Nora Volkow

Nora Volkow is an official at the National Institute on Drug Abuse whose arguments help articulate the scientific case for Medication-assisted treatment (MAT) in a treatment landscape divided over whether maintenance medication supports recovery or merely substitutes one drug for another. In the book, she counters that distinction with evidence about relapse, patient outcomes, and the dangers of forcing people away from treatment too soon.

Role in the Treatment Debate

Volkow appears amid a widening divide between public-health professionals who support MAT and criminal-justice officials and recovery communities that often resist it. That conflict had practical consequences: some people taking buprenorphine were regarded as not truly abstinent, while Virginia drug courts and some mutual-support groups restricted or rejected MAT. The book presents Volkow as a scientific counterweight to these judgments, insisting that treatment should be assessed by its outcomes rather than by assumptions about what counts as being clean.

Her intervention is not detached from the conditions facing patients. A patient abruptly taken off medication may relapse, while people buying Suboxone on the black market may be trying to avoid withdrawal rather than seeking intoxication. Volkow emphasizes that this attempt to stave off withdrawal is much safer than returning to illicit opioids. Her reasoning reframes such behavior: instead of treating it as proof that medication-based treatment has failed, it can be understood as evidence of how urgently patients need reliable access to care.

Evidence for Maintenance Treatment

Volkow argues that studies consistently show better outcomes when patients receive maintenance medications such as buprenorphine or methadone. The claim bears directly on the book’s account of how attitudes toward MAT become entangled with the treatment itself. As described in the surrounding discussion, patients tapered off too early may relapse; those relapses can then be taken as evidence that MAT does not work, reinforcing an inaccurate conclusion. Volkow identifies this cycle as a problem of interpretation as well as treatment: the outcome used to discredit medication may have followed from withdrawing it prematurely.

The book also sets her broad evidence-based claim against more qualified findings about duration and dosage. Some long-term patients had reduced their Suboxone dose substantially, but their physician hesitated to end treatment because tapering could precede relapse. One cited study found that half of those weaned from buprenorphine relapsed within a month, with better outcomes associated with lower doses at the point of taper; another found that, over five years, patients divided among being drug-free after eighteen months, remaining on MAT, or returning to heroin and other illicit opioids. These figures do not make every patient’s course identical, but they clarify why Volkow cautions against equating medication use with failed recovery.

Influence on Policy and Public Argument

The policy debate around MAT unfolded alongside federal funding decisions. In 2016, the Office of National Drug Control Policy announced that it would deny funding to drug courts that cut off access to MAT. The following spring, Tom Price, then Secretary of the U.S. Department of Health and Human Services, released the first portion of a $1 billion appropriation for treatment and prevention, including expanded MAT access, but soon publicly dismissed the approach as substituting one opioid for another.

A Tennessee public-health official told the author that Price changed his position after Volkow showed him the scientific evidence. The account attributes influence to her presentation of research, while also making clear that this evidence did not settle the public argument: Price resigned months later amid a scandal over taxpayer-funded charter flights, and his successor signaled an intention to expand MAT access. Volkow’s role is therefore both specific and emblematic. She brings findings from the National Institute on Drug Abuse into a political debate in which treatment access depends not only on evidence, but on whether institutions accept what that evidence implies.

Significance

Volkow’s contribution is to challenge a moralized distinction between medication and recovery with an outcome-focused account of care. Her argument recognizes that a person taking buprenorphine may be sustaining recovery, not evading it, and that interrupting treatment can expose that person to relapse. In a book attentive to the gaps between health care and criminal justice, she represents the public-health position that those gaps should not be filled by stigma or by rules that deny effective medication. Her evidence does not erase the varied paths patients take; it makes the consequences of dismissing maintenance treatment harder to ignore.