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Dr. Carl Hart’s Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear opens with a controversial admission. The Columbia University Ziff Professor of Psychology declares that he is “an unapologetic drug user” and, consequently, “a happier and better person.” Dr. Hart urges “responsible” adults to “come out of the closet” about their recreational drug use and its myriad beneficial impacts.

Two important contentions animate Drug Use for Grown-Ups. The first is the widely accepted notion among experts that America’s long-standing criminalization of certain drugs, grounded in their anti-scientific demonization and racialization, is the crux of our problem. Simply stated, our never-ending war on drugs, which has resulted in our country’s unenviable distinction as global mass incarcerator, is an expensive and racist failure. Dr. Hart aptly characterizes American drug policy as a “monstrous, incoherent mess.” Few drug policy experts would disagree.

In fact, critiques of the U.S. drug regime tend to revolve around this theme. Scholars often implore policymakers to end the racist drug war by pointing out that it exacerbates widespread and inequitable harms. They argue that individuals who suffer from problematic drug use deserve compassion and evidence-based treatment instead of stigmatization and incarceration. Drug Use for Grown-Ups, however, not only refuses to loiter in these basic premises, it rejects them as a viable entry points to a productive conversation about American drug prohibition.

As such, the book’s significant contribution to the drug reform canon is located in its dominant and more contentious claim. That is, that responsible, recreational adult drug use enhances pleasure and happiness and that the Declaration of Independence endows all Americans with the unalienable right to such pursuits. Dr. Hart is not a legal academic and, to his credit, he makes no effort to engage with scholarly debates about the founders’ meaning of the Declaration’s “pursuit of happiness” clause. Instead, he deploys the clause to point out that government prohibition undermines our fundamental right to use drugs to enhance happiness so long as that use does not inflict collateral, societal harms. In this connection, Congress enacted a federal right to try law in 2018, which permits individuals with life-threatening health care conditions to take investigational drugs that have not yet obtained Food and Drug Administration (FDA) approval so long as they satisfy enumerated, stringent criteria. The overwhelming majority of the states have also enacted their own right to try laws. The federal courts, on the other hand, have repeatedly rejected the claim that Americans have a fundamental, constitutional right to use illicit substances.

Drug Use for Grown-Ups’s straightforward proposition that adults who do not suffer from serious or terminal illness ought to be able to use drugs to live more empathetic, enjoyable, and meaningful lives has been met with predictably vigorous resistance. Such opposition, of course, has much to do with the power and pervasiveness of American anti-drug propaganda, which teaches that the use of illicit drugs to achieve an altered consciousness is a moral failing that will inevitably lead to problematic outcomes, such as bad parenting, unemployment, substance use disorder, and premature death. Our “what doesn’t kill you makes you stronger” culture is defined by anti-pleasure principles, such as the timeless notion that euphoria is the devil’s work.

American sprinter Sha’Carri Richardson’s recent disqualification from the 2021 Summer Olympic Games due to a positive marijuana test brilliantly illustrates the tension between our cultural anti-drug programming and science. It makes no sense that Richardson was forced out of the Olympics on such grounds because there is no support for the claim that marijuana improves athletic prowess. Banning Richardson from running in the Summer Games due to marijuana use is indistinguishable from—and just as ridiculous as—banning her for taking a Tylenol.

More telling was Richardson’s explanation for her marijuana use and the public’s reception to that rationale. Richardson reported that she had legally used marijuana to cope with the unexpected death of her mother and the public response was predominantly sympathetic and supportive. One wonders how the American public would have responded if Richardson—a Black American woman and athletic superstar—had simply used marijuana to experience pleasure and happiness.

There is, of course, nothing remarkable about Richardson’s drug use. Most Americans take drugs. Some use prescription drugs to mitigate or treat health care conditions; they do so even when such use runs the risk of serious side effects, such as heart attack, seizure, or paralysis. Others routinely use legal, over-the-counter drugs—such as caffeine and alcohol—to achieve a more desirable consciousness, such as heightened alertness or reduced anxiety. Dr. Hart challenges us to examine these phenomena against our otherwise deeply held belief that there is something sinister about using drugs responsibly to enhance our happiness and well-being.

This review is in no manner intended to undermine the seriousness of substance use disorder and other forms of addiction. As already noted, however, the criminalization of drugs enhances drug use-related harms; exacerbates poor public health outcomes; fuels unsafe, illicit underground drug markets; and disparately targets minority populations and other socially and economically disenfranchised groups. Our criminal legal system both ignores the root causes of substance use disorder and devours significant resources that could be devoted to addressing the social and structural determinants of health that drive drug overdose epidemics. The pervasive criminal surveillance of certain drugs, such as opioids, coupled with concerns about substance use disorder also has led to the undertreatment of individuals with chronic pain conditions who may benefit from opioid therapeutics.

Dr. Hart intentionally unmoors his argument that responsible adults have a fundamental right to use drugs to enhance happiness from conventional advocacy for substance use disorder prevention and treatment, on the theory that most recreational drug use is for pleasure and not problematic. He dedicates a chapter of Drug Use for Grown-Ups to critique the term “harm reduction” due to its negative connotations with drug use outcomes. That stated, the evidence strongly suggests that drug decriminalization or legalization would both permit drug use for pleasure and improve the public health outcomes associated with problematic drug use. In the throes of a significant heroin drug crisis two decades ago, Portugal decriminalized simple drug possession and replaced its criminal justice approach with evidence-based public health treatment interventions. Twenty years later, Portugal’s drug overdose rate is five times lower than the European Union average and one-fiftieth of that of the United States. Equally impressive is that fact that Portugal’s drug use rate has declined among 15-to-24-year-olds, which is the population most at risk of initiating drug use.

It is important to close by noting the significant risks that Dr. Hart undertook by coming out in Drug Use for Grown-Ups. Individuals who admit to illicit drug use in the United States face a panoply of potential punitive repercussions including arrest and imprisonment, loss of custody of a child, professional licensure discipline, and even research funding exclusion. As a prolific neuropsychopharmacology expert and tenured drug researcher at a prestigious Ivy League university, Dr. Hart may be viewed as imbued with the privilege necessary to withstand the professional and legal blowback he is likely to receive in response to his candor. Because Dr. Hart is a Black man with dreadlocks living in America, it strikes me as more appropriate under the circumstances that we characterize him as a profile in courage rather than one in privilege.

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Cite as: Jennifer Oliva, Coming Out of the Drug-Use Closet, JOTWELL (October 12, 2021) (reviewing Carl L. Hart, Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear (2021)),