Carl Hart Discusses the Complexity of Drug Abuse

Question: What conditions promote drug abuse in a culture?

Hart:    The first and foremost is availability cause when we think about in New York City methamphetamine is not that available but it is here but cocaine for example is a lot more prevalent so access to cocaine is greater, that means that there’s a greater likelihood that people will abuse cocaine relative to something like methamphetamine that’s so accessibility is one of those things.  Another factor that might play a role is that if the drug itself is used to delineate the groups membership so if you think about youth culture today, and not to pick on hip hop because I’m a fan.  In some songs or people talked about marijuana use and it talked about it, and it’s glorified and so as a result people who are in that sort of culture might use that drug more often because it helps to delineate the boundaries of the group and so that increases the likelihood of use or if you think about other sort of cultures, businessman you may be at meetings in which there are martini glasses passed around in that culture the martini glass happen to drink at the work or at a meeting, that might increases the likelihood of alcohol being abused in that culture because it can helps sort of define or delineate the membership boundaries. 

Question: Do recessions exacerbate drug abuse?

Hart:    I think that if we do we may see abuse of the drugs that are more widely available like alcohol, certainly during times of crisis people may indulge a little more than they normally would so you may see increases in alcohol but in terms of the elicit drugs, I’m not sure because of their lack of availability of people who have access.  They may use of more or so than they normally but that’s a difficult question to for me to predict.

Question: Is overprescribing antidepressants increasing abuse?

Hart:    For the most part of people who are using anti-depressants for example, they need those medications and they are helping them with their psychiatric illness, the way we look at those drugs in some instances like for example, ADHD medication, there have been a lot to talk about folks abusing those medications there’s been a lot to talk about the diagnosis, people being over diagnosed with ADHD and sure you may have those instances but I think in large part folks are being responsible as possible and whenever you have human behavior there is an opportunity for abuses and I think that in this case medicine is not exempt and I just think that this is what we can expect in general from humans and this is not some aberration.

Question: Why do drugs go in and out of style?

Hart:    Generational change, people change, young people, people whoa re young today won’t be the same folks tomorrow and so as new generations come about, they have to find their own way, not only with drugs they find their own way with fashion, they find their own way with the way they wear their hair, a wide range of domains in which they find their way and drugs is just one of them, it’s not special, it’s not unique you see some generations really being into LSD whereas other or the psychedelics in general whereas other generations are really into the stimulants but at same token you found that some generations where in the bell bottoms other generations were in the straight leg pants and so I think that as each generation find their way, they will also select their cycle active, intoxicants similarly.  The drugs themselves have always been there.  So I think that the culture influences the drug use in part but it’s difficult to say for me because that’s not something that I study directly but I think that given that drugs are there and they have been because of drugs that people are using have been here for centuries and but their popularity changes, impart their popularity changes to as a function of our focus, our media focus, our educational focus on them and our concern about those drugs I think it was in the early 1970s Brecher, Edward Brecher publish a paper on how to start a nationwide drug [fact] and he talked about how, he used example of glue sniffing in Pueblo Colorado in which a few youth were sniffing glue and then it was recorded in the Denver Post and then it gained so much popularity, other newspapers reported articles on this then Time and Newsweek and those magazine they appeases and then the popularity of glue sniffing really increased during this period but before those articles advertise the glue sniffing, young people most young people had no idea about glue sniffing and nor interested and so I think our attempt to educate people about this drug we have to be careful in our attempt not to glorify them and not to over advertise them like their Nike Tennis shoes or something. 

Question: What’s the next big drug craze?

Hart:    You know, when you say the next big drug we talked about prescription [hope] it’s now were concerned about them so they are certainly a problem that’s a growing problem, that’s the current so there are concern that’s on the [horizon] so that’s that maybe a problem.  One in the future but when we th8ink about stimulants what we know is that, they tend to go in cycles, so cocaine is popular during an era and then amphetamines come back and then they will go out of fashion and then cocaine will come back which will go out of fashion and then amphetamines back and so now we might be due for an increase focused cocaine and the next 20 years or so but as you know, it’s difficult to predict the future.  I don’t have a crystal ball.

The professor talks about the conditions needed for a society to turn to


hardcore use and if the recession might inspire an upswing.

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Hold your breath at Marble Arch!

Air pollution up to five times over the EU limit in Central London hotspots

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  • Dirty air is an invisible killer, but an effective one.
  • A recent study estimates that more than 9,000 people die prematurely in London each year due to air pollution.
  • This map visualises the worst places to breathe in Central London.

The Great Smog of 1952

London used to be famous for its 'pea-soupers': combinations of smoke and fog caused by burning coal for power and heating.

All that changed after the Great Smog of 1952, when weather conditions created a particularly dense and persistent layer of pollution. For a number of days, visibility was reduced to as little as one foot, making traffic impossible. The fog even crept indoors, leading to cancellations of theatre and film showings. The episode wasn't just disruptive and disturbing, but also deadly: according to one estimate, it directly and indirectly killed up to 12,000 Londoners.

Invisible, but still deadly

Image: MONEY SHARMA/AFP/Getty Images

London Mayor Sadiq Khan

After the shock of the Great Smog, the UK cleaned up its act, legislating to replace open coal fires with less polluting alternatives. London Mayor Sadiq Khan is hoping for a repeat of the movement that eradicated London's smog epidemic, but now for its invisible variety.

The air in London is "filthy, toxic", says Khan. In fact, poor air quality in the British capital is a "public health crisis". The city's poor air quality is linked not just to thousands of premature deaths each year, but also to a range of illnesses including asthma, heart disease and dementia. Children growing up in areas with high levels of air pollution may develop stunted lungs, with up to 10% less capacity than normal.

Image: Transport for London

ULEZ phases 1 and 2, and LEZ

Khan has led a very active campaign for better air quality since his election as London Mayor in 2016. Some of the measures recently decided:

  • Transport for London has introduced 2,600 diesel-electric hybrid buses, which is said to reduce emissions by up to 40%.
  • Mr Khan has pledged to spend £800 million on air quality over a five-year period.
  • Uber fares will rise by 15p (20¢) to help drivers buy electric cars.
  • Since the start of 2018, all new single-decker buses are zero-emission and all new taxis must be hybrid or electric.
  • Mr Khan has added a T-charge on the most toxic vehicles entering the city. On 8 April, the T-charge will be replaced by an Ultra-Low Emission Zone (ULEZ), contiguous with the Congestion Charge Zone.
  • The ULEZ is designed to reduce emissions of nitrogen oxide and particulate matter by charging vehicles who don't meet stringent exhaust emission standards.
  • By October 2020, a Low-Emission Zone (LEZ), applicable to heavy commercial vehicles, will cover most of Greater London.
  • By October 2021, the ULEZ will expand to cover a greater part of Central London.

Central London's worst places for breathing

Image: Steven Bernard / Financial Times

Heathrow (bottom left on the overview map) is another pollution hotspot

What worries experts is that despite considerable efforts already made, levels of air pollution stubbornly refuse to recede – and remain alarmingly high in locations where traffic flows converge.

It's not something you'd think of, given our atmosphere's fluctuating nature, but air pollution hotspots can be extremely local – as this map demonstrates.

One important lesson for all Londoners: don't inhale at Marble Arch! Levels of nitrogen dioxide (NO2) are five times the EU norm – the highest in the city. Traffic permitting, quickly cross Cumberland Gate to Speakers' Corner and further into Hyde Park, where levels sink back to a 'permissible' 40 milligrams per cubic meter. Now you can inhale!

Almost as bad: Tower Hill (4.6 times the EU norm) and Marylebone Road (4 times; go to nearby Regent's Park for relief).

Also quite bad: the Strand (3.9), Piccadilly Circus (3.8), and Hyde Park Corner (also 3.8), Victoria (3.7) and Knightsbridge (3.5), the dirty trio just south of Hyde Park.

Elephant & Castle is the only pollution hotspot below the Thames and, perhaps because it's relatively isolated from other black spots, also the one with the lowest multiplication factor (2.8 times the maximum level).

On the larger map, the whole of Central London, including its relatively NO2-free parks, still shows up as more polluted than the outlying areas. Two exceptions flare up red: busy traffic arteries; and Heathrow Airport (in the bottom left corner).

Image: Mike Malone, CC BY SA 4.0

Traffic congestion on London's Great Portland Street

So why is Central London's air pollution problem so persistent? In part, this is because the need for individual transport in cars seems to be inelastic. For example, the Congestion Charge has slashed the number of vehicles entering Central London by 30%, but the number of (CC-exempt) private-hire vehicles entering that zone has quadrupled over the same period.

Cycling has really taken off in London. But despite all pro-cycling measures, a wide range of other transport options and car-dissuading measures, central London is still a very congested place. Average traffic speeds on weekdays has declined to 8 miles (13 km) per hour – fittingly medieval speeds, as the road network was largely designed in medieval times.

Narrow streets between high buildings, filled to capacity with slow-moving traffic are a textbook recipe for semi-permanent high levels air pollution.

The large share of diesel vehicles on London's streets only increases the problem. Diesel vehicles emit lower levels of carbon dioxide (CO2) than petrol cars, which is why their introduction was promoted by European governments.

However, diesels emit higher levels of the highly toxic nitrogen dioxide (NO2) than initial lab tests indicated. Which is why they're being phased out now.

As bad as Delhi, worse than New York

Image: Sanchit Khanna/Hindustan Times via Getty Images

By some measures, London's air quality is almost as bad as New Delhi's.

By some measures, especially NO2, London's air pollution is nearly as bad as big Asian cities such as Beijing or New Delhi, and much worse than other developed cities such as New York and Madrid.

The UK is bound to meet pollution limits as set down in the National Air Quality objectives and by EU directives, for example for particulate matter and nitrogen dioxide.

  • Particulate matter (PM2.5) consists of tiny particles less than 2.5 micrometres in diameter emitted by combustion engines. Exposure to PM2.5 raises the mortality risk of cardiovascular diseases. The target for PM2.5 by 2020 is 25 µg/m3. All of London currently scores higher, with most areas at double that level.
  • Mainly emitted by diesel engines, NO2 irritates the respiratory system and aggravates asthma and other pre-existing conditions. NO2 also reacts with other gases to form acid rain. The limit for NO2 is 40 µg/m3, and NO2 levels must not exceed 200 µg/m3 more than 18 times a year. Last year, London hit that figure before January was over.

Google joins fight against air pollution

Image: laszlo-photo, CC BY SA 2.0

Elephant & Castle, London.

Studies predict London's air pollution will remain above legal limits until 2025. Sadiq Khan – himself an asthma sufferer – is working to make London's air cleaner by measures great and small. Earlier this week, he announced that two of Google's Street View cars will be carrying air quality sensors when mapping the streets of London

Over the course of a year, the two cars will take air quality readings every 30 metres in order to identify areas of London with dangerous levels of air pollution that might be missed by the network of fixed sensors. An additional 100 of those fixed sensors will be installed near sensitive locations and known pollution hotspots, doubling the network's density.

It's all part of Breathe London, a scheme to map the British capital's air pollution in real time. Breathe London will be the world's largest air quality monitoring network, said Mr Khan, launching the scheme at Charlotte Sharman Primary School in the London borough of Southwark.

Up to 30% of the school's pupils are said to be asthma sufferers. Charlotte Sharman is close to Elephant & Castle, as the above map shows, one of Central London's air pollution hotspots.

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  • Survey by Pew Research Center shows great variation in chauvinism across Europe.
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White-nose syndrome is nearly as lethal to bats as the Black Plague was for humans.

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  • Bats serve a crucial role in our ecosystem and economy, and white-nose syndrome is already pushing many species to the brink of extinction.
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