By Alexandra Keeler

The US has had a drug czar for decades. Experts share how this position has shaped US drug policy—and what it could mean for Canada

Last week, Canada announced it would appoint a “fentanyl czar” to crack down on organized crime and border security.

The move is part of a suite of security measures designed to address US President Donald Trump’s concerns about fentanyl trafficking and forestall the imposition of 25 per cent tariffs on Canadian goods.

David Hammond, a health sciences professor and research chair at the University of Waterloo, says, “There is no question that Canada would benefit from greater leadership and co-ordination in substance use policy.”

But whether Canada’s fentanyl czar “meets these needs will depend entirely on the scope of their mandate,” he told Canadian Affairs in an email.

Canadian authorities have so far provided few details about the fentanyl czar’s powers and mandate.

A Feb. 4 government news release says the czar will focus on intelligence sharing and collaborating with US counterparts. Canada’s Public Safety Minister, David McGuinty, said in a Feb. 4 CNN interview that the position “will transcend any one part of the government … [It] will pull together a full Canadian national response — between our provinces, our police of local jurisdiction, and work with our American authorities.”

Canada’s approach to the position may take cues from the US, which has long had its own drug czar. Canadian Affairs spoke to several US historians of drug policy to better understand the nature and focus of this role in the US.

The first drug czar

The term “czar” refers to high-level officials who oversee specific policy areas and have broad authority across agencies.

Today, the US drug czar’s official title is director of the Office of National Drug Control Policy. The director is appointed by the president and responsible for advising the president and coordinating a national drug strategy.

Taleed El-Sabawi, a legal scholar and public health policy expert at Wayne State University in Detroit, Mich., said the Office of National Drug Control Policy has two branches: a law enforcement branch focused on drug supply, and a public health branch focused on demand for drugs.

“Traditionally, the supply side has been the focus and the demand side has taken a side seat,” El-Sabawi said.

David Herzberg, a historian at University at Buffalo in Buffalo, N.Y., made a similar observation.

“US drug policy has historically been dominated by moral crusading — eliminating immoral use of drugs, and policing [or] punishing the immoral people (poor, minority, and foreign/traffickers) responsible for it,” Herzberg told Canadian Affairs in an email.

Harry Anslinger, who was appointed in 1930 as the first commissioner of the Federal Bureau of Narcotics, is considered the earliest iteration of the US drug czar. The bureau later merged into the Drug Enforcement Administration, the lead federal agency responsible for enforcing US drug laws.

Anslinger prioritized enforcement, and his impact was complex.

“He was part of a movement to characterize addicts as depraved and inferior individuals and he supported punitive responses not just to drug dealing but also to drug use,” said Caroline Acker, professor emerita of history at Carnegie Mellon University in Pittsburgh, Pa.

But Anslinger also cracked down on the pharmaceutical industry. He restricted opioid production, effectively making it a low-profit, tightly controlled industry, and countered pharmaceutical public relations campaigns with his own.

“The Federal Bureau of Narcotics [at the time could] in fact be seen as the most robust national consumer protection agency, with powers to regulate and constrain major corporations that the [Food and Drug Administration] could only dream of,” said Herzberg.

The punitive approach to drugs put in place by Anslinger was the dominant model until the Nixon administration. In 1971, President Richard Nixon created an office dedicated to drug abuse prevention and appointed Jerome Jaffe as drug czar.

Jaffe established a network of methadone treatment facilities across the US. Nixon initially combined public health and law enforcement to combat rising heroin use among Vietnam War soldiers, calling addiction the nation’s top health issue.

However, Nixon later reverted back to an enforcement approach when he used drug policy to target Black communities and anti-war activists.

“We knew we couldn’t make it illegal to be either against the war or Black, but by getting the public to associate the hippies with marijuana and Blacks with heroin, and then criminalizing both heavily, we could disrupt those communities,” Nixon’s top domestic policy aide, John Ehrlichman, said in a 1994 interview.

Michael Botticelli, Acting Director of the Office of National Drug Control Policy March 7, 2014 – Jan. 20, 2017 under President Barack Obama. [Photo Credit: Executive Office of the President of the United States]

Back and forth

More recently, in 2009, President Barack Obama appointed Michael Botticelli as drug czar. Botticelli was the first person in active recovery to hold the role.

The Obama administration recognized addiction as a chronic brain disease, a view already accepted in scientific circles but newly integrated into national drug policy. It reduced drug possession sentences and emphasized prevention and treatment.

Trump, who succeeded Obama in 2016, prioritized law enforcement while rolling back harm reduction. In 2018, his administration called for the death penalty for drug traffickers, and in 2019, sued to block a supervised consumption site in Philadelphia, Pa.

Trump appointed James Carroll as drug czar in 2017. But in 2018 Trump proposed slashing the office’s budget by more than 90 per cent and transferring authority for key drug programs to other agencies. Lawmakers blocked the plan, however, and the Office of National Drug Control Policy remained intact.

In 2022, President Joe Biden appointed Dr. Rahul Gupta, the first medical doctor to serve as drug czar. Herzberg says Gupta also prioritized treatment, by, for example, expanding access to naloxone and addiction medications. But he also cracked down on drug trafficking.

In December 2024, Gupta outlined America’s international efforts to combat fentanyl trafficking, naming China, Mexico, Colombia and India as key players — but not Canada.

Gupta’s last day was Jan. 19. Trump has yet to appoint someone to the role.

Canada’s fentanyl czar

El-Sabawi says she views Canada’s appointment of a drug czar as a signal that the government will be focused on supply side, law enforcement initiatives.

Hammond, the University of Waterloo professor, says he hopes efforts to address Canada’s drug problems focus on both the supply and demand sides of the equation.

“Supply-side measures are an important component of substance use policy, but limited in their effectiveness when they are not accompanied by demand-side policies,” he said.

The Canada Border Services Agency and Health Canada redirected Canadian Affairs’ inquiries about the new fentanyl czar role to Public Safety Canada. Public Safety Canada did not respond to multiple requests for comment before publication.

El-Sabawi suggests the entire drug czar role needs rethinking.

“I think the role needs to be re-envisioned as one that is more of a coordinator [across] the administrative branch on addiction and overdose issues … as opposed to what it is now, which is really a mouthpiece — symbolic,” she said.

“Most drug czars don’t get much done.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler

A B.C. pharmacy scam investigation has led the provincial government to return to a witnessed consumption model for safer supply

More than 60 pharmacies across B.C. are alleged to have participated in a kickback scheme linked to safer supply drugs, according to a provincial report released Feb. 19.

On Feb. 5, the BC Conservatives leaked a report that showed the findings of an internal investigation by the B.C. Ministry of Health. That investigation showed dozens of pharmacies were filling prescriptions patients did not require in order to overbill the government. These safer supply drugs were then diverted onto the black market.

After the report was leaked, the province committed to ending take-home safer supply models, which allow users to take hydromorphone pills home in bottles. Instead, it will require drug users to consume prescribed opioids in a witnessed program, under the oversight of a medical professional.

Gregory Sword, whose 14-year-old daughter Kamilah died in August 2022 after taking a hydromorphone pill that had been diverted from B.C.’s safer supply program, expressed outrage over the report’s findings.

“This is so frustrating to hear that [pharmacies] were making money off this program and causing more drugs [to flood] the street,” Sword told Canadian Affairs on Feb. 20.

The investigation found that pharmacies exploited B.C.’s Frequency of Dispensing policy to maximize billings. To take advantage of dispensing fees, pharmacies incentivized clients to fill prescriptions they did not require by offering them cash or rewards. Some of those clients then sold the drugs on the black market. Pharmacies earned up to $11,000 per patient a year.

“I’m positive that [the B.C. government has] known this for a long time and only made this decision when the public became aware and the scrutiny was high,” said Elenore Sturko, Conservative MLA for Surrey-Cloverdale, who released the leaked report in a statement on Feb. 5.

“As much as I am really disappointed in how long it’s taken for this decision to be made, I am also happy that this has happened,” she said.

The health ministry said it is investigating the implicated pharmacies. Those that are confirmed to have been involved could have their licenses suspended, be referred to law enforcement or become ineligible to participate in PharmaCare, the provincial program that helps residents cover the costs of prescription drugs.

Witnessed dosing

The leaked report says that “a significant portion of the opioids being freely prescribed by doctors and pharmacists are not being consumed by their intended recipients.” It also says “prescribed alternatives are trafficked provincially, nationally and internationally.”

Critics of the safer supply program say it enables addiction, while supporters say it reduces overdoses.

Sword, Kamilah’s father, is suing the provincial and federal governments, arguing B.C.’s safer supply program made it possible for youth such as his daughter to access drugs.

Madison, Kamilah’s best friend, also became addicted to opioids dispensed through safer supply programs. Madison was just 15 when she first encountered “dillies” — hydromorphone pills dispensed through safer supply, but widely available on the streets. She developed a tolerance that led her to fentanyl.

“I do know for sure that some pharmacies and doctors were aware of the diversion,” Madison’s mother Beth told Canadian Affairs on Feb. 20.

“When I first realized what my daughter was taking and how she was getting it, I phoned the pharmacy and the doctor on the label of the pill bottle to inform them that the patient was selling their hydromorphone,” Beth said.

Masha Krupp, an Ottawa mother who has a son enrolled in a safer supply program, has said the safer supply program in her city is similarly flawed. Canadian Affairs previously reported on this program, which is run by Recovery Care’s Ottawa-based harm reduction clinics.

“I read about the B.C. pharmacy scheme and wasn’t surprised,” Krupp told Canadian Affairs on Feb. 20. Krupp lost a daughter to methadone toxicity while she was in an addiction treatment program at Recovery Care.

“Three years [after starting safer supply], my son is still using fentanyl, crack cocaine and methadone, despite being with Dr. [Charles] Breau and with Recovery Care for over three years,” Krupp testified before the House of Commons Standing Committee on Health on Oct. 22, 2024.

Krupp has been vocal about the dangers of dispensing large quantities of opioids without proper oversight, arguing many patients sell their prescriptions to buy stronger street drugs.

“You can’t give addicts 28 pills and say, ‘Oh here you go,’” she said in her testimony. “They sell for three dollars a pop on the street.”

Krupp has also advocated for witnessed consumption of safer supply medications, arguing supervised dosing would prevent diversion and ensure proper oversight of pharmacies.

“I had talked about witnessed dosing for safe supply when I appeared before the parliamentary health committee last October,” she told Canadian Affairs this week.

“I’m grateful that finally … this decision has been made to return to a witness program,” said Sturko, the B.C. MLA.

In 2020, B.C. implemented a witnessed consumption model to ensure safer supply opioids were consumed as prescribed and to reduce diversion. In 2021, the province switched to take-home models. Its stated aim was to expand access, save lives and ease pressure on health-care facilities during the pandemic.

“You’re really fighting against a group of people … working within the bureaucracy of [the B.C. NDP] government … who have been making efforts to work towards the legalization of drugs and, in doing that, have looked only for opportunities to bolster their arguments for their position, instead of examining their approach in a balanced way,” said Sturko.

“These are foreseeable outcomes when you do not put proper safeguards in place and when you completely ignore all indications of negative impacts.”

Sword also believes some drug policies fail to prioritize the safety of vulnerable individuals.

“Greed is the ultimate evil in society and this just proves it,” he said. “We don’t care about these drugs getting into the wrong hands as long as I get my money.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.