At the beginning of Dr. Rahul Gupta’s medical career, he served a community in rural Florala, Alabama, where he witnessed the “terrible consequences of overprescribing.” That experience also included working with patients who often had to decide between food or medication. These situations deeply affected the young doctor, changing the trajectory of his life and work.
Gupta soon went back to school at the University of Alabama at Birmingham School of Public Health to earn a Master of Public Health.A board-certified internist, Gupta has practiced for decades in both primary care and public health, and in October of 2021, Gupta became the first physician to serve as Director of the White House Office of National Drug Control Policy. Currently, Gupta is the president of GATC Health, a tech-bio innovation company. In a full-circle moment of sorts, Gupta delivered the keynote speech during the Reimagining Opioid Abatement Conference at the National Maritime Museum of the Gulf in Mobile in October of last year. Addressing a room filled with hundreds of community advocates, health care workers, judges, recovery professionals and people in recovery, Gupta said, “This is the work that’s going to take all of us.”
An Uphill Battle
The number of deaths from opioid misuse has decreased exponentially since Gupta’s time with the White House. During his conference keynote late last year, Gupta said the United States peaked at approximately 111,000 deaths per year. Gupta said he and his team saw a decline to about 73,000 deaths per year.
“But that’s still 73,000 too many,” Gupta said. “One death is too many.”
Opioids — a class of natural, semi-synthetic and synthetic drugs that include prescription medications, such as oxycodone, hydrocodone, morphine and codeine, and illegal drugs like heroin — present a unique challenge to communities because the drugs are both highly prescribed and highly addictive. A 2024 Mayo Clinic report says, “After only five days of taking an opioid medicine, the chances increase that you’ll still be taking opioids a year after starting a short course of the medicine.”
Given the problem’s dismal predictions and outcomes, it’s easy to despair of solutions, which is why it’s essential to get to the root of addiction. The National Institute on Drug Abuse frames the crisis as a combination of deep-seated stigma among healthcare professionals, barriers to care and the increasing deadliness of the illicit drug supply. In the NIDA’s DrugFacts, “Understanding Drug Use and Addiction,” it urges communities to implement prevention programs that involve families, schools, healthcare providers and the media through education and outreach.
“Stigma exists in families, in society, in our communities, but also is alive and well in the healthcare sectors, too,” Gupta said in 2024 on the “CommonHealth Live!” podcast interview. “When I went to medical school, there wasn’t a clear indication that addiction was a disease or a disease of the brain or a chronic brain disease. We did not understand any of those mechanisms. Today we do, and it’s incumbent upon us to learn and get educated and get up to date on that, first of all.”
The Only Way Out Is Through …
In addition to using education to eliminate stigma, in the “CommonHealth Live!” interview, Gupta outlined policy solutions, such as removing barriers to access. By making treatment accessible 24/7, no matter where you are or what time it is, more people will seek (and be able to get) help.
“Look, if someone gets up at 9 p.m. and they feel like, ‘this is enough. I want to go get help, I want to change my life around’,” Gupta said. “And they call a 988 line and say, ‘well, we have an appointment 30 days from today,’ that doesn’t work for that person.”
Gupta also recommends reimbursement systems to support providers and patients. Positing that “when reimbursements increase or are added on for a certain condition, magically, those conditions are diagnosed more often and treated more often.”
Working closely with the Department of Labor, Gupta and his colleagues are pushing for enforcement of laws that require mental health and addiction diseases to be treated in the same way as other chronic diseases, such as hypertension and diabetes.
“Somehow in this country, we figured out how to remove the head from the body,” said Gupta. “And we’re all suffering because of that. “I do not deny [my patients with diabetes] medications like insulin just because their exercise and diet have not gotten the glucose levels where they need to be … Addiction is no different. Oftentimes, there’s a chemical imbalance. People go into addiction. They need medications that stabilize their life, that [do] not cause ‘highs,’ that allow them to function in society and take control and hold over their own lives and get into recovery.”
