You cannot know what you will discover on the journey, what you will do with what you find, or what you find will do to you.
James Baldwin
On October 4, 2019, I gave a keynote address in Tulsa, Oklahoma, at the Zarrow Mental Health Symposium. It was my first visit to the state. The room was packed with an audience of more than five hundred mental-health professionals and clients. They’d come to hear me give a lecture titled “Drug Talk for Grown-Ups.” I didn’t know what to expect, especially from this crowd. How would they respond when they realized I wasn’t there to scapegoat drugs? How would they respond to my conclusion that recreational drugs should be legally regulated and available for adult use?
I began by explaining that my career had taken me on an intellectual and geographical journey. I had conducted dozens of laboratory studies investigating the behavioral and neurobiological effects of psychoactive drugs and communicated my findings in respected scientific journals. I had traveled from New York City to Accra, Ghana; to Salvador, Brazil; to Nassau, Bahamas; to Edmonton, Canada; to Chiang Mai, Thailand; to Tel Aviv, Israel; to Oslo, Norway. In fact, I had spent time on five continents and in innumerable locales within each as part of my research and continuing education. It had been one hell of a journey.
I discovered that the predominant effects produced by the drugs discussed in this book are positive. It didn’t matter whether the drug in question was cannabis, cocaine, heroin, methamphetamine, or psilocybin. Overwhelmingly, consumers expressed feeling more altruistic, empathetic, euphoric, focused, grateful, and tranquil. They also experienced enhanced social interactions, a greater sense of purpose and meaning, and increased sexual intimacy and performance. This constellation of findings challenged my original beliefs about drugs and their effects. I had been indoctrinated to be biased toward the negative effects of drug use. But over the past two-plus decades, I had gained a deeper, more nuanced understanding.
Sure, negative effects were also possible outcomes. But they represented a minority of effects; they were predictable and readily mitigated. For example, the type of drug use described in this book should be limited to healthy, responsible adults. These individuals fulfill their responsibilities as citizens, parents, partners, and professionals. They eat healthy, exercise regularly, and get sufficient amounts of sleep. They take steps to alleviate chronic excessive stress levels. These practices ensure physical fitness and considerably reduce the likelihood of experiencing adverse effects. Equally important, I learned that people undergoing acute crises and those afflicted with psychiatric illnesses should probably avoid drug use because they may be at greater risk of experiencing unwanted effects.
The vast amount of predictably favorable drug effects intrigued me, so much so that I expanded my own drug use to take advantage of the wide array of beneficial outcomes specific drugs can offer. To put this in personal terms, my position as department chairman (from 2016 to 2019) was far more detrimental to my health than my drug use ever was. Frequently, the demands of the job led to irregular exercise and poor eating and sleeping habits, which contributed to pathological stress levels. This wasn’t good for my mental or physical health. My drug use, however, has never been as disruptive or as problematic. It has, in fact, been largely protective against the negative health consequences of negotiating pathology-producing environments.
I am not alone. A large number of people use government-prohibited substances for similar reasons. In the United States, a recent nationwide survey revealed that thirty-two million Americans had used at least one such drug in the past month.1 Contrary to popular media portrayals, most drug users are not addicts. They are responsible members of their communities. They pay their bills and taxes on time; they take care of their families; and they volunteer in their local and global communities. They are artists, engineers, firemen, homemakers, judges, lawyers, pastors, physicians, politicians, professors, schoolteachers, scientists, social workers, truck drivers, writers, and many other types of professionals.
But most go to great lengths to conceal their drug use, frequently living double lives. The toll this takes on an individual, of course, can vary widely, depending upon personal attributes and societal norms. Some people experience tremendous anguish due to their duplicity, while others assuage their guilt with self-satisfying rationalizations.
Regardless, it’s not difficult to understand why so many people remain in the closet about their drug use. For the past hundred-plus years, communities around the world have been inundated with information that almost exclusively emphasizes the harmful, even deadly, effects produced by nearly all the drugs discussed here. Drug users are routinely vilified and imprisoned, and sometimes killed, for merely being identified as such. Even when respected, sober-minded experts raise doubt about the veracity of drug-blaming and exaggerated claims, efforts to ban the targeted drug and to excoriate specific users and sellers proceed with little fruitful resistance.
In the late nineteenth century, alcohol and drinkers were the targets in the United States. It was asserted that the drug “takes the kind, loving husband and father, smothers every spark of love in his bosom, and transforms him into a heartless wretch, and makes him steal the shoes from his starving babe’s feet to find the price for a glass of liquor. It takes your sweet innocent daughter, robs her of her virtue and transforms her into a brazen, wanton harlot.”2 These negative narratives became so plentiful that Congress was persuaded to amend the Constitution, banning the manufacture, sale, or transportation of alcoholic beverages. The Eighteenth Amendment took effect on January 17, 1920. It would take almost a decade and a half—and the belief that alcohol-tax revenue would lower income taxes—before reason prevailed. On December 5, 1933, the Twenty-First Amendment repealed the Eighteenth Amendment, making it the only one ever to be repealed.
Today, one hundred years later, nearly identical bankrupt arguments are hawked to support bans on other drugs in several countries, the United States included. Judging from the dominant response to the current North American opioid situation—increased restrictions placed on the legal availability of these drugs—little has been learned from the alcohol-prohibition experience. As had occurred during the prohibition era, loads of people still consume so-called banned drugs, including opioids, cocaine, and psychedelics. Many of these people are forced to obtain their drugs of choice from illicit, unregulated markets, where there aren’t any quality controls. Thus, just as during Prohibition, thousands of people have died from ingesting drugs contaminated with poisons, impurities, and other unknown substances.
Alcohol tainted with large amounts of methanol killed thousands of drinkers and left many others blind during Prohibition. As Deborah Blum masterfully explains in her authoritative work, The Poisoner’s Handbook, the U.S. government callously caused many of these deaths.3 Even before Prohibition, as early as 1906, federal officials required producers of industrial alcohol—used in antiseptics, medicines, and solvents—to add methanol and other chemicals to their batches so their products would be undrinkable. This policy was implemented to deal with manufacturers who sought to avoid paying taxes on potable alcohol. The Prohibition era brought with it sophisticated traffickers who obtained industrial alcohol, redistilled it to be quaffable, and sold it to the public and speakeasies. Government authorities were not pleased. Alcohol had been banned, but people continued to imbibe.
By the mid 1920s, the feds were fed up. They ordered industrial alcohol makers to add even more methanol—up to 10 percent—to their products, which proved to be particularly lethal. Illicit dealers were caught off guard, and redistilling industrial alcohol required much more effort. Most individuals, certainly most drinkers, were unaware of these developments. People continued to drink, and the alcohol-poisoning death toll continued to climb. By the time Prohibition ended, hundreds of thousands of people had been maimed or killed due to drinking tainted alcohol. An estimated ten thousand of these individuals died as a result of the government alcohol-poisoning program. Neither accumulating deaths nor public outcry compelled the government to change its deadly alcohol-poisoning policy. This war-on-alcohol tactic remained in effect until Prohibition was repealed.
Thinking about these events, I can’t help but see the hypocrisy of our current approach that allows the government to prosecute as a murderer anyone who provided the drug to a fatal-overdose victim. The fact of the matter is that many dealers, especially the low-level ones, don’t know the complete composition of the substances they sell. It is true that some drugs sold by these individuals may contain harmful adulterants. But unlike Prohibition authorities, their intent certainly isn’t to kill or harm consumers. If our current government—or any government—were genuinely concerned about the health and safety of drug users, it would ensure that free, anonymous drug-safety testing services were widely available. This practical approach informs users of the contents of their substances and decreases the likelihood of people ingesting fatal amounts of unknown substances.4
The parallels between the government-mandated methanol-poisoning policy and the current practice of combining an opioid with acetaminophen in a single pill are frightening. Several pharmaceutical companies offer such FDA-approved products. The pain medication Percocet, for example, contains a low dose of the opioid oxycodone and a much larger amount of acetaminophen. It is claimed that such formulations provide complementary, more effective pain relief than does the opioid alone. Even if this is true, which I do not concede, the risk-to-benefit ratio is simply not favorable when one considers the potential lethality and toxicity of acetaminophen. Acetaminophen-induced liver toxicity is the most common cause of acute liver failure, which can be fatal. Approximately 6 to 10 g of acetaminophen taken for two consecutive days is enough to cause liver damage.5
The typical prescribed dose of Percocet contains 325 mg of acetaminophen and only 5 mg of oxycodone. That means twenty pills per day taken for multiple days can yield enough acetaminophen to produce liver toxicity. The same number of pills, however, only provides a relatively small amount of oxycodone (100 mg) for the experienced opioid user. Many consumers of opioid pain relievers don’t even know that these medications often contain acetaminophen.6 For me, the solution is simple: remove acetaminophen from opioid pain formulations. The risks far outweigh the benefits.
I have also observed that the enforcement of drug laws, regardless of the country, is frequently carried out in a selective manner. Individuals from despised and marginalized groups are disproportionately targeted, arrested, and imprisoned for drug-law violations, even though recreational drug use is common in every strata of society. Overwhelmingly, the targeted are resource-poor people, and their ability to obtain appropriate legal representation is practically nonexistent. To add insult to injury, moralists and others reflexively blame drugs for poor people’s problems, including poverty. This ill-conceived logic ignores the fact that most drug users are not poor and many have ample disposable income. Think about it. Drug trafficking is a multibillion-dollar industry. “Poor people alone can’t sustain the operating budgets of drug cartels,” my friend Raphael once said. We were discussing the Gordian knot that is Brazilian drug-war politics, on a temperate evening in his upscale Rio de Janeiro neighborhood. We were also enjoying some of Brazil’s finest cocaine.
These observations forced me to take a long, uncomfortable look in the mirror. I had to acknowledge my own drug use. Like so many other privileged people, I had spent years hiding in the closet. Unlike the underprivileged, I wasn’t subjected to humiliation, persecution, and death simply for being identified as a user. Perhaps I was protected because I remained in the closet? I don’t know. What I do know, however, is that my conscience will no longer allow me to remain silent about my drug use, nor can I remain silent about the absurdity of punishing people for what they put into their own bodies. How could I? To this day, countless people are subjected to harsh punishments for using drugs. What kind of man would I be if I didn’t publicly voice solidarity with these individuals? I’d be a hypocrite and a coward. I should know because I had been living as such for many years. I refuse to do so any longer.
I have been profoundly changed by my journey. I rediscovered the Declaration of Independence and the noble ideals expressed in it. It guarantees each of us “certain unalienable Rights,” including “Life, Liberty and the pursuit of Happiness,” so long as we don’t infringe upon the rights of others. Simply put, it is my birthright to use substances in my pursuit of happiness. The point is that whether I use a drug or not is my decision; it is not the government’s decision. Further, my responsible drug use should not be subjected to punishment by authorities. These ideas are central to our notions of liberty and personal freedom. The current punitive approach to dealing with recreational drug users is wholly un-American.
And it highlights the fact that our nation doesn’t always live up to its virtuous ideals. This was particularly apparent during the slavery era. Numerous American heroes—such as Harriet Tubman, Nat Turner, and Henry David Thoreau—led rebellious acts to reconcile the government’s actions with the country’s promise of liberty for all its citizens. People such as Fannie Lou Hamer and Martin Luther King Jr. frequently quoted the Declaration in their efforts to eradicate racism. King said, in his I Have a Dream speech, “that all men, yes, black men as well as white men, would be guaranteed the unalienable rights of life, liberty, and the pursuit of happiness.”
Yes, I know that reminding the nation of its promise, its foundational principles, has yet to create a perfect society—that would be a tall order—but by doing so, it can provide clear direction toward the ideals we should seek to achieve. I hope this book clearly shows that government bans on recreational drugs violate the spirit and promise of the nation’s founding document.
The drugs described in this book should be regulated and legally available for adult consumption. We have already taken this approach with alcohol, tobacco, and, more recently, in a handful of states, with marijuana. The benefits are numerous. For starters, the legal availability of drugs fulfills the Declaration’s promise of allowing responsible adults to pursue happiness as they see fit. In addition, a legally regulated drug scheme would create numerous jobs and generate hundreds of millions of dollars in annual tax revenue. Also, such a scheme would markedly reduce drug-related deaths caused by accidental overdoses. A large proportion of these deaths are caused by adulterated substances purchased on the illicit market. A regulated market, with uniform quality standards, would virtually put an end to contaminated drug consumption and greatly reduce fatal, accidental drug overdoses.
“You are badass!” was the first comment I heard when I finished speaking to the Tulsa audience. A woman in her forties gleefully stood at the microphone when the floor opened for questions. She said that she shared my perspective but had previously remained silent because she feared she would be ridiculed. Other enthusiastic questioners expressed similar sentiments. Some wanted to know specific steps that could be taken in order to facilitate regulatory schemes that would permit adult drug use.
My responses were similar to many of the points I have emphasized within these pages. I reiterated the importance of requiring people to back up their claims about drugs with credible evidence. Too often anecdote alone and misinterpretation of data drive the unrealistic and inaccurate drug stories presented to the public. For example, despite the fact that there are practically no data indicating that recreational drug use causes a brain disease, many people, including some drug scientists, believe otherwise. But beliefs alone are insufficient to guide drug-education efforts and evidence-based health policies.
I also recommended that respectable middle-class drug users stop concealing their use. If more people followed this advice, it would be extremely difficult to pigeonhole all users as only irresponsible, troubled members of our society. I explained that my perspective had been heavily influence by King’s Letter from Birmingham Jail, in which he made a compelling case for disobeying unjust laws.7 I urged them to get out of the closet and to blatantly disregard laws that prohibit adult drug use, because such laws are ruthlessly unjust. I explained that I hope my writings and speeches inspire massive civil disobedience among the privileged class. I told them that they should stage mass protests whenever police tout “drug-crazed” myths to justify their excessive force.
Finally, I said that we have allowed our nation to build a huge law-enforcement apparatus in a misguided war-on-drugs effort. A Herculean task would be required to dismantle it, not to mention the loss of jobs for millions. So, instead, I suggested that we advocate for retraining and redirecting the efforts of this antidrug bureaucracy. Police don’t receive any training in behavioral pharmacology. Yet we often require them to deal with drug-related issues and educate the public about what drugs do and don’t do. Teaching police some basic information—such as that there are no drugs that create superhuman strength and that the effects of drugs are determined by the interaction between a user and her environment—would go a long way in dispelling the drug myths they often perpetuate. Moreover, the first priority of law enforcement should be to keep users safe, not to arrest them.
If the ideas expressed in this book are embraced, we can get on with the business of treating each other better and enjoying more meaningful and fulfilling lives. And isn’t that what we all want?