Factually! with Adam Conover - Decriminalizing Drugs with Dr. Carl Hart

Episode Date: January 27, 2021

This week, Dr. Carl Hart - professor of neuroscience and psychology at Columbia - joins Adam to argue that we’ve been approaching recreational drugs all wrong. Together they discuss how we have historically exaggerated the harmful effects of drugs on the brain, how stigma and criminalization create greater adverse effects than the drugs themselves, and more. Dr. Hart’s new book, Drug Use for Grown Ups, is out now. Learn more about your ad choices. Visit megaphone.fm/adchoices See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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So if all of that sounds good, if you want a big box of delicious snacks like this for yourself, use the code factually for $15 off your first order at Bokksu.com. That's code factually for $15 off your first order on Bokksu.com. I don't know the way. I don't know what to think. I don't know what to say. Yeah, but that's all right. Yeah, that's okay. I don't know anything. Hello, everyone. Welcome to Factually. I'm Adam Conover. Let's talk about drugs. We've got a really screwy view of drugs in this country, don't we? I mean, I was brought up late 80s, early 90s, the dare years They killed people and destroyed neighborhoods. And if you did these illicit substances once, just once, your life was going down the shitter and your parents would be left to cry at your closed casket funeral if they weren't too ashamed to show up. On the other hand, don't forget legal drugs from certified medical professionals. Oh, those are no problem.

They were medicine and they were being handed out in larger and larger quantities. But, you know, as I grew up, I started seeing some issues with this because on the bottle of Adderall, I was prescribed for my ADD. I know, I know you call it ADHD, but when I was diagnosed, we called it ADD. So I'm sticking with it. God damn it. When I looked at that bottle prescribed to me by my doctor, it said on it, amphetamine salts, amphetamine salts. I was like, hold on a second. Amphetamines. Isn't that one of those scary drugs they were just telling me about in dare after school is the salts neutralizing the amphetamines or no, it's just straight up the same drug exactly? Huh, that's a little odd. And, you know, I also couldn't help but notice that alcohol, which was and is legal and socially accepted, in fact, socially encouraged or mandatory in

many situations, kills around 100,000 people every year. Meanwhile, marijuana was killing exactly zero people, but the shitty joint my friend rolled me behind the gym was still completely illegal and would get us expelled or jailed if anybody found out about it. There was a little bit of a conflict there that didn't make sense to me, you know? Well, you know, here today in 2021,

it seems like we're starting to see the light in America. Cannabis is legal in broad swaths of the country, both for medical and recreational use. And after decades of activism and science, psychedelics like psilocybin and MDMA are being found by psychologists to be super useful for treating conditions like PTSD and depression. Now, many drugs are still illegal, but it looks like just maybe we've reached an equilibrium where we can figure out which drugs are actually good and which ones are actually dangerous and make sure that just the dangerous ones are illegal, right? That's how it seems like it's starting to feel. But what today's interview made me wonder is what if that is still a shallow

model to think about our relationship with drugs? Because what if the thing that makes drugs the most destructive is not the chemicals inside them, but the illegality itself? What if it's the process of making a drug illegal that actually generates many of the harms that we are most frightened of? Seriously, think about this. For instance, illegal drugs, as opposed to legal ones, have no dosage restrictions or recommendations

or even any consistency in their potency from batch to batch. So it's hard to create a culture of safe consumption, which would help prevent overdoses. In fact, quite the opposite happens. Often people don't know how much is in the dose they're taking, and thus they overdose. Likewise, there's no FDA to regulate what's in them. So illegal drug manufacturers can adulterate them or use substitutes that are far more dangerous. For instance, the very dangerous substance fentanyl is often used as a cheap replacement or adulteration for heroin. And when users don't know that they're getting this massively powerful

synthetic opioid, they're more likely to overdose and die. So think of it this way. If instead of buying beer at a bar from a legally licensed vendor in a standard size bottle with a clear label of how much drug is in it, imagine instead that the only way to get alcohol

was to go down to the beach and talk to some weirdo in a van who would give you an unlabeled container full of some mixture of unknown potency. And then instead of drinking it in public with your friends and family, you'd have to chug it furtively under the bleachers or something like that. I think even more people would die of alcohol than do today. I'm not positive. It just seems kind of likely to me that that might be a piece of it. And on top of those harms, we have to consider the incredible harms of the drug war itself, because the drug war itself is hurting and killing people. Despite all the noise there's been about liberalization and legalization of drugs around the country, in 2016, there were 1.5 million arrests for drugs,

and more than 80% of those were just for possession. And of course, it's minority populations that disproportionately pay the price. Black and Latinx people are much more likely to be in jail for drugs than whites, and much more likely to face mandatory minimum charges from prosecutors. That is millions of lives being degraded,

families being broken up, lives ending too soon, because we have made certain drugs illegal. And, you know, it looks like the ones that we've chosen to make illegal are primarily not the ones that are necessarily the most dangerous, because alcohol is still top of the list. Instead, they're the ones that are the most discriminatory when we prosecute them. So if you put all of that together, you might start to think it's reasonable to conclude that the best solution to our ongoing

drug crisis, the best way to reduce pain and death from drugs in America isn't to continue to tamp down on the drugs that we like the least or that we think are the most dangerous, but it's to decriminalize all of them. Now, I'm not sure that that is actually the right answer. This is a really complicated question. It's one that I grapple with. It's one that I'm still grappling with. But the conversation I had and that you're going to hear today gave me more to think about when it comes to this issue than anyone that I've had in recent memory. So I'm really excited for you to hear it and for you to have a chance to chew on these issues for yourself as well. Dr. Carl Hart has a fascinating and some would say radical perspective on this issue, but he also has the credentials to back it up. He is

a professor of neuroscience and psychology at Columbia University, and his research covers drug abuse and drug addiction. He has a new book out called Drug Use for Grownups, Chasing Liberty in the Land of Fear. And again, this was a really fascinating interview, and I really hope you enjoy it. Please welcome Dr. Carl Hart. Carl, thank you so much for being here. Thank you for having me. I'm happy to be

here. So you're a professor of neuroscience at Columbia, correct? Professor of psychology. I am a PhD in neuroscience, but I got psychology and psychiatry. And you have a new book out called Drug Use for Grownups. Tell me what, just in your own words, what is the thesis of the book? The thesis of the book is quite simple and it's contained in the subtitle. The subheading is called Chasing Liberty in the Land of Fear. I'm asking people to consider their own liberty

and other people's liberty very seriously and not in this jingoistic sort of way. And we're taking drugs, using drugs as a subject matter to consider your liberty. So, I mean, what is your let's unpack that a little bit. Do you feel that, you know, all drugs should be legal? What is your position about drug legalization? I feel that all the drugs that people seek, cocaine, heroin, MDMA, they should be legally regulated just like alcohol is legally regulated. So it brings a level of quality control to this endeavor.

So people, when they take MDMA, they know that they have MDMA just like they know that they have alcohol. Got it. And that's different. I think when a lot of people consider the position drugs should be legal, they're imagining they have alcohol. Got it. And that's different. I think when a lot of people consider the position drugs should be legal, they're imagining unregulated. But you're saying this should be regulated like alcohol. We should have various, you know, societal controls of some kind. But in general, it shouldn't be illegal to use these substances. That's exactly right. We have a federal government and the federal government should do their job like they do their job with food safety, making sure that what's contained in that food product is actually printed on the label and it's actually there and it's of high quality. The same is true with drugs, alcohol. We do that. Let's do that with MBMA.

Let's do that with NBMA. The federal government mostly does its job on that score. Doesn't always. There's always every so often that something gets in the spinach. But, you know, they do pretty good generally. What brought you to that position? Tell me how you how you got there and what you've learned in your research that's brought you to that point. Well, I've been doing this for about 30 years, studying drugs, that is. Well, I've been doing this for about 30 years, studying drugs, that is. And I started out thinking that drugs were bad and we should be controlling them and discouraging people from taking drugs.

But after having given drugs to people in a laboratory setting and studying this subject, I've come to the conclusion that the predominant effects produced by drugs are positive. People are seeking to have a good time, and they do. So why don't we make this activity more safe as opposed to keeping it unnecessarily dangerous like it is currently? And many of the sort of deaths and problems related to drugs, they are related to the illegality of the drug, not the drugs themselves. Well, so let's go through that piece by piece.

I mean, the idea that the main effect of drugs is positive, that makes some intuitive sense because it's like, yeah, wait a whole lot. And that's why you do a drug. That's why you, you smoke some pot.

That's why you get drunk. That's why, you know, cause it, cause you in the moment, it's going to bring you a positive sensation that you seek. That's why you get drunk. That's why, you know, because you, in the moment, it's going to bring you a positive sensation that you seek. It's pretty straightforward. But some would say, I suppose,

I'm going to play devil's advocate with you a lot. I really enjoy this position, and I love talking about it. But, you know, there's some things where I'm a little unsure, and there's some things where I just want to speak for the person who's, who's going to be doubting. Um, so, you know, I think a person who is, uh, you know, got the more reefer madness mindset where they're worried about the drug is going to say, well, hold on. It feels good for a second, but then there's all these other physiological downsides. I mean, sure.

It feels nice to get drunk, but there's a hangover the next day. And if you drink every day a lot, you're not, you know, that the negative effect is going to be become predominant. And so how does that fit in for you? Not very. I don't think about that position much because it's not very thoughtful and it's not very realistic. On the one hand, we can think about the vast majority of people who drink alcohol. Do they have a hangover? Not no, but hell no. I mean, it's true that some people have hangovers and they overdo it. And when you overdo it, yeah, that's there's a negative consequences as well. There should be. I mean, and those consequences, those negative consequences kind of teach us how to do it more appropriately and how to do it correctly.

And so there is a role for those negative consequences. But to think that these negative negative consequences are predominant or that they are inevitable, that's just wrong. Just like any activity, there is a potential negative consequence. No matter what you do, think about driving an automobile, one of the most potentially dangerous activities in which humans engage in. Every year, 40,000 Americans lose their life because of automobile accidents. But we don't say, well, what about the kid who will drive the car drunk and we should probably maybe ban this activity. We don't say that. That would be stupid. But we

do that with drugs and that's stupid. And so I'm trying to help people to understand how to do this better, more effectively, how to do this in a more grown up way. So that that comparison is helpful to me because, yeah, I mean, driving is something that can have catastrophic consequences. Certainly it's something that can be done irresponsibly, and it's something that no matter how responsibly you do it, there's still a risk of something bad happening. And I think those are all true of drugs as well, generally.

But you're right. We don't say this is something we're going to ban. We say this is something we're going to try to make safe. We're going to regulate. We would maybe even say, I mean, my position on driving is we should all do it less and that it would be good if we had less cars and less driving, more public transportation, more subway. If you've listened to the show, you've heard me go on about this.

So but I don't think that motor vehicles should be banned entirely as a sphere. I don't think that we should be sending people to jail, to prison for them. So is that I think that comparison is helping me understand. You hit it on the head, man. I mean, we can take your position on driving and just transfer it to drug policy, particularly when you said what we try to do is make it more safe. We have these. So we've implemented these sort of requirements like age requirement. You have to be a certain age. You have to pass a test. You have to wear seatbelts. We have speed limits, all of these requirements to enhance the safety of this activity. We can do the same thing with drugs. You have to be a certain age. You might have to pass a test requirement.

The manufacturers, they could only put a certain amount of substance in a unit dose in each package. All of these things can be done to implement to enhance the safety of this activity so okay you're i was starting to start to come together a little bit it's you're really almost envisioning like a different world where we we interact with these substances in a different manner i mean if i'm going uh if instead of going, you know, out on the street to, you know, get a baggie of whatever, I'm getting a pill from my pharmacist that has a certain dose in it that, you know, the same way I got to sign the little book, like when I buy Sudafed, right? We're talking about a completely different way of consuming

this drug that has a lot more guardrails on it. That's exactly right. We know how to do this. This is not complicated. We do this with damn near every other activity in our society. But when it comes to drugs, we just seem to lose our mind. And you know what else? It's also it's it's appropriate or OK to be an adolescent when you have this drug conversation. You can't do that with many other conversations in this country. You'd be an adolescent. Well, you can do that with sex. That's another one where you can be an adolescent when you have a discussion about sex in this country, sex and drugs. It shows how immature we are in the United States. Well, let's talk about, I want to get this out of the way right at the

beginning of this conversation, because I think a lot of people listening at this point, like our opinion on marijuana in this country has really shifted a lot more than I ever thought it would when I was, you know, 18 years old and having my first, you know, puff on a joint. I never thought we would have gotten this far. That and gay marriage are like the two big things that like wow that happened quicker than i expected america a lot of other things are happening more slowly than i that i would have expected but those two things are happening kind of quick and so i think you could make that argument to hey anybody in california is probably going to agree with that you on that right but now let's go to the opposite end of the spectrum let's talk about heroin let's say fentanyl even, right, is, you know, beyond that.

I want to know how your argument applies to those types of drugs. When you say the effects are primarily predominant, does that extend to a drug like fentanyl, say? Yeah, it's a good question. First of all, let's just be clear. The only reason that people are doing fentanyl, for the most part, is because they can't get heroin. If you know anything about opioids, heroin is a better euphoric producing drug than fentanyl. Fentanyl is okay. But when you think about the risk to benefit ratio, fentanyl is a lot more potent than heroin, meaning that

smaller amounts of the substance is needed to produce effects like respiratory depression. And whereas the euphoria doesn't necessarily increase to the same rate. So people would much prefer to have heroin. So we're talking really about heroin. Let's take heroin and deal with the question that you asked. Yeah, the predominant effects of heroin are positive. I mean, I myself am a heroin user. Heroin produces effects that are euphoric, anxiety relieving. The user can become more open, forgiving, more magnanimous, all of these positive effects.

And you don't typically have the hangover the next day that you might have from having a dose of alcohol that can produce similar sort of effects. And then as you get older, too, it's a lot less toxic on your liver than alcohol is, heroin is, that is. And so when we think about heroin in our society, we see the person with the needle in their arm and them nodding and they look like this poor soul who is in need of help, that's that is an aberration. And that is the small minority of heroin users. For one, I've never put a needle in my arm to shoot any drugs because there's nothing wrong with that. If the person likes doing that sort of thing, that's their choice. That's their choice. But personally, I don't think that you need to put a needle in your arm. If you have heroin that is of high quality, you can just snort it and get the same effects and nearly the same time course of effects.

When you put a drug in your bloodstream through intravenous injection, the effects are felt a lot more rapidly than when you snorted intranasally. But intranasal effects are felt within two to five minutes. That's fast enough for me as opposed to seconds. And when you see people nodding, it means that they've taken a dose that's too large. It means that they are wasting their heroin. And most people who are experienced heroin users don't want to waste their heroin, particularly when it's so hard to find, you know. And so this here view that we have is promulgated by filmmakers who are ignorant, who is promulgated by media personality who don't know what they're talking about. And so it's easy to vilify heroin users or ridicule them when you have this

inaccurate sort of picture of what a heroin user is. Well, let me let me, let me say to you, uh, I, I agree with you about the, you know, I just watching rewatching the Sopranos and you know, the character Christopher on that shows a heroin users, lots of scenes of him lying on his back, exactly like you're talking about. There's a very sad episode where he goes to Italy and he wants to go to Mount Vesuvius, but he doesn't cause he's, he's a nodding off in some apartment, you know, with a, with a needle in his arm. Um, and I get it, that's a stereotype, but some apartment, you know, with a needle in his arm. And I get it. That's a stereotype. But, you know, from my own experience, I've only, you know, I've only had a few friends in my life who were habitual heroin users.

And one of them passed away of, you know, he, you know, I don't want to get too graphic, but, you know, he choked and he died. And so that's my experience with it. I'm interested in, you know, your argument philosophically, right? And intellectually. And I want to track it as far as it goes. But I also want to be honest. That's my own personal experience with it. Right. And so when it comes to heroin, that's where I go, well, hold on a second. How does that how does that fit in? Like, I'm sure there's other people listening who have had similar experiences who aren't just oh, I'm not just scared by the media, but, you know, have like I've been adjacent to that. And so what am I missing from that from that argument? Does that make sense?

Great. That makes that's perfect sense. So I would answer that in multiple ways. I've had the people die from car crashes. And but when I'm thinking about driving an automobile or purchasing an automobile or talking about the subject, I don't bring up those people. understand the circumstances that happen when they die. I have had friends die from HIV AIDS that they contracted from engaging in sex. But when I think of sex, it doesn't interact whether I'm going to continue to have sex. So drugs is one of these subjects that we are allowed to do that with. And that's inappropriate. It's inappropriate because there are people who will get in trouble with heroin. That's true. Just like there are people who will

get in trouble with driving their car, with gambling, with sex, with a wide range, with playing sports. There will be people who play football this coming weekend and they will be injured and the injuries will probably be lifetime injuries. In many cases, this happens, but we don't stop playing football or boxing or whatever the sport is. But with drugs, drug use, we can say we have one person, we have one experience, and therefore we should ban this activity because of my one personal experience. That's inappropriate. That's a very good answer. And, you know, again, I don't want to be devil's advocate man this whole interview, but I think that's a good response. You would say that I suppose it's not that this is not a dangerous thing to some degree, but we don't need to necessarily ban every dangerous thing

and that we can treat it in a more adult way. That's your argument. My adult, my argument is that any activity that is worth doing to humans carry some level of risk. And so life is not without risk, but we don't ban these activities. We just try to enhance the safety of them. Otherwise you are impacting my Liberty. You are impacting my right to pursue happiness. And, and I don't want to relinquish my Liberty or my right to pursue happiness. As long as I am not interfering with anybody else's right to do the same. Yeah. Do you use the word libertarian as regards drugs with yourself? Or no, I'm always interested in how people think about that word.

No, I don't. I don't put myself in the libertarian camp, nor the Democratic camp, nor the Republican camp. I put myself in the humanitarian camp. I'm a humanitarian. And what best serves humans is where I am at. Sometimes it's a Republican position. Sometimes it's a libertarian position. Sometimes it's a Democratic position. But that's what thinking people do. They are cognitively flexible to deal with the situation at hand. People who are in who are in these camps, they're like fucking children who are on football teams. I can't I can't I can't do that. God, every every question I ask you have the best answer I've ever heard. That's a that's a wonderful way to put it. And yeah, I think that your position

is more complex than that because you're talking about regulation and you're talking about, you know, treating it the way we treat these other things. So speaking as a neuroscientist, like what do you, what have you learned about drugs specifically that has, you know, given you a perspective that most people don't have access to, because I do feel like it's coming from that place. I mean, you said you've studied it, but what, what have you seen specifically beyond, oh, there's a, there's a positive aspect to it. Can I, uh, what, can I answer that question in three ways? I'll wear my neuroscientist hat. I'll wear my psychologist hat and I'll wear my psychopharmacologist hat. Is that okay? Wonderful. Please do. Okay. So when I put on my neuroscientist hat, when wear my psychologist's hat, and I wear my psychopharmacologist's hat. Is that okay?

Wonderful. Please do. Okay. So when I put on my neuroscientist's hat, when I think about what I've learned from drugs, here are the most important things. I came into this thinking that I learned something about the brain so I could learn how to manipulate the neurons that are involved with drug addiction, such that I stop people from being addicted by manipulating these neurons. So for the past 25 years or so, I have worked in the area of medications development, developing medications that help people to stop or to help them to deal with their drug addiction. What I have learned is that we as a field, neuroscience who are studying this, we have exaggerated the harmful effects of drugs on the brain.

One of the things that we have said is that drug addiction causes a brain disease or drug addiction is a brain disease, whatever, however you want to put it. And we show these pretty pictures, these neural imaging pictures. We say, hey, you see this area here of this drug user? It lights up less than the area, that same area in someone who doesn't use drugs. I remember seeing that in like 11th grade health class. They came and showed us the image. They're like, this is someone after they've done MDMA. And let me tell you something that scared me off of doing MDMA. It was scary. I'm, I'm scared of my brain. Like I, my brain's very important to me. I want to keep it safe. Exactly. And I would feel exactly the same way as you. Uh, and I'm sure I

had my scare tactics at my high school years, but I, they didn't have neural imaging. But the point is, is that what the, what the person was doing when they show you these images, they were manipulating you. Those were not data. They were just manufactured images. When you look at the actual data of people who use drugs, MDMA or heroin, whatever, and you compare it to those who don't, you cannot find any differences that are consistent. That is, if you take a group who are drug users and you take a group who are not drug users, you would find that these images look nearly identical. And you or that researcher, if they were blinded, they could not pick out the image of somebody who used drugs versus someone who didn't use drugs. No matter, we don't, we don't have that date. That data is not available. Uh, and,

uh, there is no information that says that they are different in humans. None. That's a myth. That's a myth. And in my book, I go through the data. I take I try and carefully take the reader, the naive reader through how how to evaluate these studies and how and I try and show them how they've been manipulated. And so that's that's one of the biggest things that I've learned as a neuroscientist. Now, as a psychologist, one of the biggest things I've learned is that the most important thing, particularly when we care about somebody who gets in trouble with drugs, the most important thing is to look at their behavior, not at their brain. How are they behaving? Are they meeting their obligations? Are these people distressed by their drug use or disruptions in their functioning as a result of their drug use? Are they distressed by this? When you look at that sort of thing, that tells you a lot more about drug addiction than looking at somebody's brain. Now, if somebody is using drugs and they're using them quite frequently, but they're meeting all these obligations and

they're happy. That tells me as a psychologist, there's not a problem. And they're meeting these obligations. They're happy. I wish I could be happy. That's the goal. So it's a good thing. Now, as a psychopharmacologist, what I've learned is that there are ways to enhance the safety of this activity simply by ensuring, for example, that people have the drug that they seek. Too often, one of the things that why people are dying, for example, or getting in trouble is because they have tainted substance. That is, they think that they have heroin when in fact they have something like a fentanyl analog, which is far more potent and they take too much and they overdose. So as a psychopharmacologist, the goal is to make sure people have pure, clean, unadulterated substance

and they know what they have and to teach people about routes of administration. Taking the drug orally versus taking it intravenously, the drug effects takes longer to come on. The onset is delayed when you take it orally. But the effects last longer than when you take it intravenously. Those are the kind of things that I, those are the important things I've learned as a psychopharmacologist. I try to share this in the book.

If people know this information, now they can time the effects that they want and then they can space it out. They can titrate this, all of this sort of stuff allows one to be more knowledgeable and to behave more like an adult. So I think I am understanding your argument. Like in terms of my friend who passed away, you said earlier that so many of the negative effects are due to the criminalization of the drugs. If we didn't have such a cultural ban on these substances, if he had not had access to such an adulterated version of the drug or with a dosing that was more understandable or with a different set of culture around it so that he didn't, you know, accidentally do too much or et cetera. As you know, we have more of with alcohol than with heroin, say, you know, we've got to our culture on alcohol is not good, but it's better

than perhaps, you know, people say, well, slow down, man, or whatever, you know, you know, you get a beer in a glass, you generally know how much alcohol is in it, those sorts of things that that death would have been avoidable. It's less about the drug itself. It's about like the conditions under which we're presenting it because of its criminality. Am I getting that right? You hit it on the head. I can't say any better than you said it. So I feel like there might be a division in your argument between like what we as a society should ban and make legal versus what we as individuals should do. Does that make sense? Like talking about drinking, I quit drinking about two years ago. And I was the person that you were just describing a second ago, who, you know, I drank every night. I was high functioning.

I would say that I was happy. If you had asked me two weeks before I quit, I would say, yeah, I drink. Drinking makes me happy. After I quit, I realized I was lying to myself, um, or that the, the, that drinking was lying to me. I was like, oh my God, I'm fucking happier. And I've done episodes about this. If you listen to the episode I did with Judith, uh, Griselle, um, I did a live show about

this topic that I toured around the country. Talk about this plenty. Um, but I realized that like alcohol and in essence for me was tricking me, right? It was tricking me into thinking it improved my life. In fact, it made my life worse. Now I believe that I would tell other people that I try to encourage other people to consider that that might be true about them. I don't think that we should ban drinking, but I do believe all those other things about it. And those two things kind of coexist within me. I wonder, do you feel similarly? Does that does that fit with with your worldview? Do you feel similarly about any particular,

I don't know, substances? No, I think you hit it on the head. It's like, as you said, you felt like in retrospect, you felt like alcohol was tricking you, but it was your decision to make. And you made that decision and you made a decision that works for you. And you are an autonomous, responsible adult. That's your decision. That should not be my decision or anybody in the government's decision. And my goal or my role in the government is to make sure the activity is as safe as possible and to give you the best available information that we have at the moment. That's our role. Beyond that, it's on you as an autonomous, responsible adult. And guess what? You might fuck up, but that's on you and that's your right to do that sort of thing. That all makes sense to me. But we made the comparison to driving a lot.

And I want to come to the position of addiction. Right. Because speaking about, again, myself with drinking, like I was like, oh, I was addicted to it. Like it snuck up on me. I didn't realize this about myself. I was addicted to drinking. That is different from driving. Right.

You're not you don't get addicted. Well, I guess you kind of get trapped in it. You buy a home where you can't leave the home except by driving because you're too far away from the corner store and your place of work. So you're kind of stuck driving for the rest of your life or until you move. But yeah. How does how does addiction fit in with all of this for you? So addiction is not how often you engage in an activity. Addiction is the activity disrupting your functioning, how you're getting in trouble when you engage in the activity, whenever that happens. And so you certainly can be addicted or have some sort of addiction related to driving some other activity that's not drugs. driving, some other activity that's not drugs.

How addiction fits in this is that one of the things that we know in terms of drug addiction is that given that the majority of people who use any drug, no matter what, whether it's heroin, marijuana, alcohol, whatever it is, the vast majority of its users are not addicted. So that tells us, that's one of the things that it tells us is that you can't blame the substance. Now you have to look beyond the substance. You need to find out whether or not that person has a co-occurring illness. It could be a physical illness. They might be in pain and they're trying to treat that. Who knows? It could be a psychiatric illness, anxiety, depression, some other illness. illness, anxiety, depression, some other illness. It could be related to the fact that that person is from Ohio or Michigan or West Virginia or Maine, where the factories went away, where their middle class living went away. And now they are stuck in these

underemployed jobs or jobs that don't pay as well, and their role in their family has changed or diminished, their role in their community has diminished. It could be related to their lack of development in terms of responsibility skills. It could be related to a wide range of things. So the person who is trying to treat addiction must look beyond the drug and look at the entire individual, must look at the psychosocial environment. Too often what has happened in this country, it's been okay to blame heroin for the addiction.

And if you go to somebody, if you have a therapist who blames the drug for the addiction, you can stop listening because you are before a person who is an idiot or who thinks that you are an idiot. Right. Uh, I, before we go to break, I just want to ask,

like, you know, I talked to a lot of folks on this show who have a lot of, you know, ideas about, you know, Hey, this,

this cultural idea that we have, we're too limited in our thinking. We have cultural ideas that are making our lives worse. We just did an episode about weight stigma. We've done episodes about gender, about all these different things. And for some reason, this is the one that I find I have more hangups about than the others, right? I'm like a very, I'm like a free thinker about all this shit. That's what I based my career on, right? And yet I find myself when I'm talking to you, like pushing back a little bit more for some reason. And everything that you say makes sense to me intellectually. And yet I feel like somehow I've ingested like a little bit more of the stigma that we're trying to undo. And I wonder why that is.

Like, do you have any ideas about what is different about drugs from all these other issues that we talk about in American society? Does that make sense? It makes perfect sense. And you're no different than most of us. I mean, we all have kind of swallowed this misinformation and we've been spoon fed it and for spoon forced it, force fed this stuff. And so it makes perfect sense. And you know what? Most of us have never seen someone use heroin, really been around people who use heroin. And so as a result, we are susceptible to believing train spotting that bullshit, the stuff that we see in that movie.

We are we are susceptible to seeing, believing that this is how it is. Yeah, it might be that way for one person, this aberrant person. But the vast majority of people who use the substance, it's not that way. You know, when you think about opioid users throughout history, I mean, the guy who wrote the Declaration of Independence, Thomas Jefferson, famously known for his opioid use. And as well, he should have been. You know, it's like he laid the foundation or he, well, he plagiarized the foundation and the declaration. Well, he plagiarized the foundation and the declaration. He plagiarized he plagiarized John Locke, most likely. But those principles espoused in the Declaration of Independence, those three rights that are mentioned specifically life, liberty and the pursuit of happiness. That is profound. It is profound. The problem is most Americans don't really understand what that means.

It means that I have the right to live my life like I see fit. As long as I don't bother anybody else or disrupt their ability to do the same. Yeah. Leave me the fuck alone. That's what it means. It's a beautiful thing. It is a beautiful thing. And the third paragraph in the declaration, I believe it says that. Government should be brought about or develop in order to secure these rights. When governments fail to do so, they should be disbanded. And Americans don't know this, but yet they have their flags and they think that they're patriotic. Bullshit. Read the Declaration of Independence and then you'll know what patriotism really means. Well, I want to talk more about what happens when we don't live out those values, when, you know, when we, you the the the toll that comes from criminalizing

these substances um and why we need to make change in this area but we gotta take a really quick break we'll be right back with more dr carl hart okay carl we're back from hearing all the advertisements that go along with this show really this has been a fantastic conversation i'm excited to continue it um what do you think let's talk about the toll that the criminalization of drugs takes because i think that is a really crucial piece here that like if people are concerned about you know what what what are the harms that drugs have on people individually from taking them right um people's life being degraded people dying people just you know being less healthy etc

whatever let's talk about the enormous toll that comes from criminalization. And I mean that by any estimation, the number of people in prison by alone is, is so massive and has, it's pretty heavy on the scale of the toll of criminalization versus the toll of, of a more liberal attitude. Yeah. So when we talk about the criminalization of drugs, we're talking about this thing we call the war on drugs, right? And if we think about the modern war on drugs, it really started to take off the late Reagan administration, really early Bush one administration. The thing that listeners need to know first is that the war on drugs is a jobs program. So that's the real reason for the war on drugs, not to get drugs off the streets or anything like that. No, it's a draw. It's an economic program, a jobs program. Now, let me explain what I mean by that. In the 1970s or so,

we started to see some factories close down. The 1980s, the big factories, GM, the automobile producers, the paper mills in places like Maine. We're talking about West Virginia, those factories, Ohio, Michigan, Middle America, the Rust Belt. The factories started to go away. They went to other countries where they could get cheaper labor. Now, those factories paid really well. And American products like our automobiles at that time were stellar, top of the line, because people took pride in what they did. But the

factories started to close. People became unemployed and they became underemployed. And then you started to, people started to grumble about not making that kind of living anymore. Of course, about the same time, we really increased the intensity of our so-called war on drugs. It became a way to hire people. What we we put more cops on the street. We are all familiar with that. We'll put more cops on the street. We are all familiar with that. We'll put more cops on the street. What we're really saying is that we're not going to replace those good paying jobs, meaningful jobs. What we're going to do is give you law enforcement jobs and the predominant people who were hired. The problem is the predominant people who were hired in those jobs were white folks and their jobs were predicated

on incarcerating primarily black and brown people. And the result of that we see today, we have more than 2 million Americans behind bars. Now the persons or the group that has been affected deleteriously the most are black men in this country. Black men make up about 6 percent of the population, but damn near 40 percent of the prison population. That is outrageous. But the people haven't looked at this in this way like it's a jobs program. Law enforcement personnel benefit because people get hired in that area. Prison officials benefit because we build more prison, put more people behind. Those communities that were devastated because the factories left, we put prisons there.

Now you have some jobs, the motels or the hotels, the restaurants around the prisons. They benefit. Treatment professionals benefit like physicians and people who are in the drug treatment game. They benefit because they say you have a drug problem. You go see that person. Here is some money for that. The people who test your urine, they benefit. Politicians benefit because they look like they are the heroes. They say we're going to put more cops on the streets. You leave them alone. About the factories that have been missing from your communities and the good paying jobs. It's a distraction for the politicians. And wearing drugs was a wet dream for politicians. And so we have to look at it from this sort of complicated perspective. But that's what's really going on. It has nothing to do with drugs. Nothing. Absolutely nothing. Because if it did, if it did, when we think about drug overdoses, the primary reason that people die from drug over overdoses is because they get tainted drug or because they have combined opioids with other sedatives. And they just didn't know that they shouldn't do that. Ignorance. That ignorance could be easily addressed

by better education. We don't do it, by the way. And the sort of contaminant problem could be addressed by implementing a free anonymous drug checking services like they have in Spain, like they have in the Netherlands, like they have in Austria,

like they have in Colombia, like they have in so many other countries. It's not that expensive. It's easy to do. We don't do it in this country because our war on drugs has nothing to do with drugs. It has everything to do with economics for a certain select group of people. You know, it strikes me that we did an episode of our show, Adam Ruins Everything, years ago on drugs. And we talked about the harm reduction approach to, you know, drug treatment for, you know, folks who are at risk of dying from heroin that, you know, you give them the basically, you know, safe, medically supervised way to use drugs and you reduce the number of deaths to basically zero.

And this has been tried with great success. It's something that not a lot of places have implemented yet, but, you know, we call for it. It sounds like almost what you're saying is if you actually want to solve the problem of drugs, you would take the harm reduction approach to every piece of it, not just, hey, users who are, you know, intravenous users who you're trying to save those lives in those cases, but you could do that with every drug up and down the chain and you might be able to reduce harm so much by, okay, let's, you know, regulate the doses,

let's train people, let's improve the culture around it, let's give people access to clean supplies, let's de-stigmatize, et cetera. You would reduce the harm so much that you'd say, oh, this doesn't need to be illegal anymore because, because the harms are so low. Does that track for you? Yeah. You know, like everything you said, I just don't use the term harm reduction in part because it implies that our goal, our goal with drugs is to reduce harms. Like when I take drugs, it's not reducing harms.

I'm really enhancing pleasure and I'm really enjoying myself. Think about alcohol. We have taken that approach that you described with alcohol. We make sure that the quality of alcohol, that there's alcohol in the bottle and we tell you how much is in the bottle and we have all of these cultural norms around when and how you use alcohol. But we don't call it harm reduction. We just call it common sense education.

That's all we call it. And it's the same thing is true here. We can do this with those other drugs and we don't need a term like harm reduction. We just need people to be smart and use common sense and use education. We brush our teeth in the morning to prevent tooth decay. That's harm reduction, but we don't call that, they call it that. We just call it prevention. We call it education. Right. But I think it is a matter of yeah i think you're right it's taking that commonsensical approach and and expanding it um man this is as you talk it's like little flash bulbs going off you know in my brain it's like things are moving around and and i'm coming to new questions um so let me try something again that's a little bit devil's advocate again

um if you don't mind if that's okay with you I feel like I feel like you out of anyone I've talked to must get the most interviewers who are saying okay but but let me just counter argument to what you're saying the most pushback out of anybody I found out about you because I read about you know a profile of you in the New York Times that was a little bit like the researchers like, oh, he's a little it's a little out there, but let's hear him out. Like, I feel like you must get a lot of that. Oh, yeah. But when I get people like you who say, all right, yeah, I feel that. Right. That's logical. That's it's all worthwhile. And that's what it's all about. Right. That's exactly what it's about. It's about us altering our position based on the evidence and the data.

I change my position all the time on a variety of issues, particularly when I talk to people who know more than I do about that topic. And it's a beautiful thing. It makes life worth living for me. Well, thank you for being here and helping me do it. So so here's my question. So so here's my question. When we talk about what is habitually called the opioid epidemic, which I'm going to bet is a is a phrase you don't like. But the OK, good. I guess. Right. You know, the story that is often told about that is of a set of drugs that is supposed to be well-regulated by, you know, the FDA and,

and by our doctors and everybody else. And which led to, you know, a lot of people using them in a, in a way that hurt themselves, right. Hurt, hurt their lives. Now,

yeah, you know, of it, you know, people, people abusing these substances, you know, doctors writing scripts when they weren't supposed to. And especially of, you know, these large, large pharmaceutical corporations pushing the drugs in a way that caused those harms.

Right. And so I wonder, does that put a little bit of a wrinkle in your you know, your position that, hey, we should regulate these things just as just as we do successfully with these other drugs, with alcohol? Well, and as we're doing well with in California right now with marijuana, I think, you know, it seems like it's going fine. Except that, oh, hold on a second. Here's a whole class of drugs that we did put through the system. And it doesn't seem like it turned out so well. Curious about your take on that. Thank you. So I think I just like to say what opioids are first. So everybody understands what we're talking about. Drugs like we're talking about drugs like oxycodone. And then when it's in this formulation called Percocet, it's oxycodone along with acetaminophen. We're talking about

morphine. We're talking about heroin also is in this class, but heroin, of course, is banned in the United States. So we're talking about codeine, those kind of drugs that are prescribed. Those are the opioids, and they're used to treat pain primarily. Now, when you pointed out this issue of people who have prescriptions and they got in trouble with these drugs to the point they became addicted and they may have even sought heroin as a result of their addiction. That was a popular sort of story, but it's a myth. A psychiatrist, Sally Sattel, she's I believe Sally is at the American Heritage Foundation. She did a nice series of articles on this. She went to West Virginia. I think she's writing a book on this now, but she's published a series of articles showing that, no, these people have problems before they started to use opioids.

And opioids now became the blame for the problems that were already present, like we would expect. And the drug companies are easy to blame because they deserve blame just in general. I mean, when we think about coronavirus, when they were developing the vaccine, they wanted to some company wanted to get the orphan drug designation for the vaccine. The orphan drug designation means that the illness only affects 200000 people or less. Of course, there would be far more than 200,000 people who get vaccinated for coronavirus. And but they wanted the tax benefits associated with this designation, which would be wrong because there would be millions of dollars that we would be out of as taxpayers. But the pharmaceutical industry, of course, they're like many industries. They don't have many scruples. industry, of course, they're like many industries. They don't have many scruples. So I understand the sort of desire to vilify the pharmaceutical industry. But when it comes to these opioids,

I think that vilification is just far too simple. And we act as if they were the problem and therefore that's it. It's like they are our Hitler and it's over. And we found the enemy and we got that's just that's not how it works. If, for example, if we think about the real issue with the pharmaceutical issues for me, it's this. One of the most popular formulations is Percocet and Vicodin. Percocet contains oxycodone and acetaminophen. A small amount of oxycodone, maybe five to 10 milligrams, and a large amount of acetaminophen, which is Tylenol. We're talking about 325 milligrams or so of acetaminophen and five milligrams of oxycodone. If somebody is seeking an opioid high, particularly an experienced user,

they will need to take about 10, the 20 of those pills to really get to where they like to be, to obtain the amount of oxycodone, the opioid that they are seeking. But if you take that many pills, particularly on consecutive days of Percocets, you run the risk of shutting down your liver, not because of the opioid,

but because of the Tylenol. And people don't know this. And a number of people have injured themselves and some have died as a result of taking too many of these pills. Not because of the opioid, but because of the Tylenol. And we don't inform the population about this. And I don't understand why we put Tylenol in with oxycodone. It's stupid. But it was a formulation that it was a formulation that allowed a pharmaceutical company to have a patent on that. And so now they have the unique rights to sell it.

Right. Meanwhile, Americans are suffering. That's where we should direct our frustration to the pharmaceutical industry at right there. This notion that they are the, our anger should be focused on them because of the role they played in the opioid sort of crises, which is a misnomer. That's too simple. And that is the bordering on just being complete inaccurate. Yeah. And, you, and I've read about there are folks

who live in great pain who really needed these drugs and who were unfairly tarred with being addicts or drug seekers or unsavory people who lost access as a

result of the crackdown against the opioid epidemic. And now they're like now they're in terrible pain. They have nowhere to get the only drug that actually treated their illness. There's a terrific piece I read a couple of years ago in I believe Harper's called The Pain Refugees about this is very hard to read, actually, because it was so much about how much pain these folks were in. folks were in. But I just wonder, like, how, like, the degree to which we can be tricked as individuals by corporations, for instance, interacts with what you're talking about, because you're saying, hey, we all have the individual choice and we should be able to pursue our own pleasure as long as we're not interfering with other people's liberty. Completely agree with you. I would also add to that,

I think it's our responsibility to help make sure that those folks, when they're doing that, we care for people who are doing such a thing. And we say, we're all able as a community to say, hey, actually watch out. You might be driving your car too fast. Maybe you're doing a little bit too much of that. Let's let's help each other out and care for each other. I would you agree with that, I assume? Absolutely. I mean, that's why we're here to help each other

out and not be overbearing, of course, but help people help each other out. And many of us welcome that sort of help. But but I also have the concern about, you know, when these substances are being sold by like a large corporation. You know, thinking about the tobacco industry right now, smoking. I smoked for probably six to eight years. I was like, hey, it makes me more alert. I love it. Right. I was like, hey, it makes me more alert. I love it.

Right. And then I eventually realized, like, hold on a second. I've been tricked by a corporation into, you know, consuming an addictive substance that was not benefiting me nearly in proportion to how much it was hurting me. Right. And, you know, we we know we all know what the tobacco industry did. We know the reckoning they went through in the 80s, et cetera. I feel like I had the same realization with alcohol. You know, I feel that ultimately I was sold a bill of goods by marketing that I experienced my whole life, marketing that partially created a culture of drinking that was ultimately unhealthy and not serving me.

I think we can look at the purveyors of the big pharma industry to a certain extent the same way. of, you know, the big pharma industry to a certain extent, the same way. I think those dynamics exist. And I think that they can, a big part of the work I've done over my career is talking about how those bad actors are able to influence us as individuals. And, you know, we're walking around going, Hey, I'm just following my bliss. I'm pursuing happiness when actually someone outside of us is controlling our behavior for our benefit to our harm. Right. And how does that fit in for you? Like, I'm not saying, hey, we shouldn't sell Oxycontin. I'm not saying we should throw anybody who's doing Oxycontin in jail. But also, if we I'm a little concerned, we legalize all these things and we say, okay, now Pfizer gets to sell, gets to sell PCP and MDMA or whoever else, and they get to run ads on it,

et cetera. Well, hold on a second. Are we not creating a bad situation there? I'm not trying to create a dystopia here, but I'm curious about, about how those two things interact for you. Because I think one of the problems with the libertarian position is we actually are less free than we think we are because we are so susceptible to malign influence.

And so I'm curious how you think about that. Yeah, welcome to capitalism. I agree. I mean, but you raised so many issues in the commentary. The problem with tobacco, for example, we'll take tobacco aside for a second. The problem with tobacco is that they lied to the American public all the way throughout the 1990s. It wasn't until 1994 that the tobacco heads of the big tobacco companies were brought before Congress. Tobacco heads of the big tobacco companies were brought before Congress and then they had to face the music and they even lied there in 1994.

But tobacco was like no other. Research Council, pretending to have the scientists who were studying the effects of tobacco or nicotine to find out whether or not their product was dangerous. They knew their product caused cancer as early as 1959, but they never acknowledged this until much later. They knew that their product was capable of producing this sort of dependence or addiction, as we call it. They knew this long before the public and they lied. And that's the problem with tobacco. Big tobacco is that they lied.

Now, many of these other companies, alcohol and so forth, they don't necessarily lie. They tell you up front and they tell the government what's going on. Now, if you as a consumer are manipulated as a result of their advertisement, that's on you. That's why we try and teach people critical thinking skills in school. That's why we encourage people to get more education. I think the best advertisers out there today are the folks, whoever has that Geico account. Those people are amazing. I mean, then we're going to see something. But those people, they're just good. I mean, it's up to us to learn how to carefully dissect what is real versus what is not real. I mean, let the buyer beware. That's how our marketplace works. That's just part of being an informed citizen. And that's part of experiencing the consequences of less education and not being informed.

Now that this is a this is a potentially this is a serious game that people are participating in life and you try to be prepared as best you can. That's why we encourage our kids to do well in school, to get a college education. So they will learn how to play this game of life a lot better. But this game of life comes with risk and you identified it in the marketing. There are risks. You're absolutely right. But we don't have the power as in, I mean, like there's a huge power imbalance, right? Like, uh, marketing works on us, like no matter how good your critical thinking skills are, you know, and I'm all about critical thinking skills. Again, that's what I built my career on, you know, but when one side has hundreds of millions of dollars to, you know, spread their message to everybody, right. Um, you

know, critical thinking only takes you so far. There's a huge power imbalance between the people blasting the ads out, you know, and the rest of us. And it's one of the things we we talk about with, you know, for instance, it's a weird connection. We have the proposition system here in California, right, where anybody can get anything on the ballot. And then the people who write the propositions are able to spend hundreds of millions of dollars marketing it. And guess what? It's not reasonable to ask every single person in California, well, educate yourself, forget the ads, educate yourself on every single proposition because guess what? There's 40 of them. And a lot of them are very technical. And through that means, thank you for nodding along, through that means these corporations are able to get whatever they want passed, right? Because it's not reasonable to ask the average voter to be up on every single

one of those issues and so i do have the same concern as regards marketing i i agree that you know we need informed consumers but i also think that like if you've if you got a tobacco company or the uh pcp selling company of the future right right? Saying, spending hundreds of millions, billions of dollars saying our product is safe and you should take it on every, you know, every Friday, go down and take our, you know, do it all day long. I don't know if it's reasonable to say, hey, the way to fight that is just, you know,

make sure everybody's educated, right? If their marketing is lying, you know? I don't know. I'm of two minds about it, man. I'm of two minds about it man i'm of two minds about it wait hold up adam okay wait so first of all the fda wouldn't allow them to say that your product is safe and so forth you can't do that you know like hopefully not but it's happened in the past uh yeah but you're right we try to try to we try to correct our mistakes of the past.

And you can't you can't do that with your marketing. That's one thing. And in terms of the proposition sort of thing, as we make this analogy, the propositions are like a one time thing. And you are responsible really to being informed. Some people just are overwhelmed and they don't have the time, just like you said. But when you're talking about putting something in your body or you're talking about something that you were consumed, you damn well better make the time. I mean, if you don't, that's really on you. It's on you. I mean, you have to. I disagree in terms of like, these people have all these hundreds of millions of dollars. And so poor me, they can overwhelm me

and make me take this substance. Bullshit. You know, I mean, there are, I know that most of these, I mean, in America, let's just think about it. We have this thing like Christmas, Santa Claus, this bullshit that we teach people. And the Santa Claus is this white, jolly guy bringing these presents.

I have black children. Their father is a black guy who works so hard for his money. Now, am I going to allow my children to believe this bullshit? You know, of course not. But you talk about, you talk about marketing that, uh, that's marketing. And there are black parents who do allow their children to believe that, you know, but, um, as an informed parent, I, that's, that's, uh, that's crazy, but I understand that there are people who let that get by and that's on them and they will deal with the consequences when their children are older and so forth. But that's part of life.

That's the best argument against Santa Claus I've ever heard. Hold on a second, assholes. I bought this shit. You should be grateful to me. Look, I think I think we might disagree a bit about about the power power of advertising and how pernicious it really is. It's something I've spent a lot of time on. But I understand your overall point. And I don't need to, you know, I think when we have this argument too often, we do what I was just doing, which is project ourselves into the future and say, well, let's completely redesign society.

And what happens if corporations are selling these things? Because the first step of what you're talking about is to reduce stigma of drug use, understand drug use more and and be less punitive towards people who are using drugs, because that is the true harm. towards people who are using drugs, because that is the true harm. And I really do agree with that fundamental part of the argument that like what we do to people who use drugs is worse than what the drug is doing to them. Is that right? Yeah, you said it best. I hate to say anything to mess up what you just said. Perfect.

Well, and again, I don't want to hit this point too much but again so many of the harms that are caused by the drugs are a result of our punishment of them like um you know i work with unhoused folks i know a guy last year who who died of a fentanyl overdose um and yeah i mean that's because that was what he was driven to on the street. Right. Like I know that that is, you know, that that was the cause of his death. Was that like it's the it's the criminalization that led to that death directly. That's exactly right. That's exactly right. The criminalization is doing more harm than the drugs itself. And that's the argument I make in the book.

And I hope people grapple with these arguments and give me a shot and then we can have a discussion afterwards. Can I ask you one more question? Do you have time? Sure, sure. There's one thing that we didn't hit yet that I really want to talk about is there's a popular movement right now in the you know, there's sort of a middle class acceptance of psychedelics that's been happening over the last five years. Michael Pollan wrote that book, How to Change Your Mind, which I read was really interesting history of psychedelic use in America. You know, people are, oh, you can cure depression with psilocybin mushrooms, stuff like that. And a big thing that they draw attention to is, oh, these are natural drugs. These come from the earth, right? As a distinction. My understanding is you feel that that's an unimportant distinction. I wonder if you could speak on that a little bit. So heroin is a natural drug. Heroin is

essentially morphine. Morphine comes from the opium poppy, morphine, codeine, and opium. And the Bayer Aspirin Company just simply added two acid groups to the morphine that made heroin. But the acid groups doesn't have any pharmacological effect. What you really are getting when you have heroin is morphine. That's responsible for the effects. So we have these chemicals that are natural. effects. So we have these chemicals that are natural, but all the things that impact our behavior, drugs, these things are from some natural source. Originally, that's how we have chemicals in our bodies that respond to these chemicals because they have to be natural at

first. This distinction between natural versus synthetic, it's an artificial distinction. It's a stupid distinction. We think about aspirin, where it comes from, like the willow bark. We have synthesized aspirin. We've only taken the component that are more active to have a better aspirin. That's a good thing, not a bad thing. Um, this notion that things that are synthetic are bad. Things that are natural are good. That's adolescent childish. And I'm trying to have a grownup conversation.

Yeah. Do you think there's something like something that really can't, uh, uh, escape me is when we're talking about these things that, you know, like like Michael Pollan's book, for instance, like he went and did massive press tour on it. And you're starting to see, you know, psilocybin, know, middle class kind of drug that is like it's such a it's such a small part of this conversation. You know what I mean? And I'm aware I'm aware of that. I wonder, does it seem ironic to you at all that like that's the drug that's getting a lot of attention in this way no it's very american very white american uh it's what it is and um yeah one of the things that pollen did and a number of people who are proponents of psychedelics and i'm a proponent of them but i have to make sure that i don't uh uh associate too closely with this particular faction of that group. They have tried to distance themselves from other drugs.

For example, you mentioned PCP earlier. You mentioned PCP. Ketamine, which is considered like a psychedelic, and it's used now for depression, treating depression. PCP and ketamine are essentially the same drug. In fact, ketamine is made by slightly modifying the PCP compound. Now, they are chemical relatives, but they have wildly different narratives associated with them.

PCP, the cops say that you develop superhuman strength, which is nonsense, of course. But we believe that. And the psychedelic crowd has divorced themselves from PCP while embracing ketamine. They divorced themselves in part because of PCP's negative reputation, which is unjustified. But the folks in the psychedelic crowd have not stood up like adults and said, this is wrong. We shouldn't be vilifying these people either. Instead, they have tried to separate themselves so that they don't ruin the reputation of their favorite substances

by having it be associated with something like PCP or heroin or something else, which is wrong. There's a perpetuation of the stigma in that project where it's like the drugs like, you know, like psychedelic mushrooms have always been like kind of not that scary to people. You know what I mean? Like like a minor drug. Never been a never been really vilified on the news that much. Never been. Oh, the inner cities are are falling to psilocybin mushrooms or whatever. And so the project I've always had this in the back of my mind when reading those books. And by the way, thank you for bringing up the racial dimension of it, because I think that's part of it, too. Part of the project of those books is like,

you know, rehabilitating the least stigmatized of the drugs, the ones that are most acceptable to middle class white society anyway. Hey, mushrooms, yeah, everyone likes to go do that once a year with your friends. It's not really that dangerous. And while neglecting all these drugs that are more stigmatized in our society, and you're right, they're often stigmatized for reasons of race more than anything, or just by the media, by law enforcement, et cetera. Um, and yeah, it's like not really as revolutionary a project as one might think to go, Oh, wow. Hey, psilocybin is, is kind of groovy.

If you take it with a therapist. Yeah, I know it's, um, it is a sort of the advocates who have that position are folks who are privileged in society and their therapist will make sure they have it. Whereas there are other people who are not and they're there, they don't have a therapist. And so it's like, I'm,

I've got mine and gone, get yours and come on basically is what they're saying. We don't care about you. This is just about me. And it's wrong. And that's why I wrote this book, to show the limits of those arguments and to show how really un-American those are. Those arguments are if you understand something about the Declaration of Independence. you understand something about the Declaration of Independence. Yeah, because, yeah, that project doesn't that doesn't help the folks who are who are being oppressed by law enforcement. Right.

Because of stigma about other drugs throughout America, like on a daily basis, it's happening to people in cities across America right now. God, it's really fascinating talking to you about this stuff. Yeah, we could talk forever but I think I think we should probably come in for a landing is there anything we didn't hit yet is there any final message you want to leave with the folks please read the Declaration of Independence please if you read that and understand what it means that's where we're trying to go in this country that's not law that's the. If people really understood that we'd be

a better country. Yeah. I mean, I'm sorry. I just want to, I just want to like summarize what I've learned from talking to you, which is that like, God, I mean, this, it's just a, like what we're, what we do about drugs in this country is a stigma like any other that is hurting people more than the thing that we fear you know um it's just like the conversation we had about weight stigma on this show a couple weeks ago that like the way we treat quote fat people is harmful to their health and if we remove that stigma that's like the first step towards having a more healthy relationship with our bodies with our yada yada yada it seems like the same thing is true of drugs, that like the stigma that we place,

the criminal, which is far greater, by the way, because it's the intense criminalization that is causing so many harms and that removing that removes so many of the harms that we fear. And then we can start addressing, okay, how do you deal with addiction? How do you deal with overdose? All those other, how do you deal with regulation? Sure, we'll get to all that. First, let's remove the stigma

and have what you call an adult conversation. Did I get it right? You hit it on the head. Thank you. Carl, thank you so much for being here. And thank you again for talking to me through some of my own difficulties with the issue and your patients. I really can't appreciate you enough. Right on. Thank you for

having me, bro. Well, thank you once again to Dr. Hart for coming on the show. I hope you enjoyed that conversation as much as I did. I hope it gave you a lot to think about until next week. That is it for us this week on factually. I want to thank our producers, Kimmy Lucas and Sam Roudman, Andrew Carson, our engineer, Andrew WK for our theme song. Got to thank the folks at Falcon Northwest for building me the incredible gaming PC that I recorded this episode on. You can watch me play video games if you want at twitch.tv slash Adam Conover. I'll be using the gaming PC there as well. And you can find me on the web at adamconover.net or at Adam Conover, wherever you get your social media.

That's it for us this week. Thank you so much for listening and we'll see you next week on Factually. Please stay curious. that was a hate gun podcast