The consequences for lying about drugs

Carl Hart Ph.D. wants us to know we’ve been lied to about the effects of cocaine, methamphetamine and other drugs.

Not that we should run out and start looking for a score; that’s not the point.

“But I have been studying drugs for 22 years, 14 years at Columbia, and we have quite a bit of scientific, evidence-based information. And I am here to tell you, drugs are not the bogeyman that people said they were.”
This is not an easy message to absorb, even for an audience that’s been primed, as this one at the Apollo Theater has, by a screening of The House I Live In. The documentary, which won a grand jury prize at this year’s Sundance Film Festival, raises serious questions about the intent and efficacy of the war on drugs, and Hart — an associate professor of psychology who specializes in the impact of drugs on the brain and human behavior — was among those featured in the film. He is speaking now, along with the director Eugene Jarecki, executive producer John Legend and Rep. Robert C. Scott (D-Va.), as part of a post-movie community discussion.

The No. 1 thing we have to do is think … There are serious consequences to people for exaggerating the effects of drugs.” – Carl Hart

A woman steps to the microphone. She begs to disagree, describing her own experience with a relative struggling with addiction.

Hart is not unsympathetic and says so, alluding to elements of his own history that the film touched on (drugs’ influence in the Miami neighborhood where he grew up as well as his oldest son’s involvement with them). But he is also aware of how emotion can color a conversation, and wants to refocus her attention — all of our attention, really — on the bigger picture: that years of exaggeration and misinformation about the effects of drugs have skewed public perception and negatively influenced government regulation. Moving forward, he believes that separating myth from reality is essential to producing more reasoned social policy and laws.

“There are a wide range of things to take into consideration when we talk about drugs,” he urges the woman.

“The No. 1 thing we have to do is think.”

Several days before the screening, in his office in Schermerhorn Hall, Hart ticks through the chronology of drugs he has studied through the years: nicotine, morphine (“the same drug as heroin, basically”), then nicotine again, followed by cocaine, marijuana and amphetamines. The last is a drug class that includes MDMA (Ecstasy), methamphetamine and d-amphetamine, “the main ingredient in Adderall,” an ADHD treatment that’s also popular among college students looking to stay awake and focused during marathon cram sessions.

“I try to study the drug that is hot or that the public is really concerned about,” Hart, 46, says between sips of a seaweed-green protein shake. His dreadlocks are collected into a ponytail, and a hint of gold incisor flashes when he speaks.

“There are serious consequences to people for exaggerating the effects of drugs. People go to jail for extended periods of time, people need help and won’t seek treatment because they are afraid of being ostracized — there are all kinds of negative consequences. My aim is to increase the intellectual tone of the public discussion by collecting data. And this data, I hope, will require that other people, when they speak about drugs and their beliefs about drugs, make sure that these beliefs have foundations and evidence.”

As a graduate student — Hart earned an M.S. in 1994 and a Ph.D. in 1996, both from Wyoming — he studied the effects of drugs in rats. But over time he began grappling with the limitations of his research and its real-world applications. One episode in particular, which occurred during a period when he’d shifted his work to the NIH, in Bethesda, Md., drove home the point:

“I was giving a group of young black kids a tour of my rat lab in ’95 or so. They asked me a lot of questions about why their parents used cocaine, why their parents or their relatives were addicted. And I couldn’t answer those questions because I was studying rats. I could tell them all about dopamine in the rats’ brains; I could tell them all about neurotransmitters. But I couldn’t answer their questions about human behavior. That’s when I realized I needed to take a postdoc studying humans.”

In fact, three post docs followed, at UC San Francisco, Yale and — beginning in 1998 — at Columbia. He was recruited by Dr. Herbert Kleber and his wife, the late Marian Fischman ’60 Barnard, ’62 GSAS, who together founded the Division on Substance Abuse at Columbia University in 1992. Fischman, a research scientist whose work studying heroin and cocaine in human users contributed to a resurgence in the field of drug-impact study, became Hart’s mentor.

“She gave me an honest shot, and I worked really hard for her,” he says, recalling Fischman’s training in everything from grant writing to research methods. “She didn’t pull any punches. If I was slouching, she let me know. And that’s what you want: someone to be honest with you.

“She wrote the seminal review paper on crack cocaine and powder cocaine and how they were the same drug,” Hart adds, noting that her findings helped build the case for changes in cocaine sentencing laws that were considered under the Clinton administration; at the time, federal penalties for crack cocaine were 100 times harsher than for powder cocaine.

“The paper was probably the most influential paper for the U.S. Sentencing Commission to vote to change the law, and she testified in front of the commission. So she also provided a model of how one could do good science and also be socially conscious.” (That vote was rejected by both Congress and President Clinton, though the Fair Sentencing Act of 2010 reduced the sentencing disparity to 18 to 1.)

Since coming to Columbia, the majority of Hart’s research has been conducted at Columbia’s Substance Use Research Center at the New York State Psychiatric Institute. Investigations range from testing treatment medications for drug abuse to exploring the impact of a drug on a user’s food intake, sleep, social interactions and cognitive function. Although the work takes place under carefully controlled conditions, Hart says, some people still balk at the idea of giving illicit drugs to people for any reason.

“But for me, it would be unethical not to study these drugs in people in the lab. Because if you’re not, then what are you basing your policies on? What are you basing your treatments on? Where does your knowledge come from? How do you establish that knowledge base? It seems irresponsible to me, for a society as wealthy as ours and with all this know-how, not to have empirical information.”

Hart’s conclusions tend to go against the grain when it comes to the prevailing wisdom. Craig Rush Ph.D., an associate editor with the journal Drug and Alcohol Dependence and a professor at Kentucky who has known Hart for two decades, points to a paper about methamphetamine that was published late last year in the international journal Neuropsychopharmacology. In it, Hart and his co-authors analyzed roughly 40 studies on the drug.

“I thought I was going to be able to cure drug addiction. But over the years, of course, I learned that drug addiction wasn’t the problem.”

“The field likes to think that meth is this horrible drug and it’s frying your brain, but Carl did a really thorough review of the literature and concludes that these stories that you hear about in the media — they’re just not supported by the scientific evidence,” Rush says.

In addition to identifying misinterpretations in past research, the paper found that methamphetamine’s short-term effects included improved attention, response speed and visuospatial perception, among other things.

“It was very provocative, because it went against the status quo, though I think Carl needs to be applauded for taking what is probably a fairly unpopular stance in the field,” Rush says. “Science, in my opinion, needs people like that now and then, to shake people up and make them think about [the issue] harder.”

He adds that he is already using the paper as a teaching instrument with his graduate students. “I wanted them to see that there is this new idea out there. Scientists are supposed to be driven by the data and not by what is intuitively appealing, nor influenced by sensational ads in the newspaper or on TV. I don’t think Carl’s paper was in any way implying that meth abuse is not a problem but we need to recognize his point that we’re not making decisions based on the data. And that can have far-reaching implications, politically, in terms of policy.”

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Charles Ksir Ph.D., professor emeritus at Wyoming and Hart’s doctoral adviser, echoes the sentiment.

“There’s a great deal of resistance on the part of some people to hearing the kinds of things he has to say. There are — I would almost call them ‘entrenched experts’ — whose professional life and identity depends upon their being recognized as experts in this field and he disagrees with them on important [issues], including how to approach the public and the general drug-using population with information. They’re much more interested in trying to frighten people away from trying to use these drugs; he’s more interested in trying to educate them so that, if they use drugs, it’s in safer and less damaging ways.”

Though Hart hardly has left research behind, his tack toward a public policy message has been increasingly in evidence. He has been on the board of the Drug Policy Alliance since 2007 and recently was named to the National Advisory Council on Drug Abuse; the 18-member board advises the National Institute on Drug Abuse on a range of issues including, critically, the scientific and technical merits of applicants seeking federal assistance for research. Hart also has been giving more public lectures (New York venues have ranged from the American Museum of Natural History to the Cornelia Street Café).

At Columbia, in addition to his teaching — his survey course on drugs and behavior is popular with undergraduates — Hart is a research fellow for the Institute for Research in African-American Studies. There, he oversees and is moderator for the Conversations program, which brings members of the Harlem community together with scholars on a range of topics. “He’s trying to bridge his work as a scientist with an interest in paying attention to the very important issues that are affecting black communities, whether it’s culture or public policy,” says institute director Fredrick C. Harris. “It’s a testament in many ways to Carl’s commitment to having a broader dialogue.”

Indeed, Ksir says, through all of Hart’s work, he has “developed a broader and deeper understanding of the topic of substance abuse and substance use than probably anyone around.”

Hart’s personal history is bound up with his professional life in ways that distinguish him from others in his field and also help amplify his message. He speaks candidly on the subject, describing a Miami childhood in which, as one of eight children, he was raised partly by his mother and partly by other relatives. He describes his education as spotty at best. He sold marijuana in high school and otherwise “had an unrealistic sort of magical thinking about my life.” A skilled basketball player, he imagined a future in the NBA or working as a street DJ (as a teenager, he did a show with Run DMC).

At the urging of a high school guidance counselor, however, Hart enlisted in the Air Force, serving from 1984–88. He played basketball for the base’s team as well as a British team; more importantly, he used the opportunity to go to college.

“Growing up in Miami in the ’70s and ’80s, cocaine was a big deal,” Hart recalls. “Powder cocaine at the time, but then a few years later, crack cocaine hit and people in my neighborhood — the guys my age, and this is not an exaggeration, at least 60–70 percent were getting arrested on drug-related charges. When I used to go back, they’d tell me they were selling cocaine, all the money they were making …. I thought maybe drugs were turning them into bad people; I wanted to know what was happening.

“So when I got an opportunity [as an undergraduate] — I was approached by a professor to study the effects of morphine and nicotine on the brains of rats — I thought, maybe this is the key. Maybe I could figure out why people like drugs so much. And then maybe I’ll be able to help do something back home. I thought I was going to be able to cure drug addiction. But over the years, of course, I learned that drug addiction wasn’t the problem. The problem was law enforcement.”

In 2000, Hart, who is married with two younger sons, learned about a third son that he’d fathered as a teenager. “When I met him, he was selling drugs and he wanted to tell me about it. He must have been about 16 or 17. He had already dropped out of high school. It was overwhelming.”

Hart recounts his personal story in his memoir, High Price, which is slated for publication next year. “I thought it would be simple to write, because it’s my life. And then it wasn’t. Because it’s my life.” In it, he also discusses the science of drugs and their effects on the brain, as well as drug laws, social policy and public education.

Of the book and of his turn toward an advocacy role in general, Hart says: “The thing that I’ve noticed is that if you don’t talk to people, your views will never get out there. People might get it wrong sometimes, but sometimes it opens a conversation. And you know, the rat that presses the lever is the one that’s going to get reinforced.” He bangs his palm on the table.

“So my view is: you just keep pressing the lever.”

from:  Columbia University