Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear, by Carl Hart (2021, Penguin Press, 290 pp., $28.00 HB)

Dr. Carl Hart is a one-man drug and drug user destigmatization machine. In his new book, Drug Use for Grown-Ups, the Columbia University psychology professor blasts drug prohibition as both an affront to the American dream of the pursuit of happiness and as a tool of racial oppression. And he makes a strong, informed argument that recreational drug use can be, and usually is, a good thing.

You could hardly find someone more qualified to make the case. Hart has spent years in the trenches of neuropsychopharmacology research, handed out drugs (or placebos) to thousands of research subjects, published numerous scientific papers and popular articles in the field, and risen to the top of his profession along the way. And here is his bottom line:

"[O]ver my more than 25-year career, I have discovered that most drug-use scenarios cause little or no harm and that some responsible drug-scenarios are actually beneficial for human health and functioning. Even 'recreational' drugs can and do improve day-to-day living... From my own experience -- the combination of my scientific work and my personal drug use, I have learned that recreational drugs can be used safely to enhance many vital human activities."

Hart is refreshingly -- and deliberately -- open about his own recreational drug use. Given the stigmatization and persecution of people identified as "drug users," he feels that justice demands privileged partakers come out of the closet and give voice to their own, non-destructive drug use histories as a necessary remedy for that demonization. He certainly does so himself, revealing a disciplined yet curious mind most definitely not averse to sampling various substances.

Those substances include heroin, which he describes as his current favorite drug, one that he's been using episodically for years now: "There aren't many things in life that I enjoy more than a few lines by the fireplace at the end of the day... Heroin allows me to suspend the perpetual preparation for battle that goes on in my head... The world is alright with me. I'm good. I'm refreshed. I'm prepared to face another day, another faculty meeting, another obligatory function. All parties benefit."

But Hart is not quite so mellow when it comes to people and institutions he sees as helping to perpetuate overly negative depictions of various drugs or the persecution of drug users. He rips into Dr. Nora Volkow, head of the National Institutes on Drug Abuse (NIDA) over her "addiction is a brain disease" mantra and the rigid ideological control she has over research funding. He rips into journalists for uncritically and sensationally reporting salacious scientific findings about the evils of drugs that he argues are not supported by the evidence they are supposedly based on. He even calls Bernie Sanders "ignorant" (that word shows up more than a few times) for complaining that marijuana shouldn't be in the same drug schedule as "killer drugs like heroin."

Hart doesn't deny the potential dangers of drug use but makes the case that they are dramatically overstated. In that sense, Drug Use for Grown-Ups is a corrective to more than a century of anti-drug propaganda. In a deep dive into opioids, for instance, he notes that most opioid overdose deaths are actually opioid/benzodiazepines/alcohol deaths, and that a large number of them are due to ignorance (there's that word again) -- in that, in the black market that currently exists, drug users do not and cannot know what exactly is in that pill or powder they purchased.

As long as we are in a prohibition regime, the least we can do is widespread drug testing for quality control, as is done at some European music festivals, Hart argues. But that's the only kind of drug testing he's down with; he calls the urine drug testing industry "parasitic," a sobriquet he also applies to the drug treatment industry.

But hang on, he's not done yet. Although he is an advocate for harm reduction practices, he has a bone to pick with the term itself: It's too damned negative! Drug use doesn't typically involve harm, he argues, but pleasure-seeking. As I pondered this, I came up with "benefit enhancement" as an upbeat alternative to harm reduction, but Hart went with "health and happiness."

And he's got a bone to pick with "psychedelic exceptionalism," the notion, dear to folks like Decriminalize Nature, that psychedelics, or better yet, "plant entheogens," are somehow "better" than dirty old drugs like meth or heroin and thus deserve to be treated differently, more gently. He also snarks at the notion that taking drugs for spiritual or religious purposes is of a higher order than taking them for fun and rebels at the notion of having a shaman or guide during a tripping session: "Some people find this comforting. I find it creepy and have never done so myself."

Drug Use for Grown-Ups is bracing, informative, and provocative contribution to the literature. Even the most ardent drug reformers and defenders would benefit from reading it and reexamining their own assumptions. Maybe Carl Hart is onto something.

State legislatures are dealing with marijuana bills, the Justice Department reverts to less harsh charging and sentencing policies, and more.

Marijuana Policy

Idaho Bill to Amend Constitution to Bar Marijuana Legalization Advances. The measure, a joint resolution, would ban all psychoactive drugs not already legal in the state, but was inspired by fears of marijuana legalization. It was approved Friday in the Senate State Affairs Committee on a party line vote. To become law, the measure would have to pass both the House and the Senate with a two-thirds majority and then be approved by a simple majority of the electorate in the November 2022 general election.

New Hampshire Marijuana Legalization, Home Cultivation Bills Killed. The House Criminal Justice and Public Safety Committee voted Wednesday to retain a marijuana legalization bill, effectively killing it for the rest of the legislative session. The committee also voted to kill a bill that would allow home cultivation of marijuana.

New Jersey Home Cultivation Bill Filed. Even as the legislature and the governor continue to spar over bills decriminalizing and legalizing marijuana after voters approved it in November, Sen. Gerald Cardinale (R-Bergen) has filed S 3407 (not yet available on the legislative website), which would legalize the cultivation of up to six plants by individuals once a legalization bill is signed into law. "The people of New Jersey made it clear in November that they want to lift the prohibition on cannabis," Cardinale said in a statement. "Since then, the Legislature has spent three months fumbling around with what should have been a simple task, and complicated the legalization effort with countless fees, licensing and extra layers of bureaucracy."

Pennsylvania Governor Calls for Adult-Use Marijuana Legalization in 2021 Agenda. Gov. Tom Wolf (D) is calling for marijuana legalization as part of his 2021 agenda, which was released Thursday. "The revenue generated from legalization will be used to support historically disadvantaged small businesses through grant funding and provide them the assistance they need to build back from the economic crisis and strengthen our economy," Wolf said. "Additionally, a portion of the revenue will support restorative justice programs to help the individuals and communities that have been adversely harmed by the criminalization of marijuana."

Medical Marijuana

North Dakota Lawmakers Kill Home Cultivation for Medical Marijuana Patients. A bill that would have allowed registered medical marijuana patients to grow their medicine was unanimously defeated in the Senate Judiciary Committee Thursday.

Sentencing Policy

Justice Department Rescinds Harsh Charging and Sentencing Policy, Reverts to Obama-Era Policy. Acting Attorney General Monty Wilkinson has revoked harsh Justice Department guidance to federal prosecutors imposed by then-Attorney General Jeff Sessions in 2017. Wilkinson reverted to guidance issued by then-Attorney General Eric Holder in 2010, which, in a bid to reduce imprisonment, directed prosecutors to do an individualized assessment of relevant facts in deciding what cases to charge and what sentences to seek. That guidance, though, does not include a 2013 Holder memo directing prosecutors not to seek mandatory minimum sentences in some drug cases.

International

Canada Ponders Drug Decriminalization in Bid to Fight Overdoses. The Canadian federal government is pondering whether to decriminalize drug possession in a bid to tamp down rising drug overdose numbers, a government official told Reuters this week: "A spokesman for Health Minister Patty Hajdu said on Wednesday that decriminalization was under consideration and that discussions with Vancouver were under way but would not comment further." Vancouver has already called on the federal government to let it decriminalize drugs inside the city limits.

Marijuana legalization bills are filed in Florida and Hawaii, a bill to protect medical marijuana-using veterans is filed in Congress, and more.

Marijuana Policy

Florida Marijuana Legalization Bills Filed. State Rep. Carlos Guillermo Smith (D-Orlando) and state Sen. Jeff Brandes (R-St. Petersburg) have filed companion marijuana legalization bills, HB 343 and SB 710, respectively. The bills would "establish a robust and free-market regulatory approach to the governance of cultivation, processing, and retail sales of both medical and adult-use marijuana." They would legalize up to 2.5 ounces for people 21 and over.

Hawaii Marijuana Legalization Bill Filed. A marijuana legalization bill was filed last week in Honolulu. The bill, SB 704, would set up a system of taxed and regulated marijuana sales, as well as legalizing the possession of up to an ounce of marijuana and allowing for the personal cultivation of up to six plants, of which three can be mature.

Washington State Home Cultivation Bill Advances. A bill that would allow people to grow their own weed at home, HB 1019, was approved by the House Commerce and Gaming Committee on a 7-2 vote last Friday. Although the state has legalized marijuana, home cultivation remains a felony. This bill would allow people to grow up to six plants and keep the fruits of their harvest.

Medical Marijuana

Bill to Protect Veterans Who Use Medical Marijuana Filed in House. Rep. Greg Steube (R-FL) has filed a bill to protect military veterans who are using medical marijuana in compliance with state laws from being penalized. HR 430 would also clarify that Department of Veterans Affairs doctors can discuss the benefits and risks of medical marijuana with their patients. The bill is now before the House Committee on Veterans Affairs.

Heroin and Prescription Opioids

US Sentencing Commission Finds Big Increases in Fentanyl Prosecutions. In a report released Monday, the US Sentencing Commission finds that while fentanyl and fentanyl analogues account for only 5.8% of federal drug trafficking cases, the number of fentanyl cases has doubled each fiscal year since 2015 and the number of fentanyl analog cases has doubled each fiscal year since 2016. Fentanyl cases jumped from 24 to 886, a whopping 3,592% increase, while analog cases jumped from four to 233, an even larger 5,725% increase.

Methamphetamine

Methamphetamine Overdose Deaths Have Risen Sharply, Study Finds. A study supported by the National Institutes of Health finds that meth overdose deaths rose sharply nationwide between 2011 and 2018, with the death rate rising from 4.5 to 20.9 per 100,000 among people aged 25 to 54. The numbers rose across all racial and ethnic groups, but American Indians and Alaska Natives had the highest death rates overall. The research was conducted at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

With a decision Tuesday, the 3rd US Circuit Court of Appeals has brought to a screeching -- if hopefully temporary -- halt for efforts to establish a groundbreaking permitted safer injection facility in the city of Philadelphia. In the case of US v. Safehouse, the nonprofit group set to run the site, the court held that allowing the supervised onsite consumption of illegal drugs "will break the law" because it conflicts with a 35-year-old amendment to the Controlled Substances Act aimed at crack houses.

Never mind that the city is in the midst of an opioid overdose epidemic and needs to try something new after decades of failed prohibitionist drug policies. The sanctity of the drugs laws must be maintained, the court held: "Though the opioid crisis may call for innovative solutions, local innovations may not break federal law," it opined.

This is just the latest twist in the years-long effort to address an opioid overdose outbreak in the city that began about a decade ago, with overdose deaths nearly doubling between 2009 and 2018 and numbering more than a thousand a year every year since 2016. The crisis led to the formation of a Mayor's Task Force to Combat the Opioid Epidemic in Philadelphia, which issued a final report and recommendations in 2017 calling on the city to consider rolling out overdose prevention services, including safe injection sites, or, as Safehouse refers to them, overdose prevention sites.

Safehouse was formed to make that possibility a reality. Led by Jose A. Benitez, the executive director of the harm reduction group Prevention Point Philadelphia, Safehouse picked up a powerful ally in board member Ed Rendell, the former governor of the state and mayor and district attorney of Philadelphia. With Rendell's clout, the organization had overcome local obstacles and was preparing to open the first legal safe injection site in the country when Attorney General William Barr's Justice Department struck.

The US Attorney for the Eastern District of Pennsylvania filed a civil lawsuit in February 2019 asking a federal judge to find safe injection sites illegal under the Controlled Substance Act's "crack house" statute, throwing plans to open up into limbo. Eight months later, the court held that "the ultimate goal of Safehouse's proposed operation is to reduce drug use, not facilitate it, and accordingly, [the "crack house" statute] does not prohibit Safehouse's proposed conduct."

A February 2020 ruling from the same court reiterated the legality of safe injection sites in the Eastern District, but that summer, the judge ordered Safehouse to pause amidst the coronavirus pandemic and the police violence protests. Meanwhile, the US Attorney appealed the ruling that the proposed safe injection site was legal, with oral arguments held in November, and the 3rd Circuit's decision issued this week.

The Justice Department pronounced itself pleased.

"The Court's decision reaffirms that 'safe' injection sites are a violation of federal law," said Acting Attorney General Jeffrey A. Rosen in a statement. "The Department supports efforts to curb the opioid crisis ravaging this country, but injection sites are not the solution. There are more productive ways to address drug abuse, and today's ruling by the Third Circuit has confirmed that these sites are illegal and therefore not the answer."

"The rule of law is still alive and well in Philadelphia -- having been re-affirmed by the U.S. Court of Appeals for the Third Circuit, which held that it is a federal crime to open a heroin injection site or 'consumption room' for illegal drug use," added US Attorney for the Eastern District of Pennsylvania William M. McSwain. "The 3rd Circuit's opinion is a faithful reading of the statute's plain language and is consistent with Congress's intent to protect American neighborhoods from the scourge of concentrated drug use."

Reform advocates saw it quite differently.

"As the COVID-19 pandemic is exacerbating the already devastating overdose crisis, the Third Circuit's reversal of the earlier court's decision -- which held that safe consumption sites do not violate federal law -- will inevitably result in the unnecessary loss of countless lives," Lindsay LaSalle, managing director of policy for the Drug Policy Alliance (DPA), said in a statement. "The 3rd Circuit's decision is misguided -- it is abundantly clear that Congress never intended to criminalize legitimate public health interventions through [the 'crack house' statute]."

The 3rd Circuit's decision is precedential, meaning it holds throughout the district, which includes Delaware, New Jersey, Pennsylvania, and the US Virgin Islands. But other jurisdictions, such as San Francisco and New York City, where similar efforts are underway, are not bound by it, and DPA is encouraging groups pursuing such efforts to "continue to work toward authorization and implementation of supervised consumption sites to address the overdose crisis in their cities and states."

There may be help coming in the new Congress and Biden administration as well. Advocates say they will seek action in Congress to clarify that safer injection facilities should be permitted, and from the Biden Justice Department to provide guidance to US Attorneys to lay off on them.