The Drug Report
The Drug Report
What's Next in U.S. Drug Policy?
Drug policy in America is at a critical inflection point. Following a period dominated by extreme harm reduction approaches, we're witnessing a significant shift back toward accountability-based treatment models. This transformation comes as cities like San Francisco and states like Oregon roll back failed experiments that provided tools for addiction without addressing its root causes.
Dr. Kevin Sabet joins us fresh from United Nations meetings in Vienna, where American representation was noticeably diminished – a symptom of the current administration's still-developing drug policy strategy. Together, we analyze Dr. Nora Volkow's recent Stat News interview, where the longtime NIDA Director expressed skepticism about universalizing 12-step approaches despite compelling research supporting their effectiveness. As Sabet points out, studies from leading institutions demonstrate that 12-step programs often outperform traditional psychotherapy while lowering healthcare costs.
The encouraging decline in opioid overdose deaths presents a complex puzzle we attempt to unravel. Is it increased naloxone availability? Greater public awareness of fentanyl dangers? The tragic reality that many vulnerable users have already died? The answer likely combines these factors, highlighting why comprehensive approaches that blend harm reduction tools with accountability-focused recovery pathways remain essential. As America recalibrates its drug policy strategy, this conversation offers crucial context for understanding what works, what doesn't, and why the pendulum is swinging back toward treatment models that emphasize personal responsibility alongside compassionate care.
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Yes or no? Do you believe nicotine is not addictive?
Speaker 2:I believe nicotine is not addictive. Yes, Congressman, cigarettes and nicotine clearly do not meet the classic definitions of addiction. I don't believe that nicotine for our products are addictive. I believe nicotine is not addictive. I believe that nicotine is not addictive.
Speaker 1:Hi everyone. This is Luke Niferatos. I am your host of the Drug Report podcast brought to you by SAM Smart Approaches to Marijuana, which you can find at learnaboutsamorg, as well as FDPS, the Foundation for Drug Policy Solutions, which you can find at gooddrugpolicyorg. Great to have you all. We are back from a whirlwind tour. The last several weeks we were in Vienna, austria, at the UN, meeting with member states talking about drug policy globally and treaties and agreements across countries to schedule the various substances that are out there. So learned a lot, made a lot of progress.
Speaker 1:It was very interesting here today to join me in kind of a discussion of kind of what's going on here in the United States as it relates to our drug policy strategy is our president and CEO, dr Kevin Sabet. Hey, kevin, hello, how are you Good? Glad to have you back on. So yeah, there's obviously a lot of people are asking questions and we heard this a lot at the UN this last week which is kind of what is going on with American drug control strategy, when we look at NIH, when we look at SAMHSA and the various cuts that are happening. So what are you hearing and what are you kind of thinking?
Speaker 2:Well, I just, obviously I don't think we really know, I don't think anybody knows, I don't think the administration knows. They're still kind of, I think, figuring out their posture on drug policy. It's interesting for an issue that polls so highly in terms of interest, and mainly because of the fentanyl issue. You know, it's interesting how there really hasn't been a lot since the inauguration on this. You know, when we were in Vienna, you know it's interesting how there really hasn't been a lot since the inauguration on this Um, you know, when we were in Vienna, of course the uh there were.
Speaker 2:There was a U S delegation, as there always is, but you know, as opposed to 35 people, it was down to about eight or nine uh, very, very different than the past. The side event also that the Americans did uh was a was a video film that was a couple of years old, very different than what they would have done in the past. So you know, because the meeting is usually a time to showcase and, you know, sort of show off what you're doing, and I think they couldn't really do that because they're still figuring out what they're doing. So NIH, I think, is the same way. We've seen layoffs at SAMHSA. There is a new senior advisor coming on that we know about and you know we just I guess there was this interview in Stat News I'm sure you saw it with Dr Nora Volkow, the director of NIDA.
Speaker 1:Yeah. So I kind of talked to us a little bit about what you saw there. She was asked about RFK, she was asked about kind of the strategy for treating the drug crisis and addiction crisis and kind of where the opioid crisis stands. She talked a little bit about what she saw as the solution. What it was kind of started this decline that we've seen over the last two years in opioid crisis, opioid overdose deaths. So it was a wide ranging interview and you know some little interesting nuggets in there. So talk to me about what jumped out at you in that interview.
Speaker 2:Yeah, I think there were a couple of things. I mean, obviously I think Nora is great. I've been able to have a longstanding friendship with her and relationship as colleagues when I served both times in the last two administrations that I served in she was director of NIDA.
Speaker 2:She's really the Teflon woman when it comes to NIH, no matter the president or the issue. She's there saying very intelligent things and really working hard to make sure that US research stays on top of things. You know, as people know probably, but in case some don't, you know the US funds 85% of the world's research and that comes out of NIDA and that's significant. So 85% of the world's drug research coming from one Institute. It's a, it's a big, it's a very big deal and her position, especially in our field, is a very big deal. So, um, you know, uh, uh, uh, I think that you know, try it's, it's tricky to navigate, kind of this new administration because, again, we're just, you know, everyone's kind of learning, still learning about what we're going to. Um, you know what we're going to see. I think that what struck me a little bit was, uh, you know it, it, uh, you know, and I get that this happens in the media and interviewers, uh, you know, tend to want to like pull out juicy bits. But you know, we've heard Bobby Kennedy talk about, uh, how he supports medication for opioid use disorder, but he also realizes that he says that the gold standard that was his term, the gold standard is 12 step recovery and that's where he comes from, so obviously he sees it firsthand.
Speaker 2:And I think, you know, I think Dr Volkow was a little bit critical of this idea that if it worked for somebody it must work for everybody and that you know, um, it doesn't really. And she was talking about how it doesn't really work for everybody, um, and she's right that not everybody responds the same way to things. Of course. I mean there, we, you know, we say that there are, um, you know, different pathways to recovery, as we say, and so you know there's, there are, she said she's met many people that have um, said they don't like the philosophy of 12 step because it doesn't speak to them and and whatnot. And you know, and there are some 12 step you know, you know routes where people think that's incompatible with medications. I don't think that, by the way, but there are there, there are people that think that and I think that you know she was critical of it, I, you know, I.
Speaker 2:I think it's just important to say that 12-step programs have been thoroughly researched and Keith Humphreys talks about this.
Speaker 2:I think he did a actually a couple of years ago during COVID time he did an evaluation of almost three dozen studies in the work of over 150 scientists 140 scientists dozen studies and the work of over 150 scientists 140 scientists and found that it was the most effective, more effective than just sort of traditional psychotherapy and also lowered healthcare costs. Now, of course, again, that doesn't mean that it's incompatible with medications. I think every path is different. But you know, she did kind of poke a little bit at that and it could have just been maybe words slightly out of context, I don't know, but that was a little interesting tidbit there, because I do think that this administration, given Bobby's background, will lean on 12-step programs, a particular intervention going through Cochrane, which is what Keith who's, of course, is at Stanford and people from Harvard Medical School did, and also the European, what used to be called the European Monitoring Center for Drugs and Drug Addiction. Those groups basically came together and researched this and said that yeah, this is really working, and so I think that's important.
Speaker 1:I think it's a little bit, I think she's. You know, and we all love Dr Volkow. She does a great, great work and so we've. We've had her at Sam do webinars with us and speak at our summit. So we're definitely big fans. But I will, uh, a light critique I will say is I do think some of her comments were a little behind the times.
Speaker 1:Yeah, I think you know there's been this prevailing trend of extreme harm reduction uh, the person who's in active addiction, they know best what's for them. That's been kind of the prevailing thought really since 2020, since Oregon did their insane Measure 110. That now has been repealed. And I think, looking at the status of drug policy today, we just had the news of San Francisco's mayor rolling back their extreme harm reduction programs, saying we're no longer going to subsidize drug use and addiction. We're no longer going to provide all the paraphernalia and tools for someone to stay addicted on the streets and you know that doesn't work anymore.
Speaker 1:And in fact there there is a return, not just in San Francisco, but not just in Oregon, but nationally. There's a return to what I think we're all realizing is the common sense bedrock principle of responsibility and accountability. Accountability has to be in the mix, and that is what, to me, really embodies what the 12-step program is, which is this idea that you have to have accountability, whether the accountability is to God, to higher power, to your community, whatever that accountability is, you have to have it in order to stay out of addiction. And so I do think she's a little behind the times in terms of some of these old messages that now have been disproven and really widely rejected by the public, and so I do think we're going to see a return to hey, accountability is actually a universal principle. Now, that doesn't mean that 12-step works for 100% of people, but I do think it's tenets, given that it stood the test of time. It's a timeless program that relies on universal concepts of accountability that work, I think, everywhere.
Speaker 2:Yeah, no, it's true. I think the accountability is really important and you know obviously 12 steps, that it was like punishment or something if you relapse, but there is accountability to other people, you know, which obviously we would hope would be in all the pathways, and I think the accountability is important. We see that with the physician health programs which I was able to speak there a couple of months or two ago in San Diego to the Western Doctors in Recovery. These are 300 doctors in recovery and what worked for them and I think we talked about it the last time, but what worked for them was the fact that they did have accountability and they did do 12-step. They also did medication. So it really is about different pathways. I just hope we're not throwing the baby out with the bathwater because there are medications now and saying that 12-step don't work, because again, everybody does follow that different path, a different path, and I think it's important to realize that.
Speaker 1:Definitely so. Another part of that interview was they talked a little bit about the decrease in opioid overdose deaths, which we're all thankful for, and they asked her you know some of the reasons why she thinks that is, and she mentions naloxone. So maybe talk a little bit about what you see is you know the causes and kind of what you thought about her answer.
Speaker 2:No, I mean, look, I think we have expanded naloxone. It's more normalized. I would love to see studies that talk about rather than just kind of us assume that we've expanded it because we talk about it a lot just actually what the utilization? I do think the utilization would be up. That would be my hypothesis for any study. But it'd be great to see some numbers. Maybe they're out there and I don't know about it. It's very possible.
Speaker 2:I think that she talks about education of the public in terms of people realizing how bad it is. That, and I definitely agree that's a lot of it. This is what you know the great late david mustos would say was talking about. You know how we learn about a drug's harmfulness, often after many people have. You know many people die from it or are about to die, uh, or, or close to dying, and then we we do kind of forget that so it does come back. That's his warning.
Speaker 2:But I think with fentanyl we're in the cycle of. You know, a lot of people have learned that this is out there and every people know what that is, and they probably know what it is more than they even know what methamphetamine is, which is remarkable because we obviously had a big methamphetamine problem, which we still do in Western US and in various places 20, 30 years ago, which we still do in Western US and in various places 20, 30 years ago. So I do think that that is a lot of it. I also think that, you know, we have, I do think that some of this and she doesn't really mention that, but maybe a little bit is that you know well, she does talk about it actually at the end, I believe. But basically this idea that the most vulnerable people, vulnerable people, have already died, and I do think that's a lot of it. I think that that is a huge part of it. The people that were going to risk and take fentanyl. Unfortunately, many of them have succumbed to it. So I think that's a huge.
Speaker 1:So there's a there's a bunch of factors. I think she's right about them. I think it's she lays it out well, but I do think education is a big part of it, yeah, so I think you know we'll obviously need to see a lot more research on that, but kind of looking into the reasons for why we've seen these overdoses go down, I do think, like you mentioned, a lot of people know how deadly fentanyl is and I think that you know having that healthy and you know, fact-based fear of drug use I do think helps drive down people's willingness to experiment with drugs and to use these, to use drugs more heavily at a very minimum. So I do think that it does always come back to making sure folks are educated about the risks and how risky drug use is. Today is much more risky than it ever was before and it's always been risky, and so I do think that that that uh piece of this is something that I'm hoping to see come out more as well. Um, to kind of learn about some of these different causes.
Speaker 2:Yep, no, I completely agree.
Speaker 1:That's great. Well, Kevin, thank you for joining us. I don't know if you have any other thoughts or anything else you wanted to share.
Speaker 2:No, I think that's great.
Speaker 1:Okay, that's great, okay, awesome, good, great, well, um, to all of our listeners, thank you, as always, for listening. Thank you for supporting our podcast, please.