Tennessee pharmacies sell potent ivermectin, led by doctor who's taken 'bucketloads

 

NASHVILLE, Tenn. -- Four years ago, Tennessee became the first state to allow adults to buy the antiparasitic drug ivermectin from a pharmacy without first seeing a doctor. Pharmacies can use a pre-written, blanket prescription to sell to just about anyone who walks through their doors.

The drug is now marketed and sold across the state in roadside shops and small-town strip malls with little oversight from health authorities. Highway billboards advertise ivermectin as "Available Without a Prescription in Tennessee!" while dozens of pharmacies offer highly concentrated pills, sometimes at 10 or 20 times the potency of a standard tablet.

Ivermectin is a Nobel Prize-winning, generally safe drug approved by the FDA for treating parasitic diseases in humans, which can generally be done with a single dose of three or four prescription-strength tablets. It is also used as a dewormer for horsesIts popularity surged during the coronavirus pandemic as unorthodox doctors and anti-vaccine activists promoted it as a treatment for COVID-19. Clinical trials have shown that ivermectin is not effective against COVID-19.

Nonetheless, it has since become a symbol of resistance against the medical establishment among some conservatives and followers of the Make America Healthy Again movement, championed by Health and Human Services Secretary Robert F. Kennedy Jr.Timothy Caulfield, a professor at the University of Alberta who studies health misinformation, said ivermectin became an "ideological flag" during the COVID-19 pandemic, opening the door for influencers to push the drug for other ailments to a "captured audience" even without proof it works for those conditions.

"This is really about profit," Caulfield said in an interview with ABC News, which partnered with KFF Health News to report on ivermectin. "This is about political identity. This is about creating distrust in the existing biomedical community. This is about money."After a hantavirus outbreak on a cruise ship earlier this year, unproven claims that ivermectin is effective against that virus have been spread by some popular social media accounts and right-wing figures, including former Rep. Marjorie Taylor Greene. The World Health Organization says it has seen no research that shows ivermectin is an effective hantavirus treatment.

Tennessee's ivermectin bill was shepherded by a Republican supermajority in 2022. Its passage blindsided state medical officials and handed a victory to medical groups that spread COVID-19 misinformation.

Some pharmacy websites now offer the drug as a treatment for COVID-19, "long haul vax symptoms," diabetes, or cancer -- despite no evidence of its effectiveness for those purposes -- while the new law largely gives pharmacists immunity from lawsuits or professional sanctions related to ivermectin.The law was also a harbinger of legislation to come: More than two dozen states have since considered look-alike bills that would make the politicized medication available without requiring a doctor visit.

John Mafi, a UCLA internal medicine physician who has studied the rise of ivermectin among cancer patients, worries that it will lure people away from proven treatments. He co-authored a new study identifying a sharp increase in prescribing rates for ivermectin and another antiparasitic drug, particularly in the South. The rise followed a January 2025 episode of the Joe Rogan Experience podcast in which actor Mel Gibson claimed ivermectin and other drugs cured three friends with stage 4 cancer.

"It's going back to 19th-century quack science," Mafi said about the off-label use of ivermectin. "It is alarming that I'm seeing this really unproven therapy being touted to so many potentially vulnerable Americans."

The FDA says ivermectin can be dangerous in large doses. Tennessee has seen a small but concerning rise in signs of overuse. The Tennessee Poison Center, which fields calls from people exposed to drugs or toxic substances, received more than 60 calls for possible ivermectin poisoning in 2025, the most since 2021. They included reports of vomiting, blurred vision, neurological problems, and difficulty walking.

"People are taking this because they just feel unwell. It's almost like a panacea now," said Rebecca Bruccoleri, the poison center's medical director. "I've heard rumblings on the internet of using ivermectin for an alternative cancer treatment, and we're seeing it definitely in here."Pharmacist Paul Hughey has dispensed ivermectin under the new law at two Tennessee pharmacies: Mt. Juliet Pharmacy and Compound Rx. He estimated that "up to 20 people in a week" are buying ivermectin but that peak demand was double or triple that amount.

For years, Hughey said in an interview, customers have relayed emotional "testimonies" about the drug healing the sick, "especially with the cancer patients."

"I'll get a doctor call in and they say: 'Guess what. So-and-so is cured.' And it's just amazing to hear that," Hughey said. "So anybody who doubts that, I don't really know that they're practicing medicine. I think they're just following the narrative."

'I've taken bucketloads of this stuff'

The linchpin of Tennessee's ivermectin market is Denise Sibley, a conservative doctor who was instrumental in the creation of the 2022 ivermectin law. She has inked agreements with pharmacies across the state empowering them to sell the drug.

Tennessee's law allows pharmacies to dispense ivermectin without a specific prescription for each patient, through a "collaborative pharmacy practice agreement" with a doctor who provides what is functionally a pre-written, nonspecific prescription for all potential customers.In podcast interviews, Sibley has said she has made as many as 40 of these agreements with Tennessee pharmacies, which she said forward her the paperwork on each ivermectin customer. Before selling the drug, pharmacies are required to ask customers questions about medical conditions and medications that could cause complications if taken with ivermectin. Afterward, the collaborating physician also is expected to receive a record for each person who purchases ivermectin.

"We literally have folks coming from all over the world to get our ivermectin," Sibley said on the Common Sense MD podcast in February 2025. "As the collaborator for these pharmacies, I get every person's sheet."

"They're from every state," she said. "They're from Canada. They're from Europe."

Sibley did not respond to requests for comment.

KFF Health News has independently confirmed that Sibley signed agreements with at least 10 pharmacies. The agreements say pharmacists shall dispense ivermectin only in Tennessee, where Sibley is licensed, although one of those pharmacies said friends and family in Tennessee can "facilitate sending the medication."

Hughey, the Tennessee pharmacist, said Sibley had prescribing agreements ready to go when the law was enacted. He credited her with advancing ivermectin sales throughout the state.

"Had Dr. Sibley not stepped in and really pushed forward, there's no telling how hard it would have been," Hughey said. "It would have been a lot less widespread."