Drug Epidemics: Things You Need to Know Prof. Carl L. Hart Columbia University drcarlhart.com
10 MA vs. $20 Choice (max =10) 8 6 4 2 drug users can and do behave rationally 0 Drug Money Reinforcer
Things You Need to Know: Drugs neither good nor bad Car analogy
Things You Need to Know: Drugs neither good nor bad Public bombarded with lurid misinformation calculated to terrify Heroin:» use has reached epidemic proportions
Sudden increase in the number of heroin users
We might expect heroin use to look similarly Hypothetical Heroin Use 2000 2003 2006 2009 2012 2017 Time (Years)
Past Year Initiates of Specific Illicit Drugs among Persons Aged 12 or Older: 2015 Marijuana Pain relivers 2.6 million 2.1 million Cocaine 968,000 MDMA 839,000 LSD 664,000 Methamphetamine 225,000 Heroin 135,000 SAMHSA (2016). Results from the 2015 National Survey on Drug Use and Health
Past Month & Year Heroin Use among Persons Aged 12 or Older Numbers in Thousands) 2002 2006 2012 2013 2014 2015 Past year 404 560 669 681 914 (0.3) 828 (0.3) Past 30 days 166 339 335 289 435 (0.2) 329 (0.1)
Use of Specific Illicit Drugs among Persons Aged 12 or Older: 2015 Past Yr Past 30 days Marijuana 36 million 22 million Cocaine 4.8 million 1.8 million Pain Reliever 12.1 million 3.7 million Heroin 828,000 329,000 SAMHSA (2016). Results from the 2015 National Survey on Drug Use and Health
Heroin use has not reached epidemic proportions Exaggerating the extent of heroin use Who benefits? Who loses?
Things You Need to Know: Drugs neither good nor bad Public bombarded with lurid misinformation calculated to terrify Heroin:» use has reached epidemic proportions» addiction after one hit and your life is ruined
Most heroin users do not become addicted Less than a quarter of heroin users will become addicted
Most heroin users do not become addicted Less than a quarter of heroin users will become addicted Exaggerating the likelihood of addiction Who benefits? Who loses?
Things You Need to Know: Drugs neither good nor bad Public bombarded with lurid misinformation calculated to terrify Heroin:» use has reached epidemic proportions» addiction after one hit and you re life is ruined» devastating effects on the brain and body (e.g., overdose)
The brain sees heroin and morphine as same drug Heroin briefly used as non-addicting substitute for codeine and morphine Morphine Heroin
Heroin overdose potential a real concern
Heroin overdose potential a real concern (33,000 deaths) (13,000 deaths) (15,000 deaths)
Deaths involving opioids and automobile accidents, 2015 Number Rate (per 100,000) Any Opioid 33,000 10.4 Heroin 13,000 4.0 Automobile Accidents 35,000 11.3
Overdose is a real concern But important to remember: People rarely die from heroin (opioid) only overdoses > 75% of heroin-related deaths in combination with sedatives
Overdoses: keep the focus on real concerns Exaggerating heroin s effects on the brain & body diverts attention away from important public health messages:» Do not use heroin (or other opioids) in combination with sedatives such as alcohol
More about overdoses Adulterants Fentanyl: considerably more potent than heroin
Exaggerations limit our ability to implement practical solutions Community Level: Set-up free anonymous drug-testing services Community Level: increase the availability of naloxone Individual Level: use prescription opioids
Problem with many prescription opioids Opioid Other pain reliever OxyContin Roxicodon e Oxycodone (10-160 mg) Oxycodone (15 and 30 mg) Percocet Oxycodone (2.5-10 mg) Acetaminophen (325-650 mg) Vicodin Hydrocodone (5-10 mg) Acetaminophen (325-650 mg) Tylenol 3 Codeine (30 mg) Acetaminophen (300 mg)
Problem with many prescription opioids Opioid Other pain reliever OxyContin Roxicodon e Oxycodone (10-160 mg) Oxycodone (15 and 30 mg) Percocet Oxycodone (2.5-10 mg) Acetaminophen (325-650 mg) Vicodin Hydrocodone (5-10 mg) Acetaminophen (325-650 mg) Tylenol 3 Codeine (30 mg) Acetaminophen (300 mg) Acetaminophen is the leading worldwide cause of acute liver failure
Why the exaggeration? Because it: increases budgets of ADDICTION INDUSTRY PARTICIPANTS» law enforcement, treatment providers, politicians, the media, scientists
Why the exaggeration? Because it: increases budgets of ADDICTION INDUSTRY PARTICIPANTS» law enforcement, treatment providers, politicians, the media, scientists allows us to avoid dealing with real problems of the poor» unemployment, substandard education, low income
Why the exaggeration? Because it: increases budgets of ADDICTION INDUSTRY PARTICIPANTS» law enforcement, treatment providers, politicians, the media, scientists allows us to avoid dealing with real problems of the poor» unemployment, substandard education, low income allows us to target people we don t like without explicitly saying so
Things You Need to Know: Drugs neither good nor bad Public bombarded with lurid misinformation calculated to terrify Racial discrimination (racism) is rampant in drug enforcement
Defining Racism an action(s) that results in disproportionately unjust or unfair treatment of persons from a specific racial group
Defining Racism an action(s) that results in disproportionately unjust or unfair treatment of persons from a specific racial group Intent is not required
Crack & powder cocaine are the same drug Powder Cocaine Crack Cocaine
Now Infamous Federal Cocaine Laws Anti-drug Abuse Acts of 1986 & 1988 5-years no parole 10-years no parole Crack 5 grams 500 grams Powder 500 grams 5 kilos 1-to-100 Ratio
More than 80% of individuals sentenced for crack cocaine are black Clear example of racism
New Federal Cocaine Laws Fair Sentencing Act of 2010 5-years no parole 10-years no parole Crack 28 grams 280 grams Powder 500 grams 5 kilos 1-to-18 Ratio
Marijuana offenses accounts for most drug arrests Percent of drug arrests Actual number Marijuana 50 750,000 Heroin or Cocaine 23 345,000 > 80% for drug possession
State level: Racial minorities arrested for marijuana at higher rates Blacks 4x more likely to be arrested Federal level Latinos represent 2/3 of those arrested All groups use drug at similar rates Clear examples of racial discrimination (racism) not racial disparities, not implicit bias
Marijuana arrests per 100,000 2012 2014 % change Blacks 398 305-23 Latinos 195 121-38 Whites 229 105-54
Marijuana arrests per 100,000 2012 2014 % change Blacks 398 305-23 Latinos 195 121-38 Whites 229 105-54 Blacks & Latinos still are 3 times more likely to be arrested than whites
Marijuana legalization not a cure, but offers some relief decreased interaction of racial minorities & police removed (partially) one tool used to racially discriminate more than marijuana policy reform needed consequences for engaging racial discrimination
Today s so-called heroin epidemic presents another opportunity for us to be racist
Racial minorities arrested for heroin offenses at higher rates Federal level Blacks & Latinos represent more than 80% of those arrested Heroin use rates lower in groups Another examples of racial discrimination
Here s what we can do Put the work in, know the science, be exceptional Educational efforts, call out misinformation, etc.
Here s what we can do Put the work in, know the science, be exceptional Educational efforts, call out misinformation, etc. Constantly evaluate the risk-benefit ratio
Here s what we can do Put the work in, know the science, be exceptional Educational efforts, call out misinformation, etc. Constantly evaluate the risk-benefit ratio Change the narrative about drug users
Here s what we can do Put the work in, know the science, be exceptional Educational efforts, call out misinformation, etc. Constantly evaluate the risk-benefit ratio Change the narrative about drug users Work to change the legal status of all drugs Decriminalization vs legalization
Here s what we can do Put the work in, know the science, be exceptional Educational efforts, call out misinformation, etc. Constantly evaluate the risk-benefit ratio Change the narrative about drug users Work to change the legal status of all drugs Decriminalization vs legalization Call out discrimination and those who support it Even though you may have to check yourself
Here s what we can do Put the work in, know the science, be exceptional Educational efforts, call out misinformation, etc. Constantly evaluate the risk-benefit ratio Change the narrative about drug users Work to change the legal status of all drugs Decriminalization vs legalization Call out discrimination and those who support it Even though you may have to check yourself This is not a formula for popularity
Website: drcarlhart.com