Illegal drugs fundamentally shaped the 2024 Presidential election. The campaign season helped to reignite a focus on the opioid crisis and its devastating impacts on communities across the country. Conspicuously absent from both the Donald Trump and Kamala Harris campaigns, though, were proposals to expand access to treatment in any meaningful way. Instead of providing plans to aid Americans struggling with addiction, candidates from both parties advocated for harsher penalties. In what would become a winning campaign message, Trump doubled down on punitive measures, calling for “cracking down on fentanyl smugglers, securing the U.S.-Mexico border and executing drug dealers.” As one Politico headline declared, “Everyone’s tough on drugs again…Virtually no one’s talking about treatment.”
Candidates’ decisions to focus on punishment over treatment in 2024 was hardly new. In fact, that strategy has been a bedrock of U.S. politics throughout modern American history, speaking to Americans’ deep ambivalence toward psychotropic substances. Dating back to at least the late 19th century, a key question has shaped public drug debates: is addiction a disease best addressed through medical care, or is it a crime that deserves punishment? History shows us that the 2024 election represents just one more swing of the treatment/punishment pendulum that has stunted the country’s ability to manage drug use and addiction for more than a century.
This debate initially arose in the wake of the nation’s first federal drug laws. In 1914, Congress passed the Harrison Narcotics Tax Act, which for the first time made illegal the possession without a prescription of drugs like opium, heroin, morphine, and cocaine. As a result, thousands of American users who had been able to buy these substances legally and without a prescription were forced to turn to an illicit market. Treatment options for addicts were almost nonexistent, and many committed crimes so they could afford to keep up their habits. The number of Americans convicted of drug charges rose and federal prison populations increased to more than double their intended capacity. Shut out of medical care, locked up in prisons, and ostracized by the wider public, users and addicts seemed to have nowhere to turn.
In response, a group of physicians, social scientists, and politicians came together to try to fix some of the problems created by the Harrison Act. In 1929, Congress passed the Narcotic Farms Act, which for the first time established federal funding for two institutions dedicated to addiction treatment. One would treat addicts living east of the Mississippi River (established at Lexington, Ky., in 1935) and the other would treat users living west of that line (established at Fort Worth, Texas, in 1938).
Framed as modern, progressive institutions that would transform addiction care, these “narcotic farms” serviced a combination of voluntary and prisoner patients, who physicians believed were all deserving of care. Social scientists studying criminal rehabilitation were thrilled that addict prisoners could be transferred out of overcrowded prisons. The media and the public lauded the narcotic farms as the first institutions in the world to take a humanitarian approach to the issue of addiction.
Indeed, much was transformative about the narcotic farms model. The treatment program was a multi-pronged approach, which included physical detox and rehabilitation, on-site vocational training, and intensive psychotherapy. Patients were assigned jobs on the farms, such as in the dairy barn or garment factory. They attended group therapy, and they participated in recreational activities during the evenings—everything from baseball to movies to jazz concerts performed by other patients. These were designed as therapeutic communities providing moral uplift for people beaten down by addiction.
But there was a critical flaw in this model. For all the language about the transformative nature of the narcotic farms, they were hamstrung by federal policies reflecting the nation’s tug of war between treatment and punishment. Congress vested two agencies with conflicting mandates—the Public Health Service and the Bureau of Prisons—with shared oversight of the farms. While a pastoral therapeutic setting was supposed to define the institutions, bars on the windows, barbed fences, strict schedules, and punishments for breaking rules all reminded patients that they were ultimately in a carceral setting.
Plus, over their first two decades in operation, tensions rose between voluntary and prisoner patients. Some voluntary patients resented being housed with people convicted of crimes, and the majority signed themselves out well before the recommended six-month stay. Authorities at the farms lamented that the large number of prisoner patients led to the rise of what they termed a “prison culture,” recreating hierarchies, along with class and race divisions, common at other penitentiaries. Adding to the tension, many patients openly rejected the psychotherapy program as a tool of “square” society, and administrators often transferred patients back to federal prisons when they violated rules or norms. This hardly seemed like the model community envisioned by the narcotic farms’ architects.
Making matters worse, the narcotic farms were subject to political pressures and the whims of Congress. In the 1950s—when the farms were at their operational height—the political environment shifted more heavily toward a punitive approach to drug addiction. In part a response to the emergence of a new heroin subculture that developed after World War II, public sympathy for users and addicts—or “junkies” as they became popularly known—faded. Moreover, in the conservative Cold War environment, politicians and the media began to claim, often with little evidence, that addiction was being fueled by Mexican drug smugglers, undocumented immigrants, Chinese Communists, juvenile delinquents, and racial minorities living in the nation’s cities.
The public panic during the Cold War years ushered in crackdowns on drug users and sellers. State after state passed more draconian drug laws. At the federal level, the 1951 Boggs Act created the nation’s first mandatory minimum sentences for drug offenses, and the 1956 Narcotic Control Act instituted the death penalty for anyone caught selling heroin to minors. These measures led to lengthier sentences for prisoner patients at the narcotic farms; many found themselves serving five years or more at the institutions. Federal funding, while seemingly available for punitive drug measures, never materialized at the levels requested by the narcotic farm administrators. Ultimately, various pressures stunted the farms from ever fully realizing their treatment vision.
Though the narcotic farms remained open until the early 1970s, they contended with long-running criticism. They were seen as a relic of a mid-century faith in centralized bureaucracy, and some prominent politicians, physicians, and researchers argued that the model was woefully outdated by the late 1960s. Amid a tumultuous war in Vietnam, fears of a drug-fueled counterculture, and urban uprisings, the bipartisan anti-crime agenda of the late-1960s helped fuel calls to defund the narcotic farms. This dovetailed with a larger deinstitutionalization movement that argued that federal money for mental health and addiction care should be shifted to local communities. Ultimately, the narcotic farms were shuttered and their sites transferred to the Bureau of Prisons.
The roughly 40-year narcotic farm model experiment illustrates the nation’s deep commitment to punishment as a tool to address drug use and addiction. Not even these groundbreaking institutions could escape it, however hard some of their administrators, staff, and supporters tried.
Public sympathy for those addicted to drugs has always been precarious. During election seasons, calling for enhanced punitive measures—whether those are mandatory minimum sentences or the death penalty—have frequently proved politically expedient for both sides of the political aisle. If the pendulum swings too far, and the Trump Administration lives up to some of its harshest promises, it could perhaps push the public to once again demand more humane, treatment-based approaches. It happened once in the 1920s. From the vantage point of February 2025, though, the future of expanded federal support for addiction care remains precarious.
Holly M. Karibo, an associate professor of history at Oklahoma State University, is the author of Rehab on the Range: A History of Addiction and Incarceration in the American West (UT Press, 2024) and Sin City North: Sex, Drugs, and Citizenship in the Detroit-Windsor Borderland (UNC Press, 2015).
Made by History takes readers beyond the headlines with articles written and edited by professional historians. Learn more about Made by History at TIME here. Opinions expressed do not necessarily reflect the views of TIME editors.
