Psychologist and author on the myths of the opioid “epidemic,” and why it’s time to ask Americans to be adults
September 26, 2018
Laws are not natural. They are made by society. As such, they reward certain behavior and punish others. The law is not “neutral” or “blind.” It is made by the powerful, often to the disadvantage of the less powerful. America’s drug laws serve as a powerful example of how justice that is supposed to be dispensed equally becomes a form of social control.
For example, the long-running “War on Drugs” punishes the poor more than the rich. Black and brown people are racially profiled, subjected to “stop and frisk” procedures, and experience routine violations of their civil and human rights. White people — who in many places are actually more likely to possess illegal drugs — are treated much more benignly. Through lobbying, donations and other interest-group behavior, pharmaceutical, tobacco and alcohol manufacturers make sure their products are protected under the law. Politicians understand that the War on Drugs — although it has been a massive policy failure — remains a powerful political tool they can use to raise money and win elections.
What would a rational and humane drug policy look like in America? Is there really an opioid crisis in red-state or suburban America? What does it actually mean to be “addicted” to drugs? Where did the arbitrary distinctions between “legal” and “illegal” drugs come from? Who is winning and who is losing in America’s war on drugs? What social damage has been done by the many myths of the drug war?
In an effort to answer these questions I recently spoke with Dr. Carl Hart, one of America’s leading advocates for the legalization of drugs and their responsible use. He is the chair of the psychology department of at Columbia University, and is Ziff Professor of Psychology in the departments of psychology and psychiatry.
Hart has a reputation as a “myth buster” of the many public misconceptions surrounding drugs and drug use. He is the author of the award winning book “High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society” and has been a featured guest on MSNBC, CNN, NPR and HBO’s “Real Time with Bill Maher.” Hart’s essays have also appeared in the New York Times, Scientific American, and the Nation.
This conversation has been edited for clarity and length. A longer version can be heard on my podcast.
One of the dominant narratives surrounding Donald Trump’s election is that there are all these “deaths of despair” out there in white, red-state America. In turn these deaths caused by alcohol and opioids caused desperate white people to vote for Trump. What do we actually know about this “epidemic” of opioids in white America?
here is so much conflation going on when we talk about opioids. When we think about just opioids in general, for example, very few people who are addicted to opioids were actually prescribed them. Another example: Even with heroin, less than a quarter of the people who use it are actually addicted to the drug. The vast majority of people who use these drugs are not addicted. But too many people conflate “addiction” with overdose. In fact, people who are addicted are less likely to overdose from the drug, in part because they have a higher tolerance.
I love to participate in public education. But so many reporters and others who are trying to write on these “opioid addiction” stories have not done the basic research.
How do we define “epidemic,” and is there a drug epidemic in this country? What do we actually know?
In epidemiological terms an epidemic is something that is rapidly rising and spreading. Opioid use is not rapidly widening. It’s not spreading. Something like heroin is always being used by a relatively low number of people. There have always been more cannabis smokers, cocaine users, Ecstasy users or the like.
Then we think about prescription opioids. The general narrative is to say those numbers have really increased. But in reality they have not. Then we have to add in the fact that they are legally available to people who use them appropriately and there are other people who take them for not legal reasons. Again, there is no epidemic of opioid use.
From black people, marijuana and “reefer madness” back in the 1950s and 1940s, to Chinese immigrants and “opium dens” where white women would be kidnapped and put in sex slavery in the late 19th and early 20th centuries, to crack in the 1980s and opioids today, there is a consistent moral panic around drugs in America. How does this influence our conversations about drug policy?