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Melissa Harris-Perry: I'm Melissa Harris-Perry, and this is The Takeaway. Just days ago, comedian Fuquan Johnson, who was only 43 years old was found dead after overdosing, reportedly on fentanyl-laced cocaine. While the causes of death for 54-year-old actor Michael K Williams are still being investigated, several reports suggest that fentanyl may be involved in his tragic and untimely passing as well. The loss of such vibrant talented souls is a gut punch, and these high-profile overdoses are part of a much bigger trend. Drug overdoses rose 30% from 2019 to 2020.

According to the CDC, fentanyl and other synthetic opioids are primary factors in that increase. Fentanyl is often prescribed for chronic pain sufferers, like those who have sickle cell anemia, and it's used for pain management after surgery. When fentanyl is used by street pharmacists in an unregulated market, it can have deadly consequences for users who are unaware of what they're ingesting. Let's be honest, our typical national approach to these issues is to declare all drugs bad and to admonish drug users to just say no.

Speaker 2: Say yes to your life. When it comes to drugs and alcohol, just say no.

Speaker 3: What would I do if someone offered me these drugs? I tell him to take a hike.

Speaker 4: I just want to share some tips with you kids that are using drugs and think about using. For your memo, don't or else. Okay.

Melissa Harris-Perry: Nearly 40 years later, it feels like we're in the same place. Drugs are demonized, users are demonized, and the war on drugs persists. It seems past time for some new solutions. With me now is Dr. Carl Hart, author of Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear. Carl, welcome.

Dr. Carl Hart: Thank you for having me, Melissa. I'm happy to be here.

Melissa Harris-Perry: Kassandra Frederique, who is executive director of the Drug Policy Alliance, a national nonprofit working to end the war on drugs. Kassandra, welcome.

Kassandra Frederique: Thanks so much for having me. Excited to be here with you both.

Melissa Harris-Perry: Dr. Hart, you've helped over the years to take me on a bit of a journey in terms of rethinking the just say no, a tradition that I was very much raised in as a kid of the '70s and '80s. Can you say a bit about what we might need to do to shift our understanding of drug use just as a life practice?

Dr. Carl Hart: Let's think about our approach to sex. When we were concerned about HIV/AIDS, some people thought it was bad practice to hand out condoms to help people engage in safer sex. Clearly, we now know that that was not the smartest thing to do. You want to hand out condoms, you want to help people to understand how to engage in safer sex as opposed to putting people at risk, including the community at risk. The same is true with drugs. Some people may say people shouldn't use drugs. That's fine if you say that, but the reality is people are going to use drugs.

Now the question becomes, how do we enhance the safety of this activity? We don't have to rediscover the wheel because other countries are doing this sort of thing. They're grappling with these same problems. Many of them don't have the issue or the concern of fentanyl like we do because they have things like drug checking services, that is where people can submit small samples of their drugs that have been brought off the street, and they can get a chemical printout and an explanation of the chemicals that are contained in that drug, so there are no surprises like is the case in the United States when people think that they have heroin and they may have fentanyl.

Fentanyl, of course, is a lot more potent, meaning that smaller amounts is needed in order to produce an effect. That effect sometimes is even an overdose effect. There are smarter ways to deal with what we're doing in the United States. If we simply implemented drug checking, it would go a long way in saving some of these lives.

Melissa Harris-Perry: Kassandra, I want to come to you on this because it certainly feels to me like at least 40 years ago when we were having these conversations that the idea that these lives were worthy of saving was often not part of the conversation. There was a sense that if people use drugs and bad things happened, then that was one of the side effects. That was why you have to just say no. I'm wondering if you think there's space now all these decades later to begin to make an argument that actually it is the saving of lives rather than the feeding of drugs themselves that is the core outcome work we should be seeking.

Kassandra Frederique: I appreciate this question because I think we are in a moment of cognitive dissonance in this country around this. There are people who are saying this is about saving lives. I think a lot of that has been informed by the racialization of the perception of who has been impacted by the overdose crisis. Five years ago, there was this "awakening" of decision-makers who were like, "We have to save our children." Before, the save our children moniker was, and protect them from drugs.

I think we still have that, but I think people are also talking about we have to save our children from addiction and the pain that they're in. I think those children were white. At the same time, what we've seen, and with fentanyl, in particular, is that in 2018, they went to criminalize fentanyl as we started to see it more and more in the drug supply, which is only exacerbated the escalation of overdose.

Why I say there's a cognitive dissonance is that the rhetoric doesn't match the practice but, Melissa, it's never matched. The rhetoric has never matched the practice. I think what we're seeing is that there's more voices, people like Dr. Carl Hart, folks in organizations like Tracy Gardner and Monique Tula who are leading Black drug policy folks that are trying to disrupt the larger conversation, but the powers that be still do not value the lives of people who use drugs, and they especially don't value the lives of people who use drugs who are non-white.

Melissa Harris-Perry: Dr. Hart, can you weigh in a bit on the ways that race intersects with this question?

Dr. Carl Hart: When we think about race in this moment that we're in, the population is fond of saying things like, "Oh, now we care about the opioid crises because why people are dying," as if this is new. That's nonsense. The way that we're dealing with this current so-called crisis, I'll explain why I say so-called, is the same way that we dealt with previous so-called crises. When we think about the way we dealt with crack, it was the same thing. White people went to treatment, Black people went to jail. Today with the opioid crisis, the same thing happens, white people go to treatment, Black and brown people go to jail.

When we look at the numbers, for example, for heroin, people who are being prosecuted for heroin at the federal level, 80% of the people who are being prosecuted are Black and brown, even though we know the vast majority of opioid users are white. We know that race always plays a role in these crises in the United States. It's who we are. As brother Rap Brown said, is as American as cherry pie. That's not particularly new. I don't even know if it's helpful. The main thing that the population need to understand is that people will always use drugs.

What our responsibility in terms of public health officials is how do we keep our people safe to live another day because there will always be a demand for commodities that enhance joy and mitigate human suffering. There will always be a demand for those commodities, and we have to accept that. Our job is to enhance the safety of these activities. There are ways to do so. I delineate many ways in my book Drug Use for Grown‑Up. The question is, do we care as a society?

The people who are dying, many are white, many are Black, many are Latino, but one of the things that many of them have in common is that they are poor people who we don't particularly care for. Every now and then, we get a celebrity that dies, and then we have this conversation. Tomorrow, somebody else will die, and we won't know their name, and we won't have this conversation. We need all people of all races to understand that this is affecting people in your community, and there are ways to stop this nonsense.

Melissa Harris-Perry: Kassandra, I want to build on this insight from Dr. hart that people will always, all of us, will use substances, there will always be a market for those things that enhance joy and reduce suffering. When we say it that way, we realize in our own lives we do all kinds of things, whether it's binging Netflix or drinking wine, or for some folks, it's the use of cocaine or heroin to enhance joy and reduce suffering.

I'm wondering, from a public policy level, what are the incentives? The incentive for individuals, enhance joy, reduce suffering. For policymakers, what are the incentives facing them that might make it difficult? Even if they have this broader perspective on saving lives, what incentives keep them from being able to move away from a just say no and incarceration-focused drug policy?

Kassandra Frederique: I think what Dr. Carl Hart just really laid out is there's a commitment to ignorance by our decision-makers. I think part of the conversation is there is the commodification of the carceral system so there's a lot of money made in criminalization. I think activists like Bianca Tylek of Worth Rises really outlines the markets that are at play through our strategy of incarceration. I think what Carl says around substances about increasing joy and reducing suffering is true but I don't think only drugs themselves can do that. There are other things that people need.

If we're looking at it, mostly being poor people or a lot of poor people who are navigating these really hard things, it's not just that they need drug checking or regulated drugs, they also need housing, they also need education, they also need access to job and employment. Our decision-makers, as we're seeing right now, don't want to do those things. They don't want to do the infrastructural things that are necessary for people to be okay. I think some of that is cost, I think some of that is politics and ideology and it's killing us.

I think that a part of the thing that we're trying to navigate, and I think the part of the strategy which is really important and why Carl's work is so important is really understanding what is in the arena of folks around drugs. How can we reduce the suffering? Part of that is drug checking but also, that is the regulation of all drugs. It's providing a safe supply. Right now, we're in a drug poisoning situation where our drug supply is adulterated. It's known and unknown to people and it really depends on your access point to where you're getting your substances.

I think there's also this incentive for the government to not pay attention to the thing that's really happening here, which is that we have a poisoned drug supply because if they could pay attention to it, the things that Carl was saying would happen automatically. We'd check our drugs, we'd create a safe supply, we'd have a conversation about legal regulation but there's financial incentives, there are ideological incentives as to why our policymakers are stuck. Not stuck but remain steadfast in their commitment to controlling people's ability to access joy.

Dr. Carl Hart: I just want to say one word about incentives because Kassandra laid out some nice things. Particularly this need for housing, employment, that's so important for the people who are suffering. The incentives that keep us in this ridiculous war on drugs is the money. Please don't get it twisted. Every year, we spend more than $40 billion in our efforts to control the drugs in our country and most of that money goes to law enforcement.

When people talk about de-funding the police, we really should be talking about de-funding the war on drugs because police are incentivized to make these arrests, to engage in this behavior that increases the likelihood that people will be getting poisonous substances on the streets. Not only the police, the prison authorities. Not only the prison authorities, even treatment providers. All of these people participate in this thing we call the addiction industry that does not really serve the majority of people who might be using substances.

Melissa Harris-Perry: Help our listeners to understand a bit about our presumptions about what drugs do to us, and a little bit about what your research over the decades has indicated to you about the effects of drugs physiologically on our bodies.

Dr. Carl Hart: We get millions of dollars at places like Colombia, for example, to give this substance to people in the laboratory and test the effects. Of course, it's to increase our knowledge about what these drugs do and what they don't do. The concern though is that the public doesn't even know that we do this sort of thing and we have this database showing that these drugs are not as dangerous as they are said to be as long as people understand things like what they have, the dose. All of these sorts of things, we have worked out in the laboratory. They are in the scientific literature.

I have published nearly 100 papers in the scientific literature describing the effects of marijuana, opioids, methamphetamine, cocaine, a number of drugs. These drugs behave in a predictable way, that is, you increase the dose, you increase the effects that you have on blood pressure, heart rate, on pleasure. All of these sorts of things we have worked out in the laboratory and the data is there for public consumption. The problem is much of it is tucked away in scientific literature. I don't know if we should call it literature because it's so hard to decipher for literate people. The point is that the data are there.

Melissa Harris-Perry: If you really want to hide some information, put it in an academic journal for sure. Kassandra, I'm wondering about this point you made of a poisoned supply. I will be very clear, I am an almost nightly wine drinker. I like my glass of wine, it helps me to unwind. Particularly I'll say I became truly a nightly wine drinker during the pandemic. I don't know what I would do if there was some real possibility that there was arsenic in my wine.

I'd like to think that I wouldn't have that glass but I do feel like there'd be some Tuesday night where even if I knew there was some possibility of deadly arsenic in it, I'd probably still have my glass of wine. Is there any way we can get to some sense of empathy about what it means to have a poisoned supply?

Kassandra Frederique: One of the things that I think is important is that this has happened before. When we think about alcohol prohibition, part of the reason that regulation was so important was that people were dying from a poisoned alcohol supply as well. When you prohibit something and you drive it underground, what we basically do is concede that the supply that people will engage with will not always be pure. You just take away people's rights to information about what they consume. When we talk about this particular issue, that's why drug checking is so critical because people are making policies abdicating their responsibility as to why we are in the situation where fentanyl is really present in drugs.

Fentanyl has always been here but the volume to which fentanyl is a part of the drug supply currently is ever-changing and dynamic because of our policy around prohibition and the ways that people are really trying to go around the drug laws that we have set. If we can have an adult conversation about these are the substances that people use, what are the ways that we can create access points for people and how can we give people their own dignity to make choices for themselves and check them, that would be important. They're like sommeliers who when you go get your wine, they talk to you about what's in it, what's going on.

We're seeing this with cannabis where you go to the dispensaries and people say like, "If you use this, this is helpful for this." We've done this before and we've regulated drugs because we wanted that information. It's the same moment that we're in right now but the histrionics, and the racism, and the classism that is associated with drugs are impeding us from actually getting to a place where we can have adult conversations about our drug supply. The thing that to me, it's like the red herring is that we're not talking solely about one substance and we never have been.

When we were first starting to talk about the rise in deaths, a lot of it was because people were mixing substances and didn't know how mixing certain different classes of drugs was going to impact their body because we can't have conversations. Now we're more presently dealing with a poisonous drug supply because of the way that we regulated drugs and the incentives that we have to not actually deal with regulation and drug checking.

Melissa Harris-Perry: Dr. Hart, let me ask you the final question here. I know in your book, Drug Use for Grown-Ups, you lay out some very practical steps. I know people need to read the book and you can't lay out all of them. Can you give us, maybe just the top three or four or just, you don't have to rank them, a few key practical steps to addressing this issue?

Dr. Carl Hart: Yes. If we're really concerned about people dying first, the first thing that we would do is that we would implement drug checking services in the United States. They're not that expensive. They are in other countries. These services allow people to submit anonymous small samples of their substance, and then they get a chemical printout and readout. They are educated about what substances are contained in their drugs that they submitted. That way people will know if there's something like a fentanyl in the substance, don't take it or take a smaller amount of it. That would go a long way in saving people.

Another thing we can do and we should do immediately, we have this new administration, whoever takes over the Office of National Drug Control Policy, the first thing they should do is start some national public service announcements to help people to understand what drugs, which drugs they can mix. If you mix opioids with other sedatives, you increase the likelihood of overdoses. If you mix opioids with stimulants, people find that combination to be good. That is not as toxic as mixing opioids with other sedatives like alcohol, benzodiazepine, and other sedative.

Those two things will go a long way and people need to understand that this is not new. They do this in Europe where they don't have this problem of drug overdoses as we do. Then finally what we need to do is we need to stop exaggerating the numbers such that people in the country seem to think that the overdoses are always caused by opioids. That's just simply not true. Opioids make up maybe about half of the overdoses, but the way it's presented in the press is that the opioids are responsible for all of these. Even when opioids are involved minus fentanyl, there are always multiple drugs involved.

Opioids themselves are not the problem. When we act as if opioids themselves are the problems, what we do and what we've done is that we have made it difficult for people who are suffering from pain-related illnesses to get their opioid pain medications because physicians are afraid to prescribe opioids because of this current hysteria around opioids. Meanwhile, those pain patients are suffering in silence. Some have committed suicide and that is not right for a society that calls itself compassionate and free.

Melissa Harris-Perry: Carl Hart is the author of Drug Use for Grown-Ups, and Kassandra Frederique is executive director of the Drug Policy Alliance. Thank you both for joining The Takeaway today.

Dr. Carl Hart: Thank you for having us.

Kassandra Frederique: Thank you.

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