Carl Hart's Challenge Against the Drug Assumption

by Rachel Kosciusko

On February 12, 2014, a crowded line assembled outside of the lobby of Western Psychiatric Institute and Clinic as a mixture of students, professors, psychologists, and neuroscientists passed through security. All were waiting to hear the controversial yet inspiring words of the first African American male to get his Ph.D. in neuroscience: Carl Hart. His presentation, “Challenging the Assumptions of Drugs,” argues that the drug war propaganda our society has created exaggerates the pathology associated with drug use.

Hart begins his argument in the year 1912, when Edward Huntington Williams, M.D., wrote The New York Times article “Negro Cocaine Fiends are a New Southern Menace” This article reported that Southern sheriffs had increased the caliber of their weapons from .32 to .38 to bring down dangerous “Negroes” under the effects of cocaine. Williams’ writings demonstrate Hart's claim: there is a historical link between drug abuse and racism, an unfortunate reality that continues to be a cultural barrier today.

In support of this claim, Hart points out how the difference in law enforcement regulation between powder cocaine and crack cocaine leads to a skewed percentage of African American arrests. In fact, a 100:1 weight ratio for possession of crack versus powder cocaine was enforced in the United States in 1986, meaning that while a person found in possession of five grams of crack cocaine would face a five year minimum prison sentence, a person holding powder cocaine would only receive the same sentence if found holding 500 grams.

Because powder cocaine is generally preferred by wealthier, usually white consumers, this disparity led to a significant racial bias in drug arrests. In fact, a study conducted after the enforcement of this legislature reported that the national drug arrest rate among African Americans was over four times the drug arrest rate of whites. Furthermore, four years after the law was enacted, the average sentence for possession of cocaine was 93 percent higher for African Americans compared to the white population.

Considering these statistics, it is important to note that from a pharmacological perspective, there is actually little difference between the molecular structure of powder cocaine and crack cocaine. Powder cocaine simply has a hydrochloric acid component that turns the substance into a salt and gives powder cocaine its fine texture. Yet, despite this knowledge, the current sentencing ratio by weight today, enforced by President Obama’s Fair Sentencing Act, remains 18:1. The Fair Sentencing Act was only recently approved by Congress in 2010, eliminating the five-year minimum on sentencing for possession of crack cocaine.

Through Hart's extensive research concerning methamphetamine, he also challenges common beliefs held by law enforcement and government officials that methamphetamine (m-AMPH) has a unique pharmacological profile and results in severe cognitive impairment. Methamphetamine is actually very structurally similar to dextroamphetamine (d-AMPH), a drug authorized to help increase focus within US military aircrews. Interestingly, the only molecular difference between m-AMPH and d-AMPH is one extra methyl group in m-AMPH, which makes it more lipid-soluble, thereby allowing it better access across the blood brain barrier.

Hart's 2012 article published in Neuropsychopharmacology provides data suggesting that short-term use of m-AMPH actually improves select forms of cognitive functioning, including visuospatial perception, attention, and inhibition. The paper also questions much of the current literature that documents a 10-20 percent decrease in brain activity, which has been previously associated with long-term m-AMPH use. Hart and his colleagues argue that the vast majority of these comparative PET brain-imaging studies select long term m-AMPH users as participants who are generally older and less educated than the control group they are compared against, which usually consists mainly of college graduates. Seeing more brain activity and cognitive functioning in a control group that has a higher overall level of education is no surprise, and does not scientifically prove that long term use of m-AMPH leads to a concerning decrease in brain function.

”Don’t believe the hype,” says Hart. While there is always potential for abuse, these misconceived notions stigmatize drug users and lead to ill-advised policy making. Hart asserts that one of his main motivations to conduct this study was to refute the idea that long-term m-AMPH users could not benefit from cognitive behavioral therapy. This is an effective treatment paradigm that helps patients recognize the damaging thoughts that point them toward destructive behavior. Hart hopes to see his research have further influence in decriminalizing drug use. With one-and-a-half million arrests for drug use each year, we damper the likelihood of these same number of individuals finding a steady job and paying taxes. Moreover, Hart argues that stigmatized drug use leads to skewed public health outreach. With a majority of public health funding going toward the war on drugs, there is not enough focus on how to actually avoid the likely causes of overdose mortality. For example, many heroin-related deaths result from mixing the drug with a depressant, such as alcohol or Xanax.

Many of us grew up with the D.A.R.E. program, viewing commercials and billboards about the toxic effects of drugs. But through this process, could we be missing a whole other host of underlying issues? It will be up to future clinicians and researchers to improve this intriguing yet disturbing sector of health care, where the fields of neuroscience and social justice intersect.