Drugs with a Hart pt. 1
Debunking the Opioid Crisis Narrative: A Conversation with Dr. Carl Hart
The opioid epidemic has been a central focus of media and public discourse for years, with sweeping generalizations about drug use shaping policies and perceptions. In the latest episode of Tea and Other Drugs, I had the pleasure of sitting down with Dr. Carl Hart, a professor at Columbia University, author of Drug Use for Grown Ups, and an expert on psychoactive substances, to unravel the myths surrounding opioids, 7-hydroxymitragynine, and drug policy in the U.S.
The Problem with the "Opioid Epidemic" Narrative
The prevailing idea that opioids alone are responsible for a nationwide crisis oversimplifies a complex issue. As Dr. Hart pointed out, the Centers for Disease Control and Prevention (CDC) reports "drug-involved deaths" rather than "opioid overdoses," because in most cases, multiple substances are present in toxicology reports. This distinction matters because it highlights how attributing deaths solely to opioids inflates statistics and feeds into fear-driven policies rather than science-based harm reduction approaches.
Dr. Hart also emphasized the importance of autopsies in confirming causes of death—something that is inconsistently applied in drug-related fatalities. Without proper investigations, deaths that involve opioids are often misclassified, further distorting public understanding of drug use and its actual risks.
7-Hydroxymitragynine and Kratom: A New Boogeyman?
Our conversation also explored the rising hysteria around 7-hydroxymitragynine, a potent alkaloid derived from kratom. Kratom itself has long been in a regulatory gray area, but now, as 7-hydroxymitragynine products become more popular, there are increasing calls for prohibition.
Much of the fear surrounding this compound stems from its classification as a full mu-opioid receptor agonist, meaning it binds to opioid receptors more completely than mitragynine, kratom’s primary alkaloid. However, as Dr. Hart noted, demonizing a drug based purely on its pharmacological action without considering dosing, tolerance, and real-world usage is unscientific and unfair.
In the absence of human studies, much of the current research on 7-hydroxymitragynine relies on rodent models, which do not necessarily translate to human effects. Mice given high doses of opioids in laboratory settings may experience respiratory depression, but that doesn’t mean humans consuming reasonable doses will suffer the same fate. Additionally, opioid users often develop tolerance to respiratory effects while still experiencing the drug’s desired benefits.
Drug Policy and the War on Pleasure
One of the most critical points of our discussion was how drug policy in the U.S. is shaped not by science but by societal biases and moral panic. Historically, drug prohibition has been weaponized against marginalized communities, from the racist origins of anti-cocaine laws targeting Black Americans to the anti-opium hysteria aimed at Chinese immigrants. Today, similar tactics are used to regulate and demonize new substances, like kratom and its derivatives.
Dr. Hart argued that rather than banning substances outright, the focus should be on education, harm reduction, and ensuring that people know what they’re consuming. The government could facilitate safe drug use by providing purity testing, clear dosing guidelines, and resources to mitigate risks. Instead, we see a continued push toward prohibition, which drives people toward dangerous, unregulated markets.
The Infighting Within the Kratom Industry
A fascinating—and frustrating—element of this conversation was the division within the kratom industry itself. Established kratom companies, fearing regulatory backlash, often vilify 7-hydroxymitragynine as a dangerous substance, positioning themselves as the “good” side of the industry while throwing newer entrants under the bus.
This internal battle is counterproductive. Both kratom and 7-hydroxymitragynine have potential benefits for different types of consumers. Rather than fighting each other, industry leaders should unite against the real issue: a broken regulatory system that criminalizes pleasure and personal autonomy.
The Path Forward: Science, Not Scare Tactics
Our conversation ended on a hopeful note, emphasizing the importance of pushing for policies based on empirical evidence rather than hysteria. If the goal is truly to reduce harm, then education, regulation (not prohibition), and a commitment to bodily autonomy must be prioritized.
If you’re interested in the intersection of drugs, policy, and personal freedom, be sure to check out Tea and Other Drugs for more conversations like this. And as always, question everything—especially the narratives that fuel fear instead of understanding.
