Overmountain Recovery opened in Gray, Tennessee, in September 2017 after a prolonged campaign to establish treatment in a community wary of a methadone clinic. Its significance lay both in the service it offered—medication-assisted treatment combined with counseling and other support—and in the coalition that negotiated its opening when local resistance threatened to stop the project.

The Treatment Gap

The clinic was planned for a rural town between Johnson City and Kingsport, where the nearest methadone facility was over a mountain and roughly sixty miles away. The distance gave the project a practical purpose: make a form of treatment available locally rather than require patients to travel far for it. Methadone was selected as the clinic’s main medication in part because it was cheaper than alternatives and harder to divert; participants would drink their doses daily in front of a nurse. The outpatient clinic would eventually offer Suboxone as well.

The book sets this effort against a wider landscape of limited access. Tess Henry, pregnant and seeking treatment in Virginia, had to find one of the few facilities willing to accept patients receiving medication-assisted treatment. Elsewhere, the Hope Initiative’s volunteers assembled a five-page spreadsheet listing thirty-six treatment and aftercare providers, while some members remained opposed to medication-based care despite evidence supporting it. These accounts show how treatment could depend on geography, available beds, cost, and a provider’s policy—not simply a person’s willingness to seek help.

A Coalition Builds the Clinic

Overmountain Recovery was a project of the East Tennessee State University working group, an alliance of mental-health and substance-use administrators led by Robert Pack’s coalition. With backing from the university, a regional nonprofit hospital corporation, and the state mental-health agency, the group had secured $2.5 million in grants, funded eight projects, developed twenty-five research proposals, and opened a Center for Prescription Drug Abuse focused on research. The clinic was therefore part of a broader effort to build regional capacity, not an isolated facility.

The project was co-led by Steve Loyd, a physician with local roots and a history of opioid addiction who had been in recovery for more than a decade. His experience gave him a direct way to explain addiction to neighbors: before seeking help, he had pursued prescriptions from colleagues, taken medicine from relatives’ cabinets, and feigned an ankle injury to obtain painkillers after surgery. His father confronted him in 2004 and pushed him toward treatment, beginning a long period of monitoring and support. Loyd’s own account made the clinic’s purpose tangible to a town where the subject was close to home, including for people who privately acknowledged that their sons were affected.

The name joined local history to the clinic’s intended approach. Overmountain referred to the farmers and frontiersmen known as the Overmountain Men, who helped defeat the British at the Battle of Kings Mountain. Recovery signaled a program broader than medication alone: group and individual counseling, yoga and other alternative therapies, and job-training support were part of its design.

Opposition and Negotiation

Gray’s residents did not receive the proposal as an uncomplicated benefit. Citizens to Maintain Gray, led by a respected local farmer, worried that people taking methadone might be too impaired to drive safely. Some opponents did not object to a clinic in principle but wanted it located elsewhere. The concern persisted despite private admissions to Loyd and Pack that addiction was affecting members’ own families.

The working group responded by engaging with opponents and bringing outside police chiefs and methadone providers into the discussion. Their examples and studies from other communities helped address safety concerns before local and state decision-makers. The approval process required more than a year of sustained public opposition. In a town of 1,222 people, more than 300 spoke publicly against the project, and some denounced Pack and Loyd as drug dealers. The group nevertheless secured near-unanimous approval from the city zoning board and the state, then opened the clinic in September 2017.

Significance

The opening represented a negotiated expansion of care in a region where treatment access was constrained by distance and institutional resistance. Its model joined methadone or, eventually, Suboxone with counseling, alternative therapies, and employment support, treating recovery as more than the provision of medication. The coalition’s method mattered too: it heard local concerns, brought in outside expertise, and used research and examples from other communities to win authorization.

The book presents Overmountain Recovery as evidence that cooperation among researchers, health organizations, state agencies, and a physician with lived experience could create a local treatment option despite intense opposition. The opening did not erase the barriers described elsewhere in the book, but it established a clinic where a distant service had been the nearest one available.