Carl Hart on Studying Drugs, Using Drugs & Staying Safe

any type of drug. Hello, Psychoactive listeners. Today is kind of fun for me because my guest today is somebody who have been friends with for almost twenty years now and have huge admiration and respect for. That's Karl Hart, the Columbia professor who's written a very important book Drug Used for Growing Ups and follow his first other kind of semi autographic called book High Price. So Carl, thanks a lot for doing this. It's good to see you man.

Yeah you too, Carl. Let's start off with this. You're in some hotel, maybe about to give a talk, and you got the book, and you got somebody says, hey, man, I saw you got that book. What's it about. Well, the book is called Drug Used for grown Ups and the subtitle is Chasing Liberty in the Land of Fear. I'm just trying to get people to think about their own liberty and what it means to be free. That's that's it. And I'm using the subject that I know best as a vehicle to help people to think about

their liberty. Uh. And I don't mean liberty in this kind of Trumpian sense um, where your liberty Trump's everybody else's and you can do whatever the funk you want to do. That's not what I mean. I mean your liberty in that you're not bothering anybody, so why should people care what you do? As long as you are responsible a dope man. I'm using drug use as as a topic so people can think about their liberty not only in this subject, but also with just other subjects.

I mean, from prostitution to a range of things. We have over police people's personal behaviors and we don't even think about it anymore. And in this book, I'm trying to get people to think about why do we do this? Stupid ship? M hmm, we you don't. I mean, look, you were on my board of the Drug Policy Alliance for ten years at the beginning in two thousand and seven,

maybe more than that. And so in terms of what's wrong with the war on drugs, in terms of mass incarceration and a deporation of rights and all the harms, I mean, we're very much together on that. What's unusual, though, is for you to put the argument of liberties so front and center. And I say unusual because typically it's

something that libertarians do, civil libertarians do. And I will tell you something that as me, as a white man advocating on these principles of liberty, I would get a lot of ship for this, you know, like, oh, you can talk about your liberty, yeah, but what about poor people suffering, black and brown people suffering the ghettos? You know, what's liberty for them? You know that this is the rich man's How do you how do you respond to

that or how do you deal with that? Because I love the fact that you did this, but I want to know the experience of coming out in that argument for you. Well, you know, in our country in the US, uh, people think of liberty as a construct owned by the libertarians. Uh. And those people don't understand the founding principles of the country. The founding promise of the country is that we are

all guaranteed life, liberty in the pursuit of happiness. Doesn't matter who you are, You're guaranteed those freedoms, those rights. And so I'm trying to reclaim liberty for the American people and not only for the libertarians. This is an American principle, not a Libertarian principle. But it's a hard one for people to understand. And I get it. I get the fact that some political groups have kind of owned these kind of principles and and other people who

have been shut out as a result. But this is liberty for all, and I'm asking us to live up to our principles. Make our practice match our promise. That's all I'm asking you. Go man, I'll tell you years ago, I got asked to speak at some kind of progressive economics conference and it was all people on the left,

progressive liberals, unions, whatever. And I spoke on the second day, and I get a big speech and I say, you know something, I've been here for over the whole day, right, and I share overwhelming the values that the people are here. But there's two words I have not heard mention in the entire first day, day and a half of this conference. And that's of the words freedom and liberty. Right, what is the left wing seating these these words and these values to the right. And so I think for you

coming out on this thing is incredibly important. Now, what I also liked was, you know, not often does one see Jerry Garcia, the Grateful Dead Maestro and Martin Luther King put together making essentially the same argument. So just elaborate on that one. Yeah, you know, this is a thing that I wish people read the book because then we can see how much overlap, how much connection we all have in this country in terms of our heroes.

Jerry Garcia was influenced by Martin Luther King, and Martin Luther King was influenced by the Row and all of these people were influenced by what Thomas Jefferson wrote. And we know Thomas Jefferson had his problems. Uh And and of course I I talked about that a little bit. But the point is the ideals which these people espoused, they are ideals that are bigger than the people who

are espousing these ideas. And so I'm trying to get the reader to think about these ideas and then if, if, if we could maybe live up to these ideals, then we would be a better country. We will be a more compassionate country. Yeah. You reference went at one point to a letter from a Birmingham jail by marlou Uther King, which is something I used to sign to my students back when I was teaching a princeton on law in society.

Why did you reference that piece? Yeah, I referenced that piece because us where King dealt with in that letter were his allies coming at him. The white ministers were coming at him, asking him to go slow and saying that his actions were maybe not prudent. And so he talked the time and patients to explain why it's so important to move in the way that he was moving. In the way that he was moving was simply that black people in this case deserved their humanity, deserved to

be respected just like everybody else's humanity. And um, there is no such thing as moving too fast when you want to make sure people's humanity are respected, and that that's the same thing with drugs. We say things like let's start with this one here, M D M A, but not heroine here, it's like who gave you the right? You know, you go back and you talk about the history of the criminalization of drugs, about the Chinese and the opium bands and blacks and their wine, and also

about you know, cocaine and the crazed negro drug fiend. Right, the story going back a hundred years, and how it's manifesting today. Right. I mean you wrote that very powerful at been in New York Times a while back about George Floyd and how the cops trying to say, hey, because he was on drugs, right, And so do you think that more people, and especially more black people are beginning to wake up to the things about the anti drug piece of this thing when they see so many

I mean one after another. I mean black people are being killed by the cops, and the cops saying it was because of the drug, because he was selling drugs and he was using or whatever it might be. Do

you see a change happening there? I think so. I think when you have George Floyd and you have Brianna Taylor, particularly with someone like Brianna Taylor, um, she was not in the game, and but the justification was that her ex boyfriend was in the game and they were just the cops were justified to come in and kill her. And I think people are finally starting to see that,

wait a second, this is crazy. No matter how many drugs this particular person was selling, the were alleged to him, So you shouldn't be able to kick someone's door down and then murder them. And so I think people are starting to see. People are starting to put together Philando can still uh he had marijuana and that cop of shot him to death. Um, we think about Lakwan MacDonald, the seventeen year old kid in Chicago where they said that he had PCP in the system and he was

shot sixteen time. I think people are putting it together, particularly now in this age where we see the police abuses, and people are starting to see that drugs are always used as this convenient scapegoat to justify this awful behavior. And so on the one hand, I'm really happy that

people are starting to see. On the other hand, it makes me um profoundly sad that we have to steal deal with this particular issue when it goes all the way back to the turn up the last century, the turn up the twentieth century, and we're still dealing with it. So that makes me profoundly sad. Yeah, yeah, I don't know. I almost don't know where to go from there. I mean, it's the question of, well, let me put it this way.

You know, sometimes I think we know and you and I have both been out there talking for years and you can speak to it from a much more personal basis about the role that race and racism has played in the war on drugs going back to the early years, and the multiple levels at which it plays down, and so we know that racism permeates this. It permeates why blacks get treated different than white It's like the crack powder laws and tougher penalties on crack. It permeates on

so many different levels. But you know, sometimes I put out there that there's another ism that we're not even willing to deal with, and for lack of a better term, it's druggism, right that there is. Now it's not longer possible, at least publicly to say racist things. I mean, now on the trumpet begins to become possible again. But basically

that's been delegitimized and you can lose your job. There's all sorts of things for making a comment that sounds at all racist, right, But when it comes to druggism, when it comes to disparaging addicts junkies, when it comes to making assumption about them, that seems to be one of the last remaining really legitimate prejudices, and not just

on the right, even across the political spectrum. No, you're absolutely right when we speak about this language in terms of the role of rais and uh drug policy or drug policy being used to subjugate like black people, for example. The thing that I have to be careful about is I have to not be lazy, and when I'm lazy, I might say that drug policy is used to subjugate black people, when in fact that's just an example of

how drug policy is used. But drug policy is really used to subjugate the powerless, the people on the margins of our society. And then I can give an example of how black people are disproportionately arrested, but I can give another example to talk about white folks in Oklahoma who use methamphetamy, they are also disproportionately subjugated. And I can talk about the users in the Philippines. They're being

subjugated for the same reasons. And so um, that's why I have to be careful so that people understand that this is a universal sort of thing that's going on with drug policy. It's not unique to black people. But in the United States, um our drug policy. Because we have this conspicuous difference in our race, it makes it easier to point to it. But don't get it twisted.

This is the universal thing. And the people who are in the middle classes, who have power, who are the educated class, Um, they're not being subjugated in the same way. In fact, they are so busy distancing themselves from the methamphetamine users, from the heroin user, from the black user, what have you, and so um, these laws are not equally applied as we know. Yeah, you know, it's interesting

because it's another commonality we have in this thing. You know, for many years, going back decades, I would go to speak safety annual conferences of Normal the Marijuana Legalization Group, which I support, and they were fighting for legalization and they're my allies. But sometimes people we get up there and say, you know, we gotta legalize marijuana so we

can crack down on the meth heads. And I with them, lecture them and say no matter what you think of mess and even if it is a more dangerous drug, that's no basis for treating those folks differently. And make the analogy to the First Amendment. The first a moment doesn't just protect elevated speech, right, it also protects you know, quote unquote ugly speech less elevated speech. We'll be talking more after we hear this. Add what you do in this book that I think really breaks some new ground

in different ways. Isn't talking about myth amphetamine, heroin, PCP in a way that really, I mean, very few people have. I know, I put my toe in the water, but you take it many steps further. And so, you know, and we see that with marijuana, right, we see that Mariana legalization, we've radically changed that, you know, from reform madness and brain on drug stuff and all that that's turned. Now psychedelics is kind of opening up and changing people's

minds and things like that. But there's other drugs, the ones who are most of what people are going to prison for selling and possessing. You take on those one. So let's just start off with meth amphetamine, because that's something you've been studying for a long time, and you've produced reports and studies on that thing. So can you explain to our listeners, you know why what they may

think about methamphetamine is more or less flat out wrong. Yeah, So when when I think about methymphetamine, Uh, it's important for the listener to know one thing, Adderall the methymphetamine are essentially the same compound adderall. Of course, it is the medication that's used to treat attention deficit disorder. Methamphetamine also is at the proved to treat attention deficit disorder as well as obesity. UM. The only difference between the

active ingredients and adderall, which is d amphetamine. The only difference between d emphetamine and methamphetamine is an additional methyl group, and that method group, we have said in research makes it easier for the methomphetamine across the blood brain barriers such that it gets into the brain more rapidly, so there's a more rapid onset of effects. Now, there is no data in humans to prove that or show that this is mainly uh kind of based on animal studies

and speculations about what that sort of increased lip solubilility means. Now, we have said that that makes methamphetamin more reinforcing, that is more addictive. Again, no evidence to show that, because all of the evidence when you test methomphetamy against UH, something like a d amphetamy UH in the same human users they choose used to take the drugs on the same number of occasions, and the self administration patterns look the same. Humans can't distinguish between the two drugs on

the double blind conditions. So methamphetamine is essentially the same drug that people are taking in adderall. Not that's not to say that people should stop taking their adderall because this is such a danger struct No, that's the same that methemphetamine. It's f the approved for a reason because it's effective, because it's a safe medication when used in the doses when the medication is prescribed. So they are

essentially the same drug. Now, what people see in the natural ecology is that methamphetamine use is primarily smoking or injection, and so rout of administration certainly impacts the speed at which the drug reaches the brain. It also impacts a number of things the conditions under which the drug is taken. So what people are really seeing is a function of the legality of the drug, the route of administration, and all of these sorts of things, but not the drug itself.

But they are attributing all these factors to the drug, when in fact it's really about these sort of psycho social characteristics are factors more so than the pharmacological factors. So if I were to summon up by saying that if you were to take that, I don't know ten million, twenty million. However, many young mostly boys, are being prescribed adderall today and substitute for that an equivalent dose of oral meth amphetamine. Probably those kids would not even know

the difference, or it would be roughly comparable. And conversely, if you were to crush up those kids adderall and smoke or injected, it would be fairly indistinguishable from the people using kind of underground illicit meth amphetamine smoking ejecting that apart from maybe the effect of the contaminants in the illegally produced stuff. Absolutely. And another thing about adderall

is that it has three amphetamines. There's an L, there's a d UH and the L doesn't cross as well as the D doesn't cross the blood brain barrier as well, and so the adderall has more cardiovascular activity that I don't really need um, and so UM, I think that the D and methamphetamine is actually more ideal. You know, I got my doctor to prescribed to me blow dose five milligram dextro amphetamine. You know, I told him I needed for jet lag, which is true, and you know

I use it occasionally. UM. And then at one time I got a friend of mine to give me one of his kids adderalls, and my sense was that adderall was more kind of jagged e like. It almost felt like the dextro amphetamine was a smoother one. And it made me wonder, why aren't they using dexter amphetamine with kids. Was there a possibility it actually might be better for many young teenagers or is there some good reason not to be doing that. Well, they do use a D

M fetamine dexterro emphetamine for kids. First it owned the market of the tension deficit disorder UH and then Riddland. Eventually they tuck over. But then adderall hit the scene because Shire of Pharmaceuticals marketed and told physicians that, oh it's a slower onset of effects and this is better, and they had this big marketing campaign and that's why people are prescribed adderall because of Shires effective marketing campaign,

not because of the effectiveness of the medication. So while we're on the subject of big pharma, the one that's most notorious, right is Perdue Pharma, right in the Sackler family and their creation of of oxycontent, a drug that appeared to be a really very effective pain controlled drug for some people living with serious pain, but which then you know, it appeared they over to marketed quite seriously.

I mean, how much do you hold Perdue Pharma sort of responsible for the kind of starting phase of this significant expansion of opioid related fatalities in the beginning of this century. They certainly deserve some responsibility here because they got the FDA to schedule oxycotton at a lower level. It wasn't a scheduled too, I think it was scheduled three, whereas other opioids were scheduled too. They said it was less addictive than the other opioids, which was not true. Uh,

And so they deserve some responsibility there, of course. But when we think about, uh, the fact that people are dying from drug related overdoses. Uh, An important reason that people are dying from drug related overdoses is because people are getting contaminated drugs on the street, and that's an easy fix. You can just make sure that people have a clean supply or safe supply, or make sure that they have access to drug checking so you can check

and see what's contained in your your substance. That's an easy fix. And we as an American public, we haven't done that. But yet we're blaming the pharmaceutical company for that which they have nothing to do with that. And we also blamed the pharmaceutical company for like addiction rates, when the fiction um has nothing to do with the

drug itself. Addiction is mainly related to all these other psycho social factors, like beginning in the nineteen seventies and continuing in the eighties, when all of these factories left the Midwest, they left the rust belt places, and people who once had jobs that paid the middle class salaries they no longer had it. They once had standing in that community, they no longer had it. That increases the likelihood that people will become addicted to have all kinds

of problems. And we see that sort of thing, but we don't talk about all of these other sort of issues that are involved. Instead we just say perdue, Yeah, Carl, I mean, well you're talking about, obviously is what people have referred to as these deaths is to spare right, the high rates of alcoholism, opioid misused suicide happening in parts of the country, you know, whether black, brown, or white, where people have been struggling, and especially sometimes where people

are downwardly mobile. But the other thing I think when you're talking about is the thing about the pharmaceutical companies. I mean, obviously they're all really aggressive. Promoting of this stuff created a problem, as did ignorant doctors and ignorant nurses and patients wanting to pop a pill, and insurance companies not wanting to pay for this stuff, all those things.

But interestingly, when they were getting it there, those drugs were relatively pure, and once they started once and started to crack down for some good reason on the pharmaceudical companies, people started turn to even more black market drugs, first heroin and then fenton al And so there was a paradoxical thing where the crackdown the pharmaceutical companies may have actually made the overdose epidemic even worse than or otherwise

would have been. Yeah, we know that when you have the crackdown in the legitimate source, then you have the illegal sources pop up. Absolutely. Um just I have to be careful when we talk about this thing we're calling the opioid crisis, and we're talking about overdoses. In the book, I try to help the reader understand that these things that we're calling overdoses and we're blaming opiates for, we don't really know that opioids are the actual causal agent

for the overdose. UH and I try to walk the reader through how medical examiners and corners do their death investigations and the level of education that's needed to be a corner in most locations are high school diplomas. That's all you need and a few hours of a death investigation course. And there's no uniformity in terms of how

these death investigations are done. Most of the people who die from drug related overdoses have multiple drugs in their system, and then there is no levels that are measured to determine what drug might have been the causal agent, and in some cases they don't even get biological confirmation that that was actually opioids in the system. And so UH, I asked the reader to really think about what's going on, Because dying from a single opioid like heroin, it's not

the easiest thing to do, particularly something like fantonol. Of course, a single drug one can die from more readily. I mean, basically, what you're saying is that the large majority of what are called over those fatalities are really fatal drug combination fatalities, right, I mean, it's that mix, and that the media and sometimes the corners, you know, rather what I didn't saying, oh, this was a fatal drug combination, or saying this was a benzo death or an alcohol death or a set

amath and death. They just call it an opioid death because that's easy. That's what the media wants to report. Or even if the small print doesn't say that, that's what the headline writers put up there. That's exactly it. Now, it also seems to me that what you're saying about federal, though, is that federal is in a bit of a special category. They've given that it's what fifty times more potent per

milligram or whatever than heroin. People can die just from a straight federal way in a way that was unusual with heroin or oxyes or things like at Now that seems to me to maybe present one of the strongest arguments for some form of legalization or safe supply of opialities. Absolutely, people will use opioids. People will use drugs. The question before us as a society is how do we best

keep people safe? And it seems as though we have been comfortable and pretending that people won't use drugs and allowing people who do use these drugs to uh engage in this precarious activity of taking drugs that are purchased on the list of market. To me, that's not what responsible society should do, particularly one that claims to be

proponents of life liberty in the pursuit of happiness. Now, you talk a fair bit in the book at many places about drugs safety testing, right, testing the quality of what the pills are, and just explain why that's so important. Yeah, we call that drug checking or drug purity checking, drug purity checking um. It occurs in a number of countries including Portugal, the Netherlands, Austria's, Spain, Colombia, uh and none of these countries have so called opioid overdose crises or

any overdose crises. Drug checking what it does is that it allows UH drug users to submit anonymously UH small samples of their drug UH and then get a print out of what's contained in that sample. These subances are free and they're done with the primary goal of keeping people safe, so people are not exposed to UH poisons, adulterants, or other toxins that might be in UH the illicit drug supply. And so I have been advocating that we

do the same thing in this country. We have the technology, UH, we certainly have the resources, but we haven't and we have one of the biggest sort of overdose concerns, but yet we have not made these services available to our people. So when politicians say that they care about the opioid crisis or the health of the public, and they are not advocating for these services, then you know that they

really don't give a ship. Well, let me I say, can these testing services checking services also detect the potency of a sample? Yes, UH, they can detect the potency, They can detect the amounts UH and all of the substance. Because our seeing now, I think especially the harm reduction programs either on the US right doing these sentinel testing strips. Since you're trying to detect the presidents of fentanyl. Na, No, no, no, that's a joke. Man. That ship is a joke. I mean, obviously,

if that's all you got, Okay, I get it. But for a country like ours with so many resources, for the people who have to revert to using fentanyl strips, that's a shame. I mean that this is a shame because it only detect fentanyl and some pentonel and not any other of compounds that might be uh contained in the substance. And and we have the technology, so to pretend that that's a fix, or to pretend that that that's what we should be doing, it's insulting, particularly when

they're doing this in Colombia, in Austria. It's a joke. I mean, it's it follows in a long line, right of opposing needle exchange programs because it might encourage people to say shooting drugs is safe. Of opposing the lock

zone because it might make people feel safe for using opioids. Right, it's that whole thing or where the politicos and the public health folks are scared if even when they know better, I mean, if even goes back to a hundred years ago when they used to talk about giving how condoms to soldiers, and people say, how can you do that? It's gonna make it safer to have extramarital sex or illicit sex or whatever. That's the thing that is remarkable to me, and that why should I care what someone

else is doing? As long as they're not bothering other folks and long is that they are not preventing other people from enjoying their rights. Who am I to say what they should be doing? They are adults. You know, you're talking the book about the novel psychoactive substances, things that became known as bass salts or these synthetic cathinones are synthetic cannabinoids and things like that where it seems like the drug checking would be incredibly valuable because often

has people have no idea what their getting. Yeah, we vilified the cathinones, uh, these bath salts. Again, we lied about the effects of these cathinones. Many of these captain oons produce effects similar to M D M A and similar to cocaine um. But we said that these catherinons make people bite other people's faces off, And of course that's not true. And I detail that story of the Miami cannibal and how that person never had any cathinones

in the system. But that's not what the press said. So, UM, don't believe the hype about the catanones. Uh. Many of these cathinones produced in D M A like effects, and they produce cocaine like effects. You wrote in the book about assuming at one point that you could do a double blind test and that people taking extra amphetamine and m d m A would have the same response to it, and then being somewhat surprised that that actually wasn't the case.

The reason why I thought that they were produced nearly identical effects is because when you look at them chemically, they looked nearly identical. M d M A has a methyline dioxy ring added to the methomphetamine structure. I thought that they were produced effects that would be nearly identical, and sure enough, when we looked at some cognitive tests,

they produced a lot of overlapping effects. Uh, some different effects whereas m d m A disrupted some performance, methomphetamine improved performance, but they produced a lot of overlapping effects. But that's not what people say. In the natural ecology and the natural ecology people say that nah, M B M A, there's nothing like it. You know, this empathy,

the openness, this connection with others. And at that point in my career I had tried me them fettermy, but I hadn't tried M D M A. But then I tried M D M A and then I saw like, oh, well, maybe our lab measures are the problem in that we just are not capturing the unique bits of M D M A. Let's take a break here and go to an ad M. Carl And I know you gave a lot of thought to this one part of the book, and it's the one that's gotten a lot of attention,

which is the way you talk about heroin. Just gonna read a few of the good quotes you had in there. At one point you say, there aren't many things in life that I enjoy more than a few lines by the fireplace at the end of the day. I think you said, listen to Billie Holiday, And then you said Heroin enhances my ability to feel and think. You said, I also want to ensure that others are afforded safe out tunity needs to benefit from the serene bliss opioids

can offer. Should they so choose now I will admit that heroine's always scared me. I mean, I've tried it a numerous times to see what it's like. I mean, the last time I did it was with you and another friend in Europe a few years ago, you know, so you know, and my friends always made sure that I took just a low dose, and they were watching al for me and say, you know, look, if you're

gonna have a drink afterwards, be moderate. But I got to admit there was something about heroin that scared me almost not unlike the way that tobacco and nicotine scare me. That there's a stickiness to those drugs that if you start to like them too much, they just make the hard to detach yourself from. And you describe going through

a withdrawal experience. What I love about it is you're out there saying, you know, for all you marijuana and psycholic exceptionalists, it's not just the political principle that shouldn't be exceptional, it's actually a way we think about these drugs and understanding that they actually can play a beneficial role in your life. So just say more about you're coming from on that and how you feel about that, and if you feel like talking about how people have

responded to that. Yeah, what heroin is the boogeyman drug of course in the United States. And so h your point about liking it too much and then getting attached to it, think about that for a minute. You know, there still is nothing better than the sexual orgasm. But do we hear people saying ship like m, I better stay away from this orgasm because I might get too attached.

I mean, it's it's just a matter of when we have these drugs be illegal, then we have to go through all of these various obstacles to get the substance, and that plays a role in terms of the addictive potential of the something. And so I don't think heroin is particularly addictive. Of course, it can produce physical dependence, so two can alcohol, So too can your antidepressant. A number of these drugs can produce physical depends. But the majority of people who use heroin are not addicted to

the substance. But they just don't say that they use heroin because of this negative sort of view that we have of heroin. You alluded to how people have responded to me admitting to having used heroin. In fact, people would like to dismiss me simply because I've used heroin. And so imagine that somebody like me who published more than a hundred scientific papers, three books, and people are trying to dismiss me. Imagine what they will do to other people who don't have such a record. So I

I get it. I understand why people don't say they use heroin, and so it gives this impression that certainly, uh, this drug is so addictive that you shouldn't do it. And then the filmmakers, the documentary filmmakers, the TV filmmakers, the comedians, they need heroin as a foil because then they can describe drug addiction in this awful way and they use herible. And imagine if comedians didn't have these

drugs to make fun of. Imagine if the documentary film had somebody like me who've used these drugs and go on with their life, take care of their family, have a happy life. That would be boring. And so we need heroin in this culture to vilify for all of these pop culture sort of reasons. You mentioned that I went through heroin withdrawal. It was intentional, so I could say, okay, um, it's something, it happens. But it's not life threatening like

alcohol withdrawal, it's life threatening. I will never put myself intentionally through alcohol withdrawal because I would be afraid of the life threatening effects. But heroin withdrawal from most healthy people, it's not life threatening, and so that's why I did it. I haven't gone through heroin withdraw sense or before, certainly not in a way where the symptoms had me feeling like I described in the book. Then I can take

heroin or leave it. And being that we've had this pandemic, for example, I've been stuck in the United States, so that meant that I wouldn't have access to good, pure heroin, So that meant that I couldn't use heroin. And it's no big deal. That's just like um, caffeine or some other substance that I choose to use or choose not

to use. You know. Reading that parts of your book about heroin, it reminded me of one of the classic studies in the field, which was the Harvard professor Norman Zenberg Right, who many decades ago did a book called drug Set and Set It Right. And drug set and setting was the phrase that was coined by Timothy Leary and developed by Andrew Wild and then Norman Zenberg, professor

Hart Medical School, tested it. And I think what he did was he put advertisements in the local Boston newspapers looking for people who said they used heroin but did not feel they were addicted. And hundreds of people came out of the woodwork, postal delivery workers and school teachers and people who are living rough on the streets, and people who had significant professions, and even coined the term I think chippers to describe people who used heroin occasionally

without becoming addicted to it. Now, interestingly, between his writing that forty years ago or whatever and you're coming out, so little is actually said and written about this. And I wonder if one reason is that the key research funding agencies, so the government, naturally student on drug abuse, is just not interested in finding this sort of an information out. No, they're not, But you know, we know the role that NINER has played Nighter. It's the National

Institute on Drug Abuse. Their primary mission certainly has been for most of its life to focus on the negative effects produced by drugs, so we know they're so to bias. I was on Night as advisory council. I'd served my term. I was a grant reviewer, I was a chair of a grant review session. I had grants myself, So I'm not speaking as someone who doesn't know. I mean, I was a part of the system. But I think it's

it's a lot bigger than Nina. It's uh the people who do drug treat and they are so invested in this as well. They have come out really strongly against someone saying that you can use heroin occasionally, even though we know that heroin and noxycontin are essentially the same drug. We know that heroin and morphine are essentially the same drug. But heroin has this sort of additional uh vilification attached to it for some reason, because it has this important

role in our society. It helps us to define us, and then we can uh persecute these people who use heroin because they are somehow morally less than we are. Something. It's playing some important role in our society that is far beyond the pharmacology of the drug. Yeah, although what you're saying about heroin was probably also true of meth and messi anthetamine back in the early two thousand's right

that nobody could use it without being addicted. I remember when I go out and speak to people, and I let me give you this example. You know, an editor of a newspaper tells his reporter to go write a report about alcohol in the city, right, And the reporter goes out and he comes back with all these articles about twelve step meetings, you know, detox wards, jails, treatment programs, and the editor pulls open his drawer, pulls out his bottle of whiskey. From the drawing goes, what are you

talking about? I understand that's one part of the story, but what about the people having a beer? What about the vineyards and the wine? What about you know, story not told? Same editor tells, same reporter, go, do me a story and meth amphetamine. The reporter goes out, goes to the jails, goes to the treatment programs, goes to that sort of thing, comes back and the editor goes, great job, and never stops to say, wait a second, aren't there people using meth there who are not this way?

Who's actually attracting new meth users? Because it's not gonna be the guy who's down and out in teeth falling out all this sort of stuff. There has to be something else going on. But it doesn't even occur to people to think that way at all. That's exactly right, and that's one of the things I was trying to

do with the book. I traveled around the world. Each chapter is kind of set in another country, and I tried to show people that the vast majority of folks who are using drugs are middle to upper class people who are captains of industries, who are famous, people who are important people in our societies, people who we love and respect. They are the vast majority of our drug users.

And I tried to get people to understand that the illicit drug trade is a multibillion dollar industry, and a multibillion dollar industry could not be supported by people who are poor and down and out. That ship just doesn't make any sense. But we still believe that nonsense. I remember one time asking somebody who's middle class business owner or family, etcetera, who had taken method on daily because he had once had a heroin addiction, And I said,

why don't you speak out publicly? I mean, you would help transform the image of who is a Method on consumer? He says, he's a Let me tell you something. I run a business. If one day I come in and I'm exhausted because my kid was up sick, or I was finding my wife and I put my head down. People go, oh, poor Joe. I guess he had a rough evening when it was going on. If they knew I was on method on, they would go, oh, Joe, he must be nodding out. They'd make that negative assumption.

He goes, I can't come out, And so in your case, I'm wondering. I mean, I remember back in two thousand seven, I actually joined my board. I said, Carl, you're not even tenured as yet, and you got, you know, a drug war guy chairing your department, and you wrote me saying, Ethan, as a matter of principle, I got to do the right thing, even if it costs me a bit. Here you're coming out, but you do have tenure now and

your kids are now going to college or graduated. Right do you think you would have not done this when you're an assistant professor, when your kids were younger. I mean, there's something about this being a point both a point of the broader culture, at a point in your life where it felt safe to do so, relatively speaking, not safe,

but relatively speaking. But yeah, uh know, it's Uh, we have to also understand that, you know, I was still developing and I'm I am still developing and I'm still learning.

And so it's at a point in my life where I am comfortable enough to deal with the bullshit that I get because anybody talking about drugs and the subject I can deal with because I noticed subject so well, Whereas five years ago, ten years ago, I didn't know the subject as well, and I couldn't deal with the questions to pushbacks and and I just wasn't knowledgeable enough. And so as I gained more knowledge, I gained more confident.

And so it really has to do with my confidence and my ability to explain what I do and why I do it now, not so much a political calculus. That's not what's going on here, because as you know, people are trying to dismiss me as crazy whatever. They're still trying to do that. And people in my departments,

uh they I'm into departments. There are people who talk shit about me about this, and they are they are plotting, they're doing their things, and so there are consequences, uh to this, and there have been consequences in terms of universities. Are people who invited me to give talks, have disinvited me as a result of me coming out of the closet. I have been censored in all kind of ways. So there are so many consequences that the public does not

see and does not know. But I don't really care about that, because I would be a coward if I didn't stand up and say this, given what I know now, And so that's why I am speaking out my I mean over the moon for the way you're handling this stuff,

because it is courageous. One of the things you stress in the book is that this is a book for growing ups, and you point out that a lot of the advice and the margins of safety for using drugs like matthian fetemine or heroin and are safe, responsible way probably don't exist for tens of millions of American adults who you know are struggling in one way or another.

So what do you say about the obligation? You know, are there risks in which you're advocating for the tens of millions of Americans who don't have it together to do it responsibly. You're right, I did say that this is a book for grown ups, and I just wanted people to understand I had a definition of grown ups, people who are responsible, take care of themselves and take care of their families and so forth. But it's important for people to understand too that being a grown up

it's a dynamics sort of process. It's one in which it's not static. I mean, I'm struggling with that every day, and many of us do. Then, So, UM, I don't want to exclude people when I have my definition of grown ups, because that's not the goal here. The goal is inclusion. But then do you have this question that you raise about, like what about the people who don't have their life together to people who don't have the resources. Yeah, there are those people. Um, that's like saying, though driving

a normal bill is a tremendous amount of responsibility. You think about being on a two lane highway traffic going in opposite direction. Uh, You've got cars coming towards you, and all they have to do is just turn into your lane and maybe injure you or injured themselves. Um, but we have to um, trust them, and we do

that and they do okay. And so it would be kind of arrogant of me to think that I can say who should have access to these substances as long as they don't violate our norms, that is, in terms of preventing other people from enjoying their rights. I don't have the right to say that they should be restricted, uh, in their access. I think that's part of the problem with society. We have these people who think that they have the right to tell other people how they can

live their life, and that's wrong. You know, sometimes we define it as um the majority of people of adults who can responsibly use these drugs need to be prohibited from doing so in order to protect the minority who

cannot use them responsibly. But in point of fact, and one of the major divides in the legalization debate is between those people who think that if many more of these drugs were legally available, the number of serious addicts quote unquote would increase dramatically, whereas other people who say, you know what, even if a lot of the drugs that are now illegal were legal, the fact of the matter is the number of people getting addicted wouldn't go

up that much because there's already so many other drugs available legally and illegally that they could already screwing up on. In fact, some of the ones that they're not able to get right now might actually be less problematic than the ones that they're being prescribed by doctors are usually legally over the counter. Absolutely, the notion that the availability of these substances will cause society to fall apart. We're

living that experiment right now with cannabis. Remember what they said about cannabis and how Washington, Colorado, those states will fall apart. Not only have they not fallen apart, other states are trying to damnus to emulate those states. Uh, And so that just doesn't hold any water that sort of notion. We think about alcohol, which is one of the most potentially dangerous substances to HUGH known to humans.

But we we do that okay, because we control the unit dose, We controlled the purity, the quality, the education. That's the part of being in a society. Let me ask you how you respond when people ask me what's the strongest argument I can think of against legalization, by which I mean a legal, responsible legal regulation, And I say, my biggest fear is when I look at what the food companies have been able to do right The combinations of sugar, fat, salt, a play on the brain that

are marketed effectively. And when you look at the dramatic rise right in obesity and obesity related diseases in the US and really through much of the world, right where that where the humult of health consequences exceed those of

illicit drugs are illicit drugs, right. And I worry about the power and the ability of major league, multinational companies to devise interesting concoctions of all these drugs that are adept at getting people to be dependent, even if they can control it up to a point, and that ultimately land up doing even more harm. That's my biggest fear than in the capitalist world we live in. That may

be hard to prevent. You no, I agree, but what you're describing is a problem with capitalism, not a pharmacological problem. And so that's partly what happens when we have these discussions about legalization, all of these issues get conflated, and um, we we have some problems with our capitalism. I mean, we can think about the billionaires that we have in this country that pay no taxes, but that's not a

drug problem. That's a capitalism problem. That's like saying that, well, ship we have the bad food because these people you have these sophisticated ways of marketing these foods. It's like, we're not gonna ban food. We need to check our capitalism. We need to check the regulations that we have on these companies. Uh. And we're trying to do that a little bit with we do and on some of these other drug companies. But that's capitalism, that's not the drug.

You know, in the earlier years of my studying drugs, to the formative experiences, one was going to Amsterdam in eighty nine and not just seeing the clannabis coffee shops

but also seeing their harm aduction stuff in action. And the other one was going to Switzerland and ninety two I happen to be there the day that this federal government green lighted doing the heroin maintenance programs for people who had not succeeded in method on programs, and then going back a number of times to actually see these programs in action. So you write about that in your book. You write about the successful heroin maintenance programs there for

people which don't exist in the US. And now you tell me tomorrow you're heading off to Switzerland again, so you know, are we gonna see her coming back to the U. S here you're giving up on this place here,

gonna gonna hanging Europe for a long time. I gotta tell you, man, Like I remember in the board meetings or I don't know, at some point, um in the early two thousand's, I don't know when you you were pretty enthusiastic about the results that they were achieving in Switzerland with the heroin maintenance for people who were struggling with heroin addiction. That you you helped me to understand that early on. And um, and I think I remember telling you many years later, like damn, you were right.

And I was actually embarrassed because here I am a scientists, a pH d in this area, and I hadn't read the studies that showed what you were so enthusiastically telling us, and we were dismissing you, um and um. So it was an embarrassing moment for me. And I don't ever want to be embarrassed like that again. So you're right.

Who are right then? And you're right now about this and so much so that I have decided to spend half of my time in the US and half of my time in Switzerland, not because I think the Swiss are are somehow better than most people on the planet. Not that's not It's just that they simply treat their

citizens better than we treat our citizens here. And I have a scientific community that I can interact with, and they are also close to Paris, and they and I can get to Spain and other places in the European Union that have better drug policies, and they are more civilized about this issue, and so um staying in the US for extended periods of time, it just makes me a more angry person. And I don't want to be

that way. I like feeling like, uh, I have taken M D M A. I like feeling like I have taken six A p B because I'm more generous, I'm more forgiving, I'm more magnanimous, and those are qualities that we should encourage other people to be. Well. Carl Le, let me just say, I so much value what you've been doing with your life, with your books, with your teaching. I value our friendship. I'm gonna miss you a bit when we're out in Switzerland, but I do you know.

I love your man and wish you all the best in these next steps. I love you too, man, and you know. I learned from you a lot. But one of the most important things is that you always say, oh my bad, Miacopa, I sucked up, and you never have any qualms with doing that. And we all do we I mean, we all screw up, but we don't take responsibility for screwing up. But you always have done that, and that's one of the sort of important lessons that I have taken from you. Thanks a lot. Okay, Carl,

you take care and have a good trip. Okay, Great to see you, bro. Psychoactive is a production of I Heart Radio and Protozoa Pictures. It's hosted by me Ethan Naedelman. It's produced by Katcha Kumkova and Ben Cabrick. The executive producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren Aronovski for Protozoa Pictures, Alex Williams and Matt Frederick for I Heart Radio and me Ethan Nadelman. Our music is by Ari Belusian and a special thanks to a Vivit Brio,

sph Bianca Grimshaw and Robert Beatty. If you'd like to share your own stories, comments, or ideas, please leave us a message at eight three three seven seven nine sixty. That's one eight three three psycho zero. You can also email us as Psychoactive at protozoa dot com or find me on Twitter at Ethan Nadelman. And if you couldn't keep track of all this, find the information in the show notes. Tune in next time when I talk with Pat Denning, a longtime friend who's working at the cutting

edge of harm reduction drug Tree. When we had prohibition in this country, the law of the land said alcohol is so dangerous, it's so poisonous, that no one should ever be allowed to consume it, And thirteen years later we made it legal again. To make that make any sense at all, we had to adopt this idea that there's this disease called alcoholism and some people have it

and some people don't. That's an insane way of reintroducing a drug into society is by saying, oh, well, ten percent of you can't drink at all, and the rest of you can drink as much as you want to. It's a political ideology, it's not settled science. Subscribe to Psychoactive now see it, don't miss it.