Elected on a law and order platform, Richard Nixon launched the War on Drugs with a June 1971 press conference in which he declared drug abuse on the streets of American cities to be “public enemy number one.” Or so the conventional narrative goes. But drug historian Emily Dufton says that the true story is much more complicated – and interesting.

In fact, Dufton writes in her fascinating new book, Addiction Inc.: Medication-Assisted Treatment and America’s Forgotten War on Drugs, between 1971 and 1973 the Nixon administration presided over a massive expansion of publicly-funded methadone clinics and other treatment services that began to deliver real results in addressing the country’s burgeoning heroin addiction crisis, before largely abandoning the effort in the face of political backlash and public misunderstanding. And that was just the first of many systemic failures in a maddening, decades-long history of missed opportunities and failed approaches to dealing with the opioid addiction problem that plagues blue cities, which Dufton lays out in her book.

So we invited Emily to join us to talk about the history of what has gone wrong with our efforts to treat opioid addiction. That initial, promising early ‘70s effort to build an expansive treatment system of methadone clinics was fully defunded once Ronald Reagan took office in 1981. After that, she tells us, the clinic system was largely privatized, and efforts to effectively and comprehensively help the addicted became secondary to the profit motives of drug manufacturers and clinic operators. This was, she says, the rise of what she terms "Addiction Inc.," and she points out that today only about one in five American addicts receives Medically-Assisted Treatment (via one of the three approved drugs: methadone, buprenorphine, or naltrexone), which is the gold standard for treating opioid addiction.

As the conversation continues, it turns personal, as Sandeep explains both his deep initial reluctance to treat his own spiraling addiction in the ‘90s with methadone, but how once he overcame the stigma “methadone saved my life.” And Dufton tells the story of Dana, a close high school firend whose debilitating opioid addiction led to his suicide shortly after his 30th birthday, a tragedy that inspired her to spend eight years researching and writing the book.

As the episode concludes, we come to the disheartening conclusion that the American debate on addiction is trapped between two poles: either punishment without treatment, or, as is too often the case in blue cities, tolerance without intervention. Emily then points to the counter example of Switzerland, which in the 1980s faced an addiction crisis similar to that in the US, but which subsequently developed an effective multi-pronged approach that combines law enforcement with robust treatment interventions to greatly reduce the suffering and social harm addiction creates.

“Other countries don’t have the same issues with Medically-Assisted treatment that the United States does, and of course their overdose deaths are significantly lower,” Dufton says. “We should be almost embarrassed in the United States about how poorly we treat this issue. But I think we’re just too angry at drug users and simply too ready to transform their forms of treatment into additional forms of punishment to actually change our way of thinking.”

OUTSIDE SOURCES:

Emily Dufton, Addiction Inc.: Medication-Assisted Treatment and America’s Forgotten War on Drugs, University of Chicago Press (2026).

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