R Street Letter to VA Governor Abigail Spanberger in Support of VA SB 421, Remote Pharmacy Dispensing at OTPs
March 12, 2026
The Honorable Abigail Spanberger
Governor of Virginia
Patrick Henry Building
1111 E. Broad Street
Richmond, VA 23219
Re: R Street’s Support for VA SB 421, Remote Pharmacy Dispensing at OTPs
My name is Stacey McKenna and I am a resident senior fellow and associate director in Healthier Communities at the R Street Institute. R Street is a nonprofit, nonpartisan public policy research organization focused on solving complex public policy challenges, including opioid use disorder (OUD), through free markets and limited, effective government. OUD is a complex, often recurring health challenge that requires access to a comprehensive continuum of evidence-based, individualized treatment options, including low-barrier access to medications for opioid use disorder (MOUD).[1] This is why we support SB 421.
More than 450 Virginians died of an opioid overdose in 2025, and about 150,000 are estimated to be living with an OUD.[2] Although Virginia has taken important steps to combat the harms associated with OUD in recent years—expanding access to life-saving tools like drug checking and improving treatment resources for pregnant women who use opioids—the epidemic still costs taxpayers billions annually.[3] However, access to methadone, the gold standard treatment for OUD, remains overregulated in the state, hindering people’s ability to access and remain engaged in recovery.[4] SB 421 would help reduce some of the barriers that prevent Virginians with an OUD from accessing needed treatment.
In the United States, including Virginia, people with an OUD have three medication-based treatments available to them. Among these, methadone is widely considered to be the best treatment option for many individuals, especially in a market dominated by fentanyl. Methadone reduces withdrawal symptoms and cravings, lowering the risk of overdose by as much as 80 percent compared to non-medication treatment.[5] It also improves treatment retention, decreases illicit drug use and criminal activity, and helps individuals regain stability in their lives.[6]
Despite these proven benefits, methadone is one of the most heavily regulated prescription drugs in the nation and is only available for the treatment of OUD through a network of restrictive clinics known as opioid treatment programs (OTPs).[7] OTPs require many people with an OUD to visit almost daily—often traveling an average of 45 minutes each way—to take their medication under supervision.[8] This daily travel discourages many people from starting or staying in treatment. Among those individuals who do manage to visit the clinic regularly, many find it disrupts their broader attempts at recovery and rebuilding their lives, making it difficult to hold a job, care for family, or work on relationships with friends and loved ones.[9]
The negative consequences created by mandatory in-person dosing requirements can balloon when policies dictate operations in ways that constrain existing clinics’ ability to provide services or prevent new clinics from opening.[10] In Virginia, the mandate that a pharmacist be physically present to oversee medication dispensing and dosing supervision is one of the ways that state law makes it difficult for OTPs to operate to the best of their ability. In turn, when states have restrictions like this, it can drive an insufficient number of OTPs or prevent programs from opening in more rural and otherwise underserved communities. This forces individuals to travel even longer distances, and as a result makes it even harder to initiate or stay in treatment.[11]
SB 421 would remove this unnecessary impediment by allowing pharmacists to remotely supervise dosing and provide counseling and oversight to technicians and other qualified individuals providing care. This would reduce the cost and human capital strain on OTPs looking to expand their reach, allowing them to provide much needed care to more patients. Furthermore, remote dosing of methadone has been shown to be safe and effective in the home, absent of health professionals, and this bill would allow remote dosing and oversight but in the presence of clinic care staff. [12] Therefore, this change would increase options for OTPs to expand their reach and provide care to more patients without taking on any additional risk.
Expanding and reducing barriers to evidence-based treatment for OUD would save Virginians’ lives, improve quality of life, increase community wellbeing and safety, and reduce overdose and OUD epidemic costs to taxpayers. SB 421 is an important step toward doing just that. Therefore, we urge you to sign into law SB 421.
Thank you for your time and consideration.
All the best,
Stacey McKenna, PhD
Resident Senior Fellow and Associate Director
Healthier Communities
R Street Institute
(970) 443-8063
smckenna@rstreet.org
CC: Gerica Goodman, Legislative Director, Office of Governor Abigail Spanberger,
Rebecca Eichmann, Policy Director, Office of Governor Abigail Spanberger,
Grant Neely, Deputy Chief of Staff for Policy and Communications, Office of Governor Abigail Spanberger
[1] The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update, American Society of Addiction Medicine, 2020. https://www.asam.org/quality-care/clinical-guidelines/national-practice-guideline.
[2] Drug Overdose Deaths, Virginia Department of Health, Jan. 21, 2026. https://www.vdh.virginia.gov/drug-overdose-data/overdose-deaths; Olivia Trani, “The opioid epidemic cost Virginians $5 billion in 2021, new data shows,” VCU news, Jan. 17, 2024. https://news.vcu.edu/article/2024/01/the-opioid-epidemic-cost-virginians-5-billion-in-2021-new-data-shows#:~:text=The data from 2021 revealed,overdose every day on average.
[3] Trani. https://news.vcu.edu/article/2024/01/the-opioid-epidemic-cost-virginians-5-billion-in-2021-new-data-shows#:~:text=The data from 2021 revealed,overdose every day on average; Virginia SB 924, Drug paraphernalia and controlled paraphernalia; drug checking products, 2025 regular session. https://lis.virginia.gov/bill-details/20251/SB924; “Virginia Advances Integrated Care for Pregnant and Parenting Women with Substance Use Disorder,” National Academy for State Health Policy, Dec. 16, 2019. https://nashp.org/virginia-advances-integrated-care-for-pregnant-and-parenting-women-with-substance-use-disorder.
[4] J. Travis Donahoe et al., “Restrictive State Opioid Treatment Program Regulations Constrain Local Access to Methaodne Maintenance Treatment,” Health Affairs, 44: 9 (September 2025). https://www.healthaffairs.org/doi/10.1377/hlthaff.2025.00341.
[5] Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. World Health Organization. 2009. Chapter 6, Methadone maintenance treatment. https://www.ncbi.nlm.nih.gov/books/NBK310658.
[6] Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. World Health Organization. 2009. Chapter 6, Methadone maintenance treatment. https://www.ncbi.nlm.nih.gov/books/NBK310658.
[7] Stacey McKenna, “How Red Tape Limits Access to Medications for Opioid Use Disorder,” R Street Institute Explainer, November 2023. https://www.rstreet.org/research/how-red-tape-limits-access-to-medications-for-opioid-use-disorder.
[8] Chelsea Boyd, “Why Opioid Treatment Program Locations Matter,” R Street Institute Explainer, October 2025. https://www.rstreet.org/wp-content/uploads/2025/10/FINAL-Opioid-treatment-program-explainer-1.pdf.
[9] David Frank et al., “’It’s like ‘liquid handcuffs’’: The effects of take-home dosing policies on Methadone Maintenance Treatment (MMT) patients’ lives,” Harm Reduction Journal, 18: 88 (2021). https://link.springer.com/article/10.1186/s12954-021-00535-y.
[10] Stacey McKenna, “Barriers to Opening an OTP,” R Street Institute Explainer. Sept. 3, 2025. https://www.rstreet.org/research/barriers-to-opening-an-otp.
[11] Boyd. https://www.rstreet.org/wp-content/uploads/2025/10/FINAL-Opioid-treatment-program-explainer-1.pdf.
[12] Stacey McKenna, “We can supervise methadone dosing outside of OTPs,” R Street Institute Real Solutions. https://www.rstreet.org/commentary/we-can-supervise-methadone-dosing-outside-of-otps.