By Sean Lawlor
Dr. Carl Hart is neuropsychopharmacologist and Chair of Columbia University’s Department of Psychology. His research, which focuses on the behavioral and neuropsychological effects of psychoactive drugs in humans, has been published widely in academic journals, and Dr. Hart has discussed his research on numerous shows including Democracy Now!, The O’Reilly Factor, and The Joe Rogan Experience. His award-winning memoir, High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society, charts Dr. Hart’s journey from childhood in a harsh Miami neighborhood to an academic life devoted to reframing society’s biased and harmful narratives around stigmatized drugs.
At the 2019 Psychedelic Science Summit in Austin, TX, Dr. Hart addressed a crowd of psychedelic enthusiasts about concerning language he’s noticed in psychedelic-focused conversations. In this interview, Dr. Hart explains how these narratives create a “psychedelic exceptionalism” that perpetuates harmful narratives around drugs like heroin, methamphetamine, and crack cocaine, by extension demonizing people who choose to use such substances. In these transitional times, Dr. Hart reminds us of the importance to hold healthy criticism while always maintaining focus as humanitarians.
SL: In your speech, you were less gung-ho about this psychedelic renaissance than other people. This was partly due to something called “psychedelic exceptionalism.” Can you speak about this?
CH: This term refers to the perspective that psychedelics are somehow better and more useful than other classes of drugs like opioids or stimulants. I was just trying to remind people that these are all psychoactive substances. They interact on receptors in the brain to produce their effects, and we shouldn’t be treating some drugs as if they’re special while other drugs are somehow evil. Drugs all carry some risk, and depending on how you define danger, they fall on different levels of the spectrum of risk, and benefits.
SL: So, you’re responding to seeing people glorifying psychedelics while continuing to demonize substances that have been demonized since the War on Drugs, if not before?
CH: That’s exactly it. It’s great to be enthusiastic about your drug of choice. But remember not to vilify other drugs. That puts people at risk, and it marginalizes people. I don’t think anybody really wants to do that.
SL: Can you say more about how that puts people at risk?
CH: When people talk about heroin being evil or dangerous in generalized ways, it stigmatizes that drug and, by extension, people who use that drug. Then, we have increased penalties, and we view those people as being defective for even using that drug.
SL: A way of “othering” those people, putting them in a negative box.
CH: That’s right. We did that with crack, and we did that with that methamphetamine. But you look at MDMA versus methamphetamine, and the chemical structures are not that different. But we have wildly different narratives about them. It’s just not warranted.
SL: What do you see as the roots of this exceptionalism?
CH: I think people think that they’re being strategic. Folks who want to increase the availability of psychedelics for medicinal reasons, for recreation — I think they feel that if they associate with stigmatized drugs, then that stigmatizes their drug of choice. They’re playing a political game, a numbers game — you could say they’re calculating this. But there are people who are really suffering, who don’t have a choice to calculate, and no one’s given us the right to play with people’s lives based on politics. What’s wrong is wrong, what’s right is right, and it’s wrong to vilify drugs and people. No matter what.
That’s why I try to keep the focus on doing what’s right as a human being, as a humanitarian. It’s just wrong to vilify people for wanting to alter their consciousness and the particular drug that they use, especially when you’re doing the same thing with another drug. That’s just inconsistent with respecting other people’s humanity.
SL: I think a lot of people have seen friends and family die from opiates. You talk about how these deaths may be due to what they’re getting, how much fentanyl may be in there, etc. But if someone’s caught in cycles of addiction with drugs that have a higher overdose potential than, say, mushrooms, and a high dose of mushrooms could allow them to work on deeper issues fueling addictive cycles, how could that drug not be seen as more healing?
CH: Because there are all kinds of assumptions with that question that are flawed. First of all, it’s not up to me to decide what people choose to work on and what drug they use. If they choose heroin as opposed to mushrooms, that’s cool. That’s their decision as autonomous adults. And if we think heroin is uniquely more dangerous than mushrooms — well, if we’re talking about respiratory depression, yes, it certainly can be. But if we’re talking about paranoia at large doses, mushrooms are more dangerous.
When we look at the Swiss situation, with a regulated supply of heroin and all sorts of services, you don’t have the problems of overdose that we see in this country. So it’s not the drug. It’s the conditions under which the drug is being administered.
Now, we do have people in our country who are dying from heroin or opioid-related overdoses. That’s a fact. But that has more to do with the stigma and the social conditions under which the drug is being taken. I am wholeheartedly in support of dealing with those issues, which are not that complicated. We could have a regulated supply of heroin. We could check the mixture to verify that people don’t have an adulterated drug. With mushrooms, you’re less likely to have adulterants in your compounds than you are with opioids. That’s a problem, but not of the opioid itself. That’s a problem of our supply.
SL: How about the problem of what’s underlying people’s addictions in general?
CH: That’s a whole different issue, that we have to figure out why people are addicted. People are addicted for a variety of reasons — and when I say “addiction,” I mean the DSM criteria for substance use. Those criteria have to do with people’s inability to inhibit, their lack of responsibility skills, or the conditions under which these drugs are available or not available. It has more to do with all of those things than, again, the drug itself.
It’s true that opioids can produce a physical dependence, whereas other drugs are less likely to. But alcohol can produce a physical dependence that is deadly, and we do alcohol relatively well in this country. There are people who have problems with alcohol, but the vast majority of folks don’t. So, alcohol will remain legal.
Whether it’s a drug or an activity like driving a car, people can and will get in trouble. It’s crazy to think we’re somehow going to prevent all negative possible outcomes of some activity. We can certainly take steps to minimize it. And we do. And we could do the same thing with drugs like heroin.
SL: You said something during a panel that elicited a strong response. I believe your quote was, “Heroin made me a better person.” I’m curious what that meant.
CH: I don’t remember the context that I was saying that. But the point I was trying to make is simple. We have alcohol at receptions, for example, where alcohol functions as a social lubricant. The same can be true with a drug like heroin.
Many of these psychoactive substances people use make them less anxious, more magnanimous — all of these kinds of things. That’s not a shocking statement. It’s only shocking for people infected with the Puritanism virus. Anybody who knows anything about drug use, particularly with opioids, knows they can enhance positive social interactions, and that’s why many people take them.
SL: You’ve said that only 25% of people who use heroin are addicted, which is different than the instant-addiction cultural narrative we’ve inherited.
CH: Yeah. But still, you don’t want people to become addicted. And when I say addicted, I mean the DSM criteria, not just physical dependence. People who take antidepressants, for example, have physical dependency. They can’t abruptly stop after taking antidepressants for a number of years. They have to be weaned off. The same is true with opioids. So when I say “addiction,” I mean that the person is distressed by their drug use and the consequences of their drug use, and they have disruptions in psychosocial functioning.
That 25% still concerns me. But I think it has to do with the stigma associated with heroin. People have to hide their use and engage in tremendous risk because of how society sees heroin. In places like Switzerland, where heroin is available medically, you don’t see people engaging in disruptive behaviors to get it. They just go to the clinic and they get their daily doses. In many cases, these people work. They’re responsible members of society.
SL: If there’s a psychedelic correlate to these trends, I’d say it’s LSD. Microdosing is popular, but LSD carries the heaviest social stigma of any psychedelic. I hear far less people speak publicly about their use of it than mushrooms and MDMA, which have essentially been adopted as “good.” And LSD often appears at festivals, where you don’t know what you’re getting, and really bad stuff can happen.
CH: Exactly. You hit it on the head. We see that with all stigmatized drugs. People are more likely to take risks that decrease their likelihood of getting the drug they’re seeking, because people can replace them with more potent drugs. And that could be dangerous.
SL: Do you see any effort in this psychedelic community to combat psychedelic exceptionalism?
CH: I have to tell you, I’m always disturbed when people identify themselves as a “psychedelic community.” That seems fucking bizarre to me. When you have all of these psychoactive substances, and people are taking them for similar reasons of altering consciousness, and then you have a line — these drugs over here, these drugs over here — I just find it bizarre that people would even identify as such a thing.
SL: Have you noticed that delineation more than me saying it right now?
CH: Oh, yeah. I didn’t mean — you’re absolutely right. I’m just saying as a neuropsychopharmacologist, as somebody who’s interested in consciousness and having your consciousness altered by these substances, it just seems strange that people would have the audacity to include themselves in a single sort of community that delineates its boundaries in a way that excludes other people doing the same thing.
SL: Yeah, that very language is a kind of exceptionalism, aligning with a “community” that uses drugs that are becoming less stigmatized and more popular.
CH: Yeah. It’s very disturbing. It’s just inconsistent with being a humanitarian.
SL: I’m thinking about how the War on Drugs set regulations in place that have disproportionately affected people from particular areas or particular races who tend to associate with particular drugs, and how that’s created, institutional divisions.
CH: But it’s not necessarily the laws. It’s the enforcement of the laws. The laws can be enforced in a way that hits across the various dimensions of society. But the laws are not enforced in that way. The enforcement of the laws seems to focus on specific communities of color, so enforcement is the problem.
My expertise is in drugs, so I focus on that. But this is not unique to drug law enforcement. This is how we behave in this country in general. That’s why I try to help people to understand how their verbal behavior about one compound versus another contributes to a misperception that allows for disproportionate enforcement of the drug laws.
SL: What is your parting advice for people invested in this psychedelic renaissance?
CH: I would ask that people think about the language they’re using for substances they like versus their language for substances that have been vilified. I ask that people think about the narratives that have been built around crack cocaine and heroin versus the narratives built around drugs like psilocybin and MDMA, and how wildly they conflict. Whether people are using heroin or MDMA, they’re seeking to alter their consciousness. They’re seeking intimacy with partners. They’re seeking the same things.
SL: Thank you for your time, Dr. Hart. I figured some biases and assumptions would come through my questions, but hopefully representing them here can help dismantle them for others who read it.
CH: I hope so. Thank you for doing this. And if you just remind people to think about other people’s humanity in the same way they think about their own, this won’t be an issue. If they think of people as being equal to them, this is not a problem. We all make mistakes, and that’s fine. But once you remember that no matter who you’re dealing with, they’re another person who deserves the same kind of respect you deserve, then it becomes easy.
About Sean Lawlor
Sean Lawlor is a writer, Naropa grad student, and practitioner of flotation therapy in Boulder, CO. His interest in non-ordinary states owes great debt to Aldous Huxley, Ken Kesey, and Hunter S. Thompson, and his passion for dreaming draws endless inspiration from Carl Jung and J.K. Rowling.
Learn more at: www.seanplawlor.com.