The National Institute on Drug Abuse (NIDA) is a federal agency that appears in three episodes of The Bob Zadek Show as a recurring target of criticism from guests across different areas of drug policy. Dr. Rick Doblin discusses NIDA’s role in monopolizing federally legal marijuana production; Theodore Dalrymple identifies NIDA as the institutional embodiment of the disease model of addiction; and Dr. Jeffrey Singer describes NIDA’s shifting guidance on opioid prescribing and cites its director’s published research. Across these episodes, guests treat NIDA not as a neutral research body but as an agency whose institutional positions shape medical practice, research agendas, and drug policy.
The federal marijuana monopoly
In a 2016 episode, Dr. Rick Doblin told Bob Zadek that since 1968 there has been only one source of federally legal marijuana, grown at the University of Mississippi under contract to NIDA. Doblin described this arrangement as a government monopoly that “can only provide marijuana for academic research but not as a prescription medicine,” and said the fix has been in since 1968, making it impossible to make marijuana into a medicine federally Dr. Rick Doblin on MAPS and the War on Drugs (2016). He noted that 25 states had passed medical marijuana laws and even more had passed laws concerning CBD, one of marijuana’s main components.
Doblin said MAPS had been involved since 2000 in trying to break the federal monopoly on marijuana production, working with Professor Lyle Craker at UMass Amherst and the law firm Covington & Burling. He mentioned that Attorney General Holder, after leaving office, went to work for that firm, and that Peter Barton Hutt, a former FDA lawyer and one of Doblin’s dissertation advisors at the Kennedy School, was a senior partner there who agreed to take the case pro bono to sue the DEA. Doblin called private production the key factor in the medical marijuana issue and expressed hope that before Obama left office he would order the Attorney General to order the DEA to license Professor Craker and others to grow marijuana domestically.
Bob Zadek interjected that he guessed Trent Lott was still in power when the Mississippi arrangement was made, and Doblin called the situation incredible. The exchange frames NIDA’s research monopoly as a product of political circumstance as much as scientific judgment.
Addiction as choice versus disease
In a 2019 episode, Theodore Dalrymple told Bob Zadek that in the prison where he worked, heroin addiction was the most important one, and that it is presented everywhere by doctors as a medical illness pure and simple. Dalrymple acknowledged there are medical aspects and important medical consequences to taking heroin, including death, but argued it is not a medical condition in itself Theodore Dalrymple on Negligence and Unaccountability (2019). He said addiction is a genuine physiological phenomenon but that addiction to heroin is not something that happens to you; it is something that you do.
Dalrymple cited the average length of time people in Britain take heroin intermittently by injection before becoming physically addicted—18 months—as evidence that addiction does not simply fall on them. He noted that injecting heroin requires knowing where to get it, how to prepare it, and how to inject it, and that users must overcome inhibitions and learn to disregard unpleasant side effects. He said that before any of this starts, people know the consequences because heroin addiction has become so widespread.
Dalrymple then identified NIDA directly, saying that the attitude that addiction is something that happens to you is the attitude of the National Institute on Drug Abuse, and that it has been adopted more or less as an orthodoxy in the New England Journal and other journals and among the leaders of the medical profession, though perhaps not among the foot soldiers. Bob Zadek responded that there is a somewhat sinister but human reason why the medical profession’s approach to drug addiction might differ from society at large, mentioning public choice and greed, and noted that Dalrymple’s book False Positive examined 52 issues of the New England Journal of Medicine and found the journal wandering beyond orthodox medical practice into social policy.
The overdose crisis and shifting guidance
In a 2022 episode, Dr. Jeffrey Singer told Bob Zadek that the Joint Economic Committee of Congress reported in 2019 that overdose rates started climbing in 1959, and that by 1970 President Nixon declared war on drugs, creating the Drug Enforcement Administration and scheduling drugs Fresh Approaches to the Overdose Crisis (2022). Singer explained that Schedule I drugs are those with no medical use, including marijuana and diamorphine, while Schedule II drugs have medical use but high addictive potential.
Singer described how the overdose crisis evolved: heroin and cocaine in the 1970s and 1980s, diverted prescription pain pills like Percocet and Vicodin in the 1990s, and OxyContin in the early 21st century. He said the crisis attracted attention when it began involving white middle-class people rather than mainly inner-city minority users. He recalled being a medical student during Nixon’s war on drugs and being indoctrinated to avoid prescribing opioids, and described post-op patients in the 1980s refusing morphine for fear of addiction.
Singer distinguished addiction from dependency, defining addiction as compulsive use despite negative consequences, and said it is a behavioral disorder that can involve substances or behaviors like gambling. He cited Dr. Nora Volkow, the current head of NIDA, who wrote in the New England Journal of Medicine that addiction in chronic long-term opioid users and chronic pain patients is very uncommon, “even in those with pre-existing vulnerabilities.” Singer said people tend to equate opioid dependency with opioid addiction, but they are two completely different things.
Singer also said that by the late 1980s and early 1990s, medical researchers were pointing out that pain was being undertreated because of an irrational and non-evidence-based fear of opioids, coining the term “opiophobia.” He said that by the late 1980s and early 1990s, everyone was being told, including by NIDA, to stop undertreating pain and not to be afraid to prescribe opioids because they have low addiction potential. He cited Volkow again, saying that as recently as 2016 she said the addiction rate is between 1% and maybe 5% depending on whose studies you read, though he believed it was closer to 1%.
Singer described how prescribing increased in the 1980s and 1990s, making prescription pain relievers familiar and associated with safe use, and how OxyContin became popular for non-medical use. He said that when prohibitionists decided to blame the drug rather than prohibition, they forced doctors to prescribe less. Opioid prescribing peaked in 2012 and is down 60% since, while the overdose rate has soared. He said that in 2018 the DEA reported less than 1% of prescription pain pills get diverted into the black market. As prescription pills became less available, users moved to heroin, then to fentanyl. In the 12 months ending April 2021, there were 100,000 overdose deaths, a record high, with about 70,000 opioid-related and 83% of those involving fentanyl. Singer said over 90% were poly-drug, with 22% containing cocaine and 23% containing methamphetamine.
Singer said the notion being promulgated is that Purdue Pharma and other pharmaceutical companies fooled doctors into prescribing opioids, turning patients into addicts, and that this is absolutely untrue. He cited his own published study using the National Survey on Drug Use and Health, which started in 2002, showing that past-month non-medical use of pain relievers by persons aged 12 and up has been essentially a straight line, as has past-year diagnosed pain reliever use disorder. From 2002 to 2012, prescriptions per 100 persons doubled, then fell 60% since 2012, while those two metrics remained flat. Singer said there is no correlation between the number of prescriptions written and people getting hooked or using drugs non-medically.
Across episodes
The three episodes span 2016 to 2022 and show NIDA discussed in different contexts without direct development between them. Doblin in 2016 focuses on NIDA’s marijuana research monopoly; Dalrymple in 2019 identifies NIDA as the source of the disease-model orthodoxy on addiction; Singer in 2022 describes NIDA’s shifting guidance on opioid prescribing and cites its director’s published work. Each guest advances a distinct criticism, and the excerpts do not show the same question argued across episodes or a change in treatment over time.
What the sources do not cover
The excerpts do not state when NIDA was founded, what its formal mission is, or how it is organized within the federal government. They do not describe NIDA’s budget, leadership beyond Dr. Nora Volkow, or any internal research programs other than the marijuana contract at the University of Mississippi. The excerpts do not include any statement from a NIDA representative responding to the guests’ criticisms, nor do they cover NIDA’s positions on drugs other than marijuana and opioids.