Stacey McKenna, a resident senior fellow in Integrated Harm Reduction at the R Street Institute, testified before the Virginia House Health and Human Services Committee in support of Senate Bill 421. The bill would allow pharmacists to remotely verify and provide counseling in opioid treatment programs (OTPs), changing the current requirement for pharmacists to be physically present during methadone dispensing.
McKenna explained that opioid use disorder (OUD) remains a significant challenge in Virginia. In 2025, more than 450 Virginians died from opioid overdoses, and an estimated 150,000 residents are living with OUD. According to data from the Virginia Department of Health and VCU News, the opioid epidemic cost Virginians $5 billion in 2021 (https://www.vdh.virginia.gov/drug-overdose-data/overdose-deaths;https://news.vcu.edu/article/2024/01/the-opioid-epidemic-cost-virginians-5-billion-in-2021-new-data-shows#:~:text=The%20data%20from%202021%20revealed,overdose%20every%20day%20on%20average). Efforts have been made to expand access to tools like drug checking products and improve treatment resources for pregnant women using opioids (https://nashp.org/virginia-advances-integrated-care-for-pregnant-and-parenting-women-with-substance-use-disorder).
Despite these efforts, McKenna argued that methadone access remains overregulated. She cited research indicating that restrictive state regulations on OTPs hinder local access to methadone maintenance treatment (https://www.healthaffairs.org/doi/10.1377/hlthaff.2025.00341). Methadone is one of three medication-based treatments for OUD available in the United States and has been shown to reduce withdrawal symptoms, cravings, and risk of overdose by up to 80 percent compared to non-medication treatments (https://www.ncbi.nlm.nih.gov/books/NBK310658).
Current regulations require many people with OUD to travel long distances—often averaging 45 minutes each way—to receive daily supervised doses at OTPs (https://www.rstreet.org/wp-content/uploads/2025/10/FINAL-Opioid-treatment-program-explainer-1.pdf). McKenna stated that this creates significant barriers for patients seeking consistent treatment: “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.”
She also noted that operational requirements limiting clinic capacity or opening new clinics further exacerbate these barriers (https://www.rstreet.org/research/barriers-to-opening-an-otp). When there are not enough OTPs or when they are not accessible in rural areas, individuals may struggle even more with accessing care.
SB 421 proposes allowing pharmacists to supervise dosing remotely while providing counseling and oversight through clinic staff rather than being physically present. McKenna emphasized: “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.” She added that evidence shows remote methadone dosing can be safe when overseen by clinic staff (https://www.rstreet.org/commentary/we-can-supervise-methadone-dosing-outside-of-otps).
McKenna concluded her testimony stating: “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.”
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