At a Senate hearing, Sen. Angela Alsobrooks pressed Health Secretary Robert F. Kennedy Jr. about his idea for national “wellness farms” — rural, work-based communities he has said would help “reparent” young people. Kennedy apologized if he used that specific term and said he did not recall the phrasing, but he has repeatedly cited San Patrignano, a long-running Italian therapeutic community, as a model for his plan while campaigning and since taking office. HHS told NPR that Kennedy had used the psychotherapy term “reparenting” before becoming secretary and that some of his comments were taken out of context.
Kennedy describes these farms as structured places where residents, including youth he says have been harmed by street drugs or by prescription anxiety and depression medications, would live, perform supervised work, attend workshops, and undergo a form of reparenting. San Patrignano is often pointed to in discussions of that model: founded in 1978 near Coriano, Italy, it spans roughly 700 acres and houses about 850 people in recovery. Residents follow regimented schedules centered on work, responsibility, education and abstinence; reporters and visitors have documented residents praising the sense of community and steady routine as transformative.
But San Patrignano’s approach is controversial. The community emphasizes total abstinence and rejects medications commonly used to treat opioid and alcohol dependence — including methadone and buprenorphine. Leaders defend that stance with the argument that “no drugs can cure drugs,” and they maintain that rebuilding a life through work and a sustained community is the path to recovery. They also say past scandals prompted reforms intended to increase transparency and safety.
Medical researchers, public health officials, and drug policy experts in the United States warn that transplanting an abstinence-only model that excludes medication-assisted treatment (MAT) would be dangerous here, given the U.S. opioid crisis driven by fentanyl and other potent synthetic opioids. Studies show people with opioid use disorder who stop using street drugs without medications commonly relapse quickly; because relapse after a period of reduced tolerance carries a high overdose risk, experts say medications that reduce cravings and stabilize patients are lifesaving and the standard of care. The CDC and other health agencies advocate expanding access to these medications to reduce deaths.
Addiction researchers have been blunt in their criticism. Dr. Robert Heimer of Yale, who studies addiction therapies, said abstinence-focused programs “fail over and over” and warned that treating opioid addiction without medication can leave people at enormous risk when relapse occurs. Critics say therapeutic communities and work-based routines can be valuable components of recovery, but only when they complement evidence-based medical treatments rather than replace them.
San Patrignano also has a troubled history. When the community tried to expand in the 1990s, scandals emerged that nearly destroyed the program: reporting and a Netflix documentary highlighted episodes in which residents were reportedly held against their will and other abuses occurred. The community’s founder, Vincenzo Muccioli, was later convicted in connection with covering up the murder of a resident; he died in 1995 while his case was on appeal. Current leaders acknowledge past mistakes and say they have implemented reforms.
Officials at San Patrignano and independent observers also note practical limits to treating it as a direct template for a U.S. national program. San Patrignano’s current medical director told NPR it would be “impossible” to safely scale their model into a nationwide system like the one Kennedy has proposed. The community serves far fewer people than Kennedy has sometimes suggested, and most residents are adults rather than the children or teenagers Kennedy has at times described. San Patrignano’s spokesperson said they had no record of formal contact with Kennedy or HHS and first learned of his interest through media reports.
Kennedy himself has given mixed signals about medications for addiction. In some remarks he called them “practical and pragmatic” when used alongside faith-based approaches; in others he expressed skepticism about using drugs to “fix what’s wrong inside of you.” When unveiling a federal initiative called the Great American Recovery Initiative, he emphasized faith, work and abstinence-centered programs as central to his vision.
Public-health experts and lawmakers who oppose an abstinence-only national approach argue that the U.S. context — where synthetic opioids and high overdose rates are dominant — requires broad access to medications that reduce overdose risk. They say offering structured communities and meaningful work can help many people, but doing so without integrating medication-assisted treatment could increase harm rather than reduce it.
NPR sought interviews and detailed answers from Kennedy and HHS about his emphasis on San Patrignano and on the concerns raised by experts and lawmakers; HHS declined further comment and Kennedy did not provide an interview. Residents and staff at San Patrignano described lives remade by the community’s routines and relationships, while medical experts, public-health officials and the community’s own leaders cautioned that the program’s history, its abstinence-only stance and its limited scale make it an imperfect and potentially risky model for national policy in the United States.