Key Takeaway
Blackburn co-sponsored the 2016 Ensuring Patient Access Act that stripped the DEA of its primary tool to freeze suspicious opioid shipments — contributing to an epidemic that killed over 24,000 Tennesseans between 2012 and 2022, with Sullivan, Washington, and Carter counties among the hardest hit.
How Tennessee’s Delegation Split on the Ensuring Patient Access Act
The Ensuring Patient Access and Effective Drug Enforcement Act passed both chambers unanimously in 2016, meaning every member of Tennessee’s delegation who voted supported it. However, when the Washington Post and 60 Minutes investigation brought the bill’s consequences to light in 2017, the political response diverged sharply. Some legislators called for revisiting the law, while Blackburn defended it. In 2018, Congress passed the SUPPORT for Patients and Communities Act, which partially reversed the 2016 law’s weakening of DEA authority. Blackburn voted for the 2018 fix, but critics noted that the damage during the intervening two years was severe, particularly in states like Tennessee, West Virginia, and Kentucky that were ground zero for the epidemic.
Why Opioid Policy Matters in the 2026 Governor’s Race
As Blackburn campaigns for governor, the opioid issue follows her. Tennessee still ranks among the top states for opioid overdose deaths. Fentanyl has replaced prescription opioids as the primary driver, but the enforcement gaps created by the 2016 law contributed to the distribution infrastructure that enabled the crisis to take root in Appalachia. A governor has significant power over state-level drug enforcement, public health funding, and treatment programs. Voters in East Tennessee, where the opioid crisis hit hardest, deserve to know that their potential governor played a direct role in weakening the federal tools that were supposed to protect them.
Blackburn Co-Sponsored a Law That Hamstrung the DEA During the Opioid Epidemic
In 2016, then-Representative Marsha Blackburn co-sponsored the Ensuring Patient Access and Effective Drug Enforcement Act, a bill that raised the legal standard the DEA needed to meet before it could suspend suspicious opioid shipments from pharmaceutical distributors. While proponents framed the law as protecting legitimate patient access, critics—including former DEA officials—have described it as a gift to the pharmaceutical industry that blunted one of the agency’s most effective tools for fighting the opioid crisis.
Opioid Deaths in Sullivan, Washington, and Carter Counties
Tennessee’s 1st Congressional District, spanning much of the northeastern corner of the state—including communities like Johnson City, Kingsport, and Bristol—was hit especially hard by the opioid epidemic. Appalachian counties in East Tennessee have consistently ranked among the highest in the nation for opioid prescribing rates, overdose deaths, and neonatal abstinence syndrome. By making it harder for the DEA to act quickly against suspicious distributors, this law effectively allowed more pills to flow into communities that were already drowning in them.
The Timeline of Harm
The bill was signed into law in April 2016, at the peak of the prescription opioid crisis. A Washington Post and 60 Minutes investigation later revealed how the pharmaceutical industry spent over $100 million lobbying for the law, and how key provisions were drafted with direct input from drug industry attorneys. Former DEA officials went on record stating the law made it virtually impossible to freeze suspicious drug shipments in real time.
For communities across Sullivan, Washington, Carter, and Greene counties—where opioid-related emergency room visits and overdose fatalities were rising steeply—the timing could not have been worse.
Tennessee Overdose Numbers at a Glance
According to the Tennessee Department of Health, Sullivan County’s opioid dispensing rate was nearly double the national average during the years this law was in effect. Washington County saw similar patterns. Between 2016 and 2020, overdose deaths in the TN-1 region continued to climb even as national attention turned toward solutions. Critics argue that laws like the one Blackburn co-sponsored delayed meaningful enforcement action during a critical window.
How Blackburn Voted on Key Opioid Legislation
Blackburn has defended her support for the legislation by arguing it balanced patient access with enforcement. However, the law’s practical effect—making it harder for the DEA to take immediate action against distributors shipping suspiciously large quantities of opioids—speaks for itself. As she now pursues the governor’s office, voters in East Tennessee have a right to ask whether her legislative record on opioids truly served their interests.
County-Level Opioid Data: Sullivan, Washington, and Carter
The opioid crisis devastated East Tennessee at rates far exceeding national averages. Sullivan County, home to Kingsport and Bristol, recorded opioid dispensing rates of 143.7 prescriptions per 100 residents in 2016 — nearly triple the national average of 58.7. Washington County, anchoring Johnson City and the broader Tri-Cities metro area, saw its overdose death rate climb 340% between 2010 and 2020. Carter County, one of the most rural counties in the district, experienced per capita overdose deaths that ranked in the top 5% nationally during the peak years of the crisis.
These numbers are not abstractions. They represent neighbors, coworkers, and family members — the human cost of a distribution system that the Ensuring Patient Access Act made harder to shut down. When the DEA lost its ability to immediately suspend suspicious drug shipments, distributors continued flooding pharmacies in these counties with quantities of opioids that far exceeded any legitimate medical need. McKesson Corporation alone shipped 5.7 million hydrocodone pills to a single pharmacy in Kingsport between 2007 and 2012, according to DEA records obtained by the Washington Post.
What a Governor Could Do About the Opioid Crisis
Tennessee governors wield significant power over public health infrastructure, substance abuse treatment funding, and law enforcement priorities. A governor sets the state budget for TennCare (Tennessee Medicaid), which funds the majority of addiction treatment services in rural counties. The governor also appoints the commissioner of the Tennessee Department of Mental Health and Substance Abuse Services, who oversees the allocation of federal block grant funding for opioid treatment and prevention programs. In a state where 70 of 95 counties have been designated as Health Professional Shortage Areas, these decisions directly affect whether residents in Sullivan, Washington, and Carter counties can access medication-assisted treatment within a reasonable distance from home.
Fentanyl and the Ongoing Crisis in Appalachian Tennessee
Related: See also Blackburn’s 70+ votes to repeal the ACA and her vote against the $35 insulin cap.
East Tennessee remains one of the hardest-hit regions in the country for opioid-related deaths and addiction. Counties in the 1st Congressional District — including Sullivan, Washington, and Carter counties — continue to report overdose rates well above the national average. The crisis has strained local healthcare systems, law enforcement resources, and families across the region for more than a decade.
8 min read
The Ensuring Patient Access and Effective Drug Enforcement Act that Blackburn co-sponsored in 2016 was specifically criticized by DEA officials for raising the bar the agency needed to meet before it could freeze suspicious opioid shipments. This legislation made it harder for federal regulators to intervene when pharmaceutical distributors were sending suspiciously large quantities of opioids to pharmacies — including pharmacies in Appalachian communities already devastated by addiction.
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Explore All 10 Issues →Frequently Asked Questions
Did Marsha Blackburn vote to weaken DEA opioid enforcement?
Yes. In 2016, Blackburn co-sponsored the Ensuring Patient Access and Effective Drug Enforcement Act, which raised the legal bar for the DEA to suspend suspicious opioid distributors. DEA officials criticized the law for hamstringing enforcement during the opioid epidemic.
How much did Blackburn receive from pharmaceutical companies?
According to campaign finance records, Blackburn received over $715,000 in career campaign donations from pharmaceutical-related PACs, companies, and employees.
How did the opioid crisis affect East Tennessee?
East Tennessee and Appalachia were among the hardest-hit areas in the nation. Sullivan, Washington, and Carter counties in TN-1 consistently ranked among the highest for opioid prescription rates and overdose deaths.
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Last updated: March 13, 2026