High Price

narrative that we ourselves were the problem; that we were to blame for things like the selective enforcement of drug laws, the underfunded schools, and biased hiring that hindered so many.
    These were men who still tried to fit into a country that didn’t want to recognize their contributions. They were all folks who could still be put in the equivalent of a lineup outside a bank, while carrying a statement and a photo ID identifying them as a scientist at the premier government health research institution in the world.
    It infuriated me, but that’s what I realized my son would soon face. A world where even in the most clear-cut situation, someone with our skin tone could still be seen as a “crackhead” just because he dressed a certain way—or to use the language of an earlier wave of drug hysteria, a “Negro cocaine fiend.” And all of this made me think a lot more critically about my research and about how to think about drugs.

CHAPTER 13
    The Behavior of Human Subjects
    It is not heroin or cocaine that makes one an addict. It is the need to escape from a harsh reality.
    — SHIRLEY CHISHOLM
    R obert sat on a hospital bed, surrounded by about a half-dozen people. He was a tall, slender, light-skinned brother with a goatee and short hair, in his early thirties. He was reclining in a typical, austere single room, with a small window and the usual pale and sterile hospital decor. At the center of the group was Dr. Ellie McCance-Katz, the woman who had recruited me to a postdoctoral position in Yale University’s Psychiatry Department.
    A short, fortyish woman with auburn hair, Ellie led the team. A nurse and another doctor monitored Robert’s blood pressure and other vital signs. A female research assistant and I were also clustered around Robert as he slowly received an intravenous injection of cocaine. It was December 1997.
    Postdoctoral work is an important step in scientific training, which, if things go well, can lead to the ultimate academic prize: a tenure-track job at a reputable university. My Yale postdoc was also my first experience of studying the effects of psychoactive drugs on a human being. It was exciting to finally get to do this work.
    Over time, I’d come to see the limitations of the animal research that had been my initiation into neuroscience. For example, there’s a phenomenon seen in animals, called sensitization, that occurs when they are given stimulant drugs like cocaine. Typically, when rats take a drug repeatedly, they become tolerant to its effects and a higher dose is needed to reproduce the initial response. But with some effects of stimulants, animals actually become more sensitive to the drug and they have a bigger response to a smaller dose than they did at first: the opposite of tolerance.
    In humans, this sensitization was said to cause addicted stimulant users to become more paranoid and anxious over time. However, that result isn’t seen consistently in human drug users and it isn’t seen when stimulants are used therapeutically, which suggests that it is not an important pharmacological effect for people. As I continued to study drugs, I found many similar phenomena that just didn’t carry over. It all made me think that in order to discover what I really wanted to know about drug use, I’d have to study it carefully in humans.
    Robert was an affable, handsome man. Dressed neatly but casually, he didn’t look overly thin or sickly: there was nothing to suggest to anyone who saw him that he was a crack cocaine user. While we were blinded as to the dose of drug he was receiving and to whether it was a placebo, cocaine, or a cocaine-related compound called cocaethylene, I soon learned to tell when he got a decent dose of drug. Then all he wanted to do was talk. He’d go on and on, sometimes describing how cocaine gave him insight and creativity.
    Our study was designed to compare the effects of IV cocaine to IV cocaethylene, a compound that is created in the body when cocaine and alcohol are taken together. At the time, there were concerns that cocaethylene was more potent and more dangerous to the heart and blood vessels than cocaine taken alone. Under carefully controlled conditions, we wanted to learn whether this was true when the drug was given to healthy people who typically used cocaine and alcohol together.
    I recognize that some may question the ethics of giving drugs like cocaine and cocaethylene for research purposes. Over the course of my career,