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ASHINGTON — The Trump administration has gone nine months without a permanent drug czar. But within hours of the announcement that Rep. Tom Marino (R-Pa.) had withdrawn his name from consideration on Tuesday, the D.C. rumor mill was up and running.

Potential candidates, according to administration officials, Capitol Hill staffers, and others in the world of drug and addiction treatment policy, include a who’s-who of players in the current battle against the opioid crisis.

Among the figures rumored to be in contention to run the Office of National Drug Control Policy are members of the opioid commission that President Trump established.

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Here’s a look at those possible candidates and others:

Frank Guinta

The White House considered the former Republican congressman from New Hampshire for the position earlier this year. With Rep. Annie Kuster (D-N.H.), Guinta co-founded the Bipartisan Heroin Task Force in 2015. That group, which began with only a handful of legislators, has since expanded to 90-strong and unveiled an ambitious legislative agenda earlier this year.

Guinta, however, comes with baggage that extends beyond the campaign finance scandal that dogged him throughout his losing re-election campaign in 2016.

He also once viewed treatment for substance use disorder as an afterthought, preferring instead to focus on the opioid crisis from an enforcement perspective.

Then again, Guinta has a proven track record on the issue that now includes fostering medically supported approaches to addiction treatment; his enforcement-side background would likely still satisfy Republicans more hawkish on drug policy.

Guinta did not immediately respond to requests for comment.

Bertha Madras

A psychiatry professor at Harvard Medical School, Madras currently serves on the presidential commission empaneled to determine the guiding principles for the federal government’s response to the crisis. She once worked as ONDCP’s deputy director for demand reduction, a role focused on addiction treatment and prevention.

Dr. Bertha Madras
Dr. Bertha Madras Charles Dharapak/AP

The presidential commission’s interim report on the crisis, for instance, was insistent that overdose reversal drugs like naloxone should be made widely available. But nearly a decade ago, Madras — and much of the medical community — held a different view.

“I don’t agree with giving an opioid antidote to non-medical professionals. That’s No. 1,” she told NPR in 2008. “I just don’t think that’s good public health policy.”

Madras is a widely respected figure on drug policy who, beyond her work at ONDCP, now has experience working with governors from both parties, and her nomination would likely not meet with much resistance in the Senate.

Asked by email whether she would be interested in the position of drug czar, Madras said: “As much as I would like to carve a considered response to your question,  I am currently focused on an unrelenting responsibility for the final Opioid Commission report. 62,000 deaths haunt me daily and nightly to say nothing of the families affected by the disease of addiction. When November 1 comes I will be able to clear my mind and attend to the future.”

New Jersey Gov. Chris Christie Joe Raedle/Getty Images

Chris Christie

The Trump administration has been without a permanent drug czar since Inauguration Day. So why not wait until January?

That’s when Chris Christie, serving his final months as governor of New Jersey, would become available. In February, he avoided expressing interest in the position after joining Trump for lunch.

Let me be very clear, we did not get into any discussion of me joining the current administration in some type of drug abuse role, some type of czar or God forbid surgeon general,” he told reporters then.

But this time, the timing might work — if Christie is willing to step down a few months early or, more likely, if the White House is willing to wait. Christie has chaired the president’s commission on the crisis since March, and last month he unveiled a $200 million program in his state that has been billed as a potential national model for addressing the epidemic.

Christie ran Trump’s transition team for a time, has drawn praise from fellow commission members for the way he has handled the crisis, and is seen as being supportive of evidence-based policies that doctors and drug industry groups alike can support.

Christie’s office didn’t respond to a request for comment.

Pam Bondi

Long shots

Pam Bondi: Florida’s attorney general was added to the Christie commission in September (but thought she had been a commission member since March). She has worked on curbing drug abuse in Florida, but her confirmation would likely resurface pay-to-play allegations that dogged her and then-candidate Trump before the 2016 general election.

Richard Baum: The acting ONDCP director, Baum is a long-tenured career staffer at the office whose policy bona fides are widely acknowledged. But Baum is also seen as an institutionalist unlikely to change the office’s direction in a major way, and is not seen as a likely candidate for longer-term consideration.

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  • Whomever the job of Drug Czar falls to, there needs to become more awareness as to effective treatment of “opioid addiction.” Even if one follows the argument that people can accidentally get addicted to opioids while under medical treatment for a condition that doesn’t require opioids, the situation is still most about helping those that want to stop to stop.

    Much of the thinking on opioid addiction, and addiction in general, seems to come from the highly flawed 12 Step model of Alcoholics Anonymous that is increasingly under fire as a religious cult. The 12 Step model is based on the premise that people are “powerless” over their drug of choice, and that the only way to function (as sick as they are and always will be for the rest of their life) is to “turn their will and their life over to a Higher Power” and their 12 Step support group.

    The core of this thinking is much more like that of a religious cult than of a self-help group for “addiction.” What the best research indicates is that “opioid addicts” have the best outcomes with a combination of medication that helps control cravings, such as methadone or suboxone, and talk therapy. 12 Step rehab has abysmal success rate, lower even than AA’s success rate for alcohol, which is about 5-10%. And again like a religious cult, AA and 12 Step blame the majority for not doing well in their “spiritual” program rather than taking a look at how their program is truly ineffective in what it offers.

    In addition, there are self-help groups that are not religious cults, such as HAMS, SMART, LifeRing, Women for Sobriety.

    Once lawmakers see that drug use is a choice, even if it is a choice often influenced by stress and more serious psychological problems, there might finally start to be real improvement in the opioid epidemic.

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