R Street Testimony in Support of VA SB 421, Remote Pharmacy Dispensing at OTPs
Testimony from:
Stacey McKenna, Resident Senior Fellow, Integrated Harm Reduction, R Street Institute
In SUPPORT of Senate Bill 421, “Pharmacist; remote verification and counseling in opioid treatment programs.”
February 19, 2026
House Health and Human Services Committee, Health Professions Subcommittee
Chairwoman Price and members of the subcommittee:
My name is Stacey McKenna and I am a resident senior fellow in Integrated Harm Reduction 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 SB 421 is of special interest to us.
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 made considerable headway in combating 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 living with OUD have three medication-based treatments available to them, including methadone. 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] However, it 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 OUD to visit almost daily—often traveling an average of 45 minutes each way—to take their medication under supervision.[8] This daily travel can be a major obstacle to staying in treatment and is deeply disruptive to people’s 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 operational requirements constrain existing clinics’ ability to provide services and prevent new clinics from opening.[10] When states have an insufficient number of OTPs or lack programs in more rural and otherwise underserved communities, individuals are forced to travel even longer distances, and as a result struggle to initiate or stay in treatment.[11] 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 to provide and access this life-saving medication.
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, 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 vote in favor of SB 421.
Thank you for your time and consideration.
All the best,
Stacey McKenna, PhD
Resident Senior Fellow, Integrated Harm Reduction
R Street Institute
(970) 443-8063
smckenna@rstreet.org
[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.