Emily Dufton, "Addiction, Inc: Medication-assisted Treatment and America's Forgotten War on Drugs" (U Chicago Press, 2026)

Summary

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Episode Overview

Podcast: New Books Network
Host: Gregory McNeff
Guest: Emily Dufton, historian and author of Addiction, Inc: Medication-assisted Treatment and America’s Forgotten War on Drugs (University of Chicago Press, 2026)
Date: February 18, 2026

Main Theme:
This episode dives into the untold history of medication-assisted treatment (MAT) for opioid use disorder in the US, tracing the rise and fall of public health approaches, the politics and stigma involved, and lessons from abroad. Drawing on personal stories, intense research, and anecdotal evidence, Dufton uncovers how MAT became both a hope and a battleground in the ongoing American drug crisis.

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Key Discussion Points & Insights

1. Personal Motivation and Tragedy ([01:00 – 03:48])

• Dufton's personal connection:
  Emily Dufton opens by sharing how the tragic loss of her friend Dana to opioid addiction and suicide shaped her commitment to eight years of research on MAT. His death led her to wonder: “If Dana…were to present themselves for treatment, how should they have been treated to prevent their early deaths?” ([02:55])

• Research question genesis:
  Conversations with clinicians revealed a consensus—MAT would have likely helped Dana, launching Dufton's investigation into its overlooked history.

“I started to wonder if Dana or any of the other people I knew…how should they have been treated to prevent their early deaths?…They all said to one that Dana should have been placed on medication assisted treatment…” (Emily Dufton, 02:55)

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2. What is Medication-Assisted Treatment (MAT) and Why the Controversy? ([04:04 – 08:38])

• Definition:
  MAT uses one of three FDA-approved drugs—methadone, buprenorphine, or naltrexone—to treat opioid use disorder, usually by reducing withdrawal or blocking opioid effects.

• Philosophical resistance:
  In America, abstinence is seen as the gold standard; thus, using other opioids as therapy is controversial. Critics liken it to “switching an alcoholic’s vodka for beer.”

“The thing about MAT is it does not stop opioid use…the goal is to say, you don’t have to go through complete withdrawal…but the controversy is, are you just perpetuating dependence?” (Emily Dufton, 07:20)

• Stigma and willpower:
  Cultural and moral assumptions about addiction drive much opposition to MAT, which some see as a lack of willpower or continuing “dependence.”

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3. History and Early Promise of Methadone Maintenance ([09:29 – 12:29])

• Origins of methadone:
  First synthesized in Germany during WWII, methadone was repurposed by American researchers in the 1960s for heroin addiction.

• Small beginnings, big results:
  Drs. Marie Nyswander and Vincent Dole’s New York trials with just two patients proved methadone’s remarkable effectiveness and affordability for managing withdrawal.

• Political vulnerability:
  Despite early promise, methadone remained marginalized, serving only about 9,000 people by 1970.

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4. Nixon, the Forgotten Public Health Offensive, and Dr. Robert DuPont ([12:46 – 16:21])

• “War on Drugs” date:
  June 17, 1971, is commonly cited as the start of Nixon’s War on Drugs—but the host and Dufton clarify its misunderstood legacy.

• DuPont’s D.C. Model:
  Instead of just more arrests, Nixon instituted a wave of federally funded treatment clinics—modeled after Dr. Robert DuPont's programs that notably reduced heroin use and crime in DC.

“He [Nixon] says, ‘I want to spread this nationwide…not only [because] of rising rates of crime…heroin use…but also addicted soldiers returning from Vietnam.’” (Emily Dufton, 16:03)

• SAODAP:
  The Special Action Office for Drug Abuse Prevention was formed, directly backed by Nixon with unprecedented funding and authority to proliferate treatment.

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5. Institutional Shifts: SAODAP, NIDA, and Buprenorphine ([16:42 – 24:32])

• SAODAP's national impact:
  Hundreds of clinics offering MAT and other services rapidly opened nationwide between 1971-73.

• Evolution to NIDA:
  SAODAP faded post-Watergate as the National Institute on Drug Abuse (NIDA) took over, focusing more on research than public clinics.

• Buprenorphine (Suboxone):
  Developed as a safer partial-agonist alternative to methadone, buprenorphine was less tightly regulated. Initially heralded as a potential public health boon, its rollout faltered due to aggressive marketing and abuse paralleling the OxyContin crisis.

“It was the largest opioid settlement in American history—no one paid attention because we were undergoing a global pandemic.” (Emily Dufton, 23:28)

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6. Marginalized Populations: Veterans, Minorities, and Prisoners ([24:32 – 28:38])

• Veteran-driven policy change:
  Waves of opioid-addicted veterans following wars repeatedly forced policy shifts, from morphine maintenance clinics after WWI to expanded methadone programs for Vietnam vets.

“Vets inspired the two biggest changes in opioid maintenance policy… There was widespread addiction [after wars], and [government] needed solutions.” (Emily Dufton, 25:15)

• Criminalization & MAT:
  MAT drugs are deeply intertwined with the justice system. Naltrexone in particular is viewed as enabling “enforced sobriety,” stripping agency from users and appealing to drug courts.

“Naltrexone…is seen as sort of criminalizing or punishing that use. But [it’s] embraced in drug courts to enforce sobriety.” (Emily Dufton, 29:22)

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7. Pivotal Figures: Dr. Jerome Jaffe and LAM ([30:55 – 37:58])

• Dr. Jaffe’s leadership:
  Nixon appointed psychiatrist Dr. Jerome Jaffe, whose Illinois Drug Abuse Program was a model of “multi-modal” integrated care, to head SAODAP.

“[Jaffe] is given a whole lot of money and a whole lot of power, and told to dramatically reduce crime in 17 months.” (Emily Dufton, 33:27)

• Experimenting with new drugs:
  Jaffe championed LAM (L-alpha-acetylmethadol), an even longer-lasting opioid. However, LAM’s promise was undone by bureaucratic infighting, lack of champions, and commercial interests.

“LAM is this really sad story of strong and good political ideals… just couldn’t get across the finish line.” (Emily Dufton, 37:34)

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8. Reagan Revolution and the Privatization/Retrenchment of Treatment ([39:02 – 41:39])

• End of the federal MAT era:
  Reagan’s administration rapidly defunded federal support for methadone clinics, replacing grants with block funding to states (which many used to ban clinics altogether), leading to mass clinic closures or privatization.

“With the stroke of his pen…methadone went from a federal project to a private industry—just like that.” (Emily Dufton, 41:06)

• Shift to research, not treatment:
  Under Reagan, NIDA moved away from clinic support to a primary focus on research, especially animal studies and nicotine, letting much expertise and institutional knowledge dissipate.

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9. New Epidemics: Crack, HIV/AIDS, and the Limits of Zero Tolerance ([41:39 – 45:23])

• HIV's impact:
  Despite the HIV/AIDS epidemic’s strong link to injection drug use, federal zero-tolerance approaches under Reagan prevented expansion of methadone or harm-reduction efforts in the face of evidence.

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10. Buprenorphine: The “Holy Grail” With Limits ([45:23 – 49:39])

• Scientific background:
  Discovered in the UK, eventually brought to the US as Suboxone; intended to offer the benefits of methadone with fewer risks.

• Access revolution:
  For the first time, opioid maintenance could be prescribed by regular doctors and picked up at pharmacies, a huge de-stigmatization step—though hampered by regulatory and market barriers.

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11. International Comparison: Switzerland's Integrated, Humane Model ([49:39 – 54:00])

• Structural differences:
  Switzerland’s rapid, public health-driven response to HIV and opioid use in the 1980s-90s integrated addiction treatment with psychiatry, general health, harm reduction, and robust social supports.

“There is an all-encompassing approach to the treatment and care of some of the most marginalized individuals in society. And we do not offer similar levels of care here.” (Emily Dufton, 53:44)

• US isolation:
  US addiction treatment is siloed from other healthcare, contributing to worse outcomes.

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12. Why Can't the US Do What Switzerland Does? The Barrier of Memory and Profit ([54:00 – 57:55])

• Forgetting our own history:
  The US once led the world in accessible, federally funded addiction care, but a cultural and political lurch erased this memory.

• Commercialization and profit motive:
  The rise of a $16 billion opioid “treatment market” and entrenched private interests impede systemic public health reform.

• Glimmers of hope:
  Isolated programs and providers (e.g., Vicki Walters at Reach Health Services in Baltimore) show it is possible to do better—if care becomes about people, not profit.

“Everybody has a Dana…We've all been impacted by this… But I do think people want [a better system].” (Emily Dufton, 55:31)

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Notable Quotes & Memorable Moments

• “The dividing line you can say is either…perpetuating opioid dependence is either okay as long as it’s kind of calm and chill, or it’s just bad no matter what.” (Emily Dufton, 08:13)
• “He [Nixon] actually launched addiction treatment clinics, free, nationwide…we completely forget about it because we just think Nixon's law and order.” (Emily Dufton, 17:55)
• “It was the largest opioid settlement in American history—no one paid attention because we were undergoing a global pandemic.” (Emily Dufton, 23:28)
• “Methadone went from a federal project to a private industry—just like that.” (Emily Dufton, 41:06)
• “If we see people as people, you have a tendency to not want them to die. Go figure.” (Emily Dufton, 57:52)

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Timestamps of Important Segments

• [01:00] Personal story: Dana and the origins of Dufton's research
• [04:04] Defining MAT and why it’s controversial in the US
• [09:29] Methadone’s medical and political beginnings
• [12:46] Nixon’s War on Drugs and the D.C. model
• [16:43] The launch and significance of SAODAP
• [20:06] The story and commercial pitfalls of buprenorphine
• [24:32] Veterans and marginalized groups in drug policy
• [28:47] MAT in the criminal justice system
• [31:16] Dr. Jerome Jaffe and the national network of clinics
• [34:01] LAM: hopes and dashed promise
• [39:02] Reagan’s retrenchment and privatization
• [41:52] The impact of crack and HIV/AIDS on MAT policy
• [45:23] Buprenorphine’s development as “the holy grail”
• [49:39] Switzerland’s humane, integrative model
• [54:00] Why hasn’t the US followed suit? Memory, culture, and profit
• [57:52] “If we see people as people, you have a tendency not to want them to die.”

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Conclusion

Emily Dufton’s interview powerfully reframes the “forgotten” history of MAT, showing how political, cultural, and economic forces have shaped and too often derailed effective responses to opioid addiction. Through historical analysis, personal narrative, and international comparison, she challenges listeners—and policymakers—to remember, reconsider, and reshape the nation’s approach for a more humane and evidence-based future.

Transcript

[A]

Welcome to the New Books Network. Welcome to the New Books Network. I'm your host, Gregory McNeff, and I'm excited to be joined by Emily Dufton, the author of Addiction, Medication, Assisted Treatment and America's Forgotten War on Drugs, published by University of Chicago Press in April of 2026. Emily is the author of Grassroots the Rise and Fall and Rise of Marijuana in America. She is the recipient of a Whiting Creative Nonfiction Grant. Her writing has appeared in the Washington Post, Smithsonian Magazine, and other publications. She lives with her husband and children outside Washington, D.C. i selected addiction, Inc. Because it offers a deeply research examination of medication assisted treatment in the United States, highlighting the political, cultural and medical battles that have shaped addiction and drug treatment policy. It's an incredibly fascinating read and as I mentioned, deeply well researched. Emily, thank you for joining me today to discuss your book.

[B]

Oh, thank you so much for having me. That was a lovely introduction. Thank you.

[A]

Oh, very well deserved. Emily, your book really starts off with sort of a poignant personal, I guess, an aspect of your life that influenced your writing this book, specifically Dana's story, and how that led to this question, this investigation you do into Matt, could you talk about how that personal loss shaped the structure of your book?

[B]

Sure, yeah. Dana was a good friend of mine back when I was in high school in Allentown, Pennsylvania. So we got to know each other in the late 90s and early 2000s. He was a couple years younger than me, but it was a small school and we performed in school plays together every fall and spring. So we really got to know each other pretty well. But we became friends. And then I left Allentown and went to college. And I did not see Dana's decline as he started to participate in the world of illicit opioid pill that had started to flood Allentown and my high school in the late 90s and early 2000s. Dana's story of opioid use and addiction was actually fairly typical of a lot of people I went to school with. This was. This was a fairly common story at the time. But Dana did decide at one point when he was 30 years old to try to change, to try to turn his life around. He wanted to get off the drugs. He wanted to move out of his parents house and out of his childhood bedroom and become the person he wanted to be. It was in the prime of his life. It was his right to do so. But he never found effective treatment for his addiction. And after he got off the pills cold turkey, he suffered a period of really intense depression. And in the fall of 2018, he went into the woods behind our middle school and hanged himself from a tree. And no one found his body for 10 days. It was just a really horrific death. And it bothered me because Dana was so lively and vibrant and such a fully alive person. To lose him before he was even 31 was a real shock because there was many members of my generation who were being lost in this way. But I also realized that Dana's death could pose essentially a research problem. And I started to wonder if Dana or any of the other people I knew from Allentown who suffered similar fates were to present themselves for treatment, how should they have been treated to prevent their early deaths? And when I spoke to treatment providers and professors and researchers, they all said to one that Dana should have been placed on medication assisted treatment, or mat or mat, or, you know, use any of the terms you like. And I began wondering what that was. And it launched me on an eight year journey of writing its entire history for the University of Chicago Press. And that, and now we're here, it has led us to this moment.

[A]

No wonderful story. Totally makes sense, so I'll just jump right in. In the beginning, you do make some distinctions. How do you define medication assisted treatment and why has it been so controversial in American drug policy?

[B]

You can define medication assisted treatment as treatment that uses medications for the treatment of opioid addiction or opioid use disorder, which is the more current term for the disease. So medication assisted treatment uses one of three FDA approved medications, either methadone, buprenorphine, or naltrexone to either decrease the effects of opioid withdrawal through daily opioid use, known as like opioid substitution therapy. You can either take methadone or buprenorphine, which are both opioids themselves, usually once a day, sometimes twice a day, to prevent the brain from experiencing opioid withdrawal, which is a very painful, very debilitating experience with a lot of nausea, vomiting, pain and depression, which can linger for days, weeks, months, years. The other alternative is naltrexone, which is also an FDA approved pharmaceutical, but with the opposite effect of methadone or buprenorphine. Naltrexone is an opioid antagonist, so you take it more as a prophylactic once you're fully detoxed from all opioids. If you take naltrexone either daily or through a monthly shot, your brain is actually protected from opioids. Opioid use Naltrexone covers the brain's opioid receptors and that way, if you do inject heroin or take a pill, your brain visibly or physically cannot feel the effects of the opioid and its supporters argue, the most effective way to prevent opioid deaths or opioid overdose deaths, I should say. Why is it controversial? Well, because you're taking a drug and drug use is controversial, especially opioid use. For the most part. American treatment systems are based on the abstinence model where true sobriety is only achieved if you are free of all intoxicant use using methadone and buprenorphine. And some would even argue naltrexone is not the abstinence based approach to ending chaotic drug use. It is, however, its supporters argue, a really great way to still reduce the problems of illicit drug use. MAT medicalizes opioid use either through its daily sort of almost like a dietary regimen of, like a, of like a, of like a vitamin. You take it in your methadone and your buprenorphine in the morning and you're kind of set for the day. That's the ideal. Or naltrexone as a prophylactic. And that's very controversial because as people have argued from Harry Anslinger on that replacing, replacing opioids with something like methadone or buprenorphine is the equivalent to switching an alcohol, alcoholic's vodka for beer. So it's a lighter version of the same problem that does not eradicate the issue, but rather perpetuates it.

[A]

Very nice. And you make at one point the fiercest opposition is philosophical, which I guess touches on your point that it's almost like, I don't want to say, is the view from one side of the perspective that these people are lacking in willpower or they're doing something wrong. And that's why you would go to the absence approach. Or could you talk, I guess, a little bit about the stigma there?

[B]

Yes, I mean, that's a really important point. Right. Controversy or opposition, one can say to Matt, is based on the idea that any opioid use, if not specifically for like, you just had a tooth pulled or, you know, something like that, is wrong morally, ethically, it's just simply wrong. You know, it's sort of based on this idea that any drug use that's outside of medical purposes simply cannot be, you know, really acceptable in that like, legacy of puritanism of American culture. So the idea of taking and substitute medicalized opioid just to simply perpetuate the physical dependence. Right. Because the thing about MAT is that it does not stop opioid use. Right. The person is still physically dependent on opioids. The question is, are they addicted to them? Because addiction, in I think our common parlance suggests a lot of chaos to their activity, just a lot of problems with it. The goal of mat is to say you don't have to go through complete withdrawal, you don't have to deal with those effects. You can continue to perpetuate opioid use, but it's going to be comfortable for you. It's going to be like more like a daily vitamin. And it's supposed to calm the chaos now does it? Not always. And that's where the critics come back and say this is still a bad thing. But the concept is that the dividing line you can say is either that you, you think perpetuating opioid dependence is either okay as long as it's kind of calm and chill, or it's just bad no matter what and you can't do it. And if, depending on where you fall on that line is how you're going to feel about Matt.

[A]

No, that's interesting. You quote one individual who says, it just helped me feel normal. And I thought that was very interesting. And we'll talk about few of the, the doctors who sort of revolutionized this treatment and it, it felt like they almost treated the patient as a person rather than even a disease to be medicated. But they interacted with them and I don't want to say maybe gave them certain dignity. But it was interesting to see their reaction to some of the, some of the, I guess, revolutionary doctors you talk about in here. But I want to go back to the methadone treatment program starting out. What made them both promising and then politically vulnerable. And I think you alluded to this earlier, but the variable of politics in this, particularly at the federal level, the presidential level, is pretty significant in terms of determining the country's approach to drug treatment.

[B]

Totally, totally. But it becomes that for sure. But actually, early methadone started off so small and it was just these tiny little trials. The original was just with two people. So I guess to sort of explain what methadone maintenance is, is I guess to go back even further. Methadone itself is a long acting synthetic opioid. It was developed in Germany in 1938 during World War II. Germany didn't have a lot of colonies in hot poppy growing areas. So the country, in order to help many wounded soldiers, because it was World War II, they were really interested in developing synthetic opioids. So methadone was one of many, that IG Farber industry developed, and they also developed Zyklon B, which was, of course, the gas chamber drug. So, yay, there's a connection for you. But methadone came to the US after World War II as a spoils of war, along with a series of other technologies. It was originally tested at the Addiction Research center in Lexington, Kentucky, on the grounds at the US Narcotics Hospital there, which listeners might know is where a lot of jazz musicians went to train, went to serve sentences and be treated for drug addictions. But it kind of went nowhere. It kind of died off in the 1940s. No one really used it. It had a very slow onset of action. So it wasn't great as a pain reliever. But it was FDA approved by Eli Lilly in the mid-1940s as an analgesic and antitussive. It could help with coughs. Right. Because a lot of opioids help with coughs. And it just sat on the shelves and no one really used it until the mid-1960s, when two doctors named Marie Nicewender and Vince Dole started its first clinical trial in New York City at the Rockefeller Institute. And they found that methadone was not a great pain reliever. But for people who had been using heroin for years, if not decades, it was really good at controlling withdrawal. And because it had a slow onset of action and an extremely long half life, it could control withdrawal symptoms for 24 hours. Whereas with heroin, like, they would be itchy again within an hour and a half, three hours. Right. There's no way to kind of keep a heroin sort of pattern going where you weren't injecting several times a day. Dolan Niswander tried very high doses of methadone. And we're like, oh, my God, this works all day. And it's generic and it's cheap. And it seemed very much like the most promising transformation in heroin addiction treatment in 40 years. It was really remarkable. So there was a lot of hope and promise. Famous for it in the early 1960s, but it stayed very, very small. And by about 1970, there were only 9,000 people across the United States and Canada combined using this for the maintenance sort of application across this is in 1970, so maybe five years later. So it's very small still.

[A]

Okay. There's a number of avenues. I want to go down with that answer, which was great. But you mentioned 1970s. You talk about how, like most people, you thought sort of our drug policy or the war on drugs began June 17, 1971. What's the significance of that date?

[B]

Oh, that's the date. The date. The most infamous date in American drug history. Right. Where President Richard Nixon gets up on the stage surrounded by these three young men and says that he was going to wage a new all out offensive against heroin, which was public enemy number one. And a lot of people over the years and decades have pointed to this moment and said, well, that's when Nixon launched his war on drugs. And that was when Nixon's quite infamous law and order stance took shape. And we have been living with the effects of it ever since.

[A]

Okay. And I want to move from Drs. Nishawa and Dole. Their success was replicated in D.C. by, I believe, Dr. Dupont. Could you talk about, I guess, another urban area and maybe the dynamics of being, you know, the capital of the United States. How successful was he replicating their success in D.C. and what sort of obstacles did he face, you know, being in Washington D.C. and obviously the White House and Nixon.

[B]

Sure, yeah. So what's really interesting is that the kind of. Go back to your last question. June 17, 1971, is really, really important, specifically in Washington D.C. because it's the day Nixon says he's going to wage this new all out offense against heroin, public enemy number one. But he doesn't actually use more arrests, he doesn't actually use law enforcement. What he says is we are going to launch a nationwide nationalized system of addiction treatment clinics. And he's going to base it off of the model that had been in place by that point for about two years in Washington D.C. washington D.C. is hugely influential in that date on June 17, 1971. If it wasn't for the work that Dr. Robert Dupont did in Washington D.C. for like the previous year and a half, like June 17, 1971, wouldn't have happened. So he's a really, really remarkable and really important figure. And what he did basically was starting in 1969, he tried to find like, found programs, working with the Department of Corrections to keep people out of these overcrowded jail rather than punish them for heroin addiction, actually treat it instead, thereby decreasing the number of people in jail, which was escalating rapidly in the wake of the 1968 riots. And to ultimately treat the larger and growing problem with heroin addiction that he saw taking over the city in the late 1960s.

[C]

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[D]

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[B]

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[B]

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[A]

One of these treatment avenues he pursued was the formation of the Special Action Office for Drug Abuse Prevention, or SAO dap. I believe you talk about how successful that was and then I'm going to ask you a follow up about NEHDA and maybe how the two, I guess, institutions differed.

[B]

Sure. Yeah. So seodap, which I just love to say, it's so fun, the Special Action Office for Drug Abuse Prevention just rolls off the tongue, right? That was what Richard Nixon ultimately launched on June 17, 1971. He was so inspired by Dupont's success in Washington, D.C. because between 1969, when he starts this suite of treatment clinics in D.C. including methadone clinics, therapeutic communities, detox centers, counseling centers, the rate of heroin use in DC Drops, the number of overdose deaths drops, and the rate of crime plummets. And it's the only city in America to have a crime rate go down. Every other place in America in the late 1960s, crime is rising exponentially. It's kind of like a rocket going into space. So Nixon is very concerned about this. He sees the success in Washington, D.C. which he's called the nation's laboratory for crime reduction techniques. And he says, okay, I want to spread this nationwide. But he's not only doing it because of rising rates of crime and rising rates of heroin use, he's also doing it because by 1971, there are reports of tens of thousands of addicted soldiers in Vietnam who have started to use the very pure and very cheap heroin that is very readily available across the country. So Nixon is faced, in the summer of 1971, about a year and a half away from the 1972 election, with rising rates of crime Rising rates of heroin use and maybe like 30 to 40,000 addicted soldiers who are battle trained and about to go into withdrawal, coming back to the United States at the rate of about a thousand veterans returning a day. So this is a very bad situation. And he decides that rather than just like keep going for the law and order approach, more arrests, more cops on the street, blah, blah, blah, he says, okay, I'm going to open this wave of nationalized treatment clinics and I'm going to, I'm going to open a new office which he calls saodap out of the executive office, right? It is like he, the person who leads it is going to report directly to Nixon himself. This is a very important office. He gives it an enormous budget. He gives it like two thirds of the entire drug budget and promises more money if it's necessary. It is a new all out offensive against public enemy number one that is going to fund demand reduction. It's going to fund treatment, it's going to fund research, it's going to fund education, and it's going to fund prevention. It is an absolute 180 from the federal or state or local approach on any level. For the past, you know, I'd say pretty much 40 years, right? Since, since the classic era of narcotic control begins in the 1920s. So this is 50 years, right? It's, it's a 50 year transition and it is unprecedented and it happens under Richard Nixon and we completely forget about it because we just think Nixon's law and order. And it's like, no, he's actually, he actually launched addiction treatment clinics, free addiction treatment clinics nationwide. And this occurred between 1973 and 1971 under the direction of CEODAP, the Special Action Office for Drug Abuse Prevention.

[A]

Yeah, no. Fascinating. One of the, I guess, successes, and I'm going to ask you, was it a success? Was the creation of Bufranna Norphine?

[B]

Buprenorphine?

[A]

Yeah. Perfect. Was that a success? Ultimately there was a settlement, but how do you view that?

[B]

Yeah. So the cool thing about CEODAP and then the National Institute on Drug Abuse, or nida, which is what it becomes after saodap kind of dissolves in Watergate with everything else that Nixon created. The cool thing about these organizations is that they were legally mandated to continue to research new addiction treatment drugs. And for the most part these focused on opiate addiction, opioid addiction. And the most successful, one might argue, that came out of this research project is a partial opioid agonist called buprenorphine, or it might be better known by its commercial name, its brand name, which is Suboxone. And so buprenorphine is really similar to methadone. You take it every day. You can take a lower dose, though, interestingly, you take it every day, and it prevents the brain from going into withdrawal and ideally is substantially supposed to keep the patient comfortable, not experiencing withdrawal symptoms, feeling normal, as the patient I interviewed said. But what's really different about it is that over the past 50 years, methadone got locked away into these isolated, highly regulated clinics that sort of straddle the line between federal and state law and sort of straddle the line between medicine and policing. So there's about 2,000 clinics nationwide now serving actually almost 700,000 people, which is the most that's ever been served by methadone in American history. But buprenorphine is unshackled from these sort of outlier clinics. It is something that you can get from any DEA registered physician. You can pick it up at most local pharmacies. It's the private treatment of opioid use disorder, as opposed to methadone, which is sort of like you have to go publicly, announce yourself at a clinic and do all this stuff. Is it a success in that sense? Yes, but it was not the public health success that I think it was ideally promised to be. It all kind of fell apart when in the early 2000s and through the mid 2010s, the one company that was allowed to manufacture Suboxone participated in the same product hopping and generic delay and criminal misbranding crimes as Purdue Pharma did with OxyContin a decade prior. And it began heavily promoting Suboxone, following the exact same pathway that Oxy had been sold on previously, basically just following oxycontin up the Appalachian Trail. So Suboxone clinics and private physicians turned into kind of the same pill mills that were selling Oxy previously, but now it was, you know, the supposed cure. Suboxone quickly became sort of an underground economy because it didn't have the same organized rollout that methadone did under saodap. It kind of failed as a public health response to a rapidly escalating prescription opioid epidemic that has then progressed into a heroin epidemic and which now has progressed into a fentanyl epidemic. Today, it's a little bit different, as you said. There was the settlement in 2020 when the Department of Justice successfully sued indivior Reckitt Benkeiser Pharmaceuticals, the manufacturer of Suboxone, for its white collar crimes. And at the point at that time, it was actually the largest opioid settlement in American history. No one paid attention to it, of course, because we were undergoing a global pandemic and we had bigger things on our mind. But it was a huge settlement. And interestingly, Endeavour is no longer allowed to market Suboxone. It can still sell the drug and has other things that it sells and it's doing quite well, but it's no longer allowed to market Suboxone, which is just part of its punishment. So even now there are generic versions of the drug which are more accessible and more affordable. But because now even Indivior doesn't even have a salesforce for it, there's really no one out there promoting it as much as I think it could be promoted. So it's a success in terms of availability now and ease of treatment through private office based opioid treatment, but it's a failure in terms of actually stemming the enormous tide of overdose deaths and problems that opioids have caused over the past 20, 30 years since it's been available.

[A]

Absolutely. I want to take a sidebar question here and ask you. It seems like there are at least two, maybe three groups that disproportionately feel the brunt of our, you know, back and forth drug policy, namely minorities, veterans and maybe prisoners. I want to ask you about that third group as a follow up, but could you talk about, you know, in your book, in the prologue, I think you cite quotes around Civil War Veterans, World War I, World War II, certainly Vietnam. It seems like our drug treatment, drug policy really has an impact on them or is in response to these veterans coming. Coming back from war.

[B]

Yeah, it's so true. So vets inspired the two biggest changes in opioid maintenance policy. Right. So the first time was after World War I, where in 1918, 1919, rates of morphine use were increasing because the drugs were fairly. Well, I mean, at that point they're kind of not as available as they used to be. But there was like there was widespread addiction in the late 1900s. The late 1800s. Excuse me, now I'm like losing all of my history. This is amazing. In the late 1800s, there was pretty high rates of opioid addiction because drugs like heroin, morphine were just absolutely easily available for sale at pharmacies, catalogs, traveling salespeople in all kinds of snake oil and things like that. So rising rates of addiction were occurring and they were starting to become a problem when it was occurring among less respected demographics. Right. The earliest people who were addicted to opiates were usually Civil War veterans, like you said, or like elderly Southern women who got addicted through doctors for rheumatism or birth pains or whatever as they started dying off and like young immigrants, started using widely available heroin, laws started cracking down. And for the most part, the drugs weren't really available by the end of World War I. But then suddenly you have a lot of men coming back from the European front who were very badly injured and have been using morphine for the pain. And all of a sudden, after a series of laws that were being passed on the federal and state level and Supreme Court rulings, you could no longer access opiates easily from places like the pharmacy or wherever. Not only because users could be arrested, but dealers and purveyors could be arrested as well. After the Harrison Narcotics act, when these veterans started coming back addicted to morphine and combat trained people started getting kind of scared. And between 1919 and 1923, there's actually a series of 44 morphine clinics that were opened nationwide in a variety of states. Georgia, Ohio, New York, California. They were all over the place. And they offered essentially what like a methadone clinic offers, which is free or very low cost access to medical grade morphine. You, however many times a day you need it to cut down on the peddler, right? The illicit salesperson, to cut down on overuse or adulterated use that could result in overdose, and to basically medicalize morphine use. And they were really popular. They were all shut down by 1923 as America's growing intolerance for all intoxicant use really rose. I mean, remember we passed the 18th amendment in 1920. Like we outlawed alcohol, like in the 1920, 1920s are not a time when America likes drug use. We don't like any drug use, so we especially don't like morphine clinics. And we shut them all down. And that pretty much stays how it is, right? Like you cannot access medical grade opiates just for the use, just for the like, just to prevent withdrawal. They are not available. Tough luck. And that lasts for 50 years until Nixon's like, we're going to open methadone clinics nationwide. And all of a sudden there were hundreds of them and they open very, very rapidly.

[A]

I wanted to ask you, I mentioned that third class prisoners, and we've talked a little bit about methadone and buprenorphine, naltrexone. Why do we associate that with the criminal justice system or, you know, the law enforcement community?

[B]

Oh, naltrexone specifically.

[A]

Yeah. Do you think there's Some association there?

[B]

Oh, yeah, no, totally. Like, so all three of the mat drugs have, you know, like, relationships with law enforcement and the criminal justice system in, I think, from what I've heard in talking to people, ideally, if you have opioid use disorder, it's very nice if the prison or jail you go to offers methadone or buprenorphine to prevent you from undergoing withdrawal in your cell. That's ideal. Those things are not always possible. You oftentimes have to have a standing prescription with either a clinic or with a doctor or something like that. So oftentimes withdrawal is made very uncomfortable for prisoners undergoing that while they're incarcerated. But it's different with naltrexone, and that's because naltrexone has such a different philosophical approach to opiate use. Again, like we said before, naltrexone is more like a prophylactic. You take it to prevent the future use because ideally you've gone through something called. The psychological term is conditioning, where you understand that even if you were to inject or take a pill or something, you weren't going to feel the effects. And in a sort of Pavlovian way, like, the brain begins to understand, like, to no longer associate craving with the. With. With, like, the idea of opioids because it's just not going to work. And once that craving is exterminated, you know, that prophylactic is working great. You're not going to use opioids anymore. But a lot of people view that as taking away a person's sense of agency. And, you know, there's many arguments that suggest that if you. If you would like to use these substances, then you should be allowed to. There's. There's no law, you know, against, you know, experimenting with one's conscience in other ways. So the idea that you're taking away a person's agency and aspect to do what they want to do is seen as sort of criminalizing or punishing that use. But naltrexone has really been embraced in a lot of places, like drug courts, because as one person I quoted says, it kind of like, you know, sort of like shifts across the two lines. It says we can still use medications, but we're using them only to enforce sobriety.

[A]

Yeah, no, that's interesting. We've talked about Dr. Nieswander and Dole in New York and Dr. Dupont in D.C. could you comment on Dr. Jerome Jaffe in Chicago and his. He founded the Illinois Drug Abuse program, idap. And I think you got to know him pretty well on a personal level and access to his records. Can you talk a little bit about that?

[B]

Sure, yeah. So Dr. Jaffe, Jerome Jaffe, was the person Nixon tapped to run ceodap. He was the head of the organization. He was the guy who reported to Nixon himself. Really. He reported it to Bud Crow and Jeff Dunfeld, who were two of Nixon's aides. But he, you know, in theory, reported directly to Nixon himself. And he was plucked to do this job at 37 years old from Chicago, Illinois, as you said, where he was running the Illinois Drug Abuse Program. Jaffe was a psychiatrist from Philadelphia who kind of fell into treating drug addiction. He served at Narco in Lexington, but did it because he was really kind of interested in the psychopharmaceutical revolution of the 1950s, when all of these new drugs like Thaldol or Thoradol and Haldol and these other drugs were created that could create, like, they could treat previously untreatable conditions like schizophrenia and psychosis. Jaffe was really intrigued by this idea like, oh, you can. You can use drugs to treat mental disorders. How intriguing. But he wasn't interested in addiction, exactly. However, when he moved to the University of Chicago to do research there, a person at his department said, the state is having a real problem with opioid addiction, with heroin addiction and crime. They'd like to do something about it. What do you recommend? And Jaffe says, well, I think you should open a multimodal clinic system that has things like methadone maintenance, therapeutic communities, detox counseling. Make everything available. And then if you make treatment available, people will be more prone to use that than continue to use heroin and commit crimes, give them the option. And the guy was like, great, you have to run it now. And so he did. Between 1969 and 1971, you know, Jaffe was in charge of what ended up becoming one of the largest and most effective treatment programs in the United States, all throughout the state of Illinois. He's tasked with doing that on the national level with CEODAB, and he has to make success happen before the 1972 election, which means he's given a whole lot of money and a whole lot of power, and he's told to dramatically reduce crime in 17 months. And that was his. And that was very much his job. That was very much the direction that was given to him by the White House.

[A]

Thank you. I want to ask you. I think he was instrumental in introducing Lam. I'll attempt to pronounce it. L. Alpha. Athetamethadol. And I wanted to ask you, how successful do you think that was? How effective was LAM in addressing the problems of methadone?

[B]

Yeah. So Jaffe, you know, when we talk about MAT now, it's just these three drugs. It's just methadone, buprenorphine and naltrexone. That's it. But there actually used to be another contender. And at one point, researchers in the US actually started to try out other drugs. Right. Like besides, you know, current research into maybe using Ozempic and GLP1s to help reduce cravings, there hasn't been a lot of development in the medication assisted treatment field in, well, since Suboxone came out. Like, it's been a while. We have variations of these three drugs, but we really still have just these three, three drugs. Except for a brief period in the early 1990s when we had LAM, which as you said, is L alpha acetyl Methadol. And it's basically longer acting methadone. Rather than taking methadone every day, you could take LAM every third day. So you could take it like Monday, Wednesday, Friday, and that would be it. And it would be able to hold off withdrawal for a period of up to 72 hours and you'd be, you'd be set. Jaffe was interested in it because of the escalating problems with the country's methadone clinics. In the early 70s, Saodap did what it was told. It opened hundreds of clinics in hundreds of municipalities nationwide. And by like 1972, when Nixon was reelected in a landslide, crime had gone down, arrests had gone down, overdose deaths had gone down. There was, I think, a lot to say that CEODAP had a fair amount of success. But then, but then the clinics, like they were opened in a rush. There wasn't a lot of oversight, a whole lot of profiteers got into it. They were just selling the drug methadone overdoses started to rise. It became a mess. So Jaffe was like, well, if people need to dose every day with methadone and that's what's causing the chaos around these clinics. What if we go to thrice a week, Lamb? It cuts down on all the problems with distribution, it cuts down on the chaos in the neighborhood, everybody wins. But it became such a cluster because Joffe was trying to do all this work before, within his two years of being in charge of, say, Ojap, he was there from 71 to 73, working 16 hour days year round, really working himself to the bone to try to do this stuff. But after he left and Then Nixon, you know, resigned the presidency. The taste for all this stuff just disappeared. No one was interested in it. SAODAP was demoted to nida, which was like a fourth tier office in the Department of Health and Human Services. Like no longer reporting directly to the President himself. Right? Just total like divestment in the big public health project that Nixon had put into it, kind of dies a quiet slow death. And everything Jaffe did for lam, which was supposed to solve all the problems of the methadone clinics, it just falls apart. I mean it cost a lot of money. Basic scientific research costs a lot of money. Federal government put a lot of money into it and it just like in a bunch of the world of congressional infighting, pointing fingers and having no real strong proponent to push it through, it died a thousand from a thousand cuts and with no real friends and stayed dead until was briefly resurrected in the 1990s, only to die a second time because by that point privatized methadone clinics were such powerful commercial operators that they didn't want three times a week LAM either, because that would cut down on their profits. So the LAM is this really sad story of strong and good political ideals to help solve a problem that the, the government itself created with methadone clinics. And it just could not get across the finish line. It was just, it was just an absolute very sad disaster. Poor.

[A]

It is tragic.

[E]

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[F]

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[E]

Doctor about eglis and visit ebglis.lilly.com or call 1-800-lillyrx or 1-800-545-5979.

[A]

You set me up nicely for the next question here. A decade after Nixon launched his war on drugs, the coming Reagan revolution, with its emphasis on small government and states rights, was poised to dismantle it completely, all in the name of making it work. Can you talk about the effect of the Reagan administration's abandonment of methadone treatment? I think you talk about how maybe they move from treatment based to research based approaches.

[B]

Yeah. If Nixon launched his war on drugs, his treatment based war on drugs, Reagan ended it. Reagan was like, no, sir, we are not going to spend another dollar of federal money on methadone known clinics anymore. And he did this almost immediately upon assuming office. So, you know, if he's inaugurated In January of 1981, by August, he is on his ranch in California wearing his jean jacket and denim jeans and cowboy boots, signing stacks of legislation that, among a whole lot of other things, defund all of the social services that Reagan's pro small government, pro states rights government believes in. Right. So one of the things that he immediately divests from is public support for methadone clinics and treatment. He wraps that money, along with all the other money the Carter administration was spending on things like mental health treatment, alcoholism treatment, all this other stuff, puts it into a large block grant for the states, cuts the money by 25% and says that states now have the ability to distribute the money at will. So those methadone clinics, all of which were nationalized, all of which were 100% funded by the federal government, now have to compete with every other clinic in their state to get a pot of mightily reduced funds, assuming the state allows them to exist at all. Because 10 states immediately outlaw methadone access, you cannot, they close all the clinics, you cannot get it. It's done. So that's tough because methadone clinics have patients coming every day for a medication that prevents them from going into withdrawal and going back to the black market. So if they close, there's a lot of escalating problems from that. So a lot of clinics stayed open, and the only way they could was to privatize. So Reagan essentially paved the way for the very heavily privatized system of methadone clinics that we have today. With the stroke of his pen, signing those stacks of legislation, methadone Went from a federal project to a private industry, like, just like that, you know.

[A]

I want to ask you about a specific. The 80s, obviously there was the debut of crack, but also HIV. Could you talk about the impact of those two epidemics on NEDA and the larger mindset of drug treatment?

[B]

Yeah. So the. The HIV epidemic really transformed America's approach to methadone in a bad way. Right. Like, because it did not open up access to it at all. And that is very much because of the Reagan administration's very strong zero tolerance, just say no stance. So as you'd asked in the previous question and that I did not answer. So sorry about that. So, like, once. So SEODAP basically dies with the end of the Nixon administration, it turns into NIDA. And NIDA's still, like, it's still a pretty cool organization. They're still funding a lot of clinics. They're still doing a lot of research. They're doing research on lam, but they are doing more sciency research. Not just funding crazy clinics that are obviously very controversial, but also funding basic research on addiction and its treatment that's moving along. Everything's kind of going its way until 1981, when the Reagan administration is like, you're only going to do research now. It cuts NIDA's funding dramatically through a reduction in force, you know, like Elon Musk's fork in the road. Every single person who had worked on building CEODAP's system of nationalized treatment clinics, they were all let go. All the institutional knowledge about the treatment system that had been created was just, like, fired and sent away. Like, a lot of the research programs were shuttered. It was sad. The person who started in charge was named Dr. William Pollan, who was a Republican. He was a small government guy. He was very happy to simply have NIDA focus on animal tests and research on the effects of nicotine and tobacco. And that was the Nixon administration's approach. Excuse me, the Reagan administration's approach. They didn't care about heroin addiction anymore. They were really concerned about adolescent use of cannabis. That was one of their primary concerns. And they were very concerned about crack. But one of the things that they weren't very concerned about was hiv. They just didn't care about it. There was a very slow response to it and a very callous, I would argue, response to it from the administration, especially early in the epidemic, in the early 1980s. So because of their distaste for methadone anyway, there was no interest in reviving the treatment protocol, even as HIV rates started to Skyrocket, not only in the gay community, but among injection drug users in the mid-1980s. Because a really easy way to spread the virus is through swapping blood, which is someone with an active heroin addiction. That's something they might be doing several times a day as they're sharing needles. So as rates of, of HIV infection among heterosexual injection drug users started to rise, because the virus is also spread through sex, there was fear that this was going to spread HIV to astronomical numbers nationwide. And that's when the Reagan administration finally started to respond. But again, they did not support methadone. They only supported abstinence based programs that would end all drug use and that would be the way that they would eventually also end hiv. It was a blunt rejection of something that actually could have helped not only with heroin use, but with escalating and spiking rates of hiv.

[A]

Yeah, I want to move to part three of your book. You title it the Holy Grail, Buprenorphine, and I'm just going to read you a quote here from it. You say you're referring to Dr. Charles Grundzinska, please correct me there. A former commercial pharmaceutical developer and the MDD's director from 91 to 96 had one last option up his sleeve. Buprenorphine, a unique opioid that ably combined the best parts of NIDA's other treatment drugs while exhibiting seemingly none of their flaws. Could you talk about this evolution from methadone to buprenorphine and how that really seemed to change the landscape?

[B]

Sure, yeah. So buprenorphine was originally discovered in the early 1960s in England by researchers with an organization that made groceries like the same company, I think it's called Breckett and Coleman, that made Lysol and mop and glow and Coleman's mustard and all these lovely grocery store items. And they had, I think, two codeine based painkillers as well. And so they had a really small chemistry team and they were looking for new opioids and that had less of an addiction and sort of, you know, problematic causing effect. And they found this synthetic partial opioid agonist which they called buprenorphine. I think it was 1963 or so. And the guy who discovered it, John Lewis, was, you know, quite the adventurer because he actually tried it on himself, right. One evening when he was on a holiday weekend at Loch LeMond, because, you know, that's what you do when you live in the uk, right. And he said it made him feel nauseous and he didn't feel very well, but when he woke up in the morning, he felt fine and he thought, this is it, you know, the Holy Grail, the first non addicting opioid. I found it, right? It doesn't really go anywhere. It seems to cause fewer of the effects that traditional full opioid agonists do. It doesn't decrease heart rate as much, it doesn't decrease respiration. These serve the drivers of overdose, right? It seems to have like a built in sealing effect that prevents you from, from overdosing. And that's good, but it's not great as a painkiller. And so there were some countries, New Zealand, some places in Europe, they used it. America had an injectable only version called Buprinex, but it did not sell well. No one really liked it. And it was just sort of like around, right? Not one of the best sellers, but around. And then back at the ARC in Lexington, a researcher there named Donald Jasinski kind of had that same idea that Dolan Niswander had and thought, well, why don't I give this to patients with opioid use disorder and see if it holds off their withdrawal. And lo and behold, it did, right? It was very effective. Very similar to methadone, very similar to lam, could withhold withdrawal symptoms for a long period of time, 24 hours or so. Its distribution was difficult. Methadone you can just drink. Naltrexone is either a shot or a pill. You cannot just swallow buprenorphine or it will be neutralized by the liver. You have to dissolve it underneath your tongue. That's the only way you can do it. And back when buprenorphine only came in liquid form, a nurse would actually have to take a dropper and drop it in your mouth while you lifted up your tongue. So its distribution was complicated, but the federal government felt good about it. And NIDA hadn't really had a success for a while as far as its medications development division was concerned. So it says, how about this buprenorphine thing? Seems kind of promising, let's give it a try. And it, lo and behold, it did work, right? It comes on to the market in the fall of 19 or 2003 as Suboxone, which is because of a series of congressional hearings and kind of crazy legislation. The very first opioid maintenance treatment drug that can be prescribed by a private physician, distributed by a private pharmacy. It's opioid based opioid treatment program. Our office based opioid treatment programs. Transformation huge and finally available in 2003.

[A]

Yeah. And I love the title of one of the chapters here, talking about the distribution. Start the fire, Sell the house. I want to move to sort of the fourth part where you compare Switzerland to the US policy. They're obviously their policy. It seems more integrated, more humane. Could you talk about the key structural differences between the two countries?

[B]

Sure. I knew I wanted to compare the US system to some other system. And I liked the idea of Switzerland because although they're very small and obviously they're very unique demographically, economically, things like that, they went through a very similar drug problem that the US did in the 1980s when tiny, peaceful little mountainous Switzerland was the European capital of heroin use and hiv. Like it was just ground zero. It was causing some pretty serious problems. But the Swiss federal government and local cantatano government's response to the problem was so rapid and so holistic and so based in public health. And it really, it really resonated with me. And I went back in 2023 to actually see it for myself and see if a lot of the structures that they'd put in place in the late late 1980s, early night or mid-1990s in response to the HIV epidemic, if they were still holding up 30, 40 years later. And they really were right. What we kind of have a tendency to do in the US is isolate addiction treatment away from any other form of behavioral or physical healthcare. Right. Addiction treatment often isn't even included with other forms of psychiatry. Right. Which is, which is really a mistake because for the most part, people with opioid use disorder also have several psychological or psychiatric comorbidities, including depression or bipolar or things like that. They're oftentimes medicating with their opioid use. So it's very silly to not have opioid use treatment affiliated with the psychiatry department to help with what could probably co occurring disorders. So the Swiss do that. Right. In their clinics. They treat all forms of addiction. Behavioral healthcare we offer not just opioid substitution therapy drugs. Like they use methadone, they have a little bit of buprenorphine. For the most part, their patients are on oral morphine. And a few actually get injectable heroin. They're on heroin replacement programs. So they're very open to all of the treatment pharmaceuticals. They also distribute psychiatric pharmaceuticals. You can get your medication for your depression, for your bipolar, whatever. All the same place they incorporate behavioral healthcare. So if you have a behavioral addiction to addiction to gambling, to sex, to shopping, you can go to these clinics. They incorporate physical health. A lot of times people on sort of like the more marginalized end of the social spectrum. This is their only, you know, interaction with the health care industry. So they've incorporated general practitioners, dentists, gynecologists. Right. This is a place where a significant percentage of the Swiss population goes to get physical healthcare, behavioral health care and addiction healthcare. They're central, they're covered by insurance. The entire country is insured, they're legally mandated to be. And they also incorporate a lot of other social structures and harm reduction opportunities. They have injection use sites, they have controlled use sites. They have more social workers than I've ever seen in my entire life. It's like you throw a rock and you hit five social workers. So they're working to keep things copacetic between the sort of approved drug use sites and the neighborhoods, the clinics and the neighborhoods. They have programs, they have buses, they have housing programs, education programs, clothing is available, food is available. There is an all encompassing approach to the treatment and care of some of the most marginalized individuals in society. And we do not offer similar levels of care here.

[A]

Emily, my last question's a two parter. One, why can't the US adopt a similar system as you just outlined in Switzerland? And is it due to, I think, the $16 billion economy opioids represent? And then two, you, I think in the beginning of the book say you don't know if a functional system would have saved Dana, but it would at least give him a chance. Is Switzerland the model, the functional system you think we should look at? Or are there other, I guess, other approaches that we could take here in the US And I should say you do cite Vicki Walters, who is in Baltimore where you thought the way she approaches patient treatment at Reach Health Services reminds you of being back in Switzerland. So I guess there might be isolated pockets here in the US but it's a bit of a way to watch it.

[B]

But yeah, no, I think, I think what prevents us from doing something like Switzerland is the fact that we have completely forgotten that we actually tried it before. Because I think we've just been, you know, like the American memory is short, right? We kind of only remember, like at this point, I think our attention, our attention spans are so short. I feel like we remember like the last 30 seconds and maybe that's it. But, but we've been in, you know, I, it's, it's the Reagan administration that launched the law and order approach that we have continued to live with for the past 40 years. It wasn't Nixon. We, we are, we are blaming the wrong guy. It's Reagan. He was the one who passed the Anti Drug abuse Act of 1986 and 88, which really escalated and militarized the drug war. Things have been changing, obviously, with cannabis legislation, but we're seeing still living in Reagan's drug war. And because of that, because we've completely forgotten that at one point we actually tried to have widespread, accessible, attractive addiction treatment programs in, like, every community. I know it seems, like, impossible to actually try it again, but it is possible, right? Because there are these little pockets where I saw such great work being done. And I think it has to be done by people who don't want to treat it as a purely commercial opportunity. And I don't know how many of those people are around, but they are. There's a few of them. And what I see there is the glimmers of hope that a system similar to Switzerland's could be there because people want it. Like, that's what drives me bananas, is researching this book and talking to people like, everybody has Adena. It's not just me. It's everybody has a Dana. You start talking to someone and if they don't have a Dana, their friend has a Dana, or their spouse has Adena. You know, everybody has Adena. We've all been impacted by this because it's been decades of pretty much unbridled growth in, you know, drug taking and drug selling industries. That's a problem when you don't really have an actual organized response. But I do think people want it. I think people definitely need it. And I think that if we remember what we used to do and we remember what killed it, which, of course was like asking for too much, turning it too political, and allowing too much profiteering to occur. We could take the inspiration from Jerry Jaffe from Nixon in 1971, and be like, well, you know, it's been 50 years, right? We could try it again, you know, giving it another shot. That would be my ideal outcome, for sure.

[A]

No, I hope you're right. I do wonder, given the amount of money at stake and this cultural shift. We talked about this before the interview. Viewing these patients in a humane way that gives them dignity seems like also a much needed shift rather than a problem to be solved or medicated away or people lacking in willpower, if that makes sense.

[B]

Absolutely, absolutely. I 100% agree. I think if we see people as people, you have a tendency to not want them to die. Go figure.

[A]

You know, I think I can absolutely say your book goes a long way to doing that and getting that message out thank you so much for writing a book that forces us to rethink this relationship between treatment markets and the war on drugs. Definitely much needed work and appreciate the opportunity to discuss it with you. Thanks Emily.

[B]

Thank you so much Greg. I really enjoyed the conversation. This was great.

[A]

Likewise.

[G]

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