WASHINGTON — President Biden intends to nominate Dr. Rahul Gupta, who led West Virginia’s response to a devastating opioid crisis, to run the Office of National Drug Control Policy — a choice that immediately drew mixed reviews from advocates for people with substance abuse problems.
If confirmed by the Senate, Dr. Gupta would become the first medical doctor to serve as the nation’s drug czar since the role was created in 1988. He would take office at a critical juncture in twin public health crises: the coronavirus pandemic and the nation’s long-running addiction epidemic, which has taken a sharp turn for the worse over the past year with a surge in drug overdose deaths.
The White House announced Mr. Biden’s choice of Dr. Gupta
just as the Centers for Disease Control and Prevention was preparing to publish statistics, expected on Wednesday, on drug overdose deaths in 2020, which all evidence suggests will shatter previous records. Overdose deaths rose by nearly 30 percent over the 12-month period that ended in November, to over 90,000 from more than 71,000, according to preliminary federal data released last month.
Addressing that surge will be Dr. Gupta’s biggest challenge if he is confirmed, said Daniel Raymond, the director of policy for the National Viral Hepatitis Roundtable and an expert on substance abuse issues.
“Even before Covid we were seeing alarming signs that the overdose rates were creeping up again,” he said, adding, “If anybody’s hoping that once the pressures of the pandemic are alleviated that overdose rates will fall, I think they are going to be very disappointed.”
The son of an Indian diplomat, Dr. Gupta was born in India and grew up in Washington, D.C. He completed medical school at the University of Delhi when he was 21, according to a biography supplied by the White House. He is currently the chief medical officer at March of Dimes, the maternal health advocacy organization, and has several academic appointments.
As West Virginia’s commissioner of public health and state health officer from 2015 to 2018, Dr. Gupta won praise for his aggressive response to the state’s opioid crisis, one of the worst in the nation for years running. Mr. Biden’s choice of Dr. Gupta may also be politically strategic: He is an ally of Senator Joe Manchin III, the moderate West Virginia Democrat whose vote is crucial to the president’s legislative agenda.
But Dr. Gupta also drew criticism in his state job for failing to stop Charleston from closing its syringe exchange program — a crucial component of a strategy to prevent drug-related deaths known as “harm reduction,” which has been embraced by the Biden administration.
Instead of helping drug users achieve abstinence, harm reduction aims to lower their risk of dying or acquiring infectious diseases like H.I.V., including by giving them sterile syringes. Research has found that the practice works.
Charleston’s program was nationally recognized, but it was criticized by the city’s mayor when Dr. Gupta was the health commissioner. Dr. Gupta’s department issued an audit that found fault with the program, including shoddy record keeping, which led to the program’s decertification after the city had already shut it down.
Public health experts said its closure had a chilling effect on other programs, and kept some from getting off the ground.
As a state health official, Dr. Gupta had no authority to stop the closure. In a 2018 interview with West Virginia Public Broadcasting shortly before he left the health commissioner’s job, Dr. Gupta said that the closure was “not in the best interest of the community” and that needle exchange programs like Charleston’s should not be shut down “reactively.”
But critics faulted him for not using his platform forcefully enough to defend the program.
Gregg Gonsalves, an epidemiologist at Yale University and a longtime AIDS activist, on Tuesday called Dr. Gupta a “terrible choice” who “represents a return to the old ways of thinking about drug use in America, and is not the forward-thinking leader we need right now.”
Other experts said that Dr. Gupta was caught in a difficult situation with the battle over the syringe exchange. Mr. Raymond, while describing the closure of the Charleston program as “a tragedy,” called Dr. Gupta an “excellent choice.” That assessment was echoed by Dr. Joshua M. Sharfstein, a public health expert at Johns Hopkins Bloomberg School of Public Health who worked with Dr. Gupta to address the opioid crisis in West Virginia.
“He knows the value of syringe service programs, he understands the evidence on harm reduction and he is very supportive,” Dr. Sharfstein said. “West Virginia is a very difficult environment for discussion of these topics, and he had to navigate under those constraints.”
The White House announced the selection of Dr. Gupta in a statement on Tuesday, along with 10 other nominations, including that of Jeff Flake, the former Republican senator from Arizona, to be the ambassador to Turkey and that of the writer Atul Gawande to a post at the U.S. Agency for International Development.
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