12 Hard Lessons: Richard J. Baum on America's Opioid Crisis

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The arc of the opioid crisis is, by now, familiar to most people. Over-prescribing of legal opioids in the late nineties caused escalating numbers of people to develop use disorders. In the 2000s, new prescribing guidelines and controlled substance monitoring went into effect, and the legal supply of opioids rapidly reduced - so quickly that many people with opioid dependence turned to heroin to stave off withdrawal. But that only made the problem much worse. And then by the mid 2010s, fentanyl and its multitude of analogues hit the scene and overdose deaths exponentially skyrocketed. And then the pandemic hit, and the death toll literally doubled. Richard J. Baum is one of those few individuals who has had a bird’s eye view of the crisis the whole time. Baum served in the Office of National Drug Control Policy through six presidential administrations from the late nineties until he became Acting Director under President Trump. This month he joins us to discuss his perspectives. Baum is now Adjunct Lecturer at Georgetown University, where he is teaching a course based on his comprehensive book, Inside America’s Opioid Crisis, which draws on more than three decades of work on national drug policy. In this conversation, we talk about how the crisis unfolded, but focus on the current moment defined by shifting drug trends, unpredictable overdose spikes, a large grey market of unregulated dangerous drugs sold as supplements, and the rise in stimulant use even as fentanyl overdoses decline. Baum has learned a lot from his experience on all aspects of this crisis, like treatment, prevention, and how best to inform the public about the dangers of each new drug threat. As always, any opinions expressed in this episode reflect those of the guest, and do not represent the opinions of the University of Tennessee. Learn more: Richard J. Baum: https://richardjbaum.com/ Inside America’s Opioid Crisis: https://richardjbaum.com/book SMART: www.smart.tennessee.edu https://smartpolicypodcast.buzzsprout.com/

What the Brain Disease Model of Addiction Gets Right — and What It Misses

Something really has changed over the past twenty years, especially in the last ten. Our culture has increasingly come to accept the idea that addiction is a chronic, treatable disease, not a moral failure. Secretary RFK Jr. of the Dept. of Health and Human Services said this almost word-for-word just about a month ago when President Trump signed the Executive Order establishing the Great American Recovery Initiative, adding that for too long we have treated substance use disorder with “fragmentation, stigmatization and silence instead of science, compassion and coordination.”In the field of science, both clinical and academic, this is often referred to as the “brain disease model of addiction,” based on the definition of a disease as a condition that changes the structure or function of at least part of an organ or system. However, though this framework has done a lot to reduce stigma and increase the acceptance of evidence-based treatment, you don’t have to go looking very long before you see that our healthcare, housing, and criminal justice systems are still stuck in the past. And on top of that, the recovery community itself remains split on what it even means to have the disease of addiction.My guests this month are Dr. Kirsten Smith, a researcher and clinical social worker who found recovery and earned her doctorate after going to prison for robbing banks in order to pay for heroin, and Dr. Stephen Loyd, Chief Medical Officer of Cedar Recovery and Chair of the Tennessee Opioid Abatement Council, who is also in recovery from opioid and benzodiazepine use disorder. Dr. Smith was recently featured in an article by the Guardian, wherein she offered some intriguing criticisms and limitations of the brain disease model, and it caught our attention at the SMART Initiative, as well as that of Dr. Loyd. Fortunately, the two agreed to come onto our show for a deep dive, and as you can see, this episode turned out to be longer than normal. It also contains some concepts that some might find controversial. Additionally, though we frequently discuss drug use on this show, we get a bit up close and personal to the topics of cravings, recovery, and more, so some listener discretion is advised. And as always, this episode is intended to be educational, showcases the personal opinions of the guests, and does not reflect any opinion or belief of the University of Tennessee.That being said, I found this conversation to be insightful and challenging, with compelling takeaways for everyone, no matter where they stand on the matter. Learn more:Dr. Stephen Loyd: https://www.cedarrecovery.com/dr-stephen-loyd/ Dr. Kirsten Smith: https://www.theguardian.com/news/2025/sep/04/bank-robber-scholar-knoxville-change-addiction Dr. Alan Leshner’s 1997 paper on the brain disease model of addiction: https://pubmed.ncbi.nlm.nih.gov/9311924/ “Behave” by Robert Sapolsky: https://www.sackett.net/sapolsky_behave.pdf SMART: www.smart.tennessee.edu Listen on Apple: https://podcasts.apple.com/us/podcast/smart-policy-podcast/id1642539321 Listen on Spotify: https://open.spotify.com/show/5qbzONIr0hlWxiQsPwkXHM Listen on Soundcloud: https://soundcloud.com/smart-initiative

1. März 20261 h 28 min

12 Hard Lessons: Richard J. Baum on America's Opioid Crisis

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