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Vice Blog

NEW YORK - DOCTOR METH

A few weeks ago I went to a bar in Park Slope to booze with some pals. After a few pints I went downstairs to use the bathroom and I found some guy named Carl Hart in the basement wearing sunglasses, clicking through a PowerPoint slideshow...


A few weeks ago I went to a bar in Park Slope to booze with some pals. After a few pints I went downstairs to use the bathroom and I found some guy named Carl Hart in the basement wearing sunglasses, clicking through a PowerPoint slideshow, giving a lecture to about 60 people on the realities of methamphetamine. I asked someone in the crowd, “What the fuck’s going on down here?” They told me that Carl Hart’s an associate professor at Columbia Medical School’s Department of Psychology as well as a research scientist in the Division of Substance Abuse at the New York State Psychiatric Institute, now please shut up because I’m trying to listen. Two weeks later I went to his office at Columbia to talk about meth.

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Vice: What kind of research are you doing upstate at the Psychiatric Institute?
Dr. Carl Hart: We initiated a series of studies looking at the actual effects of methamphetamine in people who use the drug. So we’re giving these folks known doses at predetermined times and measuring a wide range of effects: cardiovascular effects, subjective effects, behavioral effects like cognition, food intake, the effects on sleep, a wide range of things. The dosage ranges from placebo to 50 mg of methamphetamine at a time.

What have you found?
People with narcolepsy could benefit—they can stay awake. People who have shift-work sleep disorders and are having problems staying awake because they are alternating shifts—clearly it’s beneficial for them. People who have had cognitive performance being disrupted as a result of fatigue, sleep deprivation, and that sort of thing. So those are clear groups that the drug could be useful for. And people who are depressed—5 to 10 mg daily or so could be beneficial.

Doesn’t meth kill brain cells?
There is some evidence to suggest that when people are making methamphetamine they’re producing in some cases a chemical that is neurotoxic so it kills brain cells, whereas methamphetamine itself in doses that people use to get high does not do that.

What about “meth mouth?” Does meth cause rapid tooth decay?
There is no evidence for that. Certainly you can get dry mouth, but the extent to which it will cause you to have dental problems there is no evidence. If there is, I’d like them to show it to me. But it’s not there.

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Will meth cause someone to engage in outrageous sexual behavior?
Yeah, that’s crazy. The bottom line is this, amphetamines are good drugs, whether they’re methamphetamine or d-amphetamine, good drugs to make people more alert, to improve their performance; you know, particularly performance that’s been disrupted, so you can last longer, stay awake longer. So all of those kinds of things are advantageous for people who are going to engage in sex as well as other behaviors. Cocaine will do the same thing, except cocaine’s effects won’t last as long.

So meth doesn’t impair a person’s decision-making skills?
Yeah this whole notion that it increases risky behaviors, there’s limited evidence to show that. But what we do know is that people who use the drug know something about the pharmacological effects of the drug, and if they do and they have sex, it might actually be a smart decision to use the drug to enhance your sex.

On “Frontline,” Peter Fraley (a former meth addict and gay community activist) said, “In New York, we're seeing about a thousand gay men every year become infected [with HIV], and that's just unacceptable. It's very sad. It's tragic, and it's almost entirely because of crystal meth.” What do you think about that?
Well people like that shouldn’t be allowed to make public statements, because that’s harmful and misleading. How do you know that? That’s just irresponsible for “Frontline” to even show without data.

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You say that disruptions in cognitive performance can be resolved with the consumption of meth. What if doctors are in the middle of a long shift in the ER and they’re crashing? A cup of coffee’s not gonna do it, and the effects of ingesting pills will take too long. Would a meth inhaler or smoking crystal meth be a viable alternative?
Well you know, if you could titrate the dose. When you give it orally, 5 to 10 mg that will be right, it’s not too high, you won’t get high, you’ll just be un-tired and so forth. So yeah if you can get the dosing right and you need to get this boost, sure, certainly.

So smoking crystal meth could possibly be…  beneficial?
You know I think that theoretically yeah, I can’t argue with that. But the likelihood of that happening of course is low.

Is crystal meth more addictive than other forms of methamphetamines or amphetamines?
Let’s think about it. If people take an amphetamine to get high orally, smart people, if they take an amphetamine they know it will take about 90 minutes for the peak effects to kick in, for example some people like oral THC where the effects slowly build up and they stick around longer. Some people enjoy that, so those people might be more likely to abuse the oral form as opposed to the smoke form. It all depends, like some smart users might say, “Fuck I got things to do, but I’m taking this right now and then when I get back I’m gonna be chillin’,” you know, whatever. Then I don’t have to smoke and I can just relax.

So you wouldn’t say that methamphetamine is more dangerous or worse for you than marijuana, alcohol, cocaine, or Adderall?
I wouldn’t say that generally, no. But I would say that with unrestricted use, marijuana you might be ok. Unrestricted use of amphetamines you would get into more trouble. Unrestricted use of heroin, it depends on how you’re doing it, because if you’re injecting typically your veins will collapse and that will save you at some level, so even with that you might be ok. But with amphetamines, paranoia can develop if you take large doses over extended periods of time, so no I wouldn’t say that one is less dangerous than the other, but with unrestricted use you might want to stay with marijuana.

Have you ever tried methamphetamine or any of the other drugs you are administering and testing on human subjects?
You know I might have, those kinds of questions I don’t really like to answer.

Ok one last question. Is Reefer Madness-type hysteria being spoon-fed to us about meth right now?
Yeah, the same thing is true about methamphetamine today. If you tell people that what we’re talking about is Adderall, people won’t believe that, but that’s what we’re talking about essentially, Adderall. They’re the same drug. Now if you tell people that, the sex appeal is gone. Crystal Meth is Adderall? We did the same thing with crack cocaine when we said, “Crack is not the powder cocaine, it’s something completely new.” But you can say that when few people in the population have experience with the drug. Now you say, “Why would you want to do that?” Well, it has a lot of appeal to a number of people—it has a lot of currency. Politicians can now have a cause, educators now have a cause, police officers now have a cause. Everybody makes money.

KARL DEMAREST