Neuroscientist Dr. Carl Hart: People are dying in opioid crisis because of politicians’ ignorance

Columbia University psychology and psychiatry professor Carl Hart argues that people are dying because of ignorance, not because of opioids.

SOURCEDemocracy Now!

President Trump announced Thursday that he is directing the Department of Health and Human Services to declare the opioid crisis a public health emergency – walking back his plans, announced in August, to declare it a more serious “national emergency.” The shift means the federal government will not, as of now, direct any new federal funds to address the opioid crisis, which killed 64,000 Americans last year. We speak with Columbia University psychology and psychiatry professor Carl Hart, who argues people are dying because of ignorance, not because of opioids.


This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: President Trump has announced he’s directing the Department of Health and Human Services to declare the opioid crisis a public health emergency – walking back his plans, announced in August, to declare it a more serious “national emergency.” The shift means the federal government will not, as of now, direct any new federal funds to address the opioid crisis, which killed 64,000 Americans last year.

PRESIDENT DONALD TRUMP: As you all know from personal experience, families, communities and citizens across our country are currently dealing with the worst drug crisis in American history and even, if you really think about it, world history. This is all throughout the world. The fact is, this is a worldwide problem. This crisis of drug use, addiction and overdose deaths, in many years, it’s just been so long in the making. Addressing it will require all of our effort. And it will require us to confront the crisis in all of its very real complexity.

AMY GOODMAN: President Trump also said he would consider bringing lawsuits against “bad actors” in the opioid epidemic.

Well, for more, we go to Atlanta, where we’re joined by Dr. Carl Hart, chair of the Department of Psychology and a professor of psychiatry at Columbia University, his new piece for Scientific American titled “People Are Dying Because of Ignorance, Not Because of Opioids.” Dr. Hart is the author of High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society.

Dr. Carl Hart, welcome back to Democracy Now!

CARL HART: Good to be with you, Amy.

AMY GOODMAN: Explain what you mean: “People are dying because of ignorance, not because of opioids.”

CARL HART: Well, you just played Trump, and what the people just heard was ignorance. And that’s why people are dying. We’re not really addressing what the real issues are.

It’s really simple. We think about the opioid deaths. Number one, people said – like the number you said, I think 64,000. That’s not opioid deaths only. There are other types of death that are occurring. That is all drug sort of deaths, including antidepressants, including all of those other drugs. And so, we have to be careful about inflating these numbers, one.

But the fact that people are dying because of opioids, that’s a real problem. And when we think about the deaths themselves, most of the people are dying in large part because they combine opioids with another sedative, like alcohol, like a benzodiazepine. A benzodiazepine is something like Xanax. They also combine opioids with older antihistamines. Those sorts of things, they increase the risk associated with opioids.

But a major – another major problem people are dying is because they think that they may have something like heroin, when in fact they have something like fentanyl. Much of the heroin on the street today is now being tainted with this drug called fentanyl. Fentanyl is about 50 to a hundred times more potent than heroin, just simply means that less of the drug is needed to produce the required effect. But unsuspecting users may take the amount that they usually take with heroin, thinking that it’s heroin, when in fact it’s fentanyl.

OK, so we say, “How do we fix this?” This is really simple. What we can do, we can simply set up free drug purity testing sites. They do this in Spain. They do this in the Netherlands. They do this in Switzerland. It’s really simple. That way, when people understand what’s in their drug, they can scale back their use or not use it. Free drug purity testings would tell you the complete composition of the drug that you have. So if you want to save lives, you can set that up easily. Doesn’t cost that much money. People are talking about, “We need more money! We need more money!” Maybe you need some more money, but let’s make sure we use the money smartly.

I’m concerned that if we add more money, we will send most of the money to law enforcement. And when we do that, we know what happens. We saw it with crack. We saw it with opioids before, in the 1960s. What happens is more black and brown people will be arrested. Do not forget that.

And another thing that happens is that we – I worry that people who need prescription opioids for their pain will not be able to get their prescription opioids, because we are getting crazy about opioids, in general. Opioids are excellent medications to treat pain. And we can’t forget that. We also have seen, even before this – we know that, for example, black people are less likely to be prescribed opioids even when they need it, less likely than their white counterparts. And so, all of these sort of unintended consequences, they always happen when we get crazy about drugs. And we don’t even save people.

AMY GOODMAN: Your piece, Carl Hart, in the Scientific American starts, “Recently, driven largely by opioid-related deaths – predominantly [of] our white sisters and brothers – President Donald Trump proclaimed that the opioid problem was now a national emergency. He vowed to ‘spend a lot of time, a lot of effort and a lot of money on the opioid crisis’ because ‘it is a serious problem the likes of which we have never had.’” You say this is false, and also by talking about “our white sisters and brothers.” Talk about race and the racial component of this.

CARL HART: Well, we have more white people in the country. And so, when we have these kind of issues going on, of course there will be more white people who are affected. There are more white people dying because of the opioid crisis. That’s a fact. As a result, you have – people who represent us are largely white people, white people from rural areas and that sort of thing. And they have brought this to the attention of the American public, in part because of our white brothers and sisters. That’s a fact. I mean, that’s how it always has been.

But I want to make sure people understand this clearly. I wrote a piece in The New York Times in August where I pointed out that this isn’t new. Even with crack, there were white – more white users, and those white users got treatment, whereas the brothers and sisters, black brothers and sisters, went to jail. The same sort of thing is happening in this case. Eighty percent of the people who are being currently arrested for the opioids are black and Latino, even though they don’t use those drugs at rates higher than their white brothers and sisters. And so, this is just the American pattern of dealing with drugs. It’s not new. And we continue the same thing. So I’m asking people: let’s not get crazy; let’s just focus on the real problems.

And another concern, too, is another way we can deal with these sort of deaths. And for me, that’s the real concern, because when we think about drug addiction, the people – the number of people who will become addicted to opioids are considerably lower than we are making it out to be. Only about a quarter of the people who use something like heroin will become addicted. That means the vast majority are not addicted. But one way we can deal with the deaths, the major concern – another way we can deal is just made naloxone, which is an opioid blocker, make it more available. One of the things that has happened in recent years is that pharmaceutical companies have jacked the price up of naloxone, an old drug that’s been here since the 1960s. I mean, if Congress really wanted to do something, if the president really wanted to do something, he would hold those pharmaceutical companies accountable for increasing the price of naloxone, when the price of naloxone should be really cheap. That’s one of the things he can do. But people are focused on the money and not focused on being smart.

AMY GOODMAN: Earlier this year, Attorney General Jeff Sessions vowed a major revival of the so-called war on drugs. This is Sessions speaking at the Department of Justice headquarters as he rescinded two Obama-era memos that encourage prosecutors to avoid seeking inordinately harsh sentences for low-level drug offenses.

ATTORNEY GENERAL JEFF SESSIONS: Going forward, I have empowered our prosecutors to charge and pursue the most serious offense, as I believe the law requires, most serious, readily provable offense. It means that we’re going to meet our responsibility to enforce the law with judgment and fairness. It is simply the right and moral thing to do. … And we know that drugs and crime go hand in hand. They just do. The facts prove that so. Drug trafficking is an inherently dangerous and violent business. If you want to collect a drug debt, you can’t file a lawsuit in court. You collect it with the barrel of a gun.

AMY GOODMAN: That’s Jeff Sessions, the attorney general of the United States. Dr. Carl Hart, your response?

CARL HART: Damn, it’s hard to come up with a response for that, such ignorance and such – well, I guess Saturday Night Live does it best. I don’t know what to say about this kind of ignorance. This kind of ignorance takes us back to the 1980s. And we are all concerned about mass incarceration in the country today. If you want to know how we got there, right now what we’re doing, with people like Jeff Sessions and that guy in the White House, is how we got there. And they’re trying to ensure that we go back there, in part because it’s going to affect primarily, negatively affect, black people and brown people in this country.

And so, it’s frustrating that we have such remarkably ignorant people and mean-spirited people and racist people. And I don’t use that word lightly. When I say “racist,” I mean when people who support policies and their behaviors are in such a way that one group disproportionately is unjustly treated. And that’s what we have going on right now. So when we have Jeff Sessions saying this sort of thing, the consequences will be racial discrimination. And he’s supporting that kind of policy or that action. That makes him a racist. And I don’t use that term lightly, as I said. And so I think that – I am outraged by him. And I hope the American people are outraged by him, because I thought we were better than that.

AMY GOODMAN: In Baltimore, a group of high school students are tackling the drug overdose epidemic by building a cellphone app that alerts people when a toxic batch of heroin is being distributed in the area. The students, who are mostly African-American, helped design and build Bad Batch Alert, which sends text messages to alert Baltimore residents when people in the area are overdosing at a higher rate, likely from a tainted batch of drug. The app also allows users to text for help, allowing drug users an alternative to calling 911 in the event of an overdose. This is Bad Batch co-creator Davon Harris.

DAVON HARRIS: You know it’s a problem. How can we fix it, with the inevitable future, using programs and stuff of that nature, more accessible program? That’s why we have a text-based service instead of like an actual app from the app store. So, it fits – everyone has a phone. Well, most people have a phone. Text message is kind of like standard, is very native to your phone. So, it’s more versatile. So we’re using that, and, I guess, saying that states may say this: “OK, maybe we can, you know, adopt this,” or “Maybe, you know, it’s a good way of keeping our citizens safe and involved in their communities,” and stuff of that nature. So that’s kind of like what I believe Baltimore Bad Batch is doing for the nationwide, possibly.

AMY GOODMAN: So that was Davon Harris, who is the co-creator of the Bad Batch text-alert system. We just have one minute. Dr. Carl Hart, if you could respond to this? And then, overall, on this day after President Trump has declared the opioid crisis a national public health emergency, walking back the public – national emergency, which would have meant more money devoted to this, your thoughts you want to leave people with?

CARL HART: Well, mad props to the high school students for trying to do something in their community. But for – as a nation, we should be embarrassed. First of all, you have high school students trying to contribute to this problem, where you have many people who have gone to school for many years specifically for pharmacology and these sorts of things. We know some things, and we have some answers for this, if only our government would seek out people who actually know what they’re doing, as opposed to us relying on high school students. But mad props for them for even trying.

As I think about, overall, what this thing – how we should deal with this thing, I’ll start with the overdoses. Again, it’s simple.

AMY GOODMAN: We have 10 seconds.

CARL HART: Make sure we warn people not to combine opioids with another drug. Set up free drug purity testing sites. People who are addicted to opioids and who are having a problem, and they need treatment. We should look around the world, places like Switzerland. I spent my 2015 sabbatical –

AMY GOODMAN: Carl, we’re going to have to leave it there.

CARL HART:  – in a clinic where we gave heroin –

AMY GOODMAN: I want to thank you for being with us. Carl Hart, thanks for joining us from Columbia University.


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