01/26/14 Carl Hart

Dr. Carl Hart, author of High Price: A Neuroscientist's Journey of Self-Discovery 2/2 + Doug McVay re decrease is US prison population

Program: 
Century of Lies
Date: 
Sunday, January 26, 2014
Guest: 
Carl Hart
Organization: 
Scientist
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Century of Lies January 26, 2014

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DEAN BECKER: The failure of Drug War is glaringly obvious to judges, cops, wardens, prosecutors and millions more. Now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century of Lies.

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DEAN BECKER: Hello, my friends. Welcome to this edition of Century of Lies. Today we are doing something new. We are carrying part 2 of a speech given last week up in Dallas at the Texas Drug Policy Conference. It’s from Dr. Carl Hart. You’ve seen him on TV many, many times over the last few months. He’s written a great book “High Price: A Neuroscientist's Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society.” Again, this is Dr. Carl Hart.

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CARL HART: What are the long-term effects of using methamphetamine for year? That was a question I had. I wanted to know what were the long-term effects on the brains of methamphetamine users.

One year and one-half ago I published a paper that systematically reviewed all of the literature that had been reported, the brain imaging literature that had been reported on methamphetamine brain imaging cognition. What you find consistently with the brain imaging data...actually, I should take a step back and explain the brain imaging quickly.

There are multiple types of brain imaging. MRI gives you a picture of various structures in the brain. It only tells you about structure. It doesn’t tell you anything about those structures are functioning. FMRI tells you a little something about functioning because you can see where the blood flow, where the areas are active in certain regions of the brain.

PET, which is another popular one...PET is a technique which we inject radioactive compounds into the brain. You can inject radioactive compounds into the brain to see, for example, the integrity of certain types of cells.

So you inject this compound into the brain and it binds to certain types of dopamine cells and it lights up and you can see a nice pretty picture. If those cells are not there you don’t get an area lighting up so you infer that there may have been some damage.

So when we think of all those types of imaging for methamphetamine the only one that has consistent finding is the PET imaging so I’m going to talk about the PET imaging data because in FRMI data there is no consistent finding. Researchers who have done multiple studies can’t even replicate their own findings when they do FRMI. Replication, of course, is the hallmark of science. If you don’t replicate your findings it’s probably not real.

When we look at PET imaging if you focus your attention on the circles here these are the controls. If you focus your attention on the triangle those are the methamphetamine users. These are various regions in the mid-brain. These are dopamine rich regions.

The bottom line here is that the methamphetamine users have lower binding potential in this region of certain cells, mainly dopamine cells – about a 10 to 20% difference is what we see in binding. One can infer that, perhaps, years of methamphetamine use caused this lower level of bindings. They can further infer that maybe methamphetamine killed off some cells here but that would be a leap. But that’s OK. They certainly couch it in a way or frame it in a way where people can’t be completely inaccurate but it’s an inference.

What’s important for us to note here is that each of these sort of symbols represents a methamphetamine user or a control. It’s important to note that the methamphetamine users, in many cases, look like the control. But there are a few that don’t and that’s kind of driving the mean. Nonetheless there have been several studies that have reported a 10 to 20% lower binding potential in methamphetamine users in this region.

So the question becomes what does it mean? What does it mean for functioning? An important function for brain activity is cognitive function so the question is did those studies do cognitive testing. Some of them did and what were the results of the cognitive testing?

Whenever you try to determine whether someone is cognitively impaired you must compare the score of the participant with the score of a normative database – a normative database that takes into account that person’s age and educational level. Typically in the literature this is not done. Typically in the methamphetamine literature what is done is that methamphetamine users who have a 12th grade education, for example, are compared with college graduates on cognitive tasks. Who do you think will outperform who?

If the college graduates don’t outperform the methamphetamine users they should probably get their money back, right?

Even though the literature is replete with these sorts of inappropriate methodologies – despite that – only one study in the literature has recorded impairments when it’s done correctly. That study recorded that 7 of 27 methamphetamine users were impaired compared to 2 of the 18 controls. This study was published in 2003 and has yet to be replicated.

The bottom line is when you look at the literature carefully the methamphetamine participants are not performing outside of the normal range. That’s the bottom line when you look at the literature carefully.

To summarize, we look at data from the human lab like I do when I give these drugs to people in the lab methamphetamine improves performance. When you look at the PET imaging data you get this 10 to 20% difference. Don’t know what it means. You have this tremendous amount of overlap but when you look at cognitive functioning these folks perform just like the normal range, just like they would be expected to perform.

That’s the state of the literature. Now I want to make sure that I don’t leave you all downplaying the sort of potential for harm of any drug of abuse. I don’t want to do that because there are some real potential consequences of methamphetamine abuse. One of the things that methamphetamine does quite well is that it disrupts sleep. People take the drug in part to stay awake.

So if you were taking methamphetamine regularly near a sleep time and you’re disrupting sleep - sleep disruption, for example, has been associated with psychiatric illness, physical illness. It’s a horrible thing.

So you could see some troubling effects if people are sleeping and those effects are related to sleep – not so much the drug but the drug certainly can cause this. So that’s important for us to know. There are also other types of psychosocial functioning that happens to methamphetamine use as well as other drugs of abuse.

I don’t downplay that. I want us to understand that I understand that. My point here is that we have exaggerated the extent of harm associated with methamphetamine. When we do that there are some important implications to that exaggeration. When we think about the implications in science...when we go in as scientists with this sort of perspective we know what we are going to find and we find it. It decreases the likelihood of us discovering what really is happening.

When we think about treatment from this perspective what are the implications for treatment? Arguably one of the most effective treatment techniques in substance abuse is cognitive behavioral therapy. Many people have said that methamphetamine users are cognitively impaired so, therefor, they should get that treatment because they would benefit from it. There is no evidence to support that. That’s an important implication.

When we think about the public policy implications think about this. Thailand back in 1996 were so troubled by methamphetamine they decided to ban all amphetamines – Adderall, everything for Attention Deficit Disorder, for obesity, for narcolepsy – these drugs work well for that but Thailand banned them all because of this hysteria. Some of you may know that later they decided to just take their drug users out and shoot them. Some of you may know that story.

In the United States when we think about the public policy implications we have to think about the numbers of people that we have in jail. We now have over 2 million people in jail and about 7.2 million who are under criminal justice supervision, parole and those sorts of things. When we think about the thing that has really driven that it’s clear that our sort of assumptions about drugs and how awful drugs are and us needing to do something about drugs has really driven this increase in our prison population.

We have 5% of the world’s population and 25% of the prison population. Some of us are embarrassed by that and concerned by that but what when we really start to go inside of the numbers of the hyper-incarceration we start to see that hyper-incarceration is not evenly distributed throughout our society. This impact has been even more dramatic on black males.

For example, 1 in 8 between the ages of 20 and 29 are now in prison or jail. You can see the comparison groups – Hispanics 1 in 26 which is not good, white is 1 in 63. Today 1 in 3 black males born will spend some time in prison. That’s one-third. That is a major social justice issue as some of us have been saying.

Then when we think about black males, in general, in the U.S. population we make up about 6% of the population but 35% of the U.S. incarcerated population. When you start to see all of these numbers as a thoughtful person in the academy you can’t help but be reminded of the words of James Baldwin when he said, “To be negro in this country and to be relatively conscious is to be in a rage almost all the time.”

We have to...I have to do a number on myself in terms of tapping that shit out. I really do because I think about all of the good people in this room and I think about it’s you all that do that but can you imagine walking around knowing what’s going on? It’s a hell of a number that I have to do on myself every day.

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DEAN BECKER: Alright, my friends, you are listening to Century of Lies on the Drug Truth Network. This is part 2 of a speech given last week in Dallas at the Texas Drug Policy Conference by Dr. Carl Hart. He is the author of “High Price.” You can hear part 1 of this discussion on this week’s Cultural Baggage.

Again, Dr. Carl Hart.

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CARL HART: It also makes me think about my role because if I’m going to look at you I have to look at myself. I have to look at myself because I have to tell you I have participated in this, too, so I have to look in the mirror. In my role as a scientist I’ve certainly participated in this.

In order for you to understand how I participated I have to take a step back. 100 surgeons are funded by the National Institute on Drug Abuse. Its mission is to look at primarily the negative effects associated with drugs so we look at drugs from this narrow sort of perspective and I have done that all of my career.

That’s a fine mission for the National Institute on Drug Abuse. There is nothing wrong with their mission. It’s just that we need to make sure that we understand that mission and have other organizations support a broader sort of mission but what we do at the National Institute on Drug Abuse - or we who are funded by them – is analogous to someone who loses their key at night.

When you lose your key at night you are more likely to look under the spotlight – not because the keys are there but because the light is there. Right now the spotlight is on meth ology. Almost exclusively when you talk about drug effects from a scientific perspective it’s negative even though we know that methamphetamine is outstanding for producing euphoria. It’s actually being used to treat some forms [audio cut out]

If you’ve ever taken methamphetamine your friends probably like you better – that was a joke.

We know, for example, there are drugs (marijuana) with potential benefits and we have been ignoring those types of things for years in part because of this mission. It’s like Upton Sinclair had said, “It’s simple to get a man to understand something when his salary depends on him not understanding it.”

This is me pointing the finger at myself. This fact coupled with the fact that scientists tend to err on the side of caution. When I say caution - caution for scientists means the bad effects as if there are no consequences on erring on the side of caution when, in fact, there are. There are tremendous consequences - the consequences that I kind of described.

In reality when we tend to err on the side of caution we help to this environment in which certain drugs are deemed “evil” or pathological. We have this sort of unrealistic focus on eliminating these drugs at all cost. This is the environment that I participated in creating. We communicate this information to law enforcement officials. We communicate this information to newspaper folks, the press and we wonder why they are so ignorant because we have done it. We have participated in it.

How do you remedy ignorance? With education, right?

When I think about one of the solutions one of the solutions is what I’m trying to do with the book “High Price.” I’m trying to teach people about the realistic effects of drugs. We think about Colorado, Washington, other places and marijuana. If we are worried about young people using marijuana, if we worried about the harms of using marijuana why not teach people how to do it right just like we do with driving.

For example, in the 1960s we had less automobiles on the road than we do now. We had far more accidents but we got smart, we instituted a few things – speed limits, seatbelts, airbags. The rate of accidents and accident-related injuries has dramatically dropped. We teach people how to drive safely. You certainly can die in an automobile but nobody is talking about a war on automobiles are they?

We can do the same thing with marijuana. The major sort of problem with marijuana is that experienced users might get real paranoid if they smoke too much. OK, let’s make sure people don’t use too much. You make sure that they know how to do it.

The major problem with methamphetamine...I worry about people and sleep disruption. I worry about them not eating. You make sure that you have culture norms around that. You teach people how to do it right. If you take care of people’s eating and sleeping with methamphetamine your problems go away.

Cocaine – similar sort of thing but with cocaine the effects don’t last as long so you don’t have to worry about the sleep disruptions as much. The major thing there is the route – the intranasal route. You may need to introduce a better route for cocaine. Cocaine might be an ideal drug if you want to stimulate an effect and you want to get some sleep after the party. All of these are the kinds of things we need to be aware of.

Heroin – the big thing is overdose. Just make sure people don’t use it in combination with alcohol since 75% of the people who die from heroin overdose do so because of the alcohol combination.

There are some things that we can do to teach people how to use these things safely and make sure our society is safe but we have been irresponsible and disingenuous about this.

So, with that, I will leave you with my take home message. Many assumptions about methamphetamine are simply not supported by evidence from research but what methamphetamine does nicely is it shows a nation how to launch a worldwide drug menace. If you want to know how to do that just follow the methamphetamine story right now. It was crack-cocaine in the 80s but now it’s methamphetamine.

One thing we have to be cognoscenti of as well is our current knowledge about methamphetamine as well as some of these other drugs is incomplete. We don’t know everything about it. We may learn new information but we still have to act in terms of education, treatment policy. We make some mistakes. It’s not a crime to make mistakes. We are making mistakes now.

But it is a crime to make mistakes and get new information, better information and not alter your course. That’s a crime but it’s not a crime to make a mistake.

Finally I want to leave you with this. Use your common sense because many times people will tell you incredible stories about drugs. If something seems incredible – when I say incredible I mean unbelievable – it probably is. It’s probably not true – especially when it comes to drugs.

Thank you for your time.

[audience applauds]

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DEAN BECKER: Once again that was Dr. Carl Hart speaking at last week’s Texas Drug Policy Conference. He’s author of “High Price: A Neuroscientist's Journey of
Self-Discovery That Challenges Everything You Know About Drugs and Society.”

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[ guitar ]

If they stop Afghanistan from growing opium
And they cut down the Colombian cocaine
When Mexico runs out of marijuana
They think we’ll quit getting high.
But the drug store on the corner is standing by.

Cut me loose, set me free
Judge what I do not what I put inside of me
Why do you dip in my pocket?
Just let me light my rocket
Who died and made you the boss of me?
Get out of my life – let me be.

Pfizer and Merck kill more of us
Than cartel’s crap ever could.
They thank us for our silence
Each year’s hundred billion dollars
And a chance to do it for ever more.

Drugs…the first eternal war.

Cut me loose, set me free
Judge what I do not what I put inside of me
Why do you dip in my pocket?
Just let me light my rocket
Who died and made you the boss of me?
Get out of my life – let me be.

Are we just peasants in the field
Let’s stand for truth or forever kneel
Every 16 seconds we hear the slamming door
And we owe it all to eternal war.

The first eternal war.

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DOUG McVAY: A new report by the federal Bureau of Justice Statistics released at the
very end of 2013 shows that the US criminal justice system may be evolving,
hopefully in a good way. The report Prisoners in 2012: Trends in Admissions
and Releases 1991-2012 shows that we may have finally stopped the steady
increase in incarceration.

According to the report, the population in state and federal prison
facilities of prisoners sentenced to terms of one year or more in 2012 was
1,511,480. It's important to remember also that these numbers don't include
any jail inmates, jails are counted separately.

The numbers for 2012 are high, yet some are hopeful that they show a trend:
In 2011, there were 1,538,847 prisoners sentenced to a year or more held in
state or federal prisons. The peak which we reached in 2009 was 1,553,574
prisoners sentenced to a year or more. And really, I'm hopeful too. Just
that it's hard to be overjoyed about a three-year dip in prison figures
when, as this report shows, we saw steady growth from 1978 through 2009. As
it is, we still have more people behind bars than we did in 2006. The
combined state and federal prison population, again the inmates sentenced
to one year or more, was 1,504,598 that year.

In 1981 – the year I graduated from high school, also the year Ronald
Reagan ascended to the presidency – we imprisoned 353,673 people in state
and federal prisons. To be precise, the federal system housed 19,765
sentenced prisoners that year, of whom 25.6 percent – or 5,076 people –
were drug offenders. I don't have the state data for that year, I do know
that in 1980, state prisons held 295,819 sentenced prisoners, of whom
19,000 – that's 6.4 percent – were serving time for drug offenses.

By 1990, federal prisons had grown to hold 56,989 sentenced inmates, of
whom 30,470 – 53.5 percent – were serving time for drug offenses. State
prisons that year held 684,544 sentenced inmates, of whom 148,600 – or 21.7
percent – were drug offenders.

By 2009 – the peak year for prison populations – our federal prisons held
187,886 sentenced inmates, of whom 95,205 were serving time for drug
offenses. That's 50.6 percent of the total. State prisons held 1,365,800
sentenced inmates that year, of whom 242,900 – or 17.8 percent – were
serving time for drug offenses.

We only have offense data on state prisoners as of 2011, however we have
more specific data for that year than we've had in quite some time, so we
know that state prisons in 2011 held a total of 1,341,797 sentenced
inmates, of whom 222,738, or 16.6 percent, are serving time for drug
offenses. Further, we know that in 2011, inmates whose most serious offense
was drug possession represented 4.1 percent of all sentenced prisoners,
that's 55,014 people behind bars for the simple crime of possessing a
controlled substance, of being a drug user.

So there may be some good news in criminal justice yet we still have to
keep up the pressure for reform. And as we celebrate the first state-legal
marijuana sales in the US, we need to pause and reflect on the millions of
people still targeted by the drug war. Prohibition is failing, it's a
counterproductive system, even with drugs we don't personally enjoy.

For the Drug Truth Network, this is Doug McVay with Common Sense for Drug
Policy and Drug War Facts.

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[music]

Corruption is our king – it gives us everything.
It’s our way. It’s our truth and it’s alright.

It’s the “silver or the lead” – take the money or you’re dead.
Nobody knows what’s wrong or right.

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[howling winds]

The winds of prohibition howl
As the irrational maelstrom blows.
Pipe-dreaming warriors raise their eternal chant
Dancing for rain in the eye of a ‘drug war’ hurricane.

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DEAN BECKER: That’s about it for today. I hope you’ve enjoyed this 2 parter with Dr. Carl Hart, the author of “High Price.” Be sure to check out part 1 on this week’s Cultural Baggage show. Part 2 was here on Century of Lies.

I want to thank him. I want to thank Doug McVay for his fine reporting and I want to thank you for listening. I want to encourage you to open your eyes. Take another look at this drug war and see if there isn’t something you can do to help bring it to an end.

As always, I remind you this drug war is a scam.

Prohibido istac evilesco!

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For the Drug Truth Network, this is Dean Becker asking you to examine our policy of Drug Prohibition.

The Century of Lies.

This show produced at Pacifica Studios at KPFT, Houston.

Transcript provided by: Jo-D Harrison of www.DrugSense.org