Despite the seemingly uncontroversial goal of Robert F. Kennedy Jr. to “Make America Healthy Again,” many of his health care stances are deeply divisive: In the last two years alone, he has suggested that Covid-19 was genetically engineered to spare specific ethnicities, stated that radiation from cell phones causes cancer, and doubled down on the long-disproven claim that HIV does not cause AIDS.
But at least one health care cause that has occupied much of his attention in 2024, in contrast, has major unifying potential: the addiction and opioid crisis. As a presidential candidate, Kennedy cast the issue as a symbol of the nation’s broader ills. He traveled the country with a film crew to make a documentary focused on addiction, sharing his own struggles with heroin and alcohol. He surrounded himself with doctors, recovery advocates, judges, and public health officials, seeking an answer to a question that has evaded three successive presidents: how can the U.S. bring its decades-long drug crisis to an end?
According to a STAT examination of Kennedy’s past statements on drug use and his own recovery, his documentary, and interviews with multiple advocates he spent time with during filming, his philosophy toward addiction policy is ideologically flexible. Kennedy has pitched a nationwide system of “healing farms,” espoused the virtues of 12-step recovery like Alcoholics Anonymous, and advocated “tough love” for people battling addiction. He also repeatedly expressed his admiration for Amsterdam’s response to its own drug epidemic decades ago, which included providing prescription heroin to drug users not ready to stop, and suggested at one point he was open to the controversial practice of supervised consumption. His biggest apparent takeaway was simple: What America is doing hasn’t worked.
“The government has a role in actually pressuring the addict, to say, ‘We’re not going to tolerate you on the street anymore,’ to do tough love,” Kennedy said in June at the premiere of “Recovering America,” the documentary he released on his YouTube channel. “You’re not allowed to do this anymore. We’re going to clean up your neighborhood, we’re going to talk to you three times, and if we can’t talk you into helping yourself, you are going to prison, you’re going to jail, until you choose some other option. And that’s what they’re doing that worked so well in Amsterdam.” (In reality, the Netherlands rarely incarcerates drug users.)
For decades, Kennedy’s advocacy has focused largely on issues like nutrition and vaccine safety, and what views he did express on substance use were largely ignored in medical and public policy circles. But as President-elect Donald Trump’s nominee to lead the Department of Health and Human Services, his beliefs suddenly carry immense implications for the U.S. response to the overdose crisis. Despite a recent dip in drug deaths, Americans are still dying of overdose at a rate exceeding 90,000 every 12 months, thanks to widespread addiction and a toxic drug supply dominated by fentanyl.
If confirmed by the Senate, Kennedy’s views could set a new tone for the country’s opioid crisis response. At the helm of a department that spends $1.8 trillion annually, he would control key funding streams used for addiction treatment and prevention, and oversee key sub-agencies focused on addiction, like the Substance Abuse and Mental Health Services Administration and National Institute on Drug Abuse.
The nation’s response to the opioid crisis is already at an inflection point: Billions of dollars are pouring in from opioid settlements reached between governments and pharmaceutical companies, drug distributors, and pharmacies accused of accelerating the crisis decades ago by allowing rampant prescription of addictive pain drugs, like OxyContin. Separately, the U.S. has made strides broadening access to addiction medications like buprenorphine and methadone, the overdose-reversal drug naloxone, and harm-reduction offerings like test strips used to detect the presence of fentanyl or xylazine.
Kennedy has expressed open-mindedness about which policies might be most effective at reducing drug overdose rates. But his main wish is simply for the government to take a back seat.
“There’s a tremendous diversity of approaches that are working very, very well,” he said in his documentary while visiting a recovery-focused farming program in Texas. “One thing that almost all of them have in common is that they don’t have government support. So I’m very reluctant to get government involved in a way that is going to micromanage places like this.”
Kennedy’s support for proposals to legalize and tax marijuana and to use psychedelics for therapeutic purposes is striking for a health secretary in a Republican administration. But to the extent government is involved, it is also clear that Kennedy believes the police must play a larger role in the U.S. addiction crisis response, and intends to use law enforcement and the threat of incarceration as a cudgel to force people who use drugs into treatment programs.
“It’s the moderates’ turn, in drug policy, to have a go at this,” said Tom Wolf, a San Francisco-based recovery advocate featured in Kennedy’s documentary who has used his own journey with fentanyl addiction to advocate against the city’s historically tolerant policies toward drug use and homelessness. “It’s time for the moderate doctors and policymakers, the recovery community and whoever else to come in and actually have a say. Not to de-fund harm reduction, because harm reduction is here to say, and it is a tool. But harm reduction shouldn’t necessarily be policy. I think that’s going to be the difference this time around.”
‘A double-edged sword’
Appointing an individual with a known history of addiction to a cabinet post is a powerful symbol of inclusion. Along with former Biden administration labor secretary Marty Walsh and interior secretary Deb Haaland, Kennedy may be the highest-ranking government official in American history to openly identify as a person in long-term recovery.
But when it comes to addiction policy, personal experience can be a “double-edged sword,” said Michael Botticelli, who served as director of the Office of National Drug Control Policy during the Obama administration and is, himself, in long-term recovery.
“On one hand, people with lived experience can bring a sense of compassion and empathy and understanding of the challenges and obstacles that accessing treatment and recovery supports can bring, and can translate that to policy,” he said. “On the other hand, and I’ve seen this many times throughout my career, people with lived experience can bring their own personal story to bear on a policy level that might not be consistent with the science and evidence.”
Kennedy’s own past has doubtless shaped his own views on U.S. policy regarding substance use. His own recovery began only after an arrest for heroin possession in 1983. Ever since, he has espoused the virtues of 12-step recovery, even pledging as a presidential candidate that if elected he would host a meeting of Alcoholics Anonymous, which he frequently attends, in the White House.
And he has often cited the work of Carl Jung, a Swiss psychiatrist whose belief that people addicted to alcohol are best positioned to recover if they undergo what Kennedy calls “profound spiritual realignment,” and whose views were influential in the foundation of Alcoholics Anonymous.
“I came into the program 40 years ago,” Kennedy has said, “and I remember asking a guy back then, ‘How long do you have to keep coming to these meetings?’ And he said, ‘Just keep coming ‘til you like it.’ And I’ve been going for 40 years, every day, and I still don’t like it.”
He continued: “But I go because the rest of my life works when I go, and I do it [for] the same reason that I brush my teeth. I don’t look forward to brushing my teeth, I don’t enjoy it, I don’t like the sensation. But I don’t want to live with the consequences of what happens when I stop.”
‘You’re enabling them’
The central debate that Kennedy will likely encounter as health secretary centers on the philosophy of harm reduction: measures that aim to reduce risk of overdose and improve drug users’ health, typically offered unconditionally and without any expectation of the recipient eventually entering treatment or becoming abstinent.
Under President Biden, the federal government has been historically supportive of harm reduction, backing syringe exchange programs, access to test strips used to detect fentanyl and xylazine, and even looking the other way as OnPoint NYC, a New York nonprofit, opened two supervised consumption sites in Upper Manhattan in apparent violation of federal law.
Kennedy has already indicated that he is less likely to support harm reduction measures, posting on X in October: “To end the opioid crisis we need common sense solutions not ‘harm reduction.’”
In fact, despite his support for the Netherlands’ approach, Kennedy has effectively argued the opposite, advocating for allowing people with addiction to be allowed to “hit bottom” so they can begin their recovery.
“Addicts don’t come into treatment on a winning streak,” he said in June at a panel discussion following the premiere of his documentary. “They come into treatment because they hit some kind of bottom, and if they don’t hit that bottom, you’re enabling them to do it. So I think the government has to provide a bottom for them that is at a higher floor than all the way, going into the sub-basement and then finding a trap door to go even lower. The earlier the government intervenes, the better it is for anyone.”
This philosophy is clearly reflected in the recovery-world figures Kennedy chose to highlight in his documentary, like Wolf, the San Francisco political activist. Similarly, Steven Leifman, a former administrative law judge in Florida known for his involvement in mental health issues, argued in the documentary that “if you really want to improve public safety, you have to get people with these illnesses treated. There is nothing civil or right about letting a man or a woman slowly die like that.” President-elect Trump’s transition team, according to two sources familiar with the search process, recently offered Leifman the position of SAMHSA administrator, though he declined.
Harm reduction proponents argue that interventions like housing, sterile pipes and needles, and testing of illicit drugs prior to use can help drug users avoid overdose and infectious disease. Recent years have seen a major expansion of harm reduction services: A third supervised consumption site will soon open in Rhode Island, and Vermont and Minnesota’s legislatures have also passed laws allowing for so-called “overdose prevention centers.”
It is unclear whether Trump administration figures like Kennedy and attorney general nominee Pam Bondi will choose to oppose supervised consumption, and whether they will remain supportive of less controversial measures like fentanyl test strips or naloxone distribution. (Trump’s nominee to lead the Centers for Disease Control and Prevention, Dave Weldon, voted as a congressman to bar federal funding for syringe exchange.)
But some in Kennedy’s orbit warn that harm reduction can go too far, blurring the line between well-intentioned public health measures and effectively encouraging continued drug use.
“Are we actually helping people to try to stay safe, or gear them toward access to treatment?” said Wolf, “or are we just continuing to perpetuate the cycle, keep them in a cycle of addiction, only to watch them die at a later date? That’s the message that I tried to convey to Mr. Kennedy, and I think it resonated with him.”
‘Let’s figure out what works’
While Kennedy’s belief in Alcoholics Anonymous and enthusiasm for “wellness farms” are well-documented, little else is known about his views regarding addiction medicine.
He has taken care, however, to note that not every approach will work for every person, and those who’ve spoken with Kennedy credit him with being driven largely by what’s most effective.
“If he doesn’t know the answer, he’ll say he doesn’t know — but he seems open-minded,” Brian Gallagher, a Philadelphia-based therapist featured in Kennedy’s documentary, said of Kennedy, casting the likely health secretary as driven by solutions above all else. “He’s very much of the idea that … let’s figure out what works for people and make it happen.”
Perhaps the biggest unknown regarding Kennedy’s addiction ideology is his view of two common medications used to treat opioid addiction: methadone and buprenorphine. Both medications are highly effective at reducing illicit drug use and preventing overdose, but remain stigmatized, particularly in certain 12-step recovery circles.
Gallagher, for instance, stressed that he is not opposed to the use of either medication, but doesn’t believe that either can replace a deeper form of healing that he believes people with serious addictions often require.
“At this time in history, [methadone and buprenorphine] are both extremely useful,” he said. “I would just want to then set up healing atmospheres and communities for people to figure out how to get off them safely, to where they can’t hurt themselves and can’t overdose.”
Another prominent addiction medicine figure in Kennedy’s orbit, however, is far more opinionated. Drew Pinsky, an internal medicine doctor specializing in addiction and a media personality known as “Dr. Drew,” has said he only uses buprenorphine sparingly, putting him at odds with the American Society of Addiction Medicine and broader consensus among doctors who treat opioid addiction worldwide. In a 2015 video, Pinsky argued that “most people get strung out on” buprenorphine and baselessly claimed that there are “many, many reports of violence” associated with its use. A separate blog post on Pinsky’s site in 2018 is titled simply: “Suboxone — miracle or menace?”
Kennedy has appeared on Pinsky’s podcast, and Pinsky moderated a panel discussion in June at the “Recovering America” premiere. Kennedy adopting the same view would be a major setback, said Botticelli, the former Obama administration drug czar.
“I’ve seen many times where people who are in recovery castigate the use of medications to support people’s ongoing recovery,” he said. “It’s what I’ve come to term the ‘I know a man’ philosophy of policymaking. Anybody, lived experience or not, should really be basing their decisionmaking on what the science and evidence says.”
‘A colossal failure’
For all Kennedy’s varied and sometimes contradictory statements on treatment, recovery, and harm reduction, it is clear that one idea in particular could become his marquee proposal: the “healing farm.”
Kennedy has proposed building hundreds of the programs and funding them via a tax on legalized marijuana, casting the facilities not just as a solution to the addiction crisis but as a driver of economic mobility.
“Today, the biggest industries in America’s depressed, rural areas are prisons,” he said in the documentary. “I’m going to bring a new industry to these forgotten corners of America, where addicts can help each other to recover from their addictions. We’re going to build hundreds of healing farms where American kids can reconnect to America’s soil, where they can learn the discipline of hard work that rebuilds self-esteem, and where they can master new skills as farmers, ranchers, carpenters, furniture makers, bakers and cooks, electricians and plumbers, HVAC technicians, and other trades.”
The proposal appears to reflect Kennedy’s broader view that addiction is at least as much spiritual as it is physiological. But even though it appears to represent a radical departure from the country’s addiction treatment status quo, it is not a new concept.
In 1935, the federal government opened a facility not unlike what Kennedy has proposed in Lexington, Ky., known as the “U.S. Narcotic Farm.” In some ways, the program was remarkably progressive for its era, arguably representing the first time the government treated addiction as a medical condition, not a moral failing.
The facility and a sister location in Texas operated for decades, with the original Kentucky program becoming the subject of lore among music fans for housing numerous jazz luminaries seeking recovery from heroin addiction. But ultimately, few of its residents achieved long-term recovery, and the facility was shut down amid scandal after years of effectively using its participants as guinea pigs in ethically dubious experiments meant to test how humans respond to specific drugs.
“At the end of the day, it was a colossal failure,” said Ryan Marino, a physician, medical toxicologist, and professor of medicine at Case Western Reserve University. “All of the funds and might of the U.S. federal government were thrown toward this idea of trying to treat people by putting them on a farm, even letting them go there voluntarily. So whenever that comes up and people propose it as some kind of groundbreaking concept — ‘All these people need is some fresh air and some exposure to nature’ — it just doesn’t work. It’s been tried.”
Critics fear that the healing farm concept could become emblematic of Kennedy’s efforts on addiction: a sweeping idea born of noble intentions, presented by a charismatic figure with a compelling story to tell about his own recovery. But passion and lived experience are no guarantee that the approach could help bring the drug overdose crisis to an end.
“He could have very prescient and useful things to say, but it seems like he focuses on these extremist kinds of takes, like sending everyone to a farm instead of treating addiction with evidence-based approaches,” Marino said.
The farm is “kind of a beautiful story, on one hand,” he added. “But obviously, it didn’t work.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.