28. Professor Carl Hart Argues All Drugs Should Be Legal — Can He Convince Steve?

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1:03Carl Hart is not your typical academic. Trained as a neuroscientist and now a psychology professor at Columbia University, in his research studies, he brings heavy drug users into his lab for weeks at a time to observe how drugs affect them and to learn about their decision-making. In his new book, Drug Use for Grownups, he argues for a radical overhaul of drug policy. He's not just talking marijuana. in his ideal world, heroin, methamphetamines, cocaine, they'd all be legal. Welcome to People I Mostly Admire with Steve Levitt. I've been teaching undergraduates about drug policy for two decades, and I definitely haven't been teaching them what Carl Hart advocates.

1:48So I wonder whether he'll change my mind. He certainly thought a lot harder about these issues than I have. I'm also deeply curious to see what he's like as a person. He's incredibly open in his books, talking about harsh details of his life growing up, and especially about his own extensive use of drugs. My guess is that he's going to be a lot more fun than my usual guest.

2:15All right, so let's start with the punchline. If you were in charge of drug policy in the United States, and you could start completely from scratch, no constraints, what set of policies towards currently illicit drugs would you put into place? The first thing I'd do is I would legally regulate the drugs that people seek, from cocaine to heroin to cannabis to MDMA. People might have to pass a requirement like a driver's license in order to purchase something like heroin and cocaine. I would also control a unit dose, make sure that there's not enough in a product To kill people when we're dealing with the illicit drug market, there isn't any quality control.

2:57The substances may contain poisons, toxins, and other impurities that may be dangerous to the person. Anything else goes with that? We'd have to change what we do in terms of public education. For example, we'd have to have public service announcements that would be helpful in teaching people how not to mix certain drugs, warning people about the potential dangers for overdose there, but also given realistic education, understanding that some drug mixtures are actually desired, like a sedative and a stimulant or like a speedball. Just warn people about routes of administration. If you snort a drug, it kind of functions as a safety mechanism as opposed to smoking a drug where you can put as much as you can or want into your bloodstream.

3:46And that's where people get into trouble. So I've read your book, Drug Use for Grownups, which is a new book, excellent book. And you really are in favor of a lot of drugs that a lot of other people aren't in favor of. Are you the only person on the planet who's seen the praises of opioids and crack cocaine and methamphetamines these days? Maybe I'm one of the few people who is willing to acknowledge the benefits of these drugs. But there are a number of people who privately acknowledge the benefits. I mean, they use these drugs. And so it's okay right now in our society to acknowledge psychedelic use because it's hip, cool.

4:24It's associated with our educated class, associated with white members of our society. And so that's so easy. But when you think of something like heroin or methamphetamine, now you're talking about the lower classes of society, the undesired people. And when you are standing up for the undesired. It's a lonely place to be, but it's the right place to be, and history will show that. So in your book, you mentioned that you use heroin, and there must have been a hundred headlines about Columbia professor admits to heroin use. Did it surprise you how the reporting went about that issue? Hell yeah, it surprised me.

5:03The thing about it is that I acknowledge psychedelic use, MDMA, but the only headline was heroin because heroin, of course, is the scary, evil boogeyman drug. And also, people knew that it would enhance the clickbait potential of their headlines. Actually, it pissed me off because what it did was got in the way of the book's message of being loving, being magnanimous, caring, open, and expressing some sort of compassion for people who were getting their asses kicked in this society. But how I have been treated has been really rewarding at some level because of the hostility. It gives me an opportunity to see how other people are vilified, not talking about drugs, but just for other reasons.

5:52I feel a real kinship to people who were gay in the 1960s, early 70s when they were vilified just for being. It's nice to be someone who is vilified openly. Like I'm a black man in this society, it happens a lot more subtly, but it happens. Whereas with drugs, you're permitted to say all kinds of awful things about someone just because they are identified as a drug user. For me, it's a good thing because really, I'm good. I am cognitively intact. I have a middle class income. I have a home. So I needed to have people attack me like that so I can have more sympathy for other people who are being attacked and they don't have the resources that I have.

6:49So let's backtrack a little bit because I wanted to jump in right into the bottom line so people understood what you were arguing for. But whenever I think about public policy, I like to make a sharp distinction between the set of facts and the conclusions that are drawn from those facts. And facts are presumably things that everyone can agree on. And in conclusion, sometimes reasonable people don't agree on. You're a scientist, and I just wanted to give you a chance to rattle off some of the facts that underlie the position you're representing about legalization. because I think even if you don't convince everyone of your conclusion, I think your facts are really powerful, and they might move people part of the way, open them up to some ideas they wouldn't otherwise.

7:34One of the most important facts is the promise of the country, the original promise that is laid out in the Declaration of Independence that each of us has the right to life, liberty, and the pursuit of happiness so long as we don't prevent other people from enjoying their rights. And so as part of that, it's incumbent upon any nation that claims to be as free as us to make sure that these things are legally regulated. Otherwise, how can you be preventing people from putting what they want in their own bodies if they're not bothering anybody? I find it an interesting lead for you as a scientist because I would have expected you to get all geeky and to start talking about the studies you've been doing in your lab.

8:16I'm surprised that you would lead with a libertarian argument. Not that it's a bad argument. I'm used to libertarian arguments at the University of Chicago Department of Economics. The scientists who participated in this endeavor, they may not come down on the same conclusion as me. But the fact is, we give these drugs in the laboratory to people every day. We give thousands of doses of these drugs on a yearly basis without incident. And if these drugs were so dangerous, we wouldn't be permitted to do the thing. That's a fact if you look at the scientific literature. But I wanted people to think about what it meant to be an American.

8:53I mean, you see these people with these damn lapel pins and their flags, but not understanding what it means to be an American. And that's the original promise. That's the original document. So when people say it's a libertarian argument, it's not a libertarian argument. It's an American argument. So you talked about the pursuit for happiness in the Declaration of Independence. and as I've studied drugs on and off over the last 20 years, what's been clear to me is that people think that the happiness you get from drugs, they treat that as illegitimate. It's just an observation I've had, which has always made me wonder, because as economists, we treat almost every kind of source of utility as equally good as the next one.

9:33It's okay if you like opera. It's okay if you like jazz. It's okay if you like metal. But an undercurrent of the discussion of drugs is that's not real happiness. that can't be counted. We don't add that up in our social utility function. What do you think of that argument? You're absolutely right. This idea that one has to earn pleasure. Pleasure from drugs are seen as unearned pleasure, which is a ridiculous notion. That's what I was trying to do. I was trying to write a book about drugs and pleasure. And I kept getting sidetracked with these adolescent arguments about what about the children?

10:08What about addiction? And I tried to point out that addiction and those other negative effects represent a relatively minority of effects when you think about the broad range. And so I was trying to have some balance, but people want to always bring you back to the negatives, the harms. And if you're not exaggerating the harms or stressing the harms, then you're considered irresponsible when you have these drug discussions. It's maddening as a 54-year-old adult in this country. It's like, my God, I want to have an adult conversation about this. Okay, so let's agree on our first fact that drugs make people feel good.

10:47And you have a lot of evidence from your lab to support that. That's right. But if you look at the scientific literature, when these drugs are administered, the predominant effect is euphoria, pleasure, alertness, in many cases, improvement on performance in terms of cognitive performance, increased social interactions, all of these sort of beneficial effects that we get from drugs. You would argue, based on your research, I think as well, that there are many people who use drugs regularly that are highly functional adults. That's right. The vast majority of people who use drugs regularly in the United States, as we define regularly as once a month, there are about 35 million Americans who report using drugs regularly.

11:33Now, that means that there are far more than that, but 35 million reported. And the fact people cite on the other side is that there's a whole bunch of folks who are being hurt by these drugs in the end. Going to facts again, what share of regular users would fall under the category of, I don't know, abusing or addicted? I don't really know what those different words mean officially in the literature. Yeah, so let's just define that now. So when I think of addiction, I am referring to the DSM-5's definition, that is the Diagnostic Statistical Manual of the American Psychiatric Association. And it's where you have psychosocial disruptions or disruptions in your ability to meet important obligations, work, family, educational obligations and so forth.

12:24And another component is that you are distressed by these disruptions. So that's what I mean when I'm talking about addiction. And when we think about the percentage of people who meet criteria for addiction, it ranges anywhere from 0.5 % to 30%. So we think about a drug like tobacco, a third of tobacco users will experience addiction at some point. Heroin users, about 25 to 30 percent will experience addiction at some point in their life. Cocaine, about 15 to 20 percent. Alcohol, about the same numbers. Cannabis, about 10 percent. So you can see that the numbers may range based on a drug, but the overwhelming majority of users of any drug do not meet criteria for addiction.

13:11And you also have argued that, let's just say, the fact is that many people abuse drugs have other problems going on in their life. Let me stop short of making a conclusion about causality. Some people argue the drugs are causing the problems, and other people argue the problems are causing them to abuse the drugs. I think we can all agree, though, that in the literature, there's a lot of evidence that having other issues is a strong predictor of abuse. That's right. A large percentage of people who meet criteria for addiction also meet criteria for depression, anxiety, schizophrenia, and other psychiatric illnesses.

13:44A large percentage of these people also are having problems with unemployment or underemployment. A lot of these individuals have problems with unrealistic expectations heaped on them. So a number of these sort of factors correlate with addiction. Another point I think we could agree on, you and I, is that the criminal justice enforcement of drug prohibition falls heavily on minorities. Yeah, so it's not minorities. It's a select group of minorities. So it's black people and a select group of Latinos like Mexican-Americans, Puerto Rican-Americans. Those are the ones who are really catching hell.

14:33so let me make a thought experiment let's say we followed your plan we legalized all these drugs in a regulatory environment and let's just say to make it simple the price was basically zero close to zero so that you didn't have to worry about black markets and violence related to black markets. How many Americans would you guess, so now we're out of facts, we're into educated guesses, how many Americans do you think would be abusing or addicted to drugs in that world? And how many drug-related deaths would you predict would happen in the U.S. each year? Well, I think that our drug-related deaths will go down, definitely, because many of these deaths are caused by tainted drugs and ignorance.

15:19And also, people will be less likely to feel embarrassed or the stigma associated with drugs would also be decreased. And so people can seek information. And then we would require our medical community to be better informed because the medical community is part of the problem here in terms of their own ignorance about these things. So I think the numbers of overdose deaths related to the recreational drugs will go down. Okay, let me stop you there because I think that's really interesting because that's a case where if we asked one of your rivals in your discipline, they'd probably say, no, use might be five times greater and so deaths might be five times greater.

16:00Now, I'm sure that would be an exaggeration, but it's one of those questions we don't really have. Maybe we do, I should ask you. Do we have any way other than introspection to get insight into this? I guess Portugal's. That's right. an example. Portugal decriminalized, I think, all drugs. It must have been almost 20 years ago. What's happened in Portugal? That's exactly right. The overdose rate dropped significantly in Portugal when they implemented decriminalization. People sought treatment. All of these pro-social things increased. Everything we've talked about so far, if I take an unbiased view, literally everything we've talked about supports your argument.

16:40Now, the one big chink in the arm that I see is those numbers you gave about addiction and abuse. Because I think people who are against legalization, they're just going to say, look, right now, 30 million people use drugs. If you legalize it, every teenager is going to at least try drugs. And people don't have a very good idea of who's going to get addicted or not. And so a bunch of kids, 10 % of all the kids in America are going to end up addicted to these drugs and ruin their lives. Do you have a good counter argument to that? That's some stupid s***. This notion that we should somehow ban an activity because we're afraid of kids engaging in that activity.

17:22We should ban cars because we're afraid of kids driving cars or sex because of sexually transmitted infections. That's a really ridiculous notion, but we all play into it. parents still have to parent, and these drugs are still illegal for kids to use and purchase. It annoys me when the kid argument is thrown into the mix, because what it does, it immediately shuts down any sort of rational adult conversation about these things. And we do, by the way, have pretty good information about the likelihood of who will become addicted and who will not become addicted. If you have someone who does not have well-developed responsibility skills, that person is overtaxed with expectations, unrealistic expectations, the person has psychiatric illnesses or physical pain, has recently lost a middle-class paying job, all of these things certainly increase the likelihood of somebody meeting criteria for addiction.

18:29One of the reasons that I came out about my own drug use is that I don't worry about me ever becoming addicted. I assure you that won't happen because I have all of these responsibilities that I love taking care of. And I also know that people would love to see me have an addiction problem so they can say, see, there's a cautionary tale. That challenge, I welcome. But we tell people this nonsense, like you don't know who's going to become addicted. That's bullshit. We do. And those are the same people who get in trouble with a number of other issues in their life. Okay. But let me say, I think you've been a little misleading with the automobile example, because look, you're all about trade-offs.

19:13I've read your research and you do this fascinating research where you bring heavy users of drugs like crack into the lab and you give them a choice between taking a hit of crack now or getting a voucher for money in the future. And one of the most interesting things you show is contrary to everyone's belief, these heavy users are able to make sensible trade-offs and they view drug use and the pleasures from it as fitting into some bigger hierarchy of needs and wants. So I think it's disingenuous to talk about automobiles because obviously automobiles provide a huge positive benefit. And so we take the hurt that comes with crashes with it.

19:55Because automobiles are necessary, right? That's what you're saying? No, I'm saying that without automobiles, life as we know, it would be hard to accomplish. And of course, there's this devastating tax that comes with automobiles of maybe 30 ,000 or 40 ,000 people dying per year in crashes. But if you put like the actual risk of a person driving a car of dying in a crash, it's not vanishing low, but it's really low because we spend so much time in cars. It seems to me somewhat unscientific to say, look, we tolerate deaths in cars, so why shouldn't we tolerate deaths from drugs? And I think people could very reasonably say, if you can show me the benefits of drugs are high enough that the cost of addiction is vanishingly small compared to the benefits, then that makes sense.

20:44But I think we're in a very different territory around drugs. And I mean, I know you've got a point. You're fighting against an army of people who are using every tool they have to keep drugs illegal and whatnot. And so you're probably willing to use whatever tactic you have. In some sense, you're an advocate. You're an academic and you're an advocate. And I was just trying to get the academic part separate from the advocate part. No, it's a great point. I mean, when we're talking about just the relative numbers of people who are in automobiles, there's a relatively small number of people who die from car crashes compared to the relatively small number of people who use drugs and then the numbers who die from drugs.

21:29Yes, that's what we're saying. Yeah, that was the point I was trying to make. It's a good point. Now, just to be clear, I'm not talking about addiction here. I'm talking about overdose deaths because the people who are addicted are less likely to die from overdoses. It's the people who don't have tolerance and people who are relatively inexperienced who are more likely to die. And the point that I was making was not to say that we have a comparable comparison because you're right when you talk about the relatively low number of people who die in car crashes. The point was that life is not without risk.

22:08And if we think about skiing, we think about a number of these activities where people get injured, professional football. We tolerate those sort of things because it's part of being a member of the human society. We acknowledge these risks all the time. We make these risks to benefit calculations as we go throughout our day. But somehow we have treated drugs as special. And even in this conversation, like you talked about addiction and overdose, like they're one and the same. And they're very different things. The overdoses come primarily from ignorance. And they also come from suicide. Few people are talking about drugs like gabapentin, a nerve pain medication, or about antidepressants, a number of these drugs that always show up in the person's toxicology who has died.

22:59We oftentimes talk about the opioids because that's what's sexy right now.

23:06You're listening to People I Mostly Admire with Steve Levitt and his conversation with neuroscientist Carl Hart. After this short break, they'll return to talk about Carl's lab-based research.

23:24A History of the United States in 100 Objects is a brand new podcast from 99 % Invisible and BBC Studios. Each week, we're looking at a different object from across American history with a unique story to tell about who we've been, what we've built, and what we've allowed ourselves to forget. Some of these objects are well-known, many are not, but all of them carry the story of how we got to this moment. Find a history of the United States in 100 objects on the 99 % Invisible Feed, wherever you get your podcasts. The Colonels cooked up a new$10 bucket of the day just for you. Monday, 24 nuggets for$10.

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24:59Today's listener question comes from Shane. And Shane writes, I am a high school math teacher in the state of Virginia, and the state is getting ready to do a major overhaul of the math curriculum called Virginia Mathematics Pathways Initiative. One major component of this is that when students enter 11th grade, they're required to choose from one of five different paths of mathematics. And we're excited about this new opportunity for our students, Shane writes, but there's one thing that gives me pause. We don't teach students how to make important choices. Do you have any recommendations about how to prepare students to make such an important decision?

25:39So Shane, let me start by saying hats off to Virginia for shaking up the way we teach high school math. That's an issue I'm extremely passionate about. And if people want to know more about my thoughts on that topic, they can listen to a Freakonomics Radio episode that I guest hosted. It was episode 391 and it was entitled America's Math Curriculum Doesn't Add Up. Now, let me turn to the question of decision making. So Shane, I'm not sure this answer will be very helpful to the students of Virginia, but let me at least describe how I think about making decisions. Now, I want to divide my answer into two pieces.

26:17So there are situations where you have really good information about a decision, but it's still really hard to make a choice. And there are other cases where you're either too distracted or too lazy or so uninformed that it's hard to even gather information. And then you know you can't make a good decision. Let me start with a case where I don't have good information and I'm also not willing to invest the effort to get good information. So in that case, the typical path that people follow is to hire an expert. So when I'm selling my house, I might hire a real estate agent. If I'm thinking about investing money, I might hire a financial advisor.

26:53And that's not the worst thing you can do, but you have to be really careful in thinking through the incentives that the expert has and how they're not the same as yours and how that can distort the advice that they have. Now, you don't know very much, so you're really at a disadvantage. And as we write about in Freakonomics, oftentimes these experts will therefore take advantage of you. So I don't actually think that's usually the best advice. The better option, if you can, is to find a friend or a family member or a colleague whose opinion you trust who, unlike you, is not so lazy and distracted that they're unwilling to go and gather the information to make a good decision.