Testimony in Support of Tennessee SB 1848, to Reduce Barriers to Buprenorphine Treatment for Opioid Use Disorder

Testimony from:
Stacey McKenna, Resident Senior Fellow, Integrated Harm Reduction, R Street Institute

In SUPPORT of Senate Bill 1848, “an act… relative to the use of buprenorphine products.”

February 18, 2026

Senate Health and Welfare Committee

Chairman Crowe and members of the committee:

My name is Stacey McKenna and I am a resident senior fellow in Integrated Harm Reduction at the R Street Institute, a nonprofit, nonpartisan public policy research organization. At R Street, we conduct research and outreach aimed at 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 gold standard medications like buprenorphine.[1] This is why SB 1848 is of special interest to us.

Tennessee has the highest rate of OUD in the United States. In 2024, almost 1,500 out of every 100,000 insured people in the state were diagnosed with an OUD, nearly three times the national average.[2] OUD has real consequences for the people struggling with it as well as their friends, loved ones, and communities. Although opioid-involved deaths have fallen across the country in recent years, Tennessee still lost more than 1,500 people to an opioid overdose last year.[3] With more than 40 percent of Americans knowing someone who has died of a drug overdose, the ripple effects of such deaths spread far within a community.[4] Beyond the deep emotional costs of losing a loved one or watching a friend struggle with addiction, the crisis is costing Tennessee taxpayers economically: Each case of OUD costs the state an estimated $808,000 annually.[5]

One of the most effective ways to reduce the health, economic, and even social harms associated with OUD is treatment with FDA-approved medications for opioid use disorder (MOUD), including buprenorphine.[6] Buprenorphine is a partial opioid antagonist, meaning it binds to the same receptors in the brain as heroin or fentanyl, preventing withdrawal symptoms and reducing cravings.[7] This medication has been proven to cut overdose risk by more than 60 percent, and reduces likelihood of illicit drug use as well as criminal activity.[8] Compared to non-medication treatment, people taking MOUD are more likely to remain in recovery long-term and build healthy, productive lives in their communities.[9]

Although Tennessee has made some progress in expanding access to this life-saving and life-changing medication in recent years, barriers remain that prevent Tennesseans with an OUD from accessing buprenorphine.[10] The state only has 835 clinicians who can prescribe buprenorphine and regulates the medication far beyond federal guidelines, restricting certain formulations to a narrow subset of OUD patients and in-person, supervised administration by a limited range of clinicians.[11] SB 1848 would help reduce some of these barriers to make it easier for more Tennesseans with an OUD to access the treatment that is right for them.

Another medication—methadone—gives us considerable insight into the challenges created by a regulatory environment that requires patients to visit a clinic near daily to take their medication. Opioid treatment programs require this of methadone patients, who often must commute 45 minutes or more to the clinic to take their medication under supervision.[12] This daily travel for methadone dosing has been shown to be a major obstacle to staying in treatment and disrupts people’s broader attempts at recovery and rebuilding their lives. It makes it difficult to hold a job, care for family, or work on relationships with friends and loved ones.[13] While SB 1848 does not do away with the in-person dosing requirements for mono-buprenorphine products, it would expand the pool of clinicians who can administer the medications. This would help overcome some of these barriers by making the medication more widely available—which is likely to be especially beneficial to rural residents. In addition, by reducing travel times and giving patients more choice of providers, it would likely improve treatment adherence.[14]

In addition, current Tennessee law prevents clinicians from offering mono-buprenorphine products to most OUD patients. This limitation is the opposite of patient-centered care and undermines patient autonomy and provider expertise, both of which are important when treating a complex condition like OUD.[15] By allowing clinicians to offer mono-buprenorphine products to those patients they think would benefit—rather than those the government has deemed candidates—SB 1848 puts medical decision-making back in the hands of experts.

Expanding access and reducing barriers to evidence-based treatment for OUD would save Tennesseans’ lives, improve quality of life, increase community wellbeing and safety, and reduce costs to taxpayers. SB 1848 is an important step toward doing just that. Therefore, we urge you to vote in favor of SB 1848.

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] Opioid Tracker, 2025, FAIR Health. https://s3.amazonaws.com/media2.fairhealth.org/infographic/asset/Opioid-2024/Tennessee.pdf; Adam Tamburin, “Tennessee has the highest rate of opioid use disorder in the nation,” Axios Nashville, Oct. 23, 2025. https://www.axios.com/local/nashville/2025/10/23/tennessee-opioid-use-disorder.

[3] National Vital Statistics System, “Provisional Drug Overdose Death Counts,” National Center for Health Statistics, Centers for Disease Control and Prevention, Feb. 1, 2026. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.

[4] Alison Athey et al., “An Overlooked Emergency: More Than One in Eight US Adults Have Had Their Lives Disrupted by Drug Overdose Deaths,” American Journal of Public Health, 114: 3 (March 2024). https://www.rand.org/pubs/external_publications/EP70412.html.

[5] Adam Tamburin and Maya Goldman, “Tennessee faces steep costs related to the opioid epidemic,” Axios Nashville, May 22. 2025. https://www.axios.com/local/nashville/2025/05/22/tennessee-economic-costs-opioid-epidemic.

[6] “Information about Medications for Opioid Use Disorder,” U.S. Food and Drug Administration. Dec. 26, 2024. https://www.fda.gov/drugs/information-drug-class/information-about-medications-opioid-use-disorder-moud.  

[7] Buprenorphine, Substance Abuse and Mental Health Services Administration, Dec. 23, 2025. https://www.samhsa.gov/substance-use/treatment/options/buprenorphine.

[8] Hillary Samples et al., “Buprenorphine After Nonfatal Opioid Overdose: Reduced Mortality Risk in Medicare Disability Beneficiaries,” American Journal of Preventive Medicine, 65: 1 (July 2023). https://pubmed.ncbi.nlm.nih.gov/36906496; Elizabeth A. Evans et al., “Recidivism and mortality after in-jail buprenorphine treatment for opioid use disorder,” Drug and Alcohol Dependence, (Feb. 1, 2022). https://pubmed.ncbi.nlm.nih.gov/35063323; Rachna Kumar et al., Buprenorphine, StatPearls Publishing, National Library of Medicine, National Institutes of Health, January 2025. https://www.ncbi.nlm.nih.gov/books/NBK459126.

[9] Ibid.

[10] Ryan Alexander, “Tennessee regulations prevent good addiction treatment for opioid use disorder patients,” The Tennessean, Apr. 26, 2024. https://www.tennessean.com/story/opinion/contributors/2024/04/26/opioid-use-disorder-tennessee-laws-patients-good-treatment/73055848007.

[11] Ibid.; FindTreatment.gov, U.S. Department of Health & Human Services, accessed Feb. 13, 2026. https://FindTreatment.gov/locator.

[12] 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.

[13] 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.

[14] Boyd. https://www.rstreet.org/wp-content/uploads/2025/10/FINAL-Opioid-treatment-program-explainer-1.pdf; Frank. https://link.springer.com/article/10.1186/s12954-021-00535-y.

[15] The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. https://www.asam.org/quality-care/clinical-guidelines/national-practice-guideline.