S2 EP-4: Destroying Myths About Drugs with Dr. Carl Hart

July 13, 2023




What if many of the things you think about illegal drugs and drug use are wrong? What if many of the problems associated with drugs are actually caused by the fact that they’re criminalized as part of the decades-long, failed war on drugs? For years, Dr. Carl Hart has worked to destroy myths about drugs and to change drug policies in the United States. He joins us to speak about all of this and more. Plus, we talk about state legislation that could move us away from criminalization and towards a more sensible approach to drug policy with NYCLU assistant policy director, Michael Sisitzky.


Dr. Carl Hart
Professor of Psychology & Author

Michael Sisitzky
NYCLU Assistant Policy Director

Episode Transcript

[00:00:00] Simon: What if many of the things you think about illegal drugs and drug use are wrong? What if many of the problems associated with drugs are actually caused by the fact that they're criminalized? As part of the decades long failed War on Drugs. For years, Dr. Carl Hart has worked to destroy myths about drugs and to change drug policies in the United States.

He joins us today on Rights This Way to talk about all of this and more. Plus, we'll talk about state legislation that could move us away from criminalization and towards a more sensible approach to drug policy with NYCLU Assistant Policy Director Michael Sisitzky.

And now I'm joined by Dr. Carl Hart. Dr. Hart is the Mamie Phipps Clark Professor of Psychology in Psychiatry at Columbia University, and he's also the author of Drug Use for Grownups: Chasing Liberty in the Land of Fear. Before we begin, people should be aware that Dr. Hart is speaking in his personal capacity and not as a spokesperson for the NYCLU. Michael, who we will hear from later in the episode is speaking on behalf of our organization.  Carl, welcome to Rights This Way.

[00:01:23] Carl: Thank you for having me, Simon. I'm glad to be here with you, bro.

[00:01:26] Simon: Yes. It's truly great to have you.

I'll just jump right in. One of the themes in your latest book is just the ways in which drug criminalization makes policing and police interactions both more frequent and also have worse outcomes. One of the, instances you mentioned of this is just that police have pulled over countless people and use the smell of marijuana as a reason to search them or search their cars.

Obviously in New York now marijuana is very recently decriminalized, but this sort of thing happens with other drugs and, and it's just really symptomatic of the larger theme of, of the way policing and drug criminalization mix. Can you talk about some of harms that flow from this?

[00:02:14] Carl: Yeah, I think first we need to clarify decriminalization versus legalization because you said that New York is decriminalized. Nope, New York is legally regulated. It's not decriminalized. It was decriminalized in 1977. In New York. And so with decriminalization, the law typically says that you can possess certain, a mound, but you can't sell and without being criminally prosecuted.

But in New York, we still manage to criminally prosecute people even under decriminalization. So, a few, year or so ago, we now have legal regulation. Meaning that no one should be ever criminally prosecuted for certainly having marijuana. And so there's a difference between decriminalization and legalization.

Legalization, we can also legally sell it. And that's the current sort of situation in New York and a growing number of states in the country. Now when we think about what that means for police interactions, uh, cannabis used to be the number one reason that people were arrested for drugs and drug arrests represented the greatest amount of arrest in the United States. So, now you remove this sort of cannabis arrests. Now you can also decrease the number of arrests that are being made or police interactions. Because as you pointed out, the police interaction, particularly with black men, become fraught with anxiety.

A wide range of things that the police bring to the situation and certainly black men like me, we bring to the situation because we've seen too many of our brothers be killed in those interactions. And so one of the things that by legalizing cannabis does, it takes away that interaction. It stops that needless interaction. And so it also takes away one of the sort of biggest excuses that cops use for stopping people or as we say in the hood fucking with people. It takes away that because now the cops can't say, oh, I smell cannabis, so, I stopped you. That was probable cause to fuck with you in all kinds of ways.

And so that's a huge factor being taken out of that mix. And so we hope that that decreases these interactions and thereby decrease the fatal interactions or the interactions that lead to people getting harmed and hurt and certainly destroys the sort of relationship between police and community members.

[00:04:54] Simon: Yeah and you would argue, I take it from your book certainly that, that should be the case for all drugs, right? If you can do that with cannabis, you should be able to do that with, other drugs for those same reasons. Is that fair to say?

[00:05:08] Carl: Yeah, no, it's absolutely fair to say, you know, this is a basic argument that I'm making in terms of all, when I say all drugs, I mean all the drugs that people are seeking, cocaine, the opioids, amphetamines, all the drugs that people are seeking. I think that, yeah, absolutely they should be legally regulated.

I mean, it would be consistent with what we say in our declaration of independence, the thing that we say that makes us the freest nation of all. We say we guarantee these three birthrights like liberty and the pursuit of happiness. Some people pursue their right to happiness or their right to pursue happiness by using a drug. We say that we guarantee our citizens these rights, but in practice it's not the case. And so I am oftentimes, particularly as I think about this more deeply, I, I am befuddled that more people are not upset about this sort of taking away of bodily autonomy.

As we think about what's happening with women's right to abortion, this is bodily autonomy. I'm just surprised that more people are not upset about owning their own bodies. And that's all I'm arguing. And the state's job is to make sure that, just like with foods, that these products do not have adulterants. The adulterants are the things that are, make these things more dangerous than the actual substances themselves. And so for some reason, this has become a complicated argument for some people, but it's really basic and simple. Bodily autonomy. That's all it is.

[00:06:45] Simon: And also it seems to me that both the criminalization and also the stigma around it. And as you pointed out, in, in the book also creates this situation where drugs can be blamed for things. For example, the many instances in which when black people, particularly black men, are killed by police, one of the first things that seems to inevitably get leaked or, or come out is toxicology reports, right? We're actually talking, we're recording this a day after the anniversary of the death of George Floyd. One of the myths that is still repeated in, at least on places like Fox News, I'm sure elsewhere, is that he died from a fentanyl overdose.

Which is not true. He was choked to death, but that's, you bring it up with Rodney King. It's a common occurrence, I think it's tied to those things that you described in the book, the stigmatization, the criminalization.

Can you talk a bit about that?

[00:07:42] Carl: Yeah, I think what to help people to understand, let's, let's think about the current US ambassador to Japan Rah m Emanuel. He was the mayor of Chicago back in 2014. October 2014, the Chicago Police, Jason Van Dyke is his name, shot a 17 year old Laquan McDonald 16 times. And when the reports came out, the newspapers, they said that,

oh, Laquan McDonald had PCP in his system, and PCP is known to cause people to act in a way that they can't be controlled. Somehow they develop superhuman strength. Of course, none of this is true, but this is the sort of mythology surrounding this. Now, Laquan McDonald's toxicology was released immediately in order to run with that story.

It took an entire year for the public to really see actually what happened because of some journalists who did a FOIA, Freedom of Information Act, and got a copy of the actual dash cam video. What we saw on the dash cam video was that Laquan McDonald was moving away from Jason Van Dyke, the cop who shot him 16 times, as he was shooting him and the cop shot him while he was, he laid on the ground motionless.

Now, the mayor at the time and other city officials knew about this video and, more than likely, they saw the video. Van Dyke was not fired. He had his job. He was fired. A year later when the video was made available to the public. Now, Rahm Emanuel gets promoted to be the ambassador to Japan.

And he was clearly involved in this situation. And so it's like, and this is an administration that many of us who are Democrats, we voted for. This is the kind of nonsense that goes on even with the Democrats. So you use PCP as a shield as a scapegoat to dismiss, to explain this bad behavior by police.

 So that's one example, but there are a plethora of these examples, as I explained in the book. But I am always so upset and surprised that we continue to allow this to happen. And not only do we allow it to happen it is perpetrated by those for whom we vote. Yeah, so I'm at a loss.

I try to highlight these things so people would know what's happening. But so many people vote against their own interests.

[00:10:38] Simon: Yeah. And I think, just to kind of zoom out a bit from that point you're making about PCP or, or whatever drug as being the shield, I think another theme in your book is that drugs are used as a scapegoat for all sorts of societal issues, right? For the harms of homelessness, the fact that we don't have a mental healthcare system or, a physical healthcare system for that matter.

You know, that there are all these rips in the very fragile social safety net.

[00:11:07] Carl: No, you, you make a really good point.

[00:11:09] Simon: Thank you. Well, I'm basically just restating your point to be fair, but thank you.

[00:11:12] Carl: No, that's, that's a really good point. Without drugs, you know, there's a reason that we keep believing, as they say, we keep falling for the Okeydoke. We fall for the Okeydoke because there is so much money involved with the Okeydoke, do we get paid for falling for the Okeydoke? For example, um, when we think about the War on Drugs, it's the biggest jobs program that we have. And so we, this whole sort of fentanyl crises, a lot of people are making money off of this so-called crises. It, it's not that complicated. It's not that difficult to solve. The issues aren't we only have this problem in North America.

Opioids are used in Europe and other parts of the world. They don't have this kind of problem. It's a really easy fix, as I pointed it out in the book, you can just have drug checking where people get a chemical printout of every chemical in their substance. Not that complicated. They do this in Europe, they do this in South America.

Not complicated at all. We can do it in the United States, but if we do it in the United States, that means a lot of people will not be getting these grants. This focus so-called on this opioid crisis, that's one sort of thing. I think about the physicians who are all involved in this sort of thing pretending that they're offering some sort of treatment to people.

When in fact, for example, with opioids in the place like Switzerland, they've been doing opioid maintenance treatment for 30 years, publishing in the literature. But the problem is that you gotta have the psychosocial

sort of adjunctive treatments that go along with your pharmacological treatments. That means you gotta invest in that and we're not willing to do that. Instead, we're willing to give money to, like cops to help solve an opioid crisis. What a joke. What does cops know about drugs?

We're willing to give money to people who don't have any skills in this area because, drugs are so important. I think about filmmakers, I think about peofilmingilm any movie you've ever watched about a drug, particularly something like heroin or crack. Get ready to see some bullshit. It's wrong because they don't have to develop characters. They don't have to do any of that. They can take all of these shortcuts. And so, drugs function as an important scapegoat for the artists. The drugs function as an important scapegoat for the scientist.

I mean, me, I built a career on getting NIH grants that were designed to vilify drugs. I mean, and this continues today. I wrote about it in the book. So absolutely. When we think about drugs serving as scapegoats damn near the whole society is invested in this delusion. We're invested in this delusion because it is lucrative.

[00:13:55] Simon: Yeah. And and just a quick note NIH is National Institute for Health. And I wanna circle back a little bit. I did wanna highlight one particular harm that you mentioned, which ties into some of the NYCLU's work around the family regulation system or more commonly called the the child welfare system.

You mentioned that there's a number of instances when parents, you know, they're accused of using illegal drugs and that's used as a reason to sometimes take children away from their parents, or at the very least, put them into a series of bureaucratic, sort of ensnare them in this system that makes them jump through hoops for fear of, losing their, kids or never getting them back if they're taken away.

Can you talk about that?

[00:14:39] Carl: Yeah. So, let's just be clear. When we think about people who are having their children taken away, these are black and brown women, that they are the predominant ones. It's a really easy thing to see today, I hope, for people. All right, so there are a number of women who smoke weed and get high and take care of their family, and they're responsible people.

We see this with the, the growing legalization of cannabis. Now, for that activity, we are taking away certain women, children. Simply because those women have the cannabis metabolite, the THC metabolite in their blood, in their system, a marker that they have used cannabis within the past couple weeks or so.

Now, it tells you nothing about the woman's level of intoxication. Tells you nothing about whether or not this person is a good parent or can parent, or cannot parent tells you nothing about that. Um, but simply testing positive for the cannabis metabolite, particularly upon delivering your child can get ACS, Administration for Children's Services, in your life.

And once they get in your life, it's like a past lover who won't leave. I mean, it's a hard thing to get out of your life. And so it increases the likelihood that you'll have some other infraction because they're in your life. And this happens today. Imagine if people were having their sweat tested for the metabolite of alcohol, which we can do.

And if you test positive for having a beer last night, now ACS can be in your life. That's the extent of what we're doing with certain women by taking their children, being in their life. That's not even the most egregious part of it. One of the, most sick things about this that I've seen, because, you know, if I testified in court on behalf of these women, one of the most sick things about this is that the social workers who are checking on the women and their children. These social workers are typically fresh outta college, young, 20 something. Don't know a damn thing about raising a child because they don't have children, but yet they are the ones who are making these decisions.

That is so twisted and so sick, and people just allowed this to happen.

[00:17:02] Simon: Yeah. And I think to your point about, you know, the fact that we could be testing people for beer. I didn't know until reading your book that during prohibition, when alcohol was illegal, thousands of people died, but not from alcohol, but because of the combination of alcohol and methanol.

Can, can you explain how that happened?

[00:17:27] Carl: Yeah. So, when you make elicit alcohol, sometimes people produce this byproduct or methanol, and methanol of course is toxic and you can be killed blind or some other awful sort of illness as a result of drinking too much of this. And so that certainly happened. Tens of thousands of Americans were killed, or, or maimed from 1920 to 1933 because of this.

But not only from making illicit alcohol can methanol be produced. The federal government actually put methanol in some of the supply in order to discourage people from making illicit alcohol, from drinking alcohol during prohibition. So, the federal government participated in the maiming and the killing of Americans.

And so, it shows the sort of callousness of the people who were running the government at that time. And I wanna make sure people understand that when I say the federal government, I mean its people. Just like today, there are people who are making these decisions about our approach to dealing with opioids.

Those people in many cases are callous. They don't care about the people who are using because uh, in some cases, they're so twisted. They think that if you put this substance in your body, you deserve to die. If you choose to take something like that will alter your consciousness. You deserve to die.

That's sick. That's cruel. And there are people in our federal government, particularly people who are in charge of our law enforcement strategies who are sick, like that. And so, the link between the 1920s in terms of alcohol prohibition and what's happening today with other drug prohibition, it's not that far.

It's the same sick mindset when we should all be thinking about those three birth rights that we guarantee life, liberty, and the pursuit of happiness. Everyone has that. And I can't tell them how to live their lives so long as they don't infringe on other people's rights. But yet, when it comes to drugs, somehow people think that they can suspend bridge people's rights.

[00:19:54] Simon: Yeah. And, to kind of go on the point of the similarities between alcohol and illegal drugs, I think that the ethanol example is so powerful to me because even good-hearted people might think, if you provide people with the ability to see what's in their drugs. That that is very often the things that's killing or hurting them is a lack of knowledge, right? Of what's in their drugs. And they might say, yeah, maybe who knows? But you don't even have to implement that.

You just need to look at the ethanol example to me to see like, this was a direct result of what happens when you criminalized alcohol. Like we know for a fact that this happened. And in addition to the studies and research you point out on drug testing sites and things like that, there is this historic example in alcohol. So I'm, I'm curious if you have more to add on that.

[00:20:44] Carl: Yeah, it's quite simple. I think that the people who are in charge of our drug enforcement strategy, the first goal is to make sure their budgets are taken care of. And in order to make sure your budgets are taken care of; you have to frighten the American public about what you're doing. That's their first goal.

If you don't believe me, just watch any congressional hearing with the heads of these institutions. They will invariably frighten the public and highlight some extreme aberrant activity in order to make sure that Congress funds their agency. The idiots who are our Congress people. I mean, it's a joke.

I mean, I think one of the things that really frustrates me is that almost never do we ask people to provide the empirical evidence to support their claims. If we simply do that in those congressional hearings, in our discussions about drugs, this nonsense would stop. But we almost never. What we do is we ask somebody, tell me some heart-wrenching story that will never happen to anyone other than you.

And we can't verify the veracity of the story. That's what we do. So instead, if we say, okay, what is the empirical evidence to support the claim, then it's over. This nonsense is over.

[00:22:24] Simon: Yeah. And, along those lines, there's a part in your book that I made sure to note, because I remember this story. This was a story about the quote unquote Miami Cannibal. This was in 2012, in which so-called bath salts were initially blamed for an incident in which a man attacked 65 year old man and reportedly ate part of his face. I remember this case and the sensational coverage of it, and I truly, until reading your book, I had no idea that, what are sometimes called bath salts, were actually not involved at all. And I'd love for you to expand on this, just you've talked a lot about like fact versus fiction here and, and how these myths get perpetuated.

Can you talk about this case and the broader issues around the demonization that, that we've been talking about?

[00:23:13] Carl: Yeah, so bath salts, as you point out this, the Miami Cannibal case. The initial reports was that this guy had taken bath salts and then eaten off half the face of a homeless guy near a Miami Highway, and the cops were on the scene and the leader of the police union got to the media first, and he shaped the story. And his story was that it was bath salts that caused this person to act in this indecent way, in this gruesome way, by eating off the face of this other fella. And so that story was then taken to the emergency room where the, the doctors got involved and they talked about, yeah, how horrible bath salts are.

And so, you now have the police and the ER doctors participating in this exchange of ignorance. At this point, neither of these individuals know what the toxicology said. when the toxicology finally comes back of the perpetrator, what they find was a small amount of THC in the guy's toxicology, no bath salts.

Um, so bath salts didn't participate in this. Now if you can think you will know that, like when we say bath salts, what is bath salts? Bath salts basically are synthetic compounds that are made basically based on the active ingredient in the plant, khat. Khat is a shrub that has its origin in East Africa, and it's a stimulant.

And so, in Ethiopia, Kenya, people chew on the khat sort of leave to get a caffeine like stimulating effect. These are called cathinones. The cathinones produce effects ranging from caffeine effect to MDMA effects. It looks kind of like an amphetamine when you look at the chemical structure. But the effects, they're a lot shorter than something like MDMA.

Those are the kind of effects that cathinoneS produce. Now, no one is saying that you're taking an MDMA and biting a face off of someone. Because that would be ridiculous as is it ridiculous to say this about bath salt. And so, this is what I mean when I say, if we require people to have empirical evidence to support the claims, then we stop some of this nonsense.

But one of the things that happened as a result of the story, this lure story. Congress passed further legislating, further banning these drugs, increasing penalties for these drugs. And you see this unnecessary act that helps no one, that does not help anyone. But what it does is that it gives the DEA another substance to put on the banned list. It makes the DEA look like they're doing their job. Like they are important.

This is like the DEA saying that's it, we have now added caffeine to our banned list and feeling good about themselves. It's like we live in bizarro world when it comes to drugs because we have these ignorant people out here speaking about drugs who have absolutely no education in pharmacology. Just require them to have some education in pharmacology. That's it.

[00:26:53] Simon: And Dr. Hart, speaking of pharmacology and also following the data, you know, you point out in your book where in your opioids chapter, which is one of my favorites, you mentioned that many of the deaths associated with they get chalked up as opioid deaths come from mixing, say, an opioid like Codeine mixed with an antihistamine called Promethazine. I'd love to have you talk about that, but also just the broader sort of misunderstandings around the opioid crisis, which I know you touched on, but just the idea of like drug combinations being such a big part of this.

[00:27:33] Carl: Yeah, so what the public really needs to know when they see those numbers with opioid related deaths or opioid overdose death. The thing that they need to really pay attention to is the language. Because the language is really used as a slight of hand. You never see something that say opioid overdose deaths, right?

You'll say, opioid involved, opioid related. Now, what this simply means is that, an opioid might have been in the person's system at the time of their death, or we suspect the person had taken opioids prior to their death. It doesn't mean that the opioid actually caused the death.

None of these data tell you that because no one has that information. No one has really delved into that. Maybe there are few people who are qualified in the country to do that, but these are not the vast majority of people who are calling this an opioid related overdose death. So, a person who dies and what we call from a drug related overdose, may have multiple drugs in their system.

What we know from pharmacology is that when you combine opioids with other sedative, for example, alcohol being one of them, benzodiazepines being another, barbiturates being others. But we don't oftentimes think about antihistamines, particularly the older antihistamine, like Promethazine. Promethazine is one of the older antihistamines, and it can really induce a high level of sedation.

And so, if you combine this with a large amount of an opioid and you have limited experience with either of these, you increase the risk of having respiratory depression and possibly dying. That is just one of the sort of ways that some people may be dying, but there are other drugs too that are in common use, and they should be because people use them for various medical illness.

Like the pain relievers like Neurontin or Gabapentin, Lyrica, those also induced a lot of sedation. So, when you combine now those drugs with something like alcohol or an opioid, you also increase the likelihood of respiratory depression. Oftentimes the public may not be aware of the sedating effects that these drugs can have, particularly when you combine them, cuz then you can have synergistic effects or additive effects.

And so, I think that's an important educational point that we oftentimes miss when we are frightening the public about the so-called overdose crisis.

[00:30:20] Simon: Yeah and, Dr. Hart, to your point I just kind of want to drill down into it a little bit the need to understand what is in the drugs that people are consuming especially when they are illegal drugs.

And as you just talked about, you know, even drugs that are prescription drugs often have combination of drugs that can be harmful, but especially if you're just taking a substance a lot of times the troubles come from just not knowing.

[00:30:45] Carl: Yeah, the thing that I was referring to is this thing called drug checking. There are a number of places around the country where you can submit just small amount of substance that you have 10 milligrams or very small amount, and then you can get a readout of the chemicals that are contained in your sample.

And if it contains something that is, potentially, highly toxic. You don't take it, but you'll have information, you'll be less ignorant about what you're taking than what I've always said that people are not dying from opioids. They're dying from ignorance. And so, this is one way to remedy the ignorance.

I mean, I've become so frustrated about this because this is such a simple, easy fix. I'm now trying to raise money to just buy my own machine and test people's substances in a study like. So, if the federal government won't do it, we, we'll do it as citizens to make sure that people stay safe.

[00:31:43] Simon: And so, I think you would agree with me that it would be better to live in a society where it was not up to you to raise money to have a machine, it would be great to have government involved in this.

[00:31:54] Carl: You're right. It absolutely would be. But you know, the book has been out for two years now, and we still haven't done it on, certainly not on a large scale, lower scale that people are aware. And it's not like people don't know. They know. I mean, I've talked to people in the government, I talked to them regularly.

They know, I mean, they follow me. They know what the fuck is up. They know what's up.

[00:32:16] Simon: Yeah.

And Dr. Hart I want to give you a chance to say anything else you have to say here, but first I just wanna say like, for folks, this book is quite a great book. We've only, you know, scratched the surface. I wish that I could talk to you for hours. I know you have to catch a flight and probably don't wanna spend hours talking to me, speaking of people's rights I don't wanna impact your bodily autonomy that way. But truly, it's a great book.

And one of the things that I would urge people is even if you don't agree with everything in the book, I think it's really important to be exposed to the perspective of Dr. Hart and the evidence that he brings, because I think it is so different from the water we swim in, in terms of drugs and drug policy. And I think, yeah, again, even if you don't come away completely agreeing with everything in the book, very good to be exposed to it. and with that, I'll just leave you with, the last word.

[00:33:06] Carl: Yeah. You know, you point out that the book is, that covers a lot of things. But the most important thing to me about the book was it's a love story. You know, it's about love. It's about, I don't know, my wife and me and how we move through this life in order to make sure we take care of ourselves and our children and other people in our world. So psychoactive substances are just one sort of component of all of the activities that we may use or do in order to make sure our work life balance is intact. But it's all done to make sure that we respect other people's humanity as we respect our own.

That's the big message and that's the message that gets lost. The message is like, I'm showing up for your rights. That's what I'm here for. That's the main thing. And because if I show up for your rights, I hope you'll show up for mine, and I hope we'll show up for other people who may not be able to show up for their own rights.

That's what the book is about. The book is about real patriotism. Taking care of people. But some people narrowly focus on, I don't know, one thing that's like not even germane to the major thesis, respecting other people's humanity.

[00:34:35] Simon: And with that Dr. Hart, I think that's a great place to leave it. Thank you so much for joining us on Rights This Way.

[00:34:42] Carl: Thank you for having me.

[00:34:45] Simon: And now I'm joined by NYCLU Assistant Policy Director Michael Sisitzky. Michael, welcome back to Rights This Way.

[00:34:54] Michael: Always happy to be here, Simon.

[00:34:56] Simon: So first, just to kind of set the table for our portion of the conversation, I think is important to kind of keep in mind the ways in which we could go about ending the harms of drug criminalization. And we talked a lot about that with, Dr. Hart on the first part of this episode.

And I would love for you to like, lay out the NYCLU's position on what we should do instead of continuing on with the status quo where certain drugs are illegal to possess, and to use, and to sell.

[00:35:32] Michael: Sure. So, the NYCLU's position on drug use is pretty simple, pretty straightforward. It should not be criminalized, and we support the repeal of any laws that are on the books that criminalize drug use and possession of drugs for personal use. And that's a position that's really grounded in the simple fact that criminalization is ineffective.

It's counterproductive. And especially if our goal here is to advance public health. What criminal laws are really effective at is contributing to mass incarceration and expanded policing and surveillance state and funneling lots of resources into those systems instead of into investments that could actually address public drug use through a public health framework.

And that can include, you know, things like helping people manage addictions and enroll in drug treatment programs. Or simply just get better education and support for limiting some of the risks of potentially life-threatening overdoses or, or other medical complications. But of course, that's not really the approach that we have taken in New York or in the country as a whole.

You know, for the past half century, we, we've been waging this War on Drugs that has really prioritized and led with criminalization, with aggressive and violent and sometimes even deadly policing. And those consequences of that policy have been that we have targeted black and brown communities wholesale with disproportionate policing, surveillance, incarceration and have a system where black New Yorkers are five times more likely than white New Yorkers to be arrested for drug possession, or drug charges.

Even though rates of use are pretty similar across demographic lines so it, it's not really the reality that we've been living in where we're actually targeting the right kind of solutions to this problem. We've been going at it with policing, with criminalization, and that's just not effective.

[00:37:21] Simon: Yeah. And, it just seems, we've grown up with the system you're describing. It's so hard for me at least, to even kind of like fathom what a different approach would look like because it's so ingrained, right? And, I feel like, drug criminalization is the air we breathe so much so that more than other topics.

It just seems difficult to imagine a different way of doing things, but I know that we are trying to do just that with some of the bills we're supporting. I know there's one that you had mentioned to me that would broadly decriminalize a host of different drugs.

Can you talk about what specifically that Bill would do and why we're supporting it?

[00:38:02] Michael: Sure. I should also note at the outset that this bill and some of the other ones that I think we'll be discussing throughout our conversation have all been really developed and led by groups like the Drug Policy Alliance and Vocal New York. Who are really incredible advocates on these issues.

They bring really critical and valuable perspectives from people who use drugs and are most directly impacted by these policies. So, I'd be remiss if at the outside I didn't acknowledge their leadership on these and so many other issues related to drug policy and harm reduction. And one of the pieces of legislation that we're supporting as part of that effort would really accomplish a fundamental shift in how we actually think about drug use and drug possession charges and try to move us outside of that kind of mindset. And that framework that you were talking about, Simon, where, you know, our approach has just always been so grounded in this view of drug use and people who use drugs are bad and need to be criminalized, need to be arrested, need to be locked up. And really think about this issue in a new way, which is what do people who use drugs actually need?

So, there's lots of ways that drug possession is handled in state law currently. But it starts from the point that possession of any amount of a controlled substance, even if it's just a small amount for personal use, is a crime.

And what this bill would do is take the existing misdemeanor charge that exists on the books for low level possession and decriminalize it. So, it would reclassify that existing misdemeanor for low level possession and turn it into a non-criminal violation that would not be punishable by incarceration.

Instead, the only penalty that could be imposed is a maximum $50 Fine. And what's more even that fine could actually be waived if the person participates in a needs assessment screening that can help connect that person to healthcare, to other services that can actually speak to any underlying substance use or health needs.

So, it will connect them to the services that can actually support them and their needs and based on their current situation. You know, really by not arresting or incarcerating people, we're also freeing up the resources to actually do that.

It is wildly expensive to incarcerate someone, and if we keep doing that, when we know that incarceration doesn't actually decrease drug use, it can actually worsen public health outcomes. We're just gonna continue to try to throw a criminalization solution at a problem that criminalization is just fundamentally incapable of delivering any results on.

[00:40:28] Simon: Yeah. And I, I just want to quickly underscore one of the points you made, which is that criminalizing drug use does not decrease drug use. Perhaps people who are listening to this, maybe they already believe that or understand that, but I think that is, fundamentally, at odds with what a lot of people believe, right?

[00:40:48] Michael: I mean, we've been waging the War on Drugs for 50 years, and if it were effective at actually ending drug use, I think we would've accomplished it by now. Just looking at the scale of arrests and prosecutions in the size of the prison population throughout the country. It's clearly not achieving those desired outcomes.

Drug use has not declined. And we're actually right now in the midst of a nationwide opioid epidemic that is also being felt very heavily here in New York with thousands of deaths that are occurring that we're not going to arrest our way out of.

[00:41:16] Simon: Yeah, exactly. And terrific segue as well because I want to talk about the opioid addiction and the opioid epidemic. We talked about opioids quite a bit with Dr. Hart. But one of the bills we're supporting actually seeks to decriminalize the use of Buprenorphine.

and Buprenorphine is a heavily regulated substance that, as you've told me, is mainly used to treat people with opioid use disorder. I guess I'm honestly surprised that Buprenorphine has some level of like, you could actually be in trouble with the law for using it.

I've always heard of it being used to get off of Heroin or it's used to get off of some other drug that is criminalized. But can you talk about what the reasoning is behind that?

[00:42:03] Michael: Sure. So, Buprenorphine is one of three FDA-approved medications that can be prescribed to treat opioid use disorder. The way that it works is that it activates some of the same cognitive receptors as more addictive opioids but at substantially lower doses, so it doesn't actually get the person high.

So, its use then ends up being to treat withdrawal symptoms to help someone detox. And it's been proven to be remarkably effective at lowering the risk of overdose deaths. So, it's FDA authorized, so it's not criminalized per se since it can be prescribed by a doctor, but it is a scheduled controlled substance.

And because of this, there are real limitations, also real stigma on how it ends up getting regulated and prescribed and used in practice. So, some of those restrictions have included things like requiring prescribers to undergo specialized training and imposing limits on the number of patients that they could treat with Buprenorphine.

Some of those restrictions have actually been eased and even lifted very recently. But the reality is that there have been real persistent barriers to accessing this medication especially among drug users who have the least access to treatment. So unhoused people, people without insurance, or access to trusted and competent healthcare.

And even when buprenorphine has been prescribed, there have been studies that have shown really stark racial disparities in who was actually being prescribed Buprenorphine in the first place. One study found that about 84% of patients prescribed Buprenorphine were white, while only 8% were black and just over 6% were Latinx.

So, there are real barriers in who's actually getting access to this lifesaving medication through official channels. What ends up happening is that people who are trying to manage their conditions that face barriers to access, end up obtaining and using Buprenorphine without a prescription.

And that's where we see the potential for arrest for criminalization, where we see all of the associated harms and other consequences that come with that because now, they're in possession of a controlled substance that they are not actually prescribed to have. And because of that, there's the potential risk for arrest, for prosecution under state law, even though they are really only having and using the substance because they're trying to manage their own care.

[00:44:17] Simon: Okay. That makes sense. And helps me, at least understand the need for the bill we're supporting. Can you talk about what the bill in the state legislature would do?

[00:44:28] Michael: Sure. So, there is a Buprenorphine decriminalization bill in the state legislature that quite simply just amends the state penal law to exclude Buprenorphine from the list of controlled substances that could render someone subject to arrest or prosecution. So, by removing that threat of prosecution or or incarceration for someone who's just managing their treatment the best they can, it moves our response to the opioid epidemic, again, more in the direction of public health where it belongs and takes this piece of it, at least outside of the ambit of the criminal legal system.

So, and this is also something that has a proven track record. It's delivered a result elsewhere. Back in 2021, Vermont passed similar legislation that decriminalized Buprenorphine, and they did that after they saw the results of a policy that had been adopted by the Burlington Police Department of refraining to arrest people for possession.

And that policy had been credited, at least partially, with contributing to a 50% decrease in overdose deaths in that county. So, this is something that we know works. It removes the fear, the threat, that people face in terms of not having to worry about being arrested.

It's something that should be a no-brainer for New York to actually move forward with and treat this as a medication and not as something that renders someone subject to risk of arrest or prosecution.

[00:45:53] Simon: Yes. And then speaking of opioids just to stay on that for a second. One of the best tools we have available to actually stop people from dying from overdoses that are often blamed on opioids, are overdose prevention centers.

You know, people hear about an opioid epidemic and people dying from this or that drug. And, if the goal is actually prevent people from dying, sometimes the solutions are not what people might think.

So, Michael, can you talk about what those are and how many of them there are in New York state and what they do?

[00:46:30] Michael: Sure.

So, overdose prevention centers or OPCs, they're also sometimes called safer or supervised injection sites or consumption spaces. There are places where people can use drugs that they had already obtained in a safe, sterile setting under the supervision of trained professionals who are there to intervene, prevent, and reverse what could otherwise be a fatal overdose or, or other medical emergency.

They also do things like offering resources to counseling services, to other drug and harm reduction education, and refer people to other healthcare and social services, including actually helping connect people with enrolling in drug treatment services. So, these centers are not a new development in the broader landscape of drug policy and harm reduction work.

There have been overdose prevention centers in operation for nearly four decades in various places around the world, but they are new in the United States. There are only two officially sanctioned OPCs that are currently operating in the entire country. And both of them are in New York City being operated by a nonprofit called On Point.

There's one in Washington Heights the others in East Harlem, both of which are areas that have a high concentration of overdoses and really high needs for these types of services. And those two centers, you know, they opened back in November of 2021 and since then they've reversed hundreds of overdoses.

And you know, to your point on the framing of what our goal here is, they have saved hundreds of lives. The latest numbers that I saw were that in the course of about 16 months of operation their staff were able to intervene and reverse more than 900 overdoses. So that's more than 900 cases that could have otherwise resulted in someone dying a preventable death, that the intervention of the team there were able to actually step in and prevent someone from dying.

And there have been zero cases of fatal overdoses at these overdose prevention centers. And from the data that's available on the global level, no one has ever died of a drug overdose at any of the more than 100 overdose prevention centers that operate worldwide. So these are proven public health interventions that actually do work to save people's lives and prevent needless, preventable death.

[00:48:49] Simon: That is genuinely incredible. Especially those last stats that you just mentioned. And I think it's important to hold that information in your mind as we move to this next bit, which is those overdose prevention centers have received serious pushback and I don't think it's an accident that there's only two of them in New York City.

And only two in New York state. I'd love to ask you to talk about what some of the pushback is to these centers and why there aren't more. And also if you could talk about the bill we are supporting that would actually increase the number of these centers.

[00:49:23] Michael: Sure. So there certainly has been pushback to the establishment of overdose prevention centers. And you know, some of that is about where these centers end up being located. Whether they're encouraging more drug use, bringing more drug users into communities, whether it's only some communities that are going to be asked to bear the quote unquote burden of hosting these facilities.

And that's certainly something we've heard about the two OPCs that have been operating in New York City.

There's a lot of understandable concern from communities that given the demographic makeup of those neighborhoods, if that's part of the concerns that have been raised that, more affluent, wider neighborhoods are not being asked to set up and operate these centers in the same ways.

There are, you know, the concerns about, are we bringing more people and encouraging drug use in these communities? But again, a lot of these centers are places that also operate syringe exchanges. So, they operate to actually reduce the presence and visibility of drug use. So, drug use would've otherwise occurred in public, on the streets, in a park is now happening in a clinical supervised setting that can actually dispose of syringes after their use.

So, I think a lot of the concerns, they're, you know, they're real, they're valid. There are things that people want to make sure are addressed with these centers. But they are part of the operations here. They are meant to offer these spaces where we are limiting the harms, the visibility of public drug use that could have otherwise been again, out on the streets and parks and putting it into a space that is safer, cleaner and result in better outcomes for everyone involved. And this is all something that is kind folded into how the state could potentially address this with expanding and rolling out more overdose prevention centers through legislation that's being considered up in Albany called the Safer Consumption Services Act.

So, this is a measure that would allow for the New York State Department of Health and other local health departments throughout the state to authorize and support the creation and regulation of more OPCs that can really build on and replicate the successes that we've seen so far here in New York City.

You know, one of the real challenges is that, even though the New York City OPCs have the political support of local officials, they don't actually have support via public funding. They're entirely reliant on private donations in order to operate. So, the Safer Consumption Services Act, will change that by providing a legal framework for state and local authorization and support, which is really vital because again, we know that the, these preventable and reversible overdose deaths are not just a New York City issue.

This is a problem that exists throughout the state and the scale of the problem is so great that we need an actual public response that includes funding and support for these types of interventions. And to some of the points that have been raised about the concern about where they're being placed.

There's also a process that's built in that would entail meaningful community engagement. Before any new overdose prevention centers are set up and begin their operations. So this is something that is designed to include and incorporate community buy-in and where they're set up, where they're located, how they're operating, and making sure that we are, you know. And, and the more of these that we create, the less that we are asking only a couple neighborhoods to take on the responsibility for offering these types of services.

[00:52:48] Simon: Right. That last piece I think is, critical, right? So that it's not just Harlem and, and Washington Heights. But could be all over the state. The last thing I just kind of wanna touch on is I think a lot of the debate around drugs and drug use in particular, it really gets like bogged down in morality, right?

If you're talking about reducing people's death from drugs, if you're talking about helping people get over drug use issues all of those things are really clouded.

If the idea is that morally this is bad and the best thing to do is to punish the person who is using those drugs, it just doesn't make any logical sense. Even, even if for some it may feel good to feel like you're, you know, engaging in this punitive punishment-oriented process for something that you feel is morally reprehensible.

That is the end of my soapbox. Michael, I will turn it over to you to see if you have anything else to add.

[00:53:44] Michael: Yeah, and I think that view, it's really, goes back to this kind of moralistic framing that we've really led with in, you know, the entire culture of the War on Drugs and how we talk about drug use in society. Only bad people use drugs, people with moral failings use drugs. It's only criminals who use drugs.

To that latter point, it's only criminals who use drugs because we've decided so heavily to invest in criminalizing people because they use drugs. It's not the case that someone is a bad person or has had some kind of failing because they use drugs. So many people use drugs, and we think about, and, and talk about those people often very differently and often, very differently along racial lines.

If we can get past this framework that views drug use as some kind of moral failing and into a framework that is understanding drug use as part of the human experience with all of the ways that it impacts people's lives, all of the factors that could lead to someone to use drugs, we can think about whether or not there are solutions that are.

Actually, addressing real concerns that folks have. And that's not to say that everyone who uses drugs has a concern that needs to be addressed. But where there are issues that arise, they should be examined and responded to through a public health lens that is focused on getting people the supports, the care, the services that they need, if they need them.

[00:55:07] Simon: Absolutely. Great point to end on, Michael. With that thank you so much for coming on Rights This Way.

[00:55:14] Michael: Thanks so much, Simon.