The FDA says ivermectin can be dangerous in large doses, and Tennessee’s largely hands-off 2022 law has helped create a cash market for concentrated pills sold without patient-specific prescriptions; the Tennessee Poison Center logged more than 60 possible ivermectin poisoning calls in 2025, the highest since 2021. For clinicians, the upshot is practical: expect more patients using high-potency ivermectin for covid, cancer, diabetes, or other unproven indications — and more toxicity, medication-history, and counseling challenges at the bedside.

The Move

• Tennessee became the first state to let adults obtain ivermectin from pharmacies without first seeing a doctor, using collaborative pharmacy practice agreements and effectively blanket prescribing.

• KFF Health News found the drug is now marketed across the state with limited oversight, including compounded pills at 10 to 20 times standard tablet strength and some products up to 21 times as strong.

• Similar laws passed in Arkansas, Idaho, Louisiana, and Texas in 2025, while at least 24 other states have introduced or debated related legislation.

Why it Matters for Care

• The FDA warning is not theoretical: Tennessee Poison Center reports included vomiting, blurred vision, neurologic symptoms, and difficulty walking.

• Some pharmacy websites market ivermectin for covid, “long haul vax symptoms,” cancer, and Diabetes mellitus (DM) despite no evidence of benefit for those uses.

• Clinicians may need to ask directly about compounded or cash-purchased ivermectin, especially in patients delaying proven treatment, presenting with nonspecific neurologic or GI symptoms, or using alternative cancer regimens.

Between the Lines

• Ivermectin has evolved from a pandemic misinformation flashpoint into a political identity marker tied to anti-establishment and MAHA-aligned activism, including support from HHS Secretary Robert F. Kennedy Jr.

• Tennessee’s law also gives pharmacists broad legal protection, and state board members warned early that a lightly regulated, cash-based market could create profit incentives untethered from evidence-based care.

• The market is amplified by influencers, podcasts, and testimonial-driven demand, with one recent study finding a sharp rise in ivermectin prescribing after a Joe Rogan episode featuring cancer claims.

What to Watch

• Whether Tennessee lawmakers revisit the law in 2027, when state Sen. Richard Briggs says he plans legislation to curb misleading advertising and dangerous high-dose sales.

• How aggressively state health and pharmacy regulators enforce filing, oversight, and compounding requirements, given gaps in Tennessee’s own recordkeeping.

• Whether more states copy Tennessee’s model — or whether pushback from clinicians, medical boards, and skeptical lawmakers slows the spread.

Source: KFF Health News