I love this stuff! I'm dying to know how Nixon liberalized drug policy in the US. You have mentioned that he wasn't all bad. I only know him as the guy directly responsible for the Controlled Substance Act, which gave us scheduling of substances. Completely disregarding the Shafer Commission's study, he made cannabis a Schedule I substance, i.e. no medical value and high risk for abuse. It was on Nixon's watch that Tim Leary was sentenced to 10 years in prison for two roaches, discovered in a search that had questionable probable cause. And this was after Leary had the Supreme Court overturn a previous 30 year sentence! Nixon was using drugs is a political weapon against people he perceived to be dangerous or his enemies.
Hallucinogens were caught in the crossfire of that, and veterans with PTSD, people with end-of-life existential crisis, the depressed and the addicted missed out on substantial help for 50 years because of that. Also, I'm not a drugs historian (just like I'm not the language police, ugh), but treatment approaches were becoming more enlightened without any kind of top-down influence with increasing understanding and acceptance of the diease model. The phenomenon of Vietnam veterans having spontaneous remission from their heroin addictions was significant, but again, it wasn't Nixon. When I get around to reading this, I'll be interested to know how things got better on Nixon's watch.
I’m also curious to know about “the same doctors who were prescribing OxyContin” being sold Suboxone, since they would have been required to obtain X-waivers to prescribe the medication, and were limited to 150 OUD patients in their practices. The transition to buprenorphine/Suboxone films is based in legitimate concern over misuse. The pill form can be crushed and snorted or dissolved for injection. Part of any Suboxone nursing intake includes providing education on safe storage; specifically covered is what to do should children happen to get ahold of the medication or the wrappers. The pill form is still available, but films are routinely used in most programs for safety reasons.
Hi Keith, thanks for this post. I appreciate your thoughts and what you write on your own substack about recovery. You bring up some important points, so I'll respond to them here.
You're right about this other side of the Nixon administration's approach, which focuses on criminalization and law enforcement. In fact, I wrote a book about it - my first book, "Grass Roots," is about the history of cannabis activism in America and it deals at length with Nixon, the CSA, and the Shafer Commission.
But Nixon's pivot in 1971 marks a turning point, at least in terms of his administration's response to heroin, what the president called "public enemy number one." Heroin was also a Schedule I substance by this time, but when faced with the triple threats of rising rates of crime, rising rates of heroin use, and the specter of tens of thousands of addicted "GI Junkies" returning from Vietnam, his administration supported a nationalized system of addiction treatment clinics instead. This wasn't more drug arrests or law enforcement. This was the largest expansion of treatment infrastructure in American history. It was healthcare for heroin users, not punishment. And drug arrests dropped through 1972 because of it. (This is also due to the fact that the vast majority of drug arrests occur on the state level, not the federal level, so federal drug laws are more influential in setting nationwide standards than resulting in major numbers of arrests.)
The Vietnam vets' recovery from addiction was also almost entirely because of the Nixon administration's response. Nixon's first "drug czar," Jerome Jaffe, convinced the military to decriminalize heroin use in 1971. Previously soldiers would be given dishonorable discharges or arrested for heroin possession. But starting in 1971, when urine testing machines were shipped to Vietnam, solders who were being discharged and who tested positive for opiates wouldn't be punished. Instead, they had to stay in Vietnam an additional week to go through withdrawal, and then they were sent to VA hospitals on the West Coast for additional treatment. If they needed additional services after the VA, there was a new nationalized clinic system they could use. Because of urine testing and treatment -- two services initiated by the Nixon administration -- most veterans discontinued heroin use. Their recovery wasn't only spontaneous. It was a precondition of their ability to get out of a warzone.
Finally, the Suboxone story is wild because it's precisely the same salespeople from Purdue who joined Suboxone's manufacturer and actually helped physicians with the x-waiver exam. They called it "handholding." They would often sit with the physicians while they took it to help answer questions, and because so few medical schools in the 2000s and 2010s taught addiction medicine (only 15 of the country's 180 medical schools had addiction medicine programs in 2018), salespeople also taught doctors how to prescribe. This information became weaponized after 2013 when Suboxone's manufacturer faced generic competition and began forcing physicians and state Medicaid systems to switch to the film, not because it was safer (RADARS data suggested generic pills actually had the lowest levels of pediatric exposure), but because they wanted to put patients on patent-protected film strips rather than generic buprenorphine. This may have changed today -- I focus on the past -- but between 2013 and 2020, Suboxone's manufacturer used the same playbook as Purdue to market patent-protected filmstrips as safer with flimsy evidence, distorted data, and "baby death articles." It was so blatant, in fact, that the DOJ launched a lawsuit against the company and won a $2 billion settlement, the largest opioid settlement at the time.
Thanks again for your notes and questions. I hope you read "Addiction Inc." and we can talk more!
Sorry for the delayed response, and thank you for your gracious and generous response to my initial post. I have Grass Roots, and found lots of useful information about Nixon and the CSA in there. I realize it’s a different topic as it pertains to Nixon; I’d looked at Lee Robin’s study on returning veterans, and probably made some assumptions in my last book. I’m sure you’ve done lots of research, but I’m still skeptical about Nixon and the remembrances of a 92-year-old who worked for him. I look forward to reading your book.
I checked with a couple of prescriber friends, and there was no X-waiver exam in the formal sense. This surprises me. It was an open book sort of thing at the end of an eight hour training. One of them said you could use Google if you wanted, or a pharmaceutical sales rep. I also asked her if she gained insight into prescribing for opioid use disorder from the training. She replied, “No, not at all. I didn’t learn anything until I was doing it.” However, in a variety of areas in healthcare, sales reps are expected to advise MDs and other providers on the applications, proper use and other technical considerations of their products. While I’ve seen this extensively with medical devices, technical considerations and support in prescribing is not actually that outrageous. This is especially true in view of the lack of actual addiction medicine training required for prescribing medications for addiction treatment. I touch on this in my upcoming book.
Thank you for enlightening me regarding the history of the buprenorphine/nalaxone strips I’ve seen used in every program I’ve been involved with. Unfortunately, it’s just another reason to be cynical about the pharmacological industrial complex.
I love this stuff! I'm dying to know how Nixon liberalized drug policy in the US. You have mentioned that he wasn't all bad. I only know him as the guy directly responsible for the Controlled Substance Act, which gave us scheduling of substances. Completely disregarding the Shafer Commission's study, he made cannabis a Schedule I substance, i.e. no medical value and high risk for abuse. It was on Nixon's watch that Tim Leary was sentenced to 10 years in prison for two roaches, discovered in a search that had questionable probable cause. And this was after Leary had the Supreme Court overturn a previous 30 year sentence! Nixon was using drugs is a political weapon against people he perceived to be dangerous or his enemies.
Hallucinogens were caught in the crossfire of that, and veterans with PTSD, people with end-of-life existential crisis, the depressed and the addicted missed out on substantial help for 50 years because of that. Also, I'm not a drugs historian (just like I'm not the language police, ugh), but treatment approaches were becoming more enlightened without any kind of top-down influence with increasing understanding and acceptance of the diease model. The phenomenon of Vietnam veterans having spontaneous remission from their heroin addictions was significant, but again, it wasn't Nixon. When I get around to reading this, I'll be interested to know how things got better on Nixon's watch.
I’m also curious to know about “the same doctors who were prescribing OxyContin” being sold Suboxone, since they would have been required to obtain X-waivers to prescribe the medication, and were limited to 150 OUD patients in their practices. The transition to buprenorphine/Suboxone films is based in legitimate concern over misuse. The pill form can be crushed and snorted or dissolved for injection. Part of any Suboxone nursing intake includes providing education on safe storage; specifically covered is what to do should children happen to get ahold of the medication or the wrappers. The pill form is still available, but films are routinely used in most programs for safety reasons.
Hi Keith, thanks for this post. I appreciate your thoughts and what you write on your own substack about recovery. You bring up some important points, so I'll respond to them here.
You're right about this other side of the Nixon administration's approach, which focuses on criminalization and law enforcement. In fact, I wrote a book about it - my first book, "Grass Roots," is about the history of cannabis activism in America and it deals at length with Nixon, the CSA, and the Shafer Commission.
But Nixon's pivot in 1971 marks a turning point, at least in terms of his administration's response to heroin, what the president called "public enemy number one." Heroin was also a Schedule I substance by this time, but when faced with the triple threats of rising rates of crime, rising rates of heroin use, and the specter of tens of thousands of addicted "GI Junkies" returning from Vietnam, his administration supported a nationalized system of addiction treatment clinics instead. This wasn't more drug arrests or law enforcement. This was the largest expansion of treatment infrastructure in American history. It was healthcare for heroin users, not punishment. And drug arrests dropped through 1972 because of it. (This is also due to the fact that the vast majority of drug arrests occur on the state level, not the federal level, so federal drug laws are more influential in setting nationwide standards than resulting in major numbers of arrests.)
The Vietnam vets' recovery from addiction was also almost entirely because of the Nixon administration's response. Nixon's first "drug czar," Jerome Jaffe, convinced the military to decriminalize heroin use in 1971. Previously soldiers would be given dishonorable discharges or arrested for heroin possession. But starting in 1971, when urine testing machines were shipped to Vietnam, solders who were being discharged and who tested positive for opiates wouldn't be punished. Instead, they had to stay in Vietnam an additional week to go through withdrawal, and then they were sent to VA hospitals on the West Coast for additional treatment. If they needed additional services after the VA, there was a new nationalized clinic system they could use. Because of urine testing and treatment -- two services initiated by the Nixon administration -- most veterans discontinued heroin use. Their recovery wasn't only spontaneous. It was a precondition of their ability to get out of a warzone.
Finally, the Suboxone story is wild because it's precisely the same salespeople from Purdue who joined Suboxone's manufacturer and actually helped physicians with the x-waiver exam. They called it "handholding." They would often sit with the physicians while they took it to help answer questions, and because so few medical schools in the 2000s and 2010s taught addiction medicine (only 15 of the country's 180 medical schools had addiction medicine programs in 2018), salespeople also taught doctors how to prescribe. This information became weaponized after 2013 when Suboxone's manufacturer faced generic competition and began forcing physicians and state Medicaid systems to switch to the film, not because it was safer (RADARS data suggested generic pills actually had the lowest levels of pediatric exposure), but because they wanted to put patients on patent-protected film strips rather than generic buprenorphine. This may have changed today -- I focus on the past -- but between 2013 and 2020, Suboxone's manufacturer used the same playbook as Purdue to market patent-protected filmstrips as safer with flimsy evidence, distorted data, and "baby death articles." It was so blatant, in fact, that the DOJ launched a lawsuit against the company and won a $2 billion settlement, the largest opioid settlement at the time.
Thanks again for your notes and questions. I hope you read "Addiction Inc." and we can talk more!
Sorry for the delayed response, and thank you for your gracious and generous response to my initial post. I have Grass Roots, and found lots of useful information about Nixon and the CSA in there. I realize it’s a different topic as it pertains to Nixon; I’d looked at Lee Robin’s study on returning veterans, and probably made some assumptions in my last book. I’m sure you’ve done lots of research, but I’m still skeptical about Nixon and the remembrances of a 92-year-old who worked for him. I look forward to reading your book.
I checked with a couple of prescriber friends, and there was no X-waiver exam in the formal sense. This surprises me. It was an open book sort of thing at the end of an eight hour training. One of them said you could use Google if you wanted, or a pharmaceutical sales rep. I also asked her if she gained insight into prescribing for opioid use disorder from the training. She replied, “No, not at all. I didn’t learn anything until I was doing it.” However, in a variety of areas in healthcare, sales reps are expected to advise MDs and other providers on the applications, proper use and other technical considerations of their products. While I’ve seen this extensively with medical devices, technical considerations and support in prescribing is not actually that outrageous. This is especially true in view of the lack of actual addiction medicine training required for prescribing medications for addiction treatment. I touch on this in my upcoming book.
Thank you for enlightening me regarding the history of the buprenorphine/nalaxone strips I’ve seen used in every program I’ve been involved with. Unfortunately, it’s just another reason to be cynical about the pharmacological industrial complex.