RFK Jr.’s opioid crisis plan

At his confirmation hearing on Jan. 29, Robert F. Kennedy Jr.—President Donald Trump’s nominee for Secretary of Health and Human Services—outlined his vision for addressing the opioid crisis with a national network of “healing farms” where individuals with substance abuse disorders would be sent for recovery. His approach emphasizes a morality- and sobriety-centric model, drawing from his personal experience with 12-step and faith-based programs. 

While Kennedy’s recovery journey may have worked for him, his plan overlooks other evidence-based approaches, like medication-assisted treatments (MAT), which have already helped millions of Americans struggling with addiction, and emerging therapies like ibogaine. 

The lived experience of people who use drugs can sometimes offer great insight for policy change, but not when that guidance is based solely on one person’s experience. Kennedy’s plan to address the opioid crisis is deeply personal, shaped by his 14-year struggle with heroin and other drugs. Rooted in the teachings of Swiss psychotherapist Carl Jung, 12-step programs, and faith-based therapy, his philosophy frames addiction primarily as a moral and spiritual crisis. While this perspective was once commonplace among anti-drug advocates, it has largely been replaced by a medical understanding of substance use disorders–one that recognizes addiction as a complex health condition requiring evidence-based treatment. 

During the hearing, Kennedy proposed the expansion of faith-based, labor-intensive rehabilitation centers, which he refers to as “healing farms.” His inspiration comes from San Patrignano-style recovery centers—known for their emphasis on long-term, abstinence-based treatment through vocational training and communal support, which have faced scrutiny for their use of coercion and retributive discipline. The emphasis on isolation, strict adherence to communal rules, and limited autonomy over personal decision-making raise ethical concerns about coercion and the long-term well-being of participants. Reports have also pointed to the exclusion of individuals with co-occurring psychiatric disorders, limiting access for those who may require integrated mental health support.

Research consistently shows that forced treatment is usually ineffective. Studies indicate that individuals subjected to involuntary treatment, such as civil commitment for treatment, relapse at alarming rates–often on the day they are released. These poor long-term outcomes stem from heightened institutional distrust, a lack of post-treatment support, and inadequate access to quality care. 

Many people struggling with addiction have a history of trauma, and coercive approaches can exacerbate that trauma, making individuals less likely to seek help and ultimately reducing long-term recovery rates. The facilities that house these programs often fail to provide comprehensive, trauma-informed care, as they lack appropriately trained staff and resources necessary to offer a full range of treatments, including medication, therapy, and wound care. 

While some individuals may benefit from short-term involuntary treatment in crisis situations, many do not, and many experience greater harm as a result of involuntary treatment. Creating a legally sound, ethical framework that protects individual rights while addressing the complexities of addiction remains a major challenge—one that Kennedy’s approach fails to resolve.

Medication-assisted treatment (MAT) is the only form of treatment currently approved by the Food and Drug Administration for treating opioid use disorder and should not be disregarded in favor of an abstinence-only approach. Medications like buprenorphine, methadone, and naltrexone have been extensively studied and shown to significantly reduce opioid cravings, prevent withdrawal symptoms, and decrease overdose risk. The main shortcoming with MAT, specifically methadone, is that patients are required to make daily visits to a clinic to receive medications for up to two years to achieve successful recovery from addiction. This demanding regimen contributes to high rates of treatment withdrawal and relapse.

Newly emerging treatments like ibogaine have shown potential as a possible replacement for MAT to help individuals overcome opioid use disorder because early evidence suggests high success rates after just a single administration. In one small-scale study, 75% of participating opioid addicts remained opioid abstinent for an entire year after a single ibogaine treatment. While still in the early stages of research due to legal restrictions and safety concerns, preliminary evidence suggests that ibogaine could be a breakthrough tool in addiction treatment, offering those struggling with opioid dependence a neurobiological reset. 

Rather than reverting to outdated, ideologically driven, and ineffective approaches, policymakers should prioritize expanding access to evidence-based treatments and investing in innovative treatments like ibogaine that could revolutionize addiction care. As secretary of Health and Human Services, Kennedy could make progress by pushing to allow patients to take some quantity of traditional MAT medications home with them to improve adherence to the regimen and expedite the development of ibogaine as an alternative treatment option.

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