New laws highlight Tennessee’s proactive response to growing concerns over psychiatric drug risks and potential links to violence. These model reforms should be adopted nationwide to protect children, families, and public safety.
By Jan Eastgate
President CCHR International
May 22, 2026
Tennessee has enacted two landmark measures addressing psychotropic drug use and its potential links to public safety. The first expands toxicology testing for psychiatric drugs in cases of mass shootings, while the second requires detailed, privacy-protected reporting on psychotropic prescriptions in Medicaid and foster care. These forward-looking reforms represent a strong and timely response to growing national concerns over psychiatric drug risks, demonstrating effective models of transparency and oversight that are urgently needed at the national and federal levels.
TN Precedent: Expanded Testing for Drug-Induced Violence
Tennessee lawmakers enacted a landmark measure that took effect July 1, 2025, requiring toxicology testing for psychotropic drugs in autopsies of decedents suspected of committing a mass shooting. On May 5, 2026, an expansion bill (SB 2088 / HB 2013) was approved by the governor that broadens the definition from incidents resulting in four or more deaths to those in which four or more individuals sustain injury, or where a reasonable person would conclude the perpetrator attempted to kill four or more individuals. It also extends provisions to living suspects: with probable cause, law enforcement may request consent for a blood or urine test administered by a qualified medical professional at a hospital (consent required from the individual or, for a minor, from a parent or guardian). It takes effect July 1, 2026.[1]
A key feature is the requirement to test for therapeutic levels of psychotropic drugs, allowing detection of even low amounts in the blood to identify recent or irregular intake that may still affect behavior. This establishes a critical new precedent for addressing potential drug-induced violence. Unlike past tragedies such as Sandy Hook, where toxicology testing omitted therapeutic levels, Tennessee’s law now mandates these precise measurements.
Results (redacted for privacy) are shared for study by the University of Tennessee Health Science Center, with findings included in quarterly reports submitted to the Chief Clerks of the Tennessee Senate and House of Representatives.
These measures are an important precedent for better understanding potential links between prescription psychotropic drugs and violence.
Championing this law were Amy Miller, a leading voice on medical freedom in Tennessee for over a decade, and Sheila Matthews, Co-Founder of AbleChild, a national non-profit parental rights organization.
Comprehensive Psychiatric Drug Tracking in Medicaid and Foster Care
The Psychotropic Medication Data Transparency Act (Senate Bill 2255/House Bill 2389) arose from a months-long effort to obtain psychotropic drug prescribing data that Tennessee had never consistently tracked.
In 2024, CCHR International used FOIA requests to gather data from 32 states on children prescribed psychotropic drugs under Medicaid and the associated costs. After reviewing this information, Brittany Ruiz, Director of Public Policy for CCHR Tennessee, sought current Tennessee-specific data. Persistent obstacles—even for legislators—highlighted the need for a statutory reporting requirement. Ruiz drafted the bill, which was championed by Representative Brock Martin and Senator Brent Taylor. With strong bipartisan support, it passed with nearly unanimous approval.
Driven by concerns over serious side effects associated with these drugs, high prescribing rates among young children and even infants, and an estimated $480 million in annual TennCare spending, the law mandates biannual publication of aggregate, de-identified data from TennCare medical and pharmacy claims (and federal Center for Medicare and Medicaid Services sources where authorized) to improve oversight and identify potential overprescribing and inappropriate patterns, such as children receiving multiple psychotropic drugs concurrently (polypharmacy).
The law requires biannual publication of data drawn primarily from medical and pharmacy claims in Tennessee’s Medicaid program, TennCare, and, where authorized, from federal CMS data sources. All reports are prepared in aggregate, de-identified form to fully comply with HIPAA and other privacy laws.[2]
The reports include:
- The number of persons prescribed at least one psychotropic drug, broken down by age groups: 0-5, 6-12, 13-17, 18-64, and 65 and older.
- The number of distinct covered outpatient psychotropic drugs paid through TennCare per person over one year, categorized by county and age range.
- The total cost of psychotropic drugs paid by TennCare, with separate subtotals for state and federal funds, categorized by age group, number of medications, and county.
A separate section addresses children in state custody (foster care) prescribed psychotropic drugs through TennCare, covering:
- Numbers by age groups (birth to 5, 6-12, and 13-17).
- The number of distinct psychotropic drugs prescribed per child over one year when received for 90 days or longer.
- Total costs for these prescriptions.
Each report must include comparative data for the immediately preceding two calendar years. The Bureau of TennCare must publish the first two comprehensive statewide reports no later than January 1, 2027, and biannually thereafter.
The Tennessee chapter of CCHR, which advocated for increased oversight, applauded the legislation. In a letter to policymakers, Brittany Ruiz, Director of Public Policy for CCHR Tennessee, highlighted that as of January 2022, 25% of Tennesseans were taking psychotropic drugs (up 15% from the prior year).[3] Approximately 1 in 3 foster children in Tennessee were on psychiatric drugs according to 2018 state-specific data,with more recent national Medicaid analyses showing rates near 35% as of 2023.[4] Approximately 1 in 3 foster children in Tennessee were on psychiatric drugs according to 2018 state-specific data, with more recent national Medicaid analyses showing rates near 35% as of 2023.[5]
National Context: Drugging of Medicaid Children
CCHR International has long been obtaining psychotropic drug prescribing data through FOIA requests from government agencies—information most organizations cannot access. To ensure accuracy, CCHR compiled thousands of National Drug Codes (NDCs) from the FDA, covering over 400 psychiatric drugs. These unique identifiers account for variations in manufacturer, strength, form, and packaging, enabling states to extract precise Medicaid records.
The resulting 2023 data revealed that 2,999,084 children aged 0–17 were prescribed psychiatric drugs under Medicaid, including 270,196 children aged 0–5, at a total cost of $1.78 billion. ADHD stimulants were the most common, followed by antidepressants (920,411 children, including 25,414 aged 0–5), anti-anxiety drugs (605,746 children, including 145,783 aged 0–5), and antipsychotics (465,559 children, including 34,758 aged 0–5). Many of these medications carry serious FDA warnings for suicidal thoughts, dependence, diabetes, movement disorders, and other severe risks.
CCHR recommends that prescribing physicians provide FDA Medication Guides directly to patients with a signed acknowledgment to ensure true informed consent.
Tennessee’s dual landmark laws—enhanced toxicology testing for psychotropic drugs in mass violence cases and transparent Medicaid reporting—represent a strong step toward greater oversight, informed consent, andaccountability amid growing national concerns over psychiatric drug risks.
These NDCs are the unique FDA identifiers that specify the manufacturer, drug name, strength, and dosage form, and they are the codes used for billing in Medicaid programs. The list was organized by drug class and detailed by exact drug name and dosage.
By compiling these NDCs correctly, the health departments are able to accurately compile the list from their official records. This extensive compilation, totaling thousands of entries, was submitted to the states. The resulting data was then provided by the state health departments themselves from their official records.
The data from the 32 states show that 2,999,084 children aged 0–17 were prescribed psychiatric drugs under Medicaid in 2023. This included 270,196 children aged 0–5, at a total taxpayer cost of $1.78 billion.[6]
ADHD stimulants (DEA Schedule II controlled substances) were the most commonly prescribed to 0-17-year-olds.
Antidepressants were prescribed to 920,411 children in that age range (including 25,414 aged 0–5), carrying an FDA black box warning for increased risk of suicidal thoughts and behaviors in children and adolescents. Anti-anxiety drugs (sedative hypnotics, including benzodiazepines) were third, prescribed to 605,746 children aged 0–17 (including 145,783 aged 0–5), with FDA warnings about dependence and life-threatening withdrawal. Antipsychotics, associated with serious risks such as diabetes, movement disorders, cardiovascular issues, and potentially fatal neuroleptic malignant syndrome, were prescribed to 465,559 children aged 0–17 (including 34,758 aged 0–5).
These prescribing levels and documented risks demand greater informed consent. CCHR strongly recommends that FDA Medication Guides (MedGuides, established under Title 21 of the Code of Federal Regulations (21 CFR Part 208) be provided directly by prescribing doctors, accompanied by a signed patient acknowledgment of receipt. These plain-language fact sheets detail the most serious side effects. While pharmacists are currently required to distribute them, CCHR calls for this to become a standard part of a physician’s prescribing process to support true informed consent and safer patient care.
Tennessee’s dual landmark actions—expanding toxicology testing for psychotropic drugs in cases of mass shootings and requiring comprehensive, transparent reporting on psychiatric drug use in Medicaid and foster care—represent a strong and timely response to the growing national alarm over psychiatric drug risks and poor mental health outcomes. With federal measures now calling for deprescribing, it is time for comprehensive, transparent oversight to become the standard across America—and globally.
[1] https://wapp.capitol.tn.gov/apps/BillInfo/Default?BillNumber=HB2013&ga=114
[2] https://wapp.capitol.tn.gov/apps/BillInfo/Default?BillNumber=HB2389&ga=114
[3] Tennessee Accountability Center, “The Center for State Child Welfare Data – Tennessee Accountability Center Report,” Department of Children’s Services, 31 May 2018
[4] Keefe, Rachael J., et al., “Psychotropic Medication Prescribing: Youth in Foster Care Compared with Other Medicaid Enrollees,” Journal of Child and Adolescent Psychopharmacology, May 2023
[5] Keefe, Rachael J., et al., “Psychotropic Medication Prescribing: Youth in Foster Care Compared with Other Medicaid Enrollees,” Journal of Child and Adolescent Psychopharmacology, May 2023
[6] https://www.cchrint.org/massdrugging-of-medicaid-children/; Dr. Roger McFillin, “We Call It Medicine: The Mass Psychiatric Drugging of America’s Poorest Children,” Radically Genuine, 10 Mar. 2026, https://drmcfillin.substack.com/p/we-call-it-medicine-the-mass-psychiatric?utm_medium=email&action=share
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