Robert F. Kennedy Jr. has treated the U.S. drug epidemic as a priority, both in his independent bid for president and now as President Trump’s nominee for health secretary.
But for all his advocacy surrounding the addiction crisis, Kennedy has never made clear his views on methadone and buprenorphine, the highly effective medications most commonly used to treat opioid use disorder.
On Thursday, during a Senate confirmation hearing, Kennedy shed light for the first time on his attitudes toward medication-assisted treatment. When asked by Sen. Andy Kim (D-N.J.) whether he supported the intervention, he answered simply: “Yes, I do.”
The rest of Kennedy’s answer, however, cast doubt on whether the medications were truly the best available treatment, and relied on an overt misrepresentation of scientific data. When asked by Kim whether the medications represented the “gold standard” of opioid addiction treatment, Kennedy instead bestowed that label on 12-step recovery programs like Alcoholics Anonymous and Narcotics Anonymous.
“The Cochrane Collaboration, which is the most prestigious scientific research organization … has found in studies [that] the gold standard is 12-step programs,” Kennedy said.
This is false. In an interview with STAT, one of the authors of the research review said Kennedy had misrepresented its findings. While Alcoholics Anonymous is an effective intervention for alcohol addiction, he said, the review did not analyze the effectiveness of 12-step programs on opioid use.
“That’s not what we did,” said Keith Humphreys, who is also a Stanford addiction researcher. “We only did studies where the inclusion criteria were that you had to have an alcohol use disorder. So there are certainly people in those studies who also may have used cocaine or opioids, but that was not part of the conclusion.”
Most of the participants in the studies that the review encompassed, Humphreys said, were not opioid users.
Another of the review’s co-authors, the Harvard psychiatry researcher John Kelly, concurred with Humphreys.
“That review was about alcohol addiction, not opioid addiction,” he said.
Both Humphreys and Kelly said that a review like the one described by Kennedy, which labels 12-step programs as a gold-standard treatment for opioid addiction, does not exist. Moreover, certain chapters of 12-step programs like Narcotics Anonymous remain hostile to the use of methadone and buprenorphine — putting their philosophy directly at odds with modern medicine.
Groups including the American Medical Association, American Society of Addiction Medicine, and the National Academies of Sciences, Engineering, and Medicine consider methadone and buprenorphine to be the standard of care for treating opioid use disorder.
Still, the medications remain underutilized, in large part due to stigma and misinformation. Both drugs are chemically opioids, meaning they attach to the same brain receptors as illicit drugs like heroin or fentanyl. But when administered properly as addiction treatments, they can alleviate withdrawal symptoms and leave patients clearheaded without inducing a high.
Kennedy, himself, is in long-term recovery from addiction to both alcohol and opioids. He has said that he attends Alcoholics Anonymous meetings at least once per day, and as a presidential candidate, pledged to hold a meeting in the White House.
During his presidential campaign, Kennedy filmed a documentary on the U.S. drug overdose crisis in which he outlined a “tough love” approach for people battling addiction. Beyond increased involvement from law enforcement, the centerpiece of his plan appeared to be a network of “wellness farms,” where people in need of addiction treatment could recover by spending time outdoors, away from substance use and technology. Controversially, Kennedy has suggested these farms could be appropriate interventions not just for those addicted to illicit drugs like cocaine or fentanyl, but also people who take certain medications for depression or anxiety, like SSRIs.
Despite his apparent preference for 12-step interventions, Kennedy did acknowledge at the hearing the value of methadone and buprenorphine, commonly known by the brand name Suboxone, amid the ongoing drug crisis.
Though the overdose death rate has fallen in the past year, it still exceeds 80,000 per 12-month period, including over 60,000 from opioids.
“You need an entire retinue, entire menu of treatments, because many addicts will not respond, immediately at least, to 12-step programs,” Kennedy said. “For many of them, Suboxone and even methadone are critical interventions that save lives, that get addicts off the street, and they should be available as a treatment option.”