History Exposes A Crucial Flaw In Rfk Jr.’s Vision For Treating Drug Addiction

In July 2024, Donald Trump’s Health and Human Services Secretary designee, Robert F. Kennedy Jr., participated in a virtual event in which he briefly outlined his plan to address the country’s opioid epidemic: free people incarcerated for nonviolent drug offenses, expunge their records so they can get jobs, legalize marijuana, and replace rural prisons with “wellness drug rehabilitation farms.”

There were positive elements of the plan, such as managing addiction as a disease in need of treatment instead of a crime deserving punishment. Additionally, Kennedy’s past history of substance use and recovery gave him a perspective too often missing from drug policy discussions. 

Yet, his proposal for wellness farms (which Kennedy indicated during his first confirmation hearing would be voluntary) has a critical flaw: the U.S. tried something similar in the 1930s with little success. Out of that experience, however, came a critical innovation: methadone maintenance, a drug treatment with a much better track record. Although this medication gets a bad rap because of stigma that has been around since its inception, history reveals that it is far more likely to be effective than wellness farms.

In 1935, the Federal U.S. Narcotic Farm opened in Lexington, Ky., holding anywhere from 1,000 to 1,500 patients at a time. With the country divided over whether addiction was a disease or a crime, Narco, as the farm was known, was jointly managed by the Public Health Service and the Bureau of Prisons. Its mission was threefold: to incarcerate, rehabilitate, and study people addicted to drugs.

Narco was unlike a typical prison. As part of their rehabilitation, patients were encouraged to take advantage of one of the farm’s many music studios or even to perform on the stage of its 1,300-seat theater. Back then, jazz and heroin often went side by side, and Chet Baker, Elvin Jones, Stan Levey, Jackie McLean, Red Rodney, Sonny Rollins,⁠ and many other famous jazz musicians all did time at Narco. In New York, Narco was spoken of as if it were an elite jazz workshop, and some musicians even lied about having a heroin habit just so they could check in and study from the greats.

Read More: The Conspirituality of Robert F. Kennedy Jr.

Narco’s model also included “therapeutic labor” on the institution’s sprawling farm, where men from the city learned how to milk cows and grow kale in an idyllic setting: rolling green fields, silos, dairy barns, tomato crops, and cows grazing in the clover. 

While they attempted to rehabilitate the farm’s patients, Narco scientists also saw them as the perfect subjects for drug addiction research and a locked environment as the ideal setting.⁠ That led them to conduct the first-large scale trial of methadone, a newly approved opioid in 1948. Narco’s scientists doubted pharmaceutical giant Eli Lilly’s marketing, which claimed that the drug could be a highly effective, non-addictive, long-acting painkiller. With the help of 115 men who had been addicted to morphine, the Narco trial proved that methadone did, in fact, cause dependence.

Yet, this didn’t stop Narco doctors from beginning to use methadone in their standard detox protocol instead of morphine, probably because it lasted longer than the alternatives and didn’t cause a high. That introduced Dr. Marie Nyswander, one of the clinicians at Narco, to the drug. When a patient arrived addicted to heroin, Nyswander would carefully switch him over to methadone, gradually decreasing the dose over the course of two weeks until he was no longer taking any opioids at all. The process was known as “Medicated detox” At the time, abstinence-based therapy was the name of the game — the goal was to get all Narco patients off all opioids.

For all Narco’s promise, however, its methods simply didn’t work; 90% of patients relapsed after leaving the controlled environment of the farm. Nyswander observed this with her own patients: Narco’s therapeutic model could get them off heroin, but it couldn’t keep them from relapsing within “one to twenty-four hours” after they left the drug-free environment. Engaging in talk therapy, participating in Addicts Anonymous meetings, playing music, working on the farm, and eating fresh, home-grown food simply was not enough to cure people of addiction.

The poor success rate she witnessed at Narco helped motivate Nyswander to look for other solutions to addiction. After she finished her year-long stint at the farm, she began her psychiatry residency and quickly became one of the country’s most prominent addiction physicians. But as her patients continued to die, she knew it was time to try something beyond Narco, psychoanalysis, and Narcotics Anonymous. So when Dr. Vincent Dole, a leading metabolic researcher, asked her to join his lab in 1962 at the Rockefeller Institute to study a new idea — maintenance therapy — she jumped at the chance. 

Maintenance therapy differed from “Medicated detox,” because instead of aiming to get a patient off of methadone within weeks, it kept a patient on the less dangerous opioid for a far longer period — sometimes years. Many doctors found the idea to be heretical; they believed that once someone got through the grueling pains of detox, they would be forever cured of addiction. But Nyswander had seen that this loadstar just wasn’t true. Continued sobriety seemed to be the hardest part of recovery.

Maintenance therapy also fell into a legal grey area, most practitioners considering it illegal since the 1919 Supreme Court decision in Webb v. United States, which held that maintenance treatment was not “in the course of professional treatment,” as it did not offer a “cure.” But Nyswander and Dole so believed in the potential of this treatment that they were willing to take the legal risk.

In 1965, they published their ground-breaking results in the Journal of the American Medical Association, showing that methadone reduced heroin cravings and allowed patients to return to school, work, and their families.

Some scientists considered the breakthrough from Nyswander and Dole to be as monumental as the discovery of penicillin. Finally, they had found a treatment that worked. Instead of suggesting an opioid-free existence, they were aiming for something more achievable: a normal life free of illicit drugs, with the help of a daily medication.

Read More: The Unique Challenges of the Fentanyl Epidemic

However, methadone maintenance was deeply controversial. Although methadone benefited from a brief period of political support from the Nixon Administration in the 1970s, it very quickly came under fire: conservatives thought it was a dangerous drug, liberals thought it side-stepped the root causes of addiction, the Black community saw it as a form of government control, and families did not want methadone clinics in their neighborhoods.

Even today, many in the recovery community still distrust methadone, seeing it “trading one drug for another,” despite evidence showing that methadone and its sister medication are highly effective. As a result, while methadone can get Americans off of more dangerous and disruptive drugs, it remains one of most heavily regulated medications in America. And so, less than two percent of physicians prescribe what could be a life saving medication, and less than half the country has access to a clinic.

That’s the situation that Kennedy may confront, if he’s confirmed by the Senate.

Speaking on “Latino Capitalist” in July, he laid out his vision: “I’m going to dedicate that revenue to creating wellness farms — drug rehabilitation farms — in rural areas all over this country.” He plans to replace the burgeoning rural prison industry with these farms, where people with drug addictions can go for free, and learn to grow their own “organic food, high-quality food.” Kennedy believes that will help, “because a lot of the behavioral issues are food-related.”

Kennedy correctly recognizes the problems plaguing millions of Americans and understands that addiction is an illness. He’s also right that community involvement and connection are keys in successful treatment. But what he’s proposing is to create a score of Narcos. And what we know from the original is that such treatment farms don’t work. What does work, however, is methadone maintenance. It’s much cheaper and much more effective than repeating the mistakes of the past.

Dr. Melody Glenn is a physician at the University of Arizona College of Medicine Tucson and an author whose first book, Mother of Methadone, is forthcoming from Beacon Press in Summer 2025.

Made by History takes readers beyond the headlines with articles written and edited by professional historians. Learn more about Made by History at TIME here. Opinions expressed do not necessarily reflect the views of TIME editors.