An ambitious cohort of cities across the US and Canada has moved ever closer to legalizing drug use—with tragic results. Towns once recognized as safe places to raise a family are now characterized by homeless encampments and “open-air” drug markets. Overdoses and crime rates, both supposed to decline in the wake of liberalized drug laws, have increased in many jurisdictions. Residents in a lot of these communities have been left to deal with the fallout alone as their leaders remain committed to so-called harm-reduction policies intended to make illicit drug use safer. “Harm reduction isn’t just a problem for addicts,” Atlantic staff writer Michael Powell noted recently. “In many cities, the autonomy of drug users has taken precedence over nearly everything and everyone else, not least working-class families …who must live alongside addicts and accept dystopian decay.”

Seattle and similar cities illustrate the pattern. Public fentanyl use, addicts collapsed on sidewalks and schoolchildren observing drug deals have become routine where policies prioritize “meeting users where they are.” Distributing clean needles can reduce HIV and hepatitis transmission among participants, yet this narrow benefit has been overshadowed by increasing disorder and the normalization of addiction in residential neighborhoods.

Portugal’s more structured harm-reduction approach is often cited as a model for the US to follow, yet their strategy retained police involvement and treatment pressure. Perhaps more importantly, drug distribution is still a crime. The policies put in place by state and local officials in the US lack these defining features, usually intentionally. Oregon’s Measure 110 decriminalized possession of small quantities of drugs and produced sharp rises in overdoses and public use before a rapid public backlash and partial reversal. The arrival of fentanyl intensified the death toll, but the policy’s removal of consequences and enforcement made open-air markets and visible addiction far worse.

The reality is that widespread drug use is not inevitable. Heroin-addicted Vietnam veterans largely quit upon returning home, after being removed from a drug-saturated environment, and smoking rates fell dramatically in the US after sustained stigma and restrictions. These examples are strong evidence that norms, consequences and limited supply—all variables harm reduction excludes as “judgemental”—shape demand.

“Safe supply” experiments, in which addicts are given a taxpayer-funded ration of opioids, and the elevation of active users’ autonomy above the interests of children and working families have delivered measurable social decay rather than the promised reductions in harm. Two decades of expanding harm-reduction show the same result: the welfare of families and functioning neighborhoods has been subordinated to enabling public addiction.

Join Dr. Liza Lockwood and Cam English on this episode of Facts & Fallacies as they critique the case for drug legalization.

Dr. Liza Lockwood is a medical toxicologist and the medical affairs lead at Bayer Crop Science. Follow her on X @DrLizaMD

Cameron J. English is the executive vice president at the American Council on Science and Health. Follow him on X @camjenglish

Drug legalization is supposed to spur several critical improvements in public health. As more states legalize recreational marijuana, we’re beginning to see how substantial these benefits are—and the results are underwhelming. A just-published review in The Lancet Psychiatry examining how cannabis policy changes from 2000 to 2025 relate to drug use, addiction and other psychiatric disorders paints a more complicated picture than many legalization advocates have described.

Commercialized legal cannabis markets in Canada and the US were linked to increased cannabis use and addiction among adults. “Since the mid-1990s and especially after 2015,” the review noted, “there has been an increase in the number of people using cannabis daily or near daily in the USA, who now exceed the number of people using alcohol daily or near daily.”

This increase in use has been accompanied by rises in drug potency as cannabis flower is increasingly “displaced by higher potency products that are associated with an increased risk of cannabis use disorder and psychotic disorder.” This is a striking result since legalization is generally thought to produce more predictable, safer drug supplies with fewer harmful effects as sellers begin to operate within the bounds of the law.

These markets also saw increases in hospital admissions for psychosis and for psychotic disorders occurring together with cannabis use disorder. However, there was no consistent evidence of changes in the overall prevalence or incidence of psychotic disorders at the population level. It’s also not clear if marijuana use causes psychosis or if people with psychotic disorders are more inclined to use the drug. Another more perplexing possibility is that cannabis use is both a cause and a result of psychosis in different cases.

In other parts of the world, the results varied with the scale of the changes to drug policy. In Europe, for instance, there was little connection between changes in cannabis regulation and drug use—”This is consistent with the small scale of policy change or commercialization in Europe when compared with the USA or Canada.”

The takeaway for now seems to be that markers of commercialization—retail density, lower prices, higher-potency products, and marketing—track with higher consumption and certain harms. Jurisdictions that restricted commercial influence through tight state controls or non-profit models showed weaker or no such associations. Long-term data remain limited, particularly from low- and middle-income countries, and most studies cover relatively short periods after policy changes.

Join Dr. Liza Lockwood and Cam English on this episode of Facts & Fallacies as they scrutinize the results (so far) of marijuana legalization.

Dr. Liza Lockwood is a medical toxicologist and the medical affairs lead at Bayer Crop Science. Follow her on X @DrLizaMD

Cameron J. English is the executive vice president at the American Council on Science and Health. Follow him on X @camjenglish

Robert F. Kennedy Jr. has joined the chorus of psychedelic advocates who claim the drugs could revolutionize mental health care, particularly treatment of post-traumatic stress disorder (PTSD). Despite the recent fanfare, the hype around these potent hallucinogens remains just that—overconfident speculation in search of confirmatory evidence. The conclusion has already been reached, with Kennedy and others now on the hunt for data to validate their preferred conclusion.

Kennedy contends that government barriers have blocked progress on substances such as ibogaine for treating PTSD, depression and opioid withdrawal. Ibogaine, extracted from an African shrub used in traditional ceremonies, has shown preliminary signs of reducing withdrawal symptoms and cravings in self-reported and observational studies. Evidence supporting its use specifically for PTSD is even lower quality; advocates and reporters often point to anecdotes to strengthen the case for experimental use of the psychedelic, though serious risks, including life-threatening cardiac arrhythmias, tend to be minimized during that discussion.

The poor evidence base goes back decades to Timothy Leary’s work at Harvard with another psychedelic called psilocybin. Initial research explored applications for alcoholism and prisoner rehabilitation, but concerns over study methods, undisclosed side effects and promotion of recreational use to undergraduates led to Leary’s dismissal. His “turn on, tune in, drop out” message helped establish him as a counterculture figure, but his primary concern wasn’t carefully testing potential PTSD treatments.

The problem is more troublesome in RFK Jr.’s case since he wields significant influence over federal policy as Health and Human Services secretary and is an infamous contrarian, content to reject robust evidence when it threatens his views. Although he claims the effects of ibogaine and related drugs should be settled by data, Kennedy has already staked out positions on multiple issues—vaccines, antidepressants and pesticides to name just three—that contradict the best available science. What confidence can we have, then, that his approach to psychedelics will be any better?

Join Dr. Liza Lockwood and Cam English on this episode of Facts & Fallacies as they scrutinize Kennedy’s claims about ibogaine.

Dr. Liza Lockwood is a medical toxicologist and the medical affairs lead at Bayer Crop Science. Follow her on X @DrLizaMD

Cameron J. English is the executive vice president at the American Council on Science and Health. Follow him on X @camjenglish

Politics has infiltrated every facet of modern life, including medicine. And some Americans seem increasingly inclined to make important health decisions based on their ideological commitments rather than the best evidence. That’s the implication of a recent paper published in Nature Human Behaviour.

The study, based on the long-running Add Health cohort (born roughly between 1974–1983), found that in the late 2000s there was no meaningful difference in objective health biomarkers (e.g., blood pressure) between self-identified liberals and conservatives. By 2016–2018, however, conservatives (especially “very conservative”) had significantly worse biomarker profiles and comorbidity scores than liberals. This health gap translated into slightly higher mortality for conservatives—six additional deaths—particularly from internal/disease causes like heart disease and cancer.

By 2020–2022, “very conservative” individuals had roughly a 1.1–1.4 percentage point higher probability of internal-cause death than “very liberal” peers. About half the gap was explained by demographic and socioeconomic sorting, while the other half remained unexplained by standard factors. Survey data also showed conservatives reported lower trust in medical advice, lower medication adherence and greater reluctance to seek care. The COVID pandemic response, characterized by confusing, contradictory and often politicized guidance, very likely drove this declining trust in medicine among conservatives.

The authors concluded that political identity may be emerging as a social determinant of health as the public check their beliefs about medicine against their existing ideological filters. Although this idea isn’t implausible and the influence of politics on scientific discourse is undeniable, it remains to be seen whether that incendiary partisan sparring is fueling worse health outcomes for one side of the political spectrum at the population level.

Does being a conservative put you in harm’s way? Join Dr. Liza Lockwood and Cam English on this episode of Facts & Fallacies as they scrutinize the study’s results.

Dr. Liza Lockwood is a medical toxicologist and the medical affairs lead at Bayer Crop Science. Follow her on X @DrLizaMD

Cameron J. English is the executive vice president at the American Council on Science and Health. Follow him on X @camjenglish

Consider this curious New England Journal of Medicine perspective from the University of California, San Francisco’s Center to End Corporate Harm. The article erroneously brands fossil fuels, processed foods, synthetic chemicals and prescription opioids—a diverse array of useful tools when reasonably used—as “corporate vectors” of disease, no different than cigarettes. It urges researchers to weaponize “internal industry documents,” much like the tobacco lawsuits of the 1990s, to facilitate litigation to cripple the companies that make these products.

The framing is overly simplistic and ideological, collapsing distinct tools and risks into a cartoonish conspiracy of corporate villainy. Tobacco’s decades-long denial of nicotine addiction and cancer risk was uniquely deceptive. Fossil fuels have driven the large gains in global life expectancy by replacing deadly biomass cooking fires and enabling modern agriculture and medicine—benefits the NEJM article largely ignores.

Selective document-mining amounts to hindsight bias and cherry-picking. Every industry keeps internal memos, but when you read the allegedly scandalous documents, they usually don’t reveal nefarious behavior. GLP has reported on multiple cases in recent years confirming this fact (see here and here).

Instead of blanket litigation, proper regulation and evidence-based education continue to offer a more sensible alternative. Demonizing “corporate vectors” is a distraction from the actual causes of our public health challenges.

Join Dr. Liza Lockwood and Cam English on this episode of Facts & Fallacies as they examine so-called “health harming industries.”

Dr. Liza Lockwood is a medical toxicologist and the medical affairs lead at Bayer Crop Science. Follow her on X @DrLizaMD

Cameron J. English is the executive vice president at the American Council on Science and Health. Follow him on X @camjenglish

Critics argue the label “safe” is misleading, in part because the facilities normalize illegal drug use instead of confronting addiction. They point to low treatment-referral rates in some studies, which undermine a key justification for safe injection sites, and question whether the facilities reduce overall community overdose deaths. They also highlight studies reporting increases in neighborhood disorder and crime.

In the U.S., federal statutes and local opposition have blocked or delayed many proposals, with skeptics insisting taxpayer resources would be better spent expanding evidence-based treatment, prevention and supply-side enforcement rather than government-sanctioned drug consumption.

Meanwhile, supporters cite data from individual facilities in Canada and Europe, where research shows zero deaths inside facilities and measurable drops in local disease transmission. While some advocates acknowledge the evidence for safe injection sites is preliminary and inconclusive, they contend this uncertainty should drive governments to adequately fund pilot programs and research the efficacy of this controversial harm-reduction technique.

The debate pits compassion against accountability, leaving policymakers and voters divided on whether these sites are worth the risk they may pose to the communities where they’re established.

Join Dr. Liza Lockwood and Cam English on this episode of Facts & Fallacies as they dissect the science surrounding the safe injection debate.

Dr. Liza Lockwood is a medical toxicologist and the medical affairs lead at Bayer Crop Science. Follow her on X @DrLizaMD

Cameron J. English is the executive vice president at the American Council on Science and Health. Follow him on X @camjenglish

As is often the case with Kennedy’s narrative, the real story is far more complicated. His “transformative” proposal will not only fail to improve medical education, it could prevent future doctors from learning vital information they need to properly care for their patients.

The simple fact is that medical students already receive an intensive scientific education that equips them to evaluate nutrition far more rigorously than most people—including Kennedy. From the first year of medical school, students immerse themselves in biochemistry, molecular biology, physiology, anatomy and much more. These disciplines do not treat nutrition as a vague lifestyle topic; they dissect it at the molecular level.

This foundation allows physicians to perform evidence-based risk-benefit calculations that go beyond vague platitudes about the benefits of “real food.” Far from being nutrition-illiterate, today’s doctors are well prepared to translate complex science into personalized guidance. RFK Jr.’s plan romanticizes a gap that hard science has already closed.

Join Dr. Liza Lockwood and Cam English on this episode of Facts & Fallacies as they scrutinize Kennedy’s proposal to transform medical school.

Dr. Liza Lockwood is a medical toxicologist and the medical affairs lead at Bayer Crop Science. Follow her on X @DrLizaMD

Cameron J. English is the director of bio-sciences at the American Council on Science and Health. Follow him on X @camjenglish

A perfect example of why this skepticism is justified went viral late last month: a single inhaled dose of the potent psychedelic 5-MeO-DMT sent almost 60% of treatment-resistant depression patients into remission in just one week, according to a March 25 paper in JAMA Psychiatry. It sounds like a game-changer — until you read the study, warts and all.

As it turns out, the psychedelic bros tweeting from Silicon Valley exaggerated the paper’s results, overlooking some critically important limitations in the research along the way.

Impressive results?

There’s no denying the short-term results look dramatic: a massive drop in depression severity versus placebo. But read past the abstract and bright red flags begin to appear. The original placebo group, 41 patients who got zero active drug in the week-long clinical trial, entered the 6-month follow-up period eligible for up to five doses of 5-MeO-DMT if their depressive symptoms worsened. In other words, the researchers gave their control group access to the very drug they were trying to test.

Not only does that undermine the study’s headline-grabbing results, the authors didn’t report any of the outcomes for this placebo group. “A detailed analysis of part 2, including … treatment outcomes of patients who received placebo in part 1, will be presented in a subsequent report,” they noted in passing.

Instead, the paper focused only on the 23 patients (out of 40) whose symptoms improved on the active drug in week one. Of those, just 13% stayed in remission for six months without any redosing. The rest needed 1–4 doses and 87% were back in remission at month six. Again, these are impressive numbers—but how much of that result is truly from the psychedelic versus natural fluctuation or study effects? There’s no way to know, because the researchers excluded the data that would answer that question.

Headlines v. reality

Perhaps more importantly, the study was hailed as evidence that 5-MeO-DMT is effective against treatment-resistant depression, a severe mental health disorder that doesn’t respond to antidepressants or other therapies. Yet buried deep in the study was this surprising admission:

“[R]elatively few patients had extensive histories of treatment resistance or prolonged, chronic illness courses. In subsequent research, it will be important to include patients with more advanced levels of treatment resistance and longer-standing symptoms.”

The pressing question: why was this drug promoted as a powerful therapy for treatment-resistant depression if few of the study participants actually had the condition? Join Dr. Liza Lockwood and Cam English on this episode of Facts & Fallacies as they dissect the JAMA Psychiatry study.

Dr. Liza Lockwood is a medical toxicologist and the medical affairs lead at Bayer Crop Science. Follow her on X @DrLizaMD

Cameron J. English is the director of bio-sciences at the American Council on Science and Health. Follow him on X @camjenglish

The analogy works like this: law enforcement applies the same kind of selective pressure to the illicit drug market that antibiotics apply to bacteria. When we crack down on illegal drugs—seizing precursors, shutting down labs, tightening borders—the black market doesn’t surrender. Instead, it adapts. Clandestine chemists rapidly pivot to entirely new molecular scaffolds that are harder to detect and regulate. The latest example: an opioid called cychlorphine, first flagged in Europe in 2024 and now showing up in Toronto, southwest Ohio, eastern Tennessee, central Kentucky, and Chicago.

On this understanding, the underground market functions as “a vast chemical Petri dish,” says one expert, where an almost unlimited menu of new, powerful molecules is synthesized and distributed to drug users around the world. Moral of the story? Prohibition doesn’t end the arms race—it accelerates it.

Join Dr. Liza Lockwood and Cam English on this episode of Facts and Fallacies as they explain the science, trace the evolution of illicit opioid use and confront an uncomfortable policy question: is America’s prohibitionist approach to drug policy actually making the opioid crisis worse? If so, what do we do about it?

Dr. Liza Lockwood is a medical toxicologist and the medical affairs lead at Bayer Crop Science. Follow her on X @DrLizaMD

Cameron J. English is the director of bio-sciences at the American Council on Science and Health. Follow him on X @camjenglish

“Along with the possibility of the extinction of mankind by nuclear war, the central problem of our age has therefore become the contamination of man’s total environment with such substances of incredible potential for harm … How could intelligent beings seek to control a few unwanted species by a method that contaminated the entire environment and brought the threat of disease and death even to their own kind? Yet this is precisely what we have done” (Silent Spring p 14-15 Kindle Edition).

Although Carson is remembered fondly for her colorful prose that helped to launch the modern environmental movement, her criticisms of pesticides were flawed in important ways. “Silent Spring was replete with gross misrepresentations and atrocious scholarship,” says former FDA scientist Dr. Henry Miller. While she was broadly correct that pesticides can be harmful to off-target organisms (e.g. DDT causing eggshell thinning in some bird species), Carson’s claim that the insecticide was driving many birds to extinction was contradicted by multiple studies published before and after Silent Spring hit bookstores.

Strikingly, annual data from the North American Breeding Bird Survey from 1966, a study launched in response to concerns Carson popularized, showed “through the end of the 1970s … no obvious pattern of overall increasing bird populations as would be expected to follow the 1972 banning of DDT if it were truly harming bird populations,” science writer Robert Zubrin noted in 2012.

But of particular note was Carson’s allegation that DDT caused a variety of illnesses, including cancer: it was speculative at the time and subsequently refuted by additional research. “…[S]tudies in Europe, Canada, and the United States have since shown that DDT didn’t cause the human diseases Carson had claimed,” Dr. Paul Offit observed in 2017:

“Indeed, the only type of cancer that had increased in the United States during the DDT era was lung cancer, which was caused by cigarette smoking. DDT was arguably one of the safer insect repellents ever invented—far safer than many of the pesticides that have taken its place.”

But the story of highly toxic DDT persists to this day, and mainstream accounts of Carson’s work maintain that her claims about pesticides were vindicated.

Join Dr. Liza Lockwood and Cam English on this episode of Facts and Fallacies as they take a closer look at the risks of benefits of DDT use, and challenge some common misunderstandings along the way.

Dr. Liza Lockwood is a medical toxicologist and the medical affairs lead at Bayer Crop Science. Follow her on X @DrLizaMD

Cameron J. English is the director of bio-sciences at the American Council on Science and Health. Follow him on X @camjenglish