Takeaways from the book “Addiction, Inc.” 

By Megan Buresh, MD, AAHIVS, Johns Hopkins Medicine 

During my intern year at a Boston primary care clinic, one of my first patients was a woman in her 20s who presented to clinic in active opioid withdrawal. A week after she started buprenorphine (commonly known by the brand-name Suboxone), her physical symptoms were stabilized, allowing her to focus on other life and health goals, like getting a job and treating her hepatitis C. Witnessing her dramatic life transformation led me to pursue a career in addiction medicine. However, there’s much I don’t know about the history of how we got here.  

This is where I’ve benefited greatly from the friendship of drug historian Dr. Emily Dufton  who recently published an amazing book, “Addiction, Inc.: Medication-Assisted Treatment and America’s Forgotten War on Drugs.” Dr. Dufton spent over a decade researching and writing this book, which was inspired by the loss of multiple high school friends to overdose deaths. The book traces the history of the development of medications for opioid use disorder (OUD), which started during the Nixon administration. The U.S. was instrumental in developing the gold standard for the treatment of OUD yet leads the world in opioid overdoses deaths and there remains discouraging lack of access to treatment.  

History of methadone treatment 

Despite Nixon’s War on Drugs, a national system of federally funded methadone clinics was developed between 1968-1972 and quickly scaled up to treat 20,000 individuals. Unfortunately, stigma and lack of federal oversight, as well as shift in the political tides, led to federal defunding of this system and eventual privatization under the Reagan administration. Despite the evidence for methadone, there are significant geographic and racial disparities in access, and it’s become a treatment industry dominated by for-profit private equity firms. 

Buprenorphine treatment: great medication, not-so-great pharmaceutical shenanigans 

As a primary care physician in Baltimore, I prescribe buprenorphine to hundreds of patients with opioid addiction. However, there’s much about its history that I didn’t know before reading this book. The book traces the fascinating development of buprenorphine, initially by a grocery company in England, to NIDA funded studies. There was a dark side to its initial marketing, with similar predatory marketing techniques to Purdue’s marketing of Oxycontin (even hiring the same drug reps) and promoting name brand Suboxone over generic equivalents.  

Future hope 

Dr. Dufton ends the book with hope—as do I. She spent time in Switzerland, formerly the heroin overdose capital of Western Europe, and now a leader of a national and integrated treatment system. It gives me hope that when we offer sustained funding for holistic treatment (including lifesaving medications, mental health, housing, and wrap-around social services) and treat people with dignity, we can save lives. My hope is that we can learn from history and develop sustained funding structures (like Ryan White funding for HIV/AIDS treatment). Every opioid overdose death is preventable—each death represents a person and a life lost.  

Practical takeaways from the book: 

1. Opioid addiction is treatable, but there are significant disparities in accessto treatment. It’s our duty to treat all persons with dignity and fight structures that limit access to care. Knowing about our history helps us better advocate in the present. 

2. We should all advocate for access to lifesaving medications for opioid use disorder (first-line: methadone and buprenorphine; second line: extended-release naltrexone).

3. Regardless of specialty or treatment setting, we should know how to start and link patients to treatment. Any prescriber with a DEA license can prescribe buprenorphine. While methadone can’t be prescribed outside of federally regulated clinics, hospitals and EDs can start and continue methadone, and any provider can link patients to methadone clinics.  

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.