257 - Carl Hart: The Neuroscience of Drugs and Their Role in the Good Life

37:34That's right. So they're the same drug, of course. Powder cocaine is made up of a salt that's called hydrochloride, and then the base, which is cocaine. If you want to smoke this, you have to remove the salt, the hydrochloride portion. because if you don't try and smoke that, the temperatures required to heat that up would make the base, it would decompose the base so you won't get anything. So you have to remove that salt or that hydrochloride portion. And so, I'm sorry, that acid, the hydrochloride portion is the acid. You have to remove it. And you can remove it easily by just simply adding powder with baking soda and water, heating it up, letting it dry out and come back.

38:35That acid, the hydrochloride portion is gone. And now you're just left with the base, cocaine base. The hydrochloride portion does not contribute to the pharmacology. So all the action is in the cocaine base. That's what people, that's why we, people do cocaine. And so they are the same drug, just different routes of administration. One is smoked. The other can be snorted, diluted in water and injected, taken orally. But they are the same drug. Yeah. Well, before we turn away from the Philippines and the wars on drugs and maybe turn toward the more positive aspects of drugs, Do you have any insight into why the war on drugs there was allowed to persist, why the United States funded it?

39:28And then what, I mean, what shifted so that it was finally, and now he's being tried by the international court. What changed? Does it say something broader about how people are viewing drugs now? What changed in the Philippines, you're asking? Yeah. So one of the things that changed in the Philippines, which is really important, is Duterte's relationship with the current president, Marcos, the kid of the former Philippine president, Marco. Marco's vice president was Duterte's daughter, who was in line to become president after, I suspect. But the relationship soured. And as a result, Marco allowed this investigation and to Terté to go for it.

40:27This is what I've read and I suspect happened. That's the main thing that changed. The relationship soured. Because if the relationship hadn't soured, I don't think we would be here. Okay, well then, without any further ado, I'd love to talk a bit about your own research and what you've done in the lab and then how that's contributed to your attitudes on drugs now. So what drugs have you studied in the lab? I'm guessing there are a lot of challenges associated with this too. Not as much as you might think. So let's take a step back. So in the late 80s, early 90s, I was primarily studying rat brains, you know, putting electrodes in the brains of rats while they behaved, gave them some drug and wanted to know something about the neurochemistry following drug administration or how a cell is firing as a result.

41:35So I spent maybe six, seven years studying laboratory animals. And then And subsequently, I realized that I didn't know anything about human drug use. And so I started to study human drug use in 1996 or so. And since that time, over that time, I should say, I have studied opioids, crack cocaine, powder cocaine, cannabis, methamphetamine, MDMA. All in humans? All in humans. Sleeping pills like Ambien, a wide range of different drugs. So in these studies, what we do typically is bring people into a lab. They may stay with us throughout the course of the study, or it might be an outpatient study.

42:37But the bottom line is that you do some baseline measures, give a drug, and then you assess what effect the drug is having on your measures over time. The acute effects, that is the immediate effects, and also some longer-term effects like following day, following several days, following month. And so what is well controlled are the doses and the environment in which drug use takes place. And so we can make a lot of statements or we've obtained a lot of data that really helps us to separate fact from fiction. So many of the drugs that I laid out are drugs that are vilified in society. But yet we and others give these drugs to people and have done five days a week for decades and without incident.

43:50And what we've found generally is that drug effects are predictable. If you know a few variables like dose, route of administration, something about the user's history, you know a few of these variables, drug effects, they're lawful, they're predictable. And so what does that tell you is that when people start talking about drug effects being unpredictable, it should raise a red flag. Like, okay, let me hear more. Why are you saying this new drug is unpredictable? Why are you saying that? And then so you listen carefully to see where they're going. And most often, it's just simply not true what they're saying.

44:50So we've learned that kind of lesson from these data collected in humans over the past three or four decades. Also learned things like crack cocaine. When it was a concern in the United States, we said that people, if they got addicted to crack, they, first of all, you only needed one hit to get addicted, which was not true, of course. And once they get addicted, they don't respond to anything else but crack. You know, so if you offer them crack, that's all they're going to take. And they're irresponsible. They have an inability to inhibit, inability to delay gratification. All of these things that were said, they become more violent.

45:43All of these things simply not true as a function of the drug. And so we've learned a lot of lessons, and all of this is in the literature, in the scientific literature. but it's not what is highlighted in the scientific literature. What's highlighted in the literature is that we are trying to solve drug addiction. That's the thing that is highlighted in the literature, in part because our primary funding agency, the National Institute on Drug Abuse, is a part of the NIH, which is National Institutes of Health. And the NIH mission primarily is to focus on pathology. You know, we have diseases and we want to make sure that we know how to treat them.

46:38We want to have appropriate interventions and that sort of thing. Now, that's perfectly fine. That makes sense. But when you have an activity like drug use, the vast majority of the people who use any of these drugs we're talking about don't experience addiction, don't experience those problems that we in science are focused on solving. And so you have this sort of biased focus on pathology in the scientific literature. And then what gets into the scientific literature influences what is written in textbooks, what's written in the national press. And so it starts out from a biased perspective, and that's where you're going to end up with a biased perspective.

47:33And so one of the things I've been trying to do is just bring that to people's attention. It's like, yeah, of course you want to help people who are experiencing addiction, of course. But addiction is rare. That's not the norm. That's the aberration. But we flip that to make people believe that's the norm. Right, the conventional narrative is certainly that anybody who's using cocaine is an addict. And I know from experience, friends, whatever, that's not the case. But so you still think addiction is a useful term that we should be using. It's just we need to use it correctly. Yeah, I think addiction is it's a real thing.

48:22But all right, when we diagnose addiction, there's this manual called the DSM-5, the Diagnostic and Statistical Manual of the American Psychiatric Association. And it has a list of all of these mental disorders. And substance use disorder would be the addiction equivalent. And so there are 11 symptoms, basically. And people have to endorse a certain number of symptoms. And they also have to be distressed or impaired as a result of their drug use. So those two components are necessary. But once people meet criteria, of course, you want to make sure that you have help for them. But oftentimes, the public think of addiction in terms of an activity that someone really enjoys doing.

49:22like, I don't know, the person who comes home every evening and has a glass of wine, right? So they do it on a regular basis. They would be considered addicted for some people, whereas the person is working every day, happy with their life, taking care of their family, and not having any problems related to their alcohol use. That person would not meet the medical definition of addiction. And so the public sort of mind, how we discuss addiction in the public, the first thing people have to understand is that we're speaking the same language. We have to first make sure we're speaking the same language.

50:03And once you're speaking the same language, now at least you're talking about the same concept and you can figure out what the issues are. But oftentimes we don't stop to do that. The DSM-5 is making judgments about addiction based on behavior that people are exhibiting. And I'm wondering though, as a neuroscientist, are there changes in people's brains that that are similar across people and across drugs that correspond to this labeling of addiction? In humans, so when you ask that question, are there changes in their brain, right? In humans, we don't have the documentation, the evidence to say that there are.

50:59Oh, really? Right, but people will not tell you that. No. People will say, oh, there are brain changes. You know, like this conversation you and I are having is changing our brains because, you know, learning is taking place. That's neuroplasticity. Right. So that and so there are changes that take place in the brain. Just living. But when we think about the contribution of drugs, like permanently changing someone's brain to the point where you can, I don't know, put a scan, some sort of brain scan up for a person who uses, let's say, methamphetamine versus someone who doesn't use methamphetamine.

51:47Now pick out which brain is the person who uses versus the person who doesn't use, right? You can't do it. No one can do it because the differences are not detectable with our current knowledge. Now I have to take a step back. I use methamphetamine in part because methamphetamine is the amphetamines in general. Whether we're talking about Adderall, deamphetamine, methamphetamine, MDMA, the amphetamines in general are really good at producing neurotoxicity. That is damage or death to brain cells. They're really good at neurotoxicity when given inexperienced animals large doses. That is doses that are 10, 20, 40 times what a human would take, right?

52:46So you give these large doses over several days, right? Sure, you can see some damage. You can see some cell death in some cases. And so people upset, like, there's the evidence. That's not evidence because you get the same kind of thing if you give, I don't know, Tylenol, that dose is that really you push the dose and you can really cause some damage to organs. but those doses aren't relevant because humans don't take those doses. And so people have been playing the shell game, if you will. So it's like, yes, we've demonstrated that these drugs, amphetamines, I'm using amphetamines because other drugs, it's more difficult to do.

53:39So, yeah, it's true at extraordinarily large doses given over several days to animals who are naive, yeah, you can see some neurotoxicity. But what is the relevance of that in humans? I don't know, but I think it's still important to know that that happens. So you learn some things about drugs in the brain, but you get in trouble when you extrapolate to humans. That's when you're now, now you're not showing fidelity to the data in terms of what they actually say. And then so when you look for this in humans, people have, they haven't found these differences that fall outside the range of normal human variability, let's say in structure size, a brain structure size, we have normal variability, like a woman's nucleus accumbens may be smaller than my nucleus accumbens.

54:51There's a range in which the size might be. And so when you add that into this, you don't see differences that fall outside the normal range of human variability. That's one. And two, the brain is important for function, various function. You certainly don't see, let's say, cognitive testing. In 2012, I published a paper looking at the scientific literature. It was a review of the scientific literature on brain imaging and cognitive testing of methamphetamine users, people who had used methamphetamine for some period of time and had met criteria for substance use disorder. That's what it's called.

55:43That's the addiction. And so I reviewed the literature just looking for these brain changes, these sort of this pathology that is so commonly stated. And of course, I didn't find it. But what I found was that if researchers found a difference between, any difference between folks who use methamphetamine and those who didn't, any difference was interpreted as some egregious pathology. and that's one even though the behavior like cognitive testing or whatever there was no difference in cognitive testing that's one issue another issue is that almost never are those findings, those minor findings, replicate it.

56:49And so in science, replication is really important because then it lets us know that the findings are not spurious. And so, I mean, you get the same group of researchers who can't replicate what they did in a previous study, let alone other researchers trying to replicate it. And so the thing that really concerns me about this brain damage or brain disease, as they call it, issue is that what the message that we send to people who use drugs, let's say, we tell them that your brain is damaged prematurely. And so that's devastating, right? And demoralizing, and also it might be a self-fulfilling prophecy.

57:50All of these kind of issues concern me. Even more importantly, though, is that it ain't true. And so... When I think about the harm that we do, we've done in science by promulgating this unsubstantiated notion, it upsets me. That's why I'm here to talk about these issues because there is so much harm being done. And so that's why I would like people to make sure that they always ask about the data. Where are the data that showed that? And if someone puts up an image of someone's brain, a fancy image, that's not data. Those are just some reconstruction, some statistical reconstruction. You want to know, you want to see the actual numbers, the data.

58:59And when you look at the actual numbers, this story falls apart.

59:08And yeah, I wrote that paper in 2012 and people still do this. Here's a story where I wonder if the data holds up or is useful in some way. We've been talking about addiction, and we've also been talking about how the public narrative is often not the correct narrative when it comes to drugs. This episode is brought to you by Google Chrome. You think you know a browser, but Gemini and Chrome? That's new. It can help you with practically anything on the web, like restoring a vintage motorcycle from a 50-page restoration block, or finally break down that long article you've had open for weeks. Gemini and Chrome is here for it.

59:50Ready to make anything online make sense? There's no place like Chrome. Check responses set up required, compatibility and availability varies 18+. I think a topic that's really worth discussing today is the opioid crisis. And one, maybe just given how I framed this question, how would you describe what the popular narrative is about it, but then how, from your perspective, should it best be described and dealt with? Yeah, so when people talk about the so-called opioid crises, it's important for them to talk about, to state specifically what they mean. And so like some people would say, oh, there's rising rates of opioid addiction, right?

1:00:38Which is not true, right? And then so other people might say, well, I'm concerned about overdoses, right? And so you see those nice graphs beginning in like 1999, the number of drug-involved overdoses really has dramatically increased. Now we're about 100 ,000 a year, right? Whereas we came from 20 ,000, right? And so when you look at that kind of thing, you said, there's a problem here, right? Yeah, it looks like there's a problem, but I use the term drug-involved overdoses, right? That's the term that the CDC uses, And that's a term that would be more appropriate than saying that a drug caused or this is a drug overdose.

1:01:39Drug involved means that a drug might have been involved or is suspected of being involved based on toxicology or based on reports of the family, based on reports of the friend, that sort of thing. So the role that the drug played in causing the death, now that's a whole other issue. Drug involved does not say that the drug caused the death. It just means that the person may have had drugs in their system when they die. Now, but the public hears this drug causes overdose. That's what they hear when they see those numbers. And that's not what those numbers tell you. But in the public, that's how it's being communicated because of lazy ass people who write in the press.

1:02:36The CDC, their website, they always, it says this, right? But I know the CDC also plays into this narrative. Now, all right, that's kind of the overview. Now, what my concern is, is that, well, I have to also say that it is true that those people have died. People have died. That is true. Every year in the United States, there are 2.5 to 3.5 million deaths each year. The numbers have been that way for a very long time, decades. And so these people have died. Now, what has changed is the attributed cost of their death.

1:03:37So, what I'm putting forward here is that there are not 100 ,000 people who die from a drug overdose in any United States. That's just simply not true. The evidence does not support that. Okay, that's what I'm saying. Now, why do I say this? All right? Um, everybody will remember in 2020, May, I think 26, George Floyd was killed by the police. Um, uh, we saw how he died, uh, eventually, but before we knew how he died from the video, the cause of death was fentanyl and methamphetamine. Um, and this is still something that many people say. Yeah. And so, but then people saw the video. Clearly, they saw Derek Chauvin choking him.

1:04:34And that's why he died. And that's what the full autopsy eventually said, right? Now, the national overdose tally is done by the CDC. So they take from death certificates, cause of death, basically. I know a lot about the George Floyd situation because I wrote an op-ed about it in the Times and a few other places. kind of helping people to understand why you can't say drugs caused his death. It's true George Floyd had in his system, the toxicology showed, he had a small amount of fentanyl in his system. He had a small amount of methamphetamine, cannabis, and the metabolite for nicotine, cotinine.

1:05:33So he had those drugs in his system. But when you look at his death certificate, a contributing cause of his death is listed as fentanyl and methamphetamine on the death certificate, even though the autopsy does not say that, right? So for 2020, George Floyd's death is likely included as a fentanyl death as well as a methamphetamine death. Because if a person have multiple drugs in their system when they die, each drug is counted individually. And so a person like George Floyd had two drugs in his system. it counts in both of those categories as a death, fentanyl death and methamphetamine death.

1:06:26So you can imagine many people may have multiple drugs in their system, like me at this moment. I may have multiple drugs in my system. If I drop dead because of some reason, I don't know, I get hit by a car or something. And then I have multiple drugs in my system. Well, we're in New York City. We're more careful than many places in terms of that. But there could be places, there are places, where the person who is recording the death is a coroner. A coroner, in order to be a coroner, you just need to be elected, typically a high school diploma and a registered voter. And you take a course of eight to 32 hours on death investigation, you're good.

1:07:14Now you can certify these deaths. Places like New York City, medical examiners, people who have a medical degree, at least four years of forensic pathology training. So they have a little more training. But most of the deaths, certainly drug deaths, are recorded by coroners. And most of those deaths don't have an autopsy. When you do an autopsy, you are likely to be wrong on a third of the time of your diagnosis. So imagine if you— It's a high rate. Yeah. Imagine if you don't have an autopsy. God knows. You're just eyeballing it. Yeah, yeah, and you're eyeballing it in a climate, in an environment where everybody's readily hears overdose, and there are financial incentives for calling these things overdoses because it helps to get your office funded because you need some of that opioid money to deal with these opioid deaths.

1:08:36And so you see the incentives are to overstate what's happening. And so that's why I say 100 ,000 people in the United States are not dying because of overdose. You know, there are people who die, really, it's a real thing. So I don't want to minimize that. I suspect the number would be somewhere around 20 ,000 to 30 ,000. That's where it kind of historically had been. And so, but I want to emphasize that dying from an opioid overdose is not the easiest thing to do. It's kind of difficult, you know. In my latest book, I wrote about this and I did all of these drugs in part to really see, push it.

1:09:32I wanted to know what happened. And if you really increase your opioid intake, rapidly increasing blood levels, you get sick, you vomit. I know people can get tolerant to that effect, but it's hard. It's not the easiest thing. And then the constipation and all of those awful things happen that won't allow you to put more in the system because you just feel so awful. And so this notion that people can readily die from an opioid overdose, I think that's just wildly overstated. And that's not to say that people don't do it, but they don't do it as readily as the public thinks. The death toll, the actual death toll, it will range by between 20 and 30 ,000.

1:10:33Now, I want to make it clear, I don't have evidence for that. I make that estimation based on historically what the numbers had been when we were collecting the overdose data from the Dawn system, which was called the Drug Abuse Warning Network, in which they sampled hospitals throughout the United States. And so I think it's around that number. But I'm working to get the evidence to show how this has been wildly overstated. Yeah. And the reliance on the evidence here is crucial. Yeah, because what we're doing is we're not really focused on the real concern. And we're also, at the same time, vilifying a whole class of drugs that people really need, like chronic pain patients.

1:11:38They really need these medications, and they can't get opioids because of this concern. Many of these people have been taking opioids for decades to control their chronic pain. People who have sick cell anemia, people who have other kind of chronic illnesses, and now, I mean, they've been cut off. People who, there's even a fair amount of these people who've committed suicide because they can't get their pain controlled. And that gets less attention in the public. Yeah, so certainly one consequence of the opioid crisis is, to use that word you just used, it really vilifies these people. And it perpetuates the narrative that drugs are all bad and that they will kill you.

1:12:29So I wonder though how maybe not necessarily your research in the lab, though this could be part of it, but all of your reading and thinking about drugs, how it informs your attitude or beliefs about how the opioid crisis should be thought of instead and how it should be dealt with. Yeah. So what I've learned over the course of this career, if we're talking about keeping people safe, if that's the main goal, the focus and the energy should be put in making sure that supply of drugs, what people are getting, is actually what they think the drug is. If the focus is placed there, like in countries Spain, the Netherlands, Switzerland, Colombia, I mean, around the globe, they have really good drug checking systems where people can submit small amounts of their substance and get a chemical analysis of what is in the substance, that's where our energy should be.

1:13:51And what I'm describing is not fentanyl test strips. Fentanyl test strips, they are either yes, it's there, or no, it's not. I'm not talking about that. I'm talking about GCMS, where you actually get the composition, the entire composition of what's in the substance. And so people will know what they're taking. And that alone will go a long way at preventing people from, let's say, having bad effects. But we don't put our energy there because that will actually solve any problem that you say you're having. And if you solve that problem, then you can't frighten the population about the crises. So we always need to drug crises to make sure that these budgets, law enforcement budgets, are maintained at these high levels.

1:15:03But now, you know, everybody's in on this. Pharmacists, they get money for this kind of surveillance of this. They're cops, physicians, a number of people. They're all in on it. Harm reduction organizations, they're all in. Those are the organizations that you thought were, they were really concerned about the drug users. not all of them, but many of them, they're into overblowing this crisis in order to get funding. And so the exaggeration of the crisis helped people to get funded. I think it's been really useful to talk about the misconceptions around the opioid crisis here. One other popular narrative involves the connection between drugs and poverty.

1:15:56and in line with this theme of leaders and people in power using drugs to vilify targeted populations I think the narrative that's perpetuated here is that and this is something that you I heard in for instance it wasn't put explicitly like this but if you if you do drugs you'll end up in crime impoverished and so on. But my question is, do you see this as sort of the direction in which things go? You do drugs and that leads to poverty or poverty leads to addiction and these other negative outcomes that drugs are being blamed for? Yeah. Who's the richest person? Right now? I think Elon Musk. Yeah.

1:16:42Does a lot of drugs. Does he? I don't know. Interesting. Not, well, he does drugs. He's proud of that. This is not any. He smoked pot on Rogan and that was a very famous moment. Yeah. So it's, that's not, yeah. So when we think of poverty and that kind of thing, that's just one example of people who use drugs and they certainly are not impoverished, right? But probably more important to the point. So the illicit drug trade is a multimillion dollar industry, right? In order to support this industry, you can't be impoverished. You got to have money. The people who are buying drugs have money. That's a fact.

1:17:36And the people who we show on the news as like drug users, that's the aberration. That's not the norm. That's why I wrote the book, Drug Use for Grownups, to kind of go around the world and show who are using drugs. People like me, people who are middle to upper class, those are the main people who are buying drugs. If you know Burning Man, do you know what? 70 ,000 people in the desert in the summer, a lot of drug use there. But in order to get into Burning Man, it's like$500 a ticket. If you bring a vehicle, like another$500. So the people who go to Burning Man, they have a lot of disposable income in general, certainly not impoverished.

1:18:32In fact, I'm amazed at some of the amenities that are at Burning Man. And so if people are talking about poverty and drugs, those people are narrowly focused on an issue that's not an issue. The issue related to poverty never had to do anything with drugs, but it was a distraction in order to, again, like crack. And we said poverty, it largely vilified people, right? The thing that impoverished people more than poverty, I mean more than crack at that time, was Reaganomics. You know, he cut many of these social safety nets, kind of like what they're doing now. You know, you want to see some shit that's going to happen, you're going to see some of these horrible things happening to people.

1:19:41Far more, that has far more influence than drugs ever would because the proportion of people who use drugs are low among those folks. But that's where we tell people to look. So, yeah, drugs don't have anything to do with poverty. Great. Returning maybe to some of your work in the lab, I told you about these stories I heard at DARE, what LSD or MDMA or any of these drugs will do to your brain. Before we turn to the positive ways that they can affect your life when you take them, I'd love to hear about what some of these drugs actually do when you take them to your brain. Yeah. So when we think of what goes on in the brain with drugs, again, we have to think about it being from a limited perspective in terms of what we look for in science.

1:20:48You know, in science, we spent decades really focused on dopamine after drugs are given or taken. And we see dopaminergic activity increase in response to all of these drugs, right? And it led to simple theories like dopamine is a pleasure neurotransmitter and a wide range of just simple ideas. But when we think of like neural transmission, neural transmission happens in a way in which multiple neural chemist neural neurotransmitters are released and they modulate the activity of each. But in terms of our science focus, we're not really looking at that kind of interaction because it's really complicated and complex.

1:21:49And the tools to do that, they really, we don't really have those tools to kind of look at those complex interactions between those neurotransmitters. So if you're asking what happens in the brain when you take something like cocaine, you I can say confidently that cocaine blocks the reuptake of dopamine back into the cell where it can be recycled and reused. It also blocks the reuptake of norepinephrine, serotonin. Those, we have a lot of data to show there. What does that mean for behavior? I don't know. People experience pleasure. Yeah, they are. But when you increase, let's say, serotonin, neuroprinophania, and dopamine, when you're stressed, the activity of those neurotransmitters are also increased.

1:22:58Pain can increase the activity of those neurotransmitters. So So I know we have such an incomplete sort of view of what this means in terms of just knowing that dopamine activity is increased in response to amphetamine, to cocaine. knowing that doesn't really tell you anything about the behavioral effects nor the pleasure or whatever but we pretend that it does and it really doesn't because you can give a drug that selectively blocks the reuptake of dopamine and you won't get cocaine like pleasure so I don't I don't know what it tells you but I can tell you the details but I don't know what those details mean for human behavior.

1:23:55I mean one broad question I might ask and you've written a lot about this is how drugs can play positive benefits positive roles in people's lives but since we're talking here I ought to ask you I mean what are some of the ways in which they've positively impacted your own life and how do they do it on a regular basis? Yeah so drugs taught me how to think right so i i started studying drugs uh because i was interested in the brain initially but then drug addiction became so important and the funding was focused on drug addiction and so that's where like my original work with humans focused on drug addiction And then studying drug addiction, I learned that drugs are fascinating.

1:24:49They produce a wide, the drugs that I study, that is, the psychoactive drugs, they produce a wide range of effects, effects that are much more interesting than addiction. Addiction affects a small proportion, a relatively small proportion of people who take drugs. And then you start to look at these other things like, I don't know, amphetamines. You have to be alert. You have to focus for a number of hours and to do some tasks that might seem repetitive, boring, whatever. Amphetamines help you do that and be happy about doing it. That's why, for example, our military aviators, in the Air Force at least, take amphetamines on some missions, particularly missions that they have to do at hours when they should be asleep.

1:25:49So that's a beneficial effect. Think about something like cocaine. You go to a party. You're having a good time with folks. You're more sociable. um you feel better about um interacting with people um you know i'm a faculty member at columbia you know cocaine mdma would be great to interact with my colleagues but actually it would be wasted um but you um it would make me feel better about being in that space you know um And also, if you feel better, you're more likely to be generous, you know, and not mean-spirited. And I think that's always a good thing, particularly now. We need that more than ever, people being generous and not petty and not so aggrieved.

1:26:47And so when we think about beneficial effects of drugs, mood enhancers, many of these things are. And then you can think about sometimes some of these drugs can just shift your way of looking at a problem or at something else, a way in which you hadn't thought about something. It gives you, that's kind of like creativity, a new way of thinking and maybe being more open. So those are good things. Also, sometimes you live in times that are so stressful where things just seem like they're upside down. You know, like some clown holding a chainsaw, gleefully talking about cutting people's jobs, their livelihood, talking about people losing their jobs.

1:27:55I mean, they can't take care of their families. And someone is gleefully talking about this, representing the government. That's some crazy shit. I mean, that's like, I didn't think I would live to see something like that. And so when you think about drugs, it keeps me up at night, these kind of childish behaviors who are influential. Or what is it? to single gate I'm reading these texts and people are talking about killing people in this gleeful way or in this unserious unsober way and that's disturbing you know cheering the death of someone I mean, if someone has to be killed or whatever, it's a very serious activity.

1:28:56And so when you read things like Signalgate, you read the comments, if people aren't disturbed, something's wrong with them. Or you hear things like, I don't know, immigrants. Well, they don't have constitutional protections. They don't have rights under the Constitution. What kind of shit is that? They have human rights. You know, like my ancestors were enslaved in this country. And so I think about, well, they didn't have constitutional rights. So was that okay to abuse them like that? Of course not. They have human rights. But you hear these arguments in the public. And so it's like that disrupts one's sleep if you are conscientious and worried.

1:29:46about like humanity drugs are helpful at helping one get to sleep that they need so we think about the beneficial effects of drugs they are vast I'd like to ask for some more detail just about the areas that are particularly interesting to me so for instance you mentioned creativity and problem-solving and I'm curious about which drugs somebody might use to write better or paint or play music and what effects they'd have and and how they do it with the brain yeah so i want to be careful here because i don't want to perpetuate a myth so for to start people who have to understand drugs are not going to give them some skill that they don't have um so there are a lot of people who want to play the trumpet like Miles Davis or the saxophone like Charlie Parker.

1:30:47So they did heroin. We don't know who they are. So it's not going to give you some skills that you don't have. Now, if you have the skill of writing, if you have the skill that you're interested in, some drugs could help you think about a problem that you're struggling with in a different way, just help you to be able to see it from a different angle. And so when we think about that, you could think about a wide range of drugs from MDMA to heroin to LSD to psilocybin. A wide range of drugs can just quiet the other sort of voices or activity in your head. And you could focus on that issue and you might see something from a different perspective.

1:31:42I'm just curious, though, which ones would be helpful in these circumstances. If you don't want to talk about particulars, that's fine. No, it's fine. I mean, so when we look at the scientific literature, I want to say this. You don't see this in the scientific literature. This isn't a real question that the literature is really interested in because it's not addiction kind of thing. So what I'm telling you now is personal experience. So I think MDMA, for example, really good to help one be open and shift a perspective. Heroin, really good to help people be generous and open, again, to shift a perspective.

1:32:31Those are the more reliable ones that I know when I'm struggling with some problem, particularly when the problem requires sort of generosity of the spirit. it. Interesting. When I've heard of drugs that are useful for creativity, what I've often heard that people do is either they might like microdose with LSD or, or mushroom, something like this, or also smoke a little bit of, I mean, some particular strain of pop, but I wouldn't have thought that it would be heroin or MDMA that you would have suggested. Yeah. So like, um, micro dosing let's talk about that micro dosing is this sort of sub threshold dose that people take so that is doses that you don't feel any effect and so i i don't know what that really is what people are saying i don't know if that's just placebo and you feel like you are more creative i don't know interesting is there no data on that or they've studied it in labs You know, I know one woman at the University of Chicago, Harriet DeWitt, she was studying this, and I don't know if she's published it, but we've talked about it in the past.

1:33:57Harriet may have published on this, but I'm not familiar with the data, but that's one person to kind of look up, Harriet DeWitt. So when I think about cannabis, people are cannabis smokers. Yeah, certainly. Maybe cannabis will help them think about some issue differently. I wouldn't be surprised because you get perceptual alterations that could be helpful in that regard. But cannabis is just not my thing. And so it's not the thing that I would go to. Cannabis would have me focus too much on me as opposed to the problem. But if people are comfortable with cannabis and that's their thing, maybe it's a great way to think about problems differently.

1:34:50I have heard about people incorporating microdosing into their daily routines. routines, but maybe that's something that is done largely because there's no effect, if that's and it's just a placebo effect. But are there any drugs that are commonly labeled as really deadly or horrible for you, but that can be incorporated responsibly and to a very positive effect on a daily level in one's life? So when we think about people who have ADHD, for example, they take drugs daily. And so they take amphetamines daily at low to moderate doses. And that's clearly incorporated into their life. And this is an amphetamine.

1:35:48But then there are other people who take amphetamines, say, to party. And they may not take it orally, but may snort it or smoke it. And so they wouldn't do it daily, smoking orally. I mean, smoking or intravenous. They wouldn't do that daily. So you can incorporate drugs into your life daily if you take relatively low to moderate doses and typically orally. Um, people have incorporated nicotine into their life, um, on a daily basis. Some people have incorporated alcohol in that way. Um, so it really depends on the dose and route, you know, um, that, um, will determine that more so than the drug itself.

1:36:44Well, we talk about it like it's the drug, right? So opioids can be incorporated into people's lives, daily lives. It is. In my book, I describe people who are in places like Switzerland, and they use heroin as a form of treatment. And they take heroin twice a day, relatively large doses to us. For me, those would be large doses. they do it every day and most of these people work they are happy with their life of course they have health insurance better than ours we don't really have it they have housing all of those kind of things they have those basic needs are met and so yeah it's this already happens That's in the literature.

1:37:38But in the United States, we ignore that literature to facilitate this story about the dangers of opioids. And meanwhile, the Swiss have been doing this for 30 years daily.

1:38:07Gemini and Chrome is here for it. Ready to make anything online make sense? There's no place like Chrome. Check responses set up required. Compatibility and availability varies 18+. Well, the last thing that I'd like to make sure that we discuss today is policy in the United States and how it should be informed. I think we know what the drug policy is today. We've still got a war on drugs. even if some have, our policy is more relaxed, like to marijuana. But how do you think science should inform our drug policy? And what specific policies do you think should be changed? Okay, so we have to disabuse ourselves from this notion that science informs drug policy, because it doesn't.

1:38:57So we talked earlier about the motivations for banning drugs has nothing to do with science. Science is used as fodder or post hoc explanation, but it's not the reason. So yeah, I don't, if there's any role for science here, that is helping the society to know what route should be available for consumption, which opioids should be available versus others. Science can help with that. Those are very important questions. What dose, what unit dose should be included in each unit? But science can help with that. In terms of the policy, the policy, this is not complicated because in the United States, our Declaration of Independence and codified in the Constitution, we say people have life, liberty, and the pursuit of happiness.

1:40:13If you have liberty, then you can live your life like you want, as long as you don't prevent others from doing the same. We have laws to make sure that people are not disrupting other people's rights. So when we think about policy, all we want our government to do is to live up to the promise. And the promise is life, liberty, and the pursuit of happiness. You can do whatever you like in your home. That's your business as long as you are not disrupting the society. That's your business. that's what the framers the founders that's what they believed you know thomas jefferson i don't know the quote verbatim but basically he had a famous quote where he was pointing out that when people start to let the government tell them like what substances to put in their bodies and what foods to eat and he basically was saying that you know your body will be like your mind controlled by tyranny basically and he found that objectionable and so i'm always amazed when i hear these people talking about the founding fathers on the one hand as their heroes, but then avid drug warriors.

1:41:51That goes against what the principle, the founding principles of the country, like people wanted to be left alone. The British were taxing folks, telling folks what they can and can't do. We fought a revolution for that kind of thing. And so policies should just reflect that. Our job in government should be to make sure that we have the available substance that will expedite or help facilitate people achieving that goal. So like you don't have to legally regulate all of these drugs. I mean, like the opioids you can have be available, a couple of opioids that are ideal for sort of use by a less than informed public.

1:42:56When people think of drug regulation, like legal drug regulation, they always go to some stupid frame. Oh, you'll have everything be available. That's just, that's stupid. You know, that's not even thoughtful because there are some drugs, for example, that we know cause neurotoxicity, but not the ones that people are seeking. But you won't make those drugs available because of the potential neurotoxic effect, the real potential neurotoxic effect at doses that humans might take. So it's not that complicated. We pretend that it is. I mean, we put a man on the moon. We've done some real complicated things.

1:43:43This is not one of them. The real complication is that if you do this, if you legally regulate drugs, what are you going to do with this large-ass law enforcement apparatus that you have built up around the war on drugs? What's going to happen to all those people in those jobs? And I mean, I have some ideas about that. I think that we can use those folks to help actually make sure that the system is running well, to protect people, to actually serve the public in that regard. I just want to say something about the drug policy thing that relates to New York City. In 1937, we essentially banned cannabis at the federal level.

1:44:401937. Seven years later, the mayor of New York, well, he commissioned a study that was published seven years later. Mayor LaGuardia. And the study was on cannabis because he was suspicious about the hysteria and the media sort of presentation of harms and the extent to which cannabis was being used. His study is this comprehensive study in New York City. Even by today's standards, it's comprehensive. He concluded that the government exaggerated the harms of cannabis and concluded that this would kind of decrease the research with cannabis too. When he predicted that, he was right. Fast forward to 21, when New York State legalized cannabis for recreational purposes.

1:45:54It wasn't any new knowledge or anything, and the legalization of cannabis didn't happen because of some new scientific knowledge or anything like that. It happened because, well, one, New Jersey legalized and we knew that we would be losing some potential tax money to New Jersey, one. And two, the governor was in trouble. There was some issue related to sexual harassment or something of that nature. One way to get the public on your side, for example, is legalize cannabis. That happened. And there was no conversation about the 1944 document that we already knew this. I say there was no conversation about it because there were hundreds of thousands of people arrested for cannabis in that intervening time, some of whom lives were ruined as a result.

1:46:57No acknowledgement of that. And so if we think about that cannabis story, the same shit is happening with opioids, cocaine, methamphetamine, the same thing is happening today. Well, I think that this discussion of policy coming full circle historically is a good place for us to end this. So, Carl, thank you so much for taking the time to come here. I know you said you came back early from a trip. This has been a wonderful discussion, and I hope that our viewers and listeners will check out your books if they want to go deeper into your views on the subject. Okay, thank you, and good luck.