The science of drug use, with Dr Carl Hart

I recently had the opportunity to talk to Dr. Carl Hart, one of the leading voices in the research of drug abuse and addiction. His CV is rather daunting—Professor of Neuroscience & Psychology at Columbia University; research scientist at the New York State Psychiatric Institute; author of Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear.

It was a fascinating discussion, and here are some of the highlights.

Drug Use for Grown-Ups is quite a provocative title—what is the thinking behind the book?

This book is meant to help people understand how to better serve people who identify as drug users, and how to help them do this activity more safely. The typical drug user is a middle-class, upstanding person who is responsible, but that isn’t the image the public has of the typical drug user. Drug Use for Grown-Ups attempts to remove the social stigma and emotional baggage that society has brought to drugs. It's not meant to encourage people to use drugs, but instead have a grown-up conversation about them.

Alcohol is the most consumed drug in the world—why doesn’t it suffer from the same stigma?

Alcohol is seen as the ideal psychoactive substance because of its chemical and physical properties. It’s made up of small molecules which get into the brain quickly and alter behaviour fast. Alcohol consumption is socially acceptable because of its chemical properties, but it does what all drugs do—it alters a person's consciousness. However, people are put on a path of responsibility with drinking at 18 in the UK, or 21 in the US. This allows them to get a handle on drinking, and learn by trial and error with no stigma attached to them for trying and failing.

It’s the lack of freedom to consume other drugs that is the cause of extremes such as addiction and poor use.

Is there something to be said on the regulation of alcohol compared to the lack of regulation of illegal drugs?

There is a level of quality control that alcohol consumers get, where they are assured that there are no contaminants in what they're drinking. With drugs like MDMA, cocaine, and heroin, there’s no legal regulation, and no quality control. People don’t know if they contain contaminants, or what those contaminants might be. And often, these contaminants are worse than the substances themselves, causing users to get injured and hurt.

Additionally, people aren't informed on the dose they should be taking. As a result, some may overdo it which can lead to problems, and sometimes tragedy. We need proper quality control to keep drug users safe.

What is a bad drug?

It’s important for everyone to know that drugs are not bad or good. They are inert substances waiting for a biological system to interact with, and that's how they produce the effects. Those effects are dependent on a lot of things, like the environment in which the drug is taken. If you take cocaine in a comfortable, safe environment, negative effects are a lot less common. If you take it next to a police care and you’re paranoid, that's not going to be a good experience. Context is critically important.

The predominant effect of the thousands of doses that I’ve administered is positive. There are things that we can do to enhance the likelihood of people experiencing positive effect—making sure the drug is pure, administering the right dose, having a comfortable environment, and making sure the person is healthy. These are the keys to ensuring positive experiences.

What does safe drug use look like?

There might be specific things you want to do based on the class of drugs you're going to use. If you take a drug that is a diuretic that makes you go to the bathroom, like amphetamine, you want to make sure that you’re well hydrated. If you take a drug that slows down your gastro-intestinal motility, like an opioid, you want to make sure that you’re getting enough fibre. All of these sorts of things you should know if you’re going to engage in this activity.

Do drugs have a long-term effect on your brain? What about drug dependency?

There is no evidence that the doses people take for recreational drug use negatively impact your brain function. It’s common for tabloids state that drug use causes brain diseases and abnormalities. In my new book, I demonstrate how there is no evidence to support that notion.

Ultimately, there is no biomarker that is predictive of whether or not someone will become dependent or develop a substance use disorder.

What do you see as to where the direction is moving towards drugs?

In terms of the medical community, I am not optimistic that they'll be moving quickly. In general, these are some of the most conservative people in our society, and I do not see the medical community making that change. Medicine has never been the front-runner for any sort of socially progressive actions in a society.

How do we destigmatize vilified drugs within the scientific community?

If you look at data, in many cases, heroin is very effective controlling certain psychotic and psychiatric symptoms associated with various illnesses. But even though the data is there, people don’t like to talk about heroin’s potential therapeutic properties.

There’s no short cut. It is going to require a huge effort. We all must show people in senior positions actual data. And we have to be willing to face some opposition—because there is going to be a lot of it.

And if people want to do some more research on this topic do you have any recommendations?

Other than my book? Of course, here’s a list of sources that are worth checking out.

1. Dale Bredesen: The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline

2. Documentary on the war on drugs: The House I Live in

3. David Smith: “Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial”

4. Dr. Carl Hart’s ‘High Price: Drugs Neuroscience & Discovering Myself ’

5. David Smith’s

If you want to follow Dr Carl Hart on Twitter, you can find him @drcarlhart , and Heights co-founder, Dan Murray, can be found @danmurrayserter .