Reviewed by Mike Jay
Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear
by Dr. Carl L. Hart
Penguin Press, 290 pp., $16.94
The modern meaning of “drugs” is of surprisingly recent origin. Until the twentieth century, the word referred to all medications (as it still does in “drugstore”); it was only around 1900 that it developed a more specialized meaning, uniting what had previously been a disparate group of pharmaceutical products, chemicals used in medical research, and herbal intoxicants. Initially, this new usage of “drugs” referred to toxic and addictive substances that were to be taken only under the direction of a physician. Once the trade in these substances was criminalized in the early twentieth century, the word connoted illegality.
While “drug” is freighted with negative associations, the opposite is true for “psychedelic.” The word was coined in 1956 by the psychiatrist Humphry Osmond in correspondence with Aldous Huxley, whom Osmond had supplied with the dose of mescaline that inspired Huxley’s best seller The Doors of Perception (1954). Huxley was looking for an alternative to the terms that psychiatrists used to describe mescaline and LSD, labels such as “psychotomimetic” and “hallucinogen” that connected their effects to symptoms of mental illness, particularly schizophrenia. Huxley proposed “phanerothyme,” from the ancient Greek roots phanein (to reveal) and thymos (the soul), aligning the experience of taking the substances with mystical revelation; Osmond countered with the catchier “psychedelic,” from alternative roots with similar meanings (psyche, for mind, and deloun, to make manifest). The coinage shifted attention to positive outcomes: mind expansion, personal growth, and spiritual insight. It was resisted until recently by clinical researchers, who were typically focused on the risks to vulnerable subjects of psychotic breaks.
The doublethink created by this language exasperates Carl Hart, a professor of neuroscience at Columbia University. “In recent years, psychedelic drugs have become chic,” he writes, observing that “the way drugs are categorized is often discretionary” and depends on who is doing the classifying. Drugs considered “psychedelics,” mostly used and enjoyed by “respectable, middle-class white folks,” have escaped the stigma that applies to other controlled substances, particularly those associated with marginalized social groups and nonwhite ethnicities. The dissociative psychedelic ketamine, for example, is now available, to those who can afford private health care, from hundreds of psychotherapy clinics as a treatment for conditions including depression, anxiety, and PTSD, while its close chemical cousin PCP is still perceived as “angel dust,” a street drug believed to make young Black men physically aggressive and commonly cited in cases of police homicide as a cause of “violent rage behavior.”
The toxicology reports that support this view are usually taken at face value by the media, but Hart presents this received assumption as a racist myth, pointing to the high rates of false positives in PCP toxicology screenings; the misinformation surrounding closely studied episodes such as the 1991 beating of Rodney King, whom officers falsely believed to have taken the drug; and peer-reviewed surveys that have failed to show any link between PCP and violence. Ketamine replaced PCP as a surgical anesthetic because its effects, though similar, were more controllable and of shorter duration. It now benefits from its status as a licensed medicine, which means that it can be prescribed off-label as an adjunct to psychotherapy without passing through the FDA trials required for other psychedelics. PCP “has long been established as a psychedelic,” Hart writes, and he wonders why high-profile advocates for psychedelic therapy remain silent in the face of such evident injustice. Could it be that they are “strategically protecting their mission to ensure continued public support for a select few psychedelics”?
As a Black Ivy League neuroscientist, Hart belongs to a vanishingly small cohort of experts who can address the question of drugs authoritatively from both these perspectives. His writing moves fluently from eviscerating the junk science generated by the National Institute of Drug Abuse (NIDA), which funded his research for many years, to intimate portrayals of the reality, and normality, of social and recreational drug use. His lucid and deeply felt book is part how-to guide, part science primer, and part manifesto for policy reform, cast as a personal narrative of confession and conversion.
Hart grew up in the Miami projects, in an area that outsiders characterized as “lawless and particularly unsafe for nonblack people.” He joined the air force, earned an undergraduate degree, and chose to specialize in neuroscience in the belief that this was the best way to rescue neighborhoods like his own: “I reasoned that if I could stop people from taking drugs, especially by fixing their broken brains, I could fix the poverty and crime in my community.”
It took him years to realize that the game was rigged. Institutional and federally funded “drug research” consisted of identifying drug-related harms and presenting them as dramatically as possible, through exaggerated press releases and brain imaging that makes tendentious use of differences that are ultimately trivial or inconclusive. Any benefits of illicit drugs were ignored, often unconsciously: career advancement depended on internalizing the belief that drugs were a danger from which the public must be protected. NIDA’s stated mission during this time was to bring “the power of science to bear on drug abuse and addiction,” blinding researchers to the possibility that abuse and addiction might be “a minority of the many effects produced by drugs.” Hart subscribed reflexively to this belief, despite clear evidence that the drug-using subjects with whom he worked were deriving positive outcomes in managing their moods, their responsibilities, and their lives. “Boy, was I ignorant,” he recalls. “It would take nearly a decade for me to get beyond the baseless and harmful negative stereotypes attributed to drug users.”
“Over my more than twenty-five-year career,” Hart concludes, “I have discovered that most drug-use scenarios cause little or no harm and that some responsible drug-use scenarios are actually beneficial for human health and functioning.” In the light of his experience, he recasts the policy debate as a matter of liberty, citing the guarantees in the Constitution and particularly the Declaration of Independence of the pursuit of happiness: “Governments are created ‘to secure these rights,’ not to restrict them.” With liberty comes responsibility, for drug users as for anyone else. Being a “grown-up,” as he characterizes it, “requires a considerable amount of self-inspection and a healthy respect for fellow humans.” It includes eating and sleeping well, looking after our health, behaving appropriately, and taking care of our responsibilities toward our family, society, and work.
Responsible drug users, Hart argues, are unlikely to manifest the detrimental effects highlighted by scientists; those who do are the ones who, for whatever reason, aren’t taking care of themselves in other respects. This truth is obscured by the myopic focus of drug science, in which he finds correlation routinely conflated with causation: harms caused by poverty, trauma, and injustice are attributed to concomitant “drug abuse.” He is skeptical of the “opioid crisis” (his quotation marks): he believes levels of addiction are exaggerated and sensationalized, and mortality rates inflated by compounding deaths caused by opioids alone with the far larger number of deaths in which alcohol or other sedatives are also involved. The problem extends beyond opioids to other drugs, he writes, as well as to more profound social and economic challenges.
Hart doesn’t assess the various regulatory solutions on offer, a task that requires policymaking expertise beyond his scientific range. He has, however, made the decision to advocate against drug laws, and to be open about his own drug use, as part of his grown-up responsibilities: “I am not a child, nor will I be treated as such…. Why should I be required to conceal an activity that I enjoy, especially if it doesn’t negatively impact others?” Over the course of his studies, Hart found that responsible drug use could have positive outcomes, “whether the drug in question was cannabis, cocaine, heroin, methamphetamine, or psilocybin.” Provocatively, he maintains that “heroin is probably my favorite drug, at least at the moment.” He uses it as rationally as he does alcohol, and about as often, which is rarely: both hold risks of addiction and other health harms but are valuable as “tools that I use to maintain my work-life balance.”
This feels like a riposte to advocates for psychedelics, who tend to distance themselves from other classes of drug by claiming higher motives. He recalls a “middle-aged white military veteran” accosting him at a Columbia gym to discuss his own use of psychedelics, which he referred to as “plant medicines”: “It was particularly important to him that I know he ‘didn’t get high’ and only used the plants to facilitate his ‘spiritual journey.’” Hart stumped the man with his deadpan response: “What’s wrong with getting high?” “Pleasure is a good thing, something that should be embraced,” Hart writes, adding: “It feels weird that I am compelled to write the preceding sentence because the idea seems so obvious.” He sees the psychedelic culture’s circumlocutions—referring to their preferred drugs as “medicines,” “entheogens,” and “sacraments”—as an evasion not just of the stigmatized term “drugs” but of pleasure itself. Users of all types of drug, according to his research, “expressed feeling more altruistic, empathetic, euphoric, focused, grateful, and tranquil.”
Mike Jay’s books include Emperors of Dreams: Drugs in the Nineteenth Century, This Way Madness Lies: The Asylum and Beyond, and, most recently, Mescaline: A Global History of the First Psychedelic.