A former West Virginia health official has emerged as a leading candidate to be the nation’s top drug policy official, a post that President Biden will not restore to Cabinet rank despite insisting as a senator that the “drug czar” deserves that status.

Rahul Gupta, the top health official at maternal-and-child advocacy group March of Dimes, is favored to lead the Office of National Drug Control Policy, said four people with knowledge of the selection process who spoke on the condition of anonymity to discuss confidential deliberations. A final decision is expected as soon as this week.

The three-decade-old office — which was created with the support of Biden, who coined the term “drug czar” in 1982 — coordinates national policy around fighting substance-use disorders, including the response to an opioid crisis that has worsened during the pandemic. President Barack Obama demoted the office from his Cabinet in 2009 with little explanation, and advocates have clamored for Biden to reverse the decision, pointing to his own years of advocacy to elevate the role. But a White House spokesperson said that Biden was not planning to change its status.

Gupta, who was previously West Virginia’s health commissioner and led Biden’s transition efforts for the drug policy office, has a strong working relationship with Sen. Joe Manchin III, the West Virginia Democrat who has emerged as a key swing vote in a narrowly divided Senate. Two people said Manchin’s backing was a factor in Gupta’s candidacy, and the senator’s office praised his work.

“Sen. Manchin has the utmost respect for Dr. Gupta and has expressed support for his nomination to the White House,” said Sam Runyon, the senator’s spokesperson. Gupta did not respond to a request for comment.

But Biden’s looming decision has provoked a flurry of activity from anti-addiction advocates, with some pushing the White House this week to scrutinize Gupta’s record in West Virginia, arguing he did too little to ensure safe-needle exchange during a 2017 HIV outbreak there. The National Alliance for Medication Assisted Recovery on Thursday also called on Biden to “pause” his decision in order to probe Gupta’s role in West Virginia’s moratorium on new opioid-treatment programs, according to a letter obtained by The Washington Post and confirmed by the organization. Advocates have requested Biden pick another candidate with more specialized experience fighting substance-use disorders like Santa Clara University professor H. Westley Clark, who is seen as another finalist for the job.

Clark’s background as a psychiatrist, lawyer and longtime federal official would position him to address the addiction crisis in “a behavioral way, a cultural way and restorative justice way,” said A. Toni Young, who leads a community-based organization focused on HIV/AIDS prevention.

Regina LaBelle, the office’s acting director and an official during the Obama administration, also is being considered, said the people familiar with the discussions. In addition, some advocates are championing Patrick Kennedy, the mental health advocate and former congressman who has spoken about his own struggles with addiction.

White House officials cautioned that a final decision had not been made on the position, with several potential candidates in the mix, even as overdoses are at record levels.

“Addressing substance-use disorders, reforming our country’s drug laws and combating violent crime related to drug trafficking are all priorities for President Biden — just as he laid out during the campaign — and his staffing of ONDCP and work across the administration will continue to reflect that,” said White House spokesperson Mike Gwin.

Overdose-related deaths have surged in recent months, with the Centers for Disease Control and Prevention recently warning that 81,230 people died of overdoses in the year leading up to May 2020 — a record for a 12-month period.

Advocates say the Biden administration needs to do more to ensure the drug-policy office will be a central part of the nation’s response to the worsening crisis, arguing that restoring the office director as a top adviser to the president is essential.

“If it ends up not being in the Cabinet, that’s going to be pretty disappointing for a lot of people,” said Kevin Sabet, who served in the drug-policy office under three presidential administrations. “The president is basically the founding father of ONDCP.”

In 1989, Biden criticized President George H.W. Bush for failing to make the role part of his Cabinet, calling it “a tragic mistake” and saying “the priority of drugs in the executive branch will actually decrease.” Later, Biden hailed President Bill Clinton’s decision to make the position part of his Cabinet, saying it indicated the White House’s commitment to address the nation’s drug problems. “The drug director can only be effective if he or she has a seat in the Cabinet,” Biden said then.

But advocates say that Biden, who has spent decades campaigning on the need to fight overdoses, is better-prepared to tackle the crisis than previous presidents.

“This is the first time in recent memory where a president entered the White House with a plan in place to address substance-use disorders,” said Andrew Kessler, founder of behavioral health consultancy Slingshot Solution, praising Biden’s “detailed, well-thought-out” campaign proposal.

“We’re excited about the possibilities,” Kessler added.