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.