Podcast Summary: Thriving with Addiction

Episode: “A Proven Addiction Medication Nobody Prescribes”

Host: Dr. John (Jonathan) Avery
Guest: Ben Westhoff, investigative reporter & filmmaker
Date: February 24, 2026

Episode Overview

In this compelling episode, Dr. John Avery welcomes award-winning journalist and documentarian Ben Westhoff to discuss the underutilization and misconceptions surrounding naltrexone—a proven but often overlooked medication for opioid and alcohol addiction. Drawing from Ben’s investigative experience and his recent film “Antagonist,” they explore the complex intersection of the opioid crisis, treatment modalities, industry politics, and the lived realities of those affected by addiction. The conversation is both incisive and empathetic, providing a critical but hopeful look at where American addiction treatment needs to evolve.

Key Discussion Points and Insights

Ben Westhoff’s Journey into Drug Investigative Journalism

• Background: Ben started in hip hop journalism in St. Louis, then moved to LA and covered the darker side of the music scene—the drug trade and supply chains (02:13).
• Discovery of Fentanyl’s Dangers: His research into MDMA (ecstasy) deaths revealed widespread adulteration, leading to the realization that fentanyl was the hidden driver behind many fatalities (03:44).
  • Quote:

    "I talked to this guy and he was like, you know, fentanyl is worse than all these combined. And that was sort of the light bulb moment for me."
    —Ben Westhoff (04:09)

• On-the-Ground Reporting: Ben recounted undercover work in Chinese fentanyl labs and interactions with people selling fentanyl precursors (04:51).
  • Quote:

    "They saw it as like a great job after college and had no idea what fentanyl was."
    —Ben Westhoff (05:12)

The U.S. Addiction Treatment System—Why It’s “Screwed Up”

• Root Cause: Treatment is largely controlled by money and special interests, not patient care (06:29).
• Role of 12-Step Tradition: Historical reliance on AA/12-step models fostered a suspicion of medication-based treatment, especially for alcohol use disorder (07:19).

Naltrexone: A Proven but Neglected Medication

• Mechanism & Indications:
  • An opioid antagonist, naltrexone blocks opioid receptors, preventing any intoxicating effect from opioids or alcohol (07:46).
  • Useful for both opioid use disorder and alcohol use disorder.
  • Uniquely, it is non-addictive and has minimal risk for overdose or diversion (09:38).
  • Long-acting formulation (Vivitrol) acts as an “insurance policy” against relapse, lasting 30 days per injection (11:53).
  • Quote:

    "Naltrexone should be in the drinking water. I'll say it again because it helps us with so much, including eating behaviors, alcohol, gambling, gaming, but especially important for opiate use disorder for that exact population you described..."
    —Dr. John Avery (11:11)

• Barriers to Use:
  • Requires full detox before initiation—challenging for many patients (09:38).
  • Lacks euphoria, making it less appealing for some (09:38).
  • Aggressively disparaged by the methadone clinic industry and sometimes marginalized in media and professional guidelines due to profit-driven lobbying (13:26).
  • Quote:

    "If you look on their website, they make it look like naltrexone is going to kill you... they have this long pages and pages of these horrible side effects... and they're really. I, I interviewed the head of the lobby about this... And I thought I had him in a gotcha moment, but basically he was like, yeah, you're right, that is, that is the reason."
    —Ben Westhoff (15:50)

• Realities of the “Gold Standard” Medications:
  • Methadone and buprenorphine (“agonist” therapies) are effective but themselves addictive and entangled in regulations and profit models (15:57).
  • The best medication, as both guests agree, is the one the patient will actually take (16:52).

The Politics and Profiteering in Addiction Medication

• Methadone Industry’s Influence:
  • Runs its own lobbying operation, has fought against the increased access to alternatives like buprenorphine and naltrexone, to protect business interests (13:26).
  • Notable Moment: Ben’s “gotcha moment” when a methadone lobby leader admits profits are a key motive (15:50).
• Buprenorphine/Pharma Scandals:
  • After the opioid epidemic fueled by Purdue Pharma, the dissemination of buprenorphine (Suboxone) was led by the same marketing playbook, resulting in further ethical issues and legal action (16:52).
• Quote:

  "Everywhere you look there's. And the company that makes Vivitrol has certainly been accused of a lot of ethical problems as well."
  —Ben Westhoff (18:46)

Treatment Models: The Rehab Industry & The Need for Holism

• Shortcomings of Rehab: Many high-cost, short-term rehabs function as “mills,” focusing on surface-level recovery and missing crucial supports—often resulting in relapse (21:02).
• Call for Comprehensive Care: Successful models incorporate housing, job training, psychiatric care, counseling, as exemplified by the ARCA clinic in St. Louis (21:02).
  • Quote:

    "You need to really focus on all of these things."
    —Ben Westhoff (22:14)

• Dr. Avery’s Perspective:
  • Medicines are essential, but so is rebuilding a life outside chemical dependency (22:53).
  • Quote:

    "The problem with rehab is you go, but you got to come back home. Problem with meds is you're still at home... requires a lot of interventions. But meds are essential..."
    —Dr. John Avery (22:28)

Supply-Side vs. Treatment-Side Approaches

• Drug Supply Realities: Efforts to “secure the border” or target foreign suppliers are largely futile against fentanyl’s potency and small volume; investment is much better spent on prevention, treatment, and education (20:00).
  • Quote:

    "Fentanyl is 50 times stronger than heroin... we couldn't stop 50 suitcases of heroin... so what makes us think we can stop one suitcase of fentanyl? It's just a giant waste of money..."
    —Ben Westhoff (20:00)

Naltrexone for Alcohol & Behavioral Addictions—Underused, Undervalued

• Evidence Base:
  • Strongly supported for alcohol use disorder—could benefit anyone struggling, with little risk and much flexibility in usage (24:06).
  • Failure to catch on may reflect a “too good to be true” skepticism & entrenchment in abstinence-based traditions (24:06).
  • Quote:

    "There's really not controversy... Most everyone who's in a position to know... thinks that it. It's worth. At the very least, it's worth a try. Anyone who has problems drinking, it's worth a try."
    —Ben Westhoff (24:34)

  • Can be used without total abstinence—offering benefit to harm-reduction populations (26:17).
  • Quote:

    "You can just, you could start it tomorrow... There's, there's nothing stopping you... once you don't have this reinforcing effect anymore... That's what teaches your brain to give up the addiction."
    —Ben Westhoff (26:17)

Documentary: “Antagonist”—Key Takeaways

• Filmed in open-air drug markets (San Francisco, St. Louis), exploring real-world barriers to medication access and interviewing critics and advocates. (27:13)
• Available for preview on Patreon via antagonistfilm.com (28:34).

Personal Notes & Notable Moments

• Ben’s career arc: From hip hop to public health journalism, always using investigative methods.
• Dr. Avery’s quote on naltrexone’s safety and broad utility (11:11).
• Ben’s moving story of his relationship with his Big Brothers Big Sisters mentee, whose unsolved murder he investigated for his book “Little Brother” (29:57).

Timestamps of Important Segments

• 02:13 — Ben’s investigative roots: from hip hop to drugs
• 04:09 — Discovering the hidden fentanyl crisis
• 07:19 — How AA/12-step culture influenced medical practice
• 11:11 — Naltrexone’s safety and potential: “should be in the drinking water”
• 13:26 — Methadone lobby’s opposition to naltrexone
• 15:50 — A “gotcha” moment: profit drives industry decisions
• 16:52 — The reality: the best medication is the one the patient takes
• 21:02 — The problematic rehab industry and need for holistic care
• 24:06 — Why naltrexone is underused in alcohol use disorder
• 27:13 — Documentary’s on-the-ground portraits of the crisis
• 29:57 — The story behind “Little Brother”

Memorable Quotes

• "Naltrexone should be in the drinking water." — Dr. John Avery (11:11)
• "If you look on their website, they make it look like naltrexone is going to kill you." — Ben Westhoff (15:50)
• "The best medication is the one the user takes." — Ben Westhoff (16:52)
• "If we could get [medication use] up to 50%, that would save literally tens of thousands of lives every year." — Ben Westhoff (19:20)
• "You can't stop drugs from getting into this country... it's just a giant waste of money, a giant waste of everyone's efforts. When we should be focusing on drug treatment." — Ben Westhoff (20:00)
• "It's worth a try. Anyone who has problems drinking, it's worth a try." — Ben Westhoff (24:34)

Conclusion and Further Resources

Avery and Westhoff agree: while medication—especially naltrexone—is a critical, underused tool in addiction treatment, progress at scale has been stymied by profit motives, outdated traditions, and systemic resistance. They urge patient-centered care and multi-pronged support over entrenched, profit-driven or abstinence-only approaches. Westhoff’s film “Antagonist” and his writing continue to shed much-needed light on where science, policy, and real lives intersect in the fight against addiction.

For sneak preview access to “Antagonist”: antagonistfilm.com
Ben Westhoff’s newsletter: Drugs + Hip Hop