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.

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)

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.”

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.

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.

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)

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)

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)

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.

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.

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.

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.

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)

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)

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.”

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.