Tennessee Tri-Cities became a model in the book for organizing addiction treatment across institutional boundaries. In the rural region between Johnson City and Kingsport, a university-led working group brought together public health, mental health, substance-use, hospital, and state partners. Its work culminated in Overmountain Recovery, a clinic in Gray designed to pair medication with counseling, other supports, and help finding work—not treat medication as a substitute for recovery services.

Regional Setting and Treatment Gap

Before the clinic opened, the nearest methadone facility was about sixty miles away, over a mountain. That distance made access a practical problem for people seeking care in the region. Overmountain Recovery was planned primarily as a methadone clinic because methadone was less expensive and, with patients drinking their daily dose in front of a nurse, harder to divert. The outpatient clinic would also eventually offer Suboxone.

The location shaped the response: a clinic in a rural community could bring treatment closer, but its presence also required persuading local residents and officials to accept a service they feared. Gray was a middle-class community of farmers and suburbanites, with Daniel Boone High School about a mile and a half away. Its setting made the clinic’s proximity to everyday community life a central part of the debate over whether it should open.

The Working Group and Its Approach

The collaboration was spearheaded by Robert Pack, a public-health professor at East Tennessee State University. With backing from the university, the region’s nonprofit hospital corporation, and the state mental health agency, the working group developed projects that joined research and service delivery. Its record included $2.5 million in grants, eight funded projects, twenty-five research proposals, and a Center for Prescription Drug Abuse focused on research. Overmountain Recovery was its latest undertaking, co-led by Steve Loyd, a physician with local roots who had himself been addicted to opioids.

The model contrasted with Roanoke, which had not formed a comparable working group to move treatment initiatives across bureaucratic barriers. In Roanoke, Hope Initiative volunteers struggled to connect people with residential treatment and outpatient medication-assisted treatment; in the Tri-Cities, the coalition could draw on institutional partners and shared planning to establish a clinic. The comparison makes the region significant not simply as a place where a facility was built, but as an example of coordination intended to make treatment available.

Opposition and Opening

Overmountain Recovery faced organized resistance before opening in September 2017. Citizens to Maintain Gray, led by a respected local farmer, worried that patients taking methadone might be unsafe drivers. Some residents supported the general idea of a treatment center but objected to having it nearby; some also privately acknowledged that addiction affected their own families. More than 300 people spoke against the project in a community of 1,222, and some called Pack and Loyd drug lords.

The working group responded by hearing residents’ concerns and bringing in police chiefs and methadone providers from outside the area. Their examples and studies helped address safety objections with information from other communities. The coalition endured more than a year of public opposition and ultimately won near-unanimous approval from the city zoning board and the state. The September opening demonstrated how local resistance could be met through sustained engagement and cross-sector support, even as the distance to other services and the scale of treatment need remained pressing concerns.