Addiction, Inc.: Medication-Assisted Treatment and America’s Forgotten War on Drugs

How the war on drugs created the gold standard treatment for addiction—until America’s opioid crisis got privatized for profit, to the detriment of patients.

Despite epidemic levels of overdoses in the United States, by 2020, only twenty percent of Americans suffering from opioid use disorder (OUD) received medication-assisted treatment (MAT), the gold standard of addiction treatment, which uses methadone, buprenorphine, or naltrexone to reduce illicit drug use and curb the symptoms of withdrawal. While MAT is the most effective treatment available for OUD, it’s also the most controversial, the most expensive, and the most difficult to access. And yet, the medications at the center of this treatment—and the private industries that distribute them—generate roughly sixteen billion dollars each year, on par with national sales of coffee and pet food.

In Addiction, Inc., historian Emily Dufton explains how this promising avenue of treatment emerged during President Richard Nixon’s war on drugs in 1971 as a radical experiment in public health, when hundreds of federally-funded treatment clinics opened nationwide. Dufton then explores how these nationalized clinics gave way to an immensely profitable private industry that offers poor care at high costs to an insufficient number of people. Drawing on original research and over a hundred interviews with policymakers, medical experts, pharmaceutical lobbyists, and patients and their families, she tells a gripping story of squandered potential and missed opportunities, as MAT transformed from a revolutionary political project launched from the White House itself into a commercial success—and a public health disaster.

Urgent, eye-opening, and deeply human, Addiction, Inc. reveals how, over the past fifty years, the United States built an addiction treatment system that made recovery harder instead of easier, and what it will take to change its course.