couldn't inhibit they couldn't have this long term planning they couldn't delay gratification and so forth well if they did wait until they found until the study was over they did what we asked we placed a lot of demands on them they did all those sorts of things and they engaged in planning that's a good thing it went against what we thought originally even if they went out and bought drugs but I know many didn't because in some cases we wrote checks to play to pay bills for some of them instead they wanted us to pay certain bills but the point is is that folks even in even if they meet criteria for substance use disorder can and do behave rationally especially when you present attractive alternatives and so these kinds of things these are the kind of findings we and others were finding and so it was it was blowing my mind and causing me some cognitive dissonance because it was going against what I believed so seeing all of these sort of positive effects was inconsistent with my belief system now I don't want to leave you with the impression that drug effects are only good that's not the impression that I want to leave you all with because you know that the country at the moment is losing its mind in response to so-called Oh opioid crisis you all have to affect it right right yes you all in the house it's okay to say yeah you're in a house all right all right so we think about something like overdoses that's this is sad this has been a large concern about the country it's a concern that I have when we think about opioid-related overdoses so I just put here on this slide some reasons why Americans have died in 2017 the first in the green there have been almost 50,000 Americans who died from an opioid related death in 2017 when you just take out the heroin related deaths that's 15,000 and in other sort of activities like gun related death there have been about 40,000 automobile related death there than 40,000 or so the auto mode the automobile and gun related deaths that those numbers haven't changed much they've been relatively stable so every year 40,000 America ian's die from automobile related deaths now has there been a movement to ban automobiles in the country no but hell no right and automobiles of course can be particularly that can be dangerous right so we make sure people have training before they get behind the wheel we make sure they are appropriate age seatbelts speed limits we do all of these things to make sure that we can decrease that number but we're not going to ban automobiles we're not even going to ban guns in this country you all been you all have been privy to this conversation right the Second Amendment protects this and this is not an argument to ban guns or anything it's just a reality and so again we try to have safety measures in place when we think about these other activities and even though guns by the way are designed to kill people whereas drugs are designed to bring people relief pleasure you know you all fill me you see the difference okay now back to the opioid related deaths now I didn't tell you that when we think about like the opioid related deaths the way these things work is that when we have the opioid related that's if an opioid is in your body it's considered is it's counted so you can have multiple opioids in your bodies one person but they could have four or five opioids or any other drugs in their body and those drugs are counted once each right now when we think about opioid related deaths it's not well understood why people are dying from overdoses but we have some clues it's important to know that deaths from only heroin or any other opioid is rare it's kind difficult to die from heroin alone unless you are a non tolerant kind of naive person and you take an extremely large dose not many people do that kind of thing it's it's very difficult most people when they die from an opioid related debt it's because they are combining opioids with other sedatives like benzodiazepines you all know xanax right this is a college campus and I'm sure you all know that and you all know maybe Prince valium huh back in the day Prince Valiant was big nerve pain medications things like gabapentin or neurontin you guys may know that lyrica those kind of medications they and do they induce sedation and histamines particularly the older ones something like promethazine really good at decreasing itchiness and some other sort of things that come with allergic reactions but promethazine is one that really induces a lot of sedation's particularly these older ones but also I see the meta fin is a big reason that people die as well let's see the medicine by the way when you get a drug like percocet you guys know percocet percocet has a small amount of opioid in it only about five milligrams of oxycontin that's a really low dose of oxycontin and 325 milligrams of acetaminophen large dose acetaminophen you only need about 20 of those pills to knock out your liver to cause liver toxicity and 20 pills of oxy of percocet at like 5 milligrams that's not enough to really get high to get the kind of high over that a tolerant person will need so number people don't even know that these medications contain that much acetaminophen so a lot of people are subjecting themselves to potential harm a result and these disordered nuance is never in the stories that talk about the so-called opioid crisis so people are not dying from opioids per se but dying from ignorance another reason that they're dying is that many of the street drugs opioids like heroin are now contaminated with drugs like fentanyl and other fentanyl analogues fentanyl is a more potent heroin meaning that there are small amounts of it that's required to produce an effect including overdose so fentanyl can be 50 to a hundred times from are potent in something like heroin but then when you talk about other types of fentanyl like carpet to know that's even more potent and so you can imagine if some unsuspecting person thinks that they have heroin and they have heroin Tayna with internet or just Benton oil and they take their normal dose that's a hot dose that can kill you so these sorts of things have contributed to many of these deaths that we're seeing but this is not difficult to deal with because fentanyl by the way is an FDA approved medication we've been using that drug here in the United States since about 1960 it's really good at treating intense break do pain and so it's going to be around it's going to stay around and has been huge safely but when you don't know that you have fentanyl that's a problem again people are not dying because of opioids per se they're dying because of ignorance but this is solvable so solvable we can solve these kind of problems by simply doing what they do in South America in Europe all around the world except in the United States we do it but we it's done underground this thing that we call drug consumption rooms people can go to these locations and usually in larger cities like New York where there there's a room or there's a space where drug consumption can occur in a monitored sort of private area if people are homeless they don't have to be injecting or using drugs in some unlit place or not well-lit a place that makes it even more dangerous and as also in these spaces they can get drug-related education they get other sort of medical and psychosocial help that they may need because these places are typically staffed by nurses nurses and other sort of medical experts they do these things in Switzerland Amsterdam Barcelona all around the world and they don't have these kind of crises that we have in this country also in these spaces in other spaces they have these things that we call drug purity testing services typically this is an anonymous where somebody can submit a small sample of their drug for a chemical analysis of their substance and so if the substance contained an adulterant a contaminant that's dangerous they have that information if even if even even if it contains something like fentanyl they know now to scale back their use again these services exist for free in many countries all around the world and they don't have an overdose crisis like we have in the United States this is really simple this is so elementary and fundamental unless of course you are moralistic and you think that people shouldn't alter their consciousness well they can alter their consciousness as long as they're using alcohol or but not with these other things and so when we think about when people talk about drug addiction or drug use is a public health sort of thing it's not really in the United States we are quite moralistic and our moral ISM is killing us and so that's just again these are things that I've learned on my journey around the globe now another thing that I don't want to underplay is this issue related to addiction now I know people are we are always concerned that people may become addicted to a substance and you know that's a real that's a real concern and that's an important concern other thing that we all should know is that relatively few people who use even the most vilified drugs like heroin and crack cocaine relatively few numbers of those people or the overwhelming majority of those users don't become addicted you know most of these people are upstanding citizens but maybe 10 to 25 percent will become addicted and that's still that's that's an issue that we have to deal with so I don't want to downplay that but I just want to make the point that the vast majority of those people who use drugs never become addicted they are responsible pillars of their communities they are they paid our taxes they take care of their children they give lectures but University they teach at universities they become President of the United States all three of these guys all used illicit drugs when they were young men we know Bill Clinton smoked marijuana said he didn't inhale we all laugh at that now because we know that's a joke George Bush to smoke marijuana he's widely suspected of using cocaine he never admit it but we know and that's not the besmirches reputation a guy served this country and he did his best Barack Obama of course admits to using marijuana as well as cocaine Barack Obama even like made a joke about it when they asked him if he inhaled and he looked and he said that was the point you know but you can see that all three of these men you know if they were my children I'd be proud of them you know I might be arguing with them about their policies but I would be proud that they at least they served their country to the best of their ability and they were they didn't embarrass them well they didn't embarrass us as much as this guy right but so this is the only guy who said that he doesn't use any drugs now if he didn't you if he doesn't use any drugs the major point is cleared then maybe he should right that's not the major point it's not a major point you know Donald Trump has taken up too much intellectual energy in our country as it is I won't say much more about him it's just too easy to Stephen Colbert and the rest of the comedian's they'll be doing that tonight but my major point here is this it's really simple if the majority of the people who use any drugs any particular drug do not become addicted then we can't blame the drug for drug addiction and we have been too comfortable in this country doing that we have been too comfortable saying we're gonna go after the drug that's ridiculous but but if if the drug itself is not the problem I need to talk about what are the problems why people become addicted I would just want to say a word about the people who do become addicted people who become addicted there are predictable factors and we've known this for a long time but in order to get to the bottom of the person's problem we have to make sure we give a comprehensive examination or assessment of that person and that takes some experience it takes an experienced person and it takes something an experienced person some time to really do a careful evaluation to figure out what's driving the pathological use of the substance now we know some things that are critically important when it comes to addiction we know that people who have mental illnesses or other types of illnesses are much more likely to become addicted to a substance than those folks who don't have these ailments so it tells you something about some of the risk factors another risk factor well the bottom line is that if you treat these sort of illnesses it goes a long way in preventing addiction when you treat these these illnesses well it might even mean for example that you increase people whose dose of pain medication it might actually mean that but you have to make sure that you treat folks and so they are not doing other things that are unacceptable in terms of trying to get the treatment another reason that people have become addicted relates to this issue of poverty homelessness we know that when you make sure that people are they have homes and all sorts of things their drug use well there's alcohol or some other drug use the consequences of that use are not as bad studies have shown this sort of thing we also know economic power epic economic poverty it plays an important role in determining whether or not who will become addicted who will have problems when we think about the country today with opioids we often times we highlight know where oh hi oh no disrespect Ohio but there's some places in Ohio where we have large rates of opioid related problems and then we also go to West Virginia what happened in those places the factories they all left people who have no viable sort of jobs or not at least not jobs that will take care of their families educational skills are really important to in terms of understanding your bodies understanding what's happening when you're starting to get in a we're having a problem learning skills how to inhibit in certain domains of your life all of these things are important when we subject people to unrealistic expectation I'm thinking about people who are celebrities who become addicted you can imagine the young celebrity who has taken care of their family all of their life with their stardom and they have all of these unexpected are or these unrealistic expectations heaped on them and early age and if they don't no longer have the kind of income that they had you can imagine what kind of problems those are you know or you can think about people who cannot allow the public to know that they'd like to alter their consciousness from time to time and how they have to hide this behavior and then they put themselves at greater risk because I'm thinking of somebody like Prince for example who died of an opioid related death he thought he had oxycontin when he had been to nil because certain channels may have closed and now you have another channel that you have to go and the fentanyl was of course so potent he didn't realize that's enough to kill you all of these sorts of things play an important role and why people get in trouble and how people get in trouble and another sort of thing that I learned is related to this issue of drug addiction as a brain disease this is the dominant theory and drug addicted and drug abuse science the theory holds that there are neural or neurobiological substrates or markers that differentiate those people who are addicted to drugs versus those people who are not addicted to drugs that's a simple sort of way of thinking about this so when we're thinking about drug addiction I just talked about some predictive factors if we deal with those predictive you know the predictable factors we it will go a long way in helping people with problem but my science is right now hell-bent on this notion of drug addiction is a brain disease so I just want to share just uh this is a paper published by Nora Volkow she is the director of the National Institute on Drug Abuse these folks fund 90% of the world's research in this area just want to focus on this paper just for one second because it's published in the prestigious New England Journal of Medicine perhaps the most widely read medical journal in the world this is just a quote that I take I took out from this article now in order to get a new england journal publication it has to be a really good paper i mean because this it's a really tough journal to get published in and this is just a quote from this particular article it's it's early volunteer drug use if early volunteer drug use goes undetected and unchecked the resulting changes in the brain can ultimately erode a person's ability to control the impulse to take addictive drugs now one of the things that I love about science it's that we have these clear sort of dependent measures that we we've defined we operationally define or whatever and we see it and then you measure it and it's clear now I don't know how we measure the eroding of about a person person's ability to control the impulse to take addictive drugs I don't know exactly how we she measured this kind of thing there's no there's no by the way there's no data that has ever measured this in in humans certainly and I don't or certainly shown this kind of thing but these are the kind of statements that's in this piece the point is is that it's a horrible paper that's published in the premier journal and there are many of these horrible kind of papers that are not supported evidence that promulgate this notion that drug addiction is a brain disease now when we know that we have these other predictable factors that we can really go out there and deal with to really help people I talked about some of them earlier but our science its focus here in this sort of area where there's a limited data or evidence for but let me just let me just tell you what I mean this is ocean well I'll tell you why I'm so disturbed I'm gonna stir because I started out studying Parkinson's disease and so I know something about Parkinson's disease I think Parkinson's disease it's a brain disease of course and Huntington's disease too is a brain disease I say this because both of these illnesses are progressive they are irreversible and they are fatal the person's unfortunately will die from symptoms related to these illnesses and then when you look in the brains particularly the midbrain Stu striatum of these individuals you can see this sort of progression the steady progression through the clinical manifestation of the disorder you see this sort of decline do you see this atrophy that's happening under these conditions so you have this biological sort of substrate you see also the clinical symptoms with these brain diseases compare that with something like drug addiction with drug addiction the vast majority of the people who are afflicted with drug addiction when I say drug addiction I simply mean the DSM criterias substance use disorder the vast majority of people who are afflicted with this condition recover without treatment not progressive not fatal not irreversible and there are no neuro no neurobiological correlates where we can look at the brains of someone who is addicted and compared with someone who's not and be able to tell the difference no neurobiological correlates and so that's one of the reasons that I'm disturbed that our field my field gets so much attention or has given so much attention to this particular explanations when we have these other sort of more evidence base areas to pursue that could actually help people so that's why I'm concerned now I have to tell you I understand I understand impulse to do this I know why we do this because in fact I went to graduate school in there in the early 1990s and from 1990 to 2000 George Bush won president won proclaimed it the decade of the brain we pumped a lot of money into schools universities in order to get people to study neuroscience I had a fellowship that pay for my entire PhD based on this notion and and so I was determined to find a neurobiological mechanisms that was responsible for crack cocaine addiction I learned a whole heck of a lot about the dopamine transporter about catecholamine metabolism I love that stuff and one of the things that I learned was that and better means are really good at large doses at producing neurotoxicity so when you give a large dose of amphetamine the amphetamine methamphetamine to an animal who is naive you can destroy or damaged neurons particularly the monoamine neurons Naropa nephron dopamine serotonin you can destroy those neurons or damage them and you can also see some problems with the animals behavior and so that that was one of the reasons that led people to start to think that these drugs are causing people to be have this sort of toxicity so I get it but the problem is the doses are given at levels that are 10 20 40 times what a human will take a human will die before before we before they take another dose if you give them those large doses another problem is that when you allow the animal to slowly develop tolerance over time by giving low doses initially and then slowly escalating the dose and then you give a large bolus dose you can block the neurotoxic effects you can block these sort of effects the point is the doses that we used in many of these studies that have shown the neural toxicity in laboratory animals are not relevant to the human condition and oftentimes humans develop tolerance they don't start out you don't go to a party and be like yo give me the largest dose you got you don't do that you won't be around if you do you won't be around to enjoy it and so that's where this kind of notion comes from I get it so one of the things it motivated me to do was to publish a review of all of the human data that was looking at all of the sort of neuro imaging human data that was looking at methamphetamine users or methamphetamine folks who met criteria for addiction I wanted to look at all of the human data to find out to see whether or not there were brain differences in these folks compared to people who had not used methamphetamine before and I also wanted to know whether or not the cognitive performance of the methamphetamine users would be different from folks who did not use methamphetamine I mean this is I chose to look at the methamphetamine literature because the effete amis are better at producing toxicity than any of the other drugs that people like to take for fun so what I found was that when you control for age and education that is make sure people score if their methamphetamine users make sure their scores are compared with that of a normative database correcting for age and education so now comparing high school students or high school graduates to college graduates that's not right and that's what happens in the literature so you have people who use methamphetamine high school graduate or not compare it with people who graduated from college on on some cognitive tests that the Fetterman uses may get outperformed in those conditions but when you compare them people with who are like them age and education level then you see that they score within the normal range of functioning they are normal what about brain imaging well so I have to tell you that when I when I say brain imaging I looked at fMRI PET scans and that sort of thing fMRI data were there were no consistency researchers couldn't even replicate findings of their own findings the only sort of consistency that you found was with PET imaging I just want to tell you what PET imaging is just quickly just imaging is where we inject a radioactive chemical or compound into your bloodstream and this compound often times in these studies bind to dopamine receptors or by 2 monoamine other I mean transporters or something and they bind to these areas or sales that we think will be destroyed by by dopamine I mean by methamphetamine and so here just quick data I just want to just quickly show you these data I don't want to overwhelm you by the way when people show you pretty pictures and these are imaging data these are data often times where people show you in the under these sort of circumstances when you give a talk is you just show a pretty picture and you say this one lights up more than that one that's not data these are data okay so these are the data and the controls are the circles and the triangles are the people who use methamphetamine this is a representative study it's very simple and this is in the midbrain this is a dopamine rich area the striatum dopamine rich area these are just areas throughout and this year horizontal line is the mean score for each of the group mean score for each of the group and each of these symbols represent one person each person what we see is that the methamphetamine users and the triangles have less binding potential thin the controls that means that when you inject it your radioactive compound into their brains or their bodies and goes to their brains that less of that chemical bind it in that region it's an indirect measure of saying telling you something about the availability of those receptors or those cells indirect measure so we can say well if the cells are not there then maybe they're not they've died there maybe they're damaged so that's an indirect measure it's not a direct measure because we have to do some other thing but it's an indirect measure and so what we see across the studies these kind of studies is that the methamphetamine users have a 10 to 15% lower binding potential than the controls 10 to 15% different are we there this is an important point I'm trying to make it as simple and clear hope is we're in the house okay based on these data these are the best data by the way based on these data it has helped to promulgate the notion that methamphetamine users and other people who are who meet criteria for substance use disorder are have this brain disease or brain damaged of some sort now let's look at the data if we look at the data we can see there are a few outliers in the controls that are pulling the mean scar away from each other and another thing that what we can see is that the overwhelming majority of all of the participants look about the same so if you shuffled up each person's image and asked somebody to pull out the methamphetamine users versus the controls you couldn't do it what I'm trying to tell you is that it's 10 to 20 percent difference is most likely within the normal range of human variability some people are tall some people are short some people that's variability that's a normal range of variability I think it's the normal range or I make that claim because when we look at function and that's why we look at the brain because we want to know about people's functioning when we look at these folks functioning they are performing normally they are normal they are functioning normal so you would be hard-pressed based on data that looked like this to say that somehow these folks are brain-damaged or they have some brain issues you all feel me did you all follow that logic and this is what's going on in my field and so one of the things I've done is started to write popular pieces to highlight this for the general audience this was a piece that a colleague I wrote in the American scientists it's a sort of popular sort of science magazine to try to explain this to the general public so they can understand how they're being hoodwinked and I'm also writing in places like nature nature is another one of those top journals that scientists read and I'm writing op-eds and commentaries to also to challenge my colleagues to show me better data than this or to show me how those data indicate that people are brain damaged and so I'm because I'm disturbed about what this means for people who are being labeled as being brain damaged because it's the brain damaged it's a serious charge and it's not warranted based on those data now another thing that I learned along the way and this is part of this sort of labeling people as being brain damaged another thing I learned along the way is that these drugs the fun drugs that people are taking are being scapegoated so that authorities can avoid dealing with problems that the real problems that poor people face it's so much easier to say that we're going to rid the community of crack cocaine than to say we're going to make sure everybody has a job that pays a decent wage gonna make sure people are educated it gonna make sure people have health care we're gonna do that was a far more complicated it's so much easier to say we're gonna put more cops on the street and we got to get rid of crack cocaine we're gonna get rid of heroin we got a so much easier to do that then the deal wit real problems that people face so we scape gate we skate go drugs in this way and we also scapegoat drugs so that we can target and control people we don't like without explicitly saying we don't like them so it's so much easier to say it's so much easier to say that those damn Mexicans are bringing drugs across the border than to say that we don't like Mexicans so we're gonna go after the drugs that they're bringing across the borders we did that with black people in the 80s with crack this is what we do and we fall for and not only that a number of us we got paid because of that I mean I wouldn't have a career if we weren't scapegoating drugs scientists are participating in this we get big grants because it is hoping we're all benefiting as Upton Sinclair once said that it's difficult to can I feel like George Bush - it's difficult it's difficult to convince a man or a woman of a problem when his or her salary is being is dependent upon him or her not understanding so if your salary is dependent upon you not understanding it you won't understand it so that takes me to an issue I have to define because I'm gonna talk now for a few minutes before I close about racial discrimination or racism I'm gonna use these these terms interchangeably because it has something to do with the scapegoating of drugs when I use the term racial discrimination or racism I'm simply referring to an action that results in disproportionate unfair or unjust treatment of persons from a specific racial group so there is a behavioral act and outcome I don't care what's in your head because if you didn't mean to do it that's fine but the act still occurred and the person is still harmed right now one of the things that my feel has become really skilled at is deflecting attention away from what really matters like psychology we talked about implicit bias which may or may not have anything to do with racial discrimination implicit bias is this thing that's in people's heads it's actually like a computer game how fast you respond to words and so forth it's not it's not what what what happened at Starbucks for example when the brothers in Philly they were kicked out of Starbucks you all may remember Starbucks clothes for the day did explicit they did implicit bias training which had nothing to do many had nothing to do with that act of racial discrimination but it's a way to fool people in that to do that you're doing something when you're not and implicit by a stereotype threat all of these psychological terms are really with us to avoid dealing with racial discrimination racism it's really clear you have this disproportion unfair treatment that that happens among the specific racial group very simple deal with what's before you that was in people's heads not what's in people's heart when people start doing that sort of thing then you know it's a trick to not to deal with the issue very simple in science we have to clearly define our dependent measures for that reason okay now I have to take you back to the 80s because this is how I got involved with this sort of stuff in the 1980s we were told that crack cocaine was destroying the community destroying the community that I cared about in Boston if you all know your Boston history you were critical in this regard because in 1986 the 1986 NBA Draft you all know who it's the second overall pick in a 1986 draft Oh who settle in by it's right on Len Bias Lynn Baez was the second pick in the draft and Len Bias went out and celebrated because he was excited and he died and he had taken some cocaine the media report said that he had done crack cocaine for the first time and it killed him and it was evidence of how dangerous the drug was a week later Don Rogers of the Cleveland Brown he was their Defensive Player of the Year the year before and he died of a cocaine related death and the media said that it was because of crack in both cases it wasn't the case they were mistaken in terms of the crack never mind doesn't matter we passed those laws the 1986 law and at 1988 anti drug abuse acts they punished crack cocaine violations a hundred times more harshly than powder cocaine violations and what they did in 86 it brought back to death penalty for the cocaine traffickers and it brought back mandatory minimum penalties meaning that people went to jail for small amounts of crack in order to trigger the same pill only for a powder cocaine you had to have a hundred times more powder cocaine and the 1988 law was extended to just simple possession and also the 1988 law said that the country would become drug free by 1995 and this was written into law how that work out I was written in the law smart people wrote this into law okay one of the things that happened was that what we saw the US Sentencing Commission did a study and what they found was that 90% of the people who were convicted under these laws were black people even though black people did not comprise the majority of crack cocaine users and people were appalled they this is the early 90s 94 so they were they were concerned and then they were equally concerned when they found out that crack and powder cocaine were essentially the same drug the only difference if you focus your attention on laughs it's a red circle is that the powder cocaine contained a hydrochloride group it adds nothing to the pharmacology of the drug it is there to keep the compound stable meaning that you can't smoke it that's about it if you want to smoke it you have to remove the hydrochloride portion and you can do that by boiling it within water with baking soda or heating it up and then letting it dry out the hydrochloride portion will leave and now you just left with the base and you can smoke it but the bottom line is when you dissolve powder cocaine and water and inject it intravenously it produces the same intensity onset of effects as smoking the drugs they are the same drug so the citizen Commission found all of this out they had all of these hearings they found that out the Sentencing Commission by the way are the people who determined the penalty for each sort of law infractions and the Sentencing Commission in 90 into 94 began in 95 submitted to Congress they amended the law to say that the drug should be treated equally this is wrong when they saw the racial discrimination they said it should be treated equally and it was the first time in the history of the census commission that the President Bill Clinton and Congress rejected the recommendation and they kept it the same they rejected it so now we think about like race races who's racist who's not so now many of us make mistakes and so we engage unwittingly in racial discrimination but when information is brought to our attention we change our behavior can't call us a racist the US Sentencing Commission that's what they did Bill Clinton and Congress did not present it with the information seeing the racial discrimination and on this they didn't change their behavior so no in that domain Bill Clinton and the Sentencing Commission were racist that's what we call a racist in that specific domain because we have the evidence in that domain George Bush too came along the Sentencing Commission resubmitted this okay how about one to five we treat him one to five nope how about one to ten nope George Bush did exactly the same thing Congress agree with him 2007 along comes Barack Obama on this issue running for president speaking at Howard University said I just think that this is wrong Republicans thinks that this is wrong Democrats think this is wrong and yet has been approved by Republican and Democratic presidents because no one has been willing to brave the policy because and make it right that will end when I'm president did it end when Barack Obama became president well kind of in the Obama way right kind of so Obama signed legislation that decreased the disparity from 100 to 1 1 to 2 to 18 to 1 so it wasn't 1 to 1 as the science suggested and scientists recommended but the disparity was decrease still this is inappropriate I think Malcolm X spoke to this best posthumously when he said if you stick a knife in my back nine inches and pulled it out six there's no progress so now this is back in the 80s and coming all the way up to present-day time where the law remains what Barack Obama signed it into law but let's think about drugs being scapegoated and who's paying the price for when we think about opioids that's today and let's think about a governor who was just north of you guys not long ago Paul LePage Paul LePage you all probably know paul LePage better than most of the country and he speaks for himself and I'm gonna let him talk about out-of-state drug dealers coming to Maine in response to a question it's a topic he discusses out a lot of town hall forums here's what he said last night the traffickers these are people that take drugs these are guys on the name domani smoothie shifty these type of guys that come from Connecticut New York they come up here they sell their heroin then they go back home incidentally half the time they impregnate a young white girl before they leave which is a real sad thing because men we have another issue that we got to deal with down the road so the page basically nicely in a matter of 30 seconds described how we been carrying out drug policy in our country since our inception really when we started this sort of drug war thing in the early 1900s but he was it was it was masterful so he put aside the users in Maine man you all might know it's one of the widest states in the Union they're like so do you have the white users you put aside say it's not it's not the users it's the traffickers it's d-money shifty and smoothy who has those names and they're from Connecticut in New York again if you don't get it you know with the names we got to tell you where they're from and so we know who we're going after but this is how we been carrying out our drug policy in this country since we started doing this sort of thing in the early 1900s now yeah now there that's not just what heroin we think about marijuana even these are just a few people who died in recent years because a cop or a cop proxy said that they smelled marijuana they thought the person was on marijuana and these people died marijuana which is legal in Massachusetts these are just a few of the recent people but this is how we've been carrying out drug policy and now today we are excited about psychedelics things like psilocybin ketamine I just have a slide here of PCP and ketamine by the way Academy is a derivative of PCP we we made ketamine from PCP they are disassociative sort of psychedelics they have many of the same effects pcps effects lasts longer but they have many of the same effects there they are psychedelics and I just happens just a quick slide here published in the late 80s where John Morgan and his colleagues showed that this notion that connects PCP with violence is not justified we know this but yet and still Rodney King a number of people who were beaten by the police police said that they thought they had PCP more recently in Chicago some of you all might know the laQuan McDonald story laQuan McDonald I have to just show this quick video laQuan McDonald is this black kid who was shot by the police in Chicago it's a bit graphic he was shot 16 times by the police as he's walking away but then later he shot down later they said that he had PCP in his in his system and name and the newspaper articles said that he was out of control but then they released the video a year later we find us out but PCP was used as the excuse and only after the release of the video because of the freedom of the information act that we really find out the truth the bottom line here is that no drug makes people super happy superhuman strength but PCP that story just won't go away and a number of these drugs are used in this way to promulgate social injustice now I'm at the end of my talk and I want to just say that my journey has changed me after I have learned all of this stuff over 30 some years now I'm changed I was one of these people who thought that drugs was destroying the black community and I had to do something about it and I was going to solve the problem and I was so wrong and I was I mistreated people I call people crackheads I did all of those awful things because I believed all of this sort of thing but now education finally worked for me and my education and my journey has profoundly changed me such that I believe that recreational drugs should be legally available to adults and regulate it it would be consistent with our Declaration of Independence I invite you all to read it it is such a beautiful document in it in the first sentence it talks about these uh Nayla beliefs that we have they can't be taken away three of them is life liberty and the pursuit of happiness as you see fit even if that means you use drugs in the pursuit of your happiness so long as you do not impact others to do the same to pursue their rights and in the next sentence is even more beautiful it says that government should be created for the sole purpose of protecting those rights it's amazing that document and it's amazing how we don't live according to the spirit of the founders never mind they plagiarized that document but that's ok it's a beautiful document it's a beautiful document I mean this is just one of the things that Thomas Jefferson's I said that I was really like he said if government people like government decide which foods they eat and medicines they take their bodies will soon be in a sorry-ass state as the souls of those who live under tyranny Thomas Jefferson by the way loved his opioids but he's right this means that there's a tremendous amount of responsibility for citizens for free citizens the price of freedom is responsibility and you have to that's the price that you have to pay now we've already started to do this as you all know with schemes that deal with the making cannabis available you all have it here in this state it ensures quality control you don't get contaminants that we worry about generate jobs tax revenues it's consistent with this notion of freedom and liberty several states in the United States and more are doing this Canada the entire country has done this arrghh way their countries done this of course we need to have better education based on psychopharmacology that's what I've been trying to provide for the public that's what the new book is trying to do I will continue to do this how do we get here require people to have evidence when they're talking about drug-related issues they can no longer just engage in conversations armed with information told to them by Uncle Jack you all will be at Thanksgiving dinner soon you will have an opportunity to try to sell and also respectable people who use drugs and there are a lot of us have to get out of the closet and so we can change this narrative about what respectable drug users look like and how they behave they have to get out of cop they have to get out of the closet I see it as a form of civil disobedience when I think about my heroes people like Martin Luther King Rosa Parks all of those folks they broke the law in order to highlight the in justices in order to highlight the fact that we were not living up to the promises of the Declaration of our founding documents and that's what that's what responsible people do because people are suffering otherwise there are so many people who have lost their lives because of our moralism because of our refusal to allow people to pursue happiness as they see fit now I understand we have built this large law enforcement apparatus in our misguided war on drugs and I don't want people to lose their jobs so this means that we will have to retrain and redirect the efforts of these people I have some ideas about how to do that but time is running short I wrote about it in a new book but I don't want to fire people I don't want people to lose their jobs and we just need to retrain them that they can be partners in helping people to pursue happiness and with that I'd like to open up to the floor to short speeches that are disguised as questions and thank you for your time I am yeah so I just wanted to ask I know kind of early on in the speech he mentioned I forget what you had called them but I was had always heard been referred to as like safe injection sites and how there's efforts in New York and obviously there's other countries which have been successful in implementing them and I wanted to know if you think you know within the near future we would have any chance of that becoming a widespread thing in the United States and if so how long you think it would be and what the obstacles would be in getting there I don't know if we will have open in the United States we do have them in the United States but they're underground and local governments turn a blind eye to it and they sometimes help but they can't say it publicly which is ridiculous like in New York we have them Seattle San Francisco a number of places have them but they're just not open in the public's eye I don't think we will have them until the public the man that we do and the public is just uninformed about the importance of them and that's why we have to make sure we connect it to what's happening with opioid related deaths as a way to stem the tide and as a way to help people to live another day and so we need we need the general sort of population to help the public understand the value of this and so that's why we need people to be talking about this at Thanksgiving and we need to because the lawmakers will follow the public not the other way around my question is that you talk about how black and brown people primary paid the costs for our drug in these murals but now that it started to come more legal white people are actually getting the most from me because they're making a lot more money and so we're almost seeing like so black people played the brunt of this war on drugs but now it's coming legal white people are making all this money off of it and so give any thoughts about that especially as we as we talk about racial discrimination in regards to drug usage are we seeing something now where yeah they're basically like like the majority of people who made these laws to hurt and harm people of color are now benefiting from the legalization of oh you just described America that's that's what we do in our country capitalism one of the things that's happening in this state especially I mean you guys have a really good sort of marijuana legalization sort of board they're trying to make sure that you have representation in terms of minority or ownerships and licenses where whereas other states were not as attentive to that California tried to be attentive to that and it looks like only in Oakland it's really playing out that way and so as more states come online in terms of marijuana legalization people have to be advocating for these sort of set asides for people who paid the price so like it's so warped in most places people who went to jail for marijuana related offense can't be in the industry California that's different and I believe here is different you guys have tried to make things different but the issue just has to keep being raised in these states that are legalizing right we have to 2020 election coming up and there's going to be a number of states that put it on their ballot like I think Jersey in those kind of places in New York and they're all of these these issues are being put on the ballot and we'll see how it plays out but if history is any indication it's gonna play out just like Nike or any other sort of commodity unfortunately you did an amazing job for me in demonstrating how the government is not designed to serve everyone it's designed to serve certain people and so how then can we as the bottom up how can we sort of address this problem without relying on the government at all or the any dominance structures the current administration the current president has made me really think about this because on a daily basis I get frustrated about some of the things that I see and it becomes overwhelming and then it's like I know it's too easy to yell at people or do that kind of thing so one of the things that it's done for me is that I have to look at myself and understand the role that I played in allowing this to go on and I'm a college professor and I never teach about the Declaration of Independence the Constitution I never do that and that's a failure on my part and so one of the things that I've been trying to do with my teaching now is I try to get my students to understand what a beautiful document this is in terms of Liberty and and protecting our responsibility to protect other people's Liberty if we if we if we encourage urge implore people our students highlight for them that it's their responsibility my responsibility to protect other people's Liberty I think that will go a long way and I think but we have to also not be moralistic about this there's a reason we have separation of church and state it's so long as people are not impacting other people's rights and freedoms fine enjoy yourself and that's one of the things I've been trying to do like with the new book that's what I'm trying to do I'm trying to make sure that we understand that one and in that way it will guard against all of this nonsense that we're seeing going on we want to make sure that we protect people's liberties everybody's liberties and so I'm trying to so I'm trying that's what I'm trying to do and that's I'm trying to start with me I hope that was that was good but it's a tough question so I was wondering if by cognitive function you met cognitive performance but that the use of drugs doesn't actually change structurally what happens in someone's brain and if that's the case is a full neurological recovery possible and what differentiates between the people who are able to ability like regain the ability to abuse substances and what isn't what stops them from being able to now I didn't say that drugs don't affect people's cognitive performance now we taking feta means for example to affect our cognitive performance our pilots in our military taking feta mean so they can function longer and be more focused truck drivers all of that sort of things and feta means are outstanding in that regard that's so and also you take other drugs to lessen your sort of focus on things and to so you can do other things so the goal of drug use is to alter your consciousness and impact your functioning that's the goal so I didn't say that what I was saying was that the long-term consequences drug use particularly what methamphetamine users have not the evidence has not supported a notion that these people are cognitively impaired as a result I also do come from a science background so I love the distinction you made between images and real data thinking about educating professionals and who should be re-educated in order to have better drug literacy how do we re-educate like doctors and nurses so that they can better inform patients or should that they be talking about drugs and drug usage and like thinking about how you know we've legalized marijuana if we legalize different drugs down the road how do you have medical practitioners then integrate that into the conversation of you know other avenues that people might be using to with just within their life thank you so the thing that we have to understand when we think about the medical profession nurses doctors when people come to them people are coming to them with a problem those are the people who have a problem that's the select group that actually has a problem and so it's easy for doctors or nurses and health care professionals to be afflicted with this clinic clinician bias thinking that all the people I see have a problem so therefore drugs are a problem and cops do the same thing in the people that they deal with they have a problem and so everybody who does this activity has a problem and that's wrong right that's illogical and so I am hard pressed to enlist clinicians particularly those folks in our sort of educational re educational campaign for the country because in both cases cops health care professionals they can be paternalistic they know what's best for you which is not true of course but that's how their training is in many cases and so that becomes problematic in terms of the field of drugs health care professionals are as worse as cops because at some level if you get sent to the criminal justice system you have a time limit on your sentence in medicine if you get afflicted with substance use disorder or addiction you are an addict for life there's no evidence for that but that's what the feel who says and so your sentence is a life sentence and so I teach at a medical school and I have little hope for for the people in medicine to lead our reeducation efforts eventually though they will follow just think about all the nonsense we said about marijuana in the 90s even I mean I'm not even talking about the 30s but the 90s the early 2000s in 92 when Bill Clinton ran for president he couldn't even admit having smoked marijuana because of the nonsense that's changed but it wasn't led by medicine it was led by ballot initiatives the people and so my faith is in the people and these other institutions will follow I sort of a similar one you talked about how the academics in your field sort of perpetuate these mistruths about what we think we know about addiction I was just curious about how your work is perceived in your academic field yeah thank you how my work is perceived Wow b-before 2013 the publication of high-price it's perceived really well I was the first black scientist to be tenured at Columbia so that no no no please please believe that's an embarrassment that's really an embarrassment that's an embarrassment for the United States that'sthat's really by the way if you don't know Columbia is in Harlem one of the most important black communities in the country and so that's a really embarrassing so it was it was received really well because I was I was carrying the party line I got all the big grants and and in my conscious I started to learn things and I started to get better at my craft and then I really we were perpetrating a fraud on the American public and so my science is perceived is fine but my style my delivery whatever me being out here people criticize sometimes but the science itself still get many publications still doing that sort of thing I still get invited to do grant reviews and all the rest of these kind of things but I don't know if I'll make it into the National Academy of Science as a result not that I give it not that I care you know so so thank you all last question just a quick question to follow up on the question before last the medical profession in the United States was very implicated in not paying very good attention to science and pushing paint believing pharmaceutical companies and pushing oxycontin and now the medical profession certainly in this state has been awakened to the fact that they didn't do a very good scientific job does that not present an opportunity for education now I think the oxycontin story is it's been overblown so Perdue one of the things that they did was they were able to say that oxycontin was not as addictive as other opioids and they got away with that in their marketing and I was just overblown so it really wasn't the medical profession that is to be blamed so much there because you can imagine and in 1999 there was a doctor and before this whole crises a doctor in Oregon who got sued because he was under treating a pain patient and he may have lost his license or almost lost its license and so you can imagine my physicians they're afraid particularly now now if they prescribe opioids they're in trouble in the 90s it's like you're not prescribing enough and treating pain so they just they're going back and forth like me that's a black man for example when I get pain prescriptions I over time I realize I have a problem going to the pharmacy like my physician is black so it's it's cool in that regard the pharmacy stops my prescription that my physician bro and so everybody's afraid the pharmacist is afraid the insurance companies are the ones who are really benefitting because they don't have to pay for this anymore even if your physician prescribed it because the the pharmacist will stop it so I just do what well I know a country I'm in I'm married to a white woman so I'd have her go fill the prescription and it's fine but this is what happens in our country we go depending on shifts too far back and forth and so I worry about vilifying positions because when people really need pain medications they're not going to be able to get them and opioids they are they've been around forever and they've been around because they're so good at dealing with certain types of pain and I'm afraid I'm worried that they won't be available and then we're gonna send people out into the streets to seek to get their opioids but physicians are just too afraid and we understand why they are and so I worry about blaming them for this Purdue got away with saying that oxycontin was not as addictive as other opioids patience also have a responsibility to and we haven't talked about that much like I know when I'm taking opioids one of the things that you know before you start to really have a problem you get constipated you know and then you started to see constipation and it's like something's wrong pay attention to your body you're gonna continue to pop the pills come on we know we know and we we also share in that responsibility thank you all so much for coming out [Applause] [Music]

Channel: GBH Forum Network

Views: 40,627

Rating: 4.8076582 out of 5

Keywords: Boston, WGBH, Psychology, Columbia University, Carl L. Hart, neuropsychopharmacology, Drugs, Society, human behavior, addiction, opioids, High Price, psychedelics, smoking weed, marijuana, methamphetamine, stimulant, taboo

Id: M6PHC4p1Ohw

Length: 91min 4sec (5464 seconds)

Published: Mon Dec 30 2019

Reddit Comments

[u/An0n0ps555]

Fuckin A thank you sir. I been saying this shit for years and I wish other people would jump on this bandwagon. Now that Oregon has decriminalized I’m hoping it’ll end up going like it did with legalizing weed, one state does is, then one or two more, then before you know it half the country. I’m a fairly functional and productive drug user, but because of societal stigma the minute someone finds out I use meth, I’m automatically judged to be a piece of shit tweeter and assumed to be a thief or worse. It’s frustrating and unnecessary. If more people were having this discussion, and more drug users who are successful and functional members of society were willing to stand up and show the world that the two are not mutually exclusive, then maybe that stigma would start to change. Good for you, sir. Keep it up

[u/turtlefox420]

I would also happily respectfully debate with anyone who disagrees. I'm certain about this. I do still believe that clandestine labs and places selling unknown chemicals and dosages to people, should be prosecuted. That is absolutely unacceptable, we need to demand testing and certain standards! No more racemeic, iso , msm cuts! Let the people who are going to use, use the stuff safely. I'd love to have a consistent product that I know the effects of everytime. I rarely do meth anymore because I get tired of all the washes and harm reduction that goes into being safe with this cut shit everywhere.

[u/turtlefox420]

I would like to share this with you guys. It's not really a guide for drug use, but he's really changed my opinion the past couple years about the war on drugs and the stigma on drug users. There is a horribly unnecessary stigma on drug use, more so in America, because we are a very "moralistic" society. We also base things off of personal antecdotes rather than science and facts. There are millions of responsible drug users, of all classes of drugs, who aren't addicted and live a happy functioning life. It's important to make the distinction between a user, abuser, and addict. Some say America has an opioid crisis right now and that's just not true. We have an education crisis, well, combined with a few others..
As I'm sure most of you know, MOST people don't die from just using heroin. it's usually what else is in the drug or what the person combines it with. That's because they are ignorant to the amount of drugs they are even taking and the effects/consequences. that's not the drugs fault, it's simply a chemical, if we were properly educated and there was less stigma/taboo about drugs, then far less people would have an actual drug "problem". I'm not downplaying anybody's addiction, I encourage you to get help if it is negatively effecting your life. But if it's simply not negatively impacting you or your goals, then stop beating yourself up over it simply because of social stigmas. We need better education, resources and healthy alternatives in higher populated/low income areas, to help with mental health and better understanding of life and how to deal with the problems.

We NEED to DECRIMINALIZE all drugs, and stop throwing addicts in jail, treat them like human beings, and help provide resources for them for safety and help if they want it. We waste far too much money, ruin too many lives, limit so much research, with the war on drugs. I hope us functioning users can come out to society and break the stigma on drug use. It's a natural human inclination to alter or improve our consciousness, we just can't let it negatively impact us. As an American we are entitled by the US constitution, The right to the pursuit of happiness as long as it doesn't interfere with the rights of others!

Its the people with serious societal/economic, or physical/mental issues, that are on these drugs to cope with their problems problems. It's easier to blame the drugs, and have society think drugs are the problem, than to deal with all of the underlying issues that are at hand. "If their salary is dependent on not understanding the problem, then they won't understand it " that's the problem with our government. They simply don't care or understand the problems of the minority or lower income areas.