Bill making ivermectin an over-the-counter drug signed by Gov. Greg Abbott

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Gov. Greg Abbott on Wednesday signed a bill makes ivermectin — a drug used mostly in this country to treat livestock for parasites — available to Texans without a prescription.

Texas is now the fifth state to approve the over-the-counter sale of the drug after it became popular as an unproven treatment for COVID-19. House Bill 25 filed by state Rep. Joanne Shofner, R-Nacogdoches, first passed the House, 87-47, after an energetic, three-hour debate along party lines. Shofner, surrounded by more than 20 Republicans at one point, argued her bill was championing medical freedom, giving Texans better access to a drug particularly outside cities where pharmacies outnumber physicians.

Shofner's bill does not put ivermectin on pharmacy shelves, but the drug would be available upon request from behind the pharmacist’s counter as Texans already do for other drugs, like Sudafed. The law takes effect Dec. 4.

“It's absolutely important for our rural communities — and there's a lot of people in urban communities that are not able to get to their doctor — that they have more access to their pharmacist than they would their health care practitioner,” she said on Aug. 27 from the House floor. “It's already behind the pharmacy counter. This is not a new thing."

State Sen. Bob Hall, R-Edgewood, introduced the bill during Senate floor discussion in August, arguing that there’s long been a history of using drugs that are safe and effective for other uses or “off-label” from their original use. “It is available without a prescription in many countries across the world and four states in the United States,” he said.

But Democrats were quick to point to ivermectin’s history in this country as a veterinary drug to treat parasites in livestock. “Let’s be clear. This is a drug that is used on horses, donkeys, correct?” said state Sen. Roland Gutierrez, D-San Antonio. “It is FDA approved for being prescribed by a doctor ... for the use of parasites only.”

“It’s been approved as a safe drug. for humans,” Hall said. “It has a better (safety) record than Tylenol.”

Ivermectin has remained relevant since the COVID-era zeitgeist that fueled skepticism of mainstream medicine and the health care system at large. Medical freedom advocates want to remove barriers that prevent them from taking whatever medication they say will make them healthier — especially if it’s an alternative to vaccines — even if its effectiveness is debatable. And, ivermectin is a model for their beliefs.

During a visit to the Texas Capitol in August, U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. applauded lawmakers' attempts to make ivermectin more accessible.

"I think Americans should have the choice," he said. "After Trump left office, there was this movement to put everybody into this funnel without choice in doing that."

During the House floor debate, Democrats derided the bill with state Rep. Rafael Anchia, D-Dallas calling the bill “bananas” and “crackpot.” His colleagues also raised questions about the fact there is no age limit in the bill so that children can buy it and that pharmacists are shielded from liability if any consumer suffers an adverse reaction. Shofner’s bill puts the rule-making responsibility on how to dispense on pharmacists and she said she trusts them to come up with adequate procedures.

Shofner filed an identical bill during the regular session but the House didn’t vote on it, despite 58 pages of online testimony filed by residents who want to be able to access it without a prescription. This time around, her bill comes with the support of Abbott who put ivermectin access on his expanded priority list last week after Texans for Vaccine Choice sent 7,000 signatures in support of the drug.

“Like penicillin and aspirin, ivermectin is a safe, affordable medicine with minimal side effects,” Shofner said.

While it has approved the use of ivermectin in humans to treat parasitic worms, the federal Food and Drug Administration has not approved its use in preventing or treating COVID-19.

Through social media during the pandemic, the drug gained popularity before a coronavirus vaccine was available. Doctors can prescribe it but few will do so to treat COVID-19 because of the FDA’s warning against it.

During the House debate, Republicans, including state Reps. Tom Oliverson, a Cypress anesthesiologist and Steve Roth of Conroe, said one of the reason the bill was needed was because too many pharmacists refused to fill ivermectin prescriptions during the pandemic.

But state Rep. Gene Wu, D-Houston, said that was the case because demand was so high during the pandemic that the drug's supply was diminished, and pharmacies were trying to save it for people who needed it for parasites and other uses approved by the FDA.

State Rep. John Bucy III, D-Austin, a member of the House Public Health Committee who pressed Shofner about safeguards on the bill last week, told The Texas Tribune Tuesday that he believes ivermectin will continue to be misused under the bill.

“You’re taking the doctor out of the equation,” he said. “I do believe in medical freedom for adults but this bill goes beyond that. I want to have better information, labeling and we need to protect children and this bill doesn’t do that.”

What is ivermectin?

In the past five years, the number of COVID-19 infections has dropped significantly because of vaccines and the fact that mutated versions of the virus have weakened over time. Yet, the popular clamor for the ivermectin never waned, prompting 15 states, including Texas, to introduce legislation that would allow the sale of the drug without a prescription. So far, four states have passed such bills — Arkansas, Idaho, Louisiana and Tennessee.

Ivermectin was discovered in the 1970s as an effective veterinary drug by Japanese microbiologist Satoshi Ōmura. He and William Campbell were awarded a Nobel Prize in 2015 for their work in developing ivermectin and using it to treat parasites. It’s been used in humans as a treatment for specific parasites in tropical and subtropical regions. It is also used for lice. It acts by paralyzing and then killing the parasite by interfering with its nerve and muscle functions.

In 2020, an Australian study claimed ivermectin had promising antiviral activity in a petri dish against COVID-19, and the use of a long-tested drug against a new disease prompted considerable public interest a full year before a vaccine was available. But the study was found to have used higher doses than recommended in humans and subsequent studies found ivermectin did not have a significant impact on the virus.

Shofner often points to a 2021 study of 72 Bangladesh patients that found it may have eased early COVID-19 symptoms, but that study states that more research needs to be conducted to confirm those preliminary findings.

Still, many people began asking their doctors for the drug and there was an increase in the number of those reporting side effects from using it.

No one needs a prescription to purchase ivermectin from a feed store or tractor supply store, which supplies the medication for livestock use only.

The original version of Shofner’s bill required that pharmacists produce an annual report on the number of times it was dispensed. The committee substitute version that now goes before the Texas House removes that requirement.

Under HB 25, a pharmacist would still have to discuss with patients the possible side effects, including nausea, dizziness and skin rash, before dispensing it.

What supporters, opponents say

Ivermectin can be used in humans but the FDA has tried to dissuade its use for COVID-19, adding that “taking large doses of ivermectin can be dangerous.”

In 2021, two people in New Mexico died who had used ivermectin to treat COVID-19. That state’s health agency chief at the time compared taking ivermectin for COVID-19 to taking an antacid for a heart attack.

But Shofner said that because it is safe and already available, the restrictions should be lifted.

“It would be behind the pharmacy counter, like many of our cold and cough medicines like pseudoephedrine without a prescription,” Shofner said during the committee hearing.

Dozens of supporters of her bill have filed online testimony and appeared in person before the Texas House public health committee to praise ivermectin.

“This is highly important,” insisted Tamara Bergen of Seguin who emailed her support to the house committee. “Ivermectin is extremely safe and has been used all over the world for many treatments. It is effective and should have saved many lives during the COVID pandemic.

“I SUPPORT OTC IVERMECTIN!” wrote J. Teer, a pastor in Texarkana. “Alternative meds should be avaiable (SIC) at more than vet med sources. This medication was seen as great and its creator won many awards before the so-called pandemnic (sic). We should never be in the situation that we were in during the "covid pandemic." “

But some Democratic lawmakers on the House Public Health committee questioned why this drug and not others.

“I’m concerned about the politicization of this because I think that is why we are seeing such a push,” Bucy said during the hearing. “If we want to change how Texas functions, fine, but to pick and choose which drug we want to get behind to do that is confusing to me.”

Dr. Zeke Silva, a radiologist, speaking for the Texas Medical Association, testified against the bill, saying that he feared it would diminish the doctor’s role in prescribing medication.

“The TMA is concerned that this bill will set a precedent whereby that physician-patient relationship is no longer part of the prescribing of medications, which could have significant side effects,” he said.

Writing a prescription happens only after a doctor has a chance to understand a patient’s medical history, allergies and other factors to determine the best course of treatment.

Noticeably absent from the testimony was the Texas Board of Pharmacy whose members would be directly affected by the bill. The agency did not return a request for comment.

Michelle Evans with Texans for Vaccine Choice said the bill would return the decision-making process to patients.

“HB 25 is simple and long overdue and a shared priority for many in our state, including constituents in each of your districts,” she said. “It would enable Texans to take their health into their own hands.”

Disclosure: Texas Medical Association has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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