Carl Hart: Drug Use for Grown Ups (Book Review)

Having enjoyed Michael Pollan’s “How to Change Your Mind” on psychedelics (in particular psilocybin), I was intrigued by a book that goes much broader on drug use: Dr. Carl Hart’s “Drug Use for Grown Ups.” Hart is a professor of psychology at Columbia and is basing this book on both his research and his extensive personal experience. While I have one criticism (more on that later), the book makes a very strong case that drugs should be decriminalized broadly: not just marijuana, but everything, including drugs with such terrible reputations as meth and heroin.

Here are three insights I came away with: First, the majority of drug related deaths come from drug interactions (e.g. people drinking a lot of alcohol and then also taking a drug) or from accidental overdoses due to much higher potency of mixed in / substituted drugs (e.g. heroin stretched with fentanyl). So if you can be responsible on drug interactions, and well-informed on what you are consuming, you can dramatically reduce risk. Same goes for getting started slowly on dosage on anything you don’t yet have a tolerance for.

Second, the existing drug laws and their enforcement are terribly racially skewed. I sort of knew some of that but the total amount of evidence provided by Hart makes that case forcefully. For example, at one point the mandatory sentencing threshold for crack was a hundred times lower (5 mg) than that for cocaine (500 mg), despite these being the identical drug just in different form, with usage breaking down clearly along racial lines. Another data point he provides is that in one city 96% of all drug arrests were of black people. There are many more throughout the book.

Third, there are interesting new drugs that I had never even heard of before. For instance, I had completely missed the recent extensive development synthetic cannabinoids and cathinones. Hart makes an interesting argument for how the banning of these new drugs creates an arms race between drug developers and regulators to the detriment of anyone using these drugs. As new drugs get added to the register of controlled substances they get replaced by even newer ones but now people once again don’t know what they are taking.

So what is my criticism? Hart, who had started his academic career convinced drugs were bad, clearly had a Saulus to Paulus conversion. And like most converts he comes on really strong. Now that may be a strategy for positioning the book, recognizing that criticism will help it become better known. Still I feel that the book lacks a chapter on addiction and is on occasion too dismissive on downsides, despite acknowledging that some users wind up having issues. I would also appreciate a longer science appendix and/or companion website that goes into more detail on some of the studies. Hart makes strong claims, which require strong evidence.

All in all I recommend reading “Drug Use for Grownups.” The case for changing the laws is extremely compelling and I hope that marijuana legislation is just the beginning.

PS Reading the book also reminded me to write a post supporting the decriminalization of sex work.