Small white boxes are bolted to walls inside the bustling bars, restaurants and tattoo parlors along Lower Broadway, in the cavernous Bridgestone Arena and in every public school across Nashville, TN.
Lt. Mike Hotz of the Metro Nashville Police Department knows them well. He personally installed more than 400 of the kits, each containing two doses of naloxone—the opioid-overdose antidote—along with simple video instructions on how to administer them.
“Our latest number is 428 kits,” said Hotz, who created the department's overdose unit in 2020 and has since become one of the country’s most vocal supporters for the ONEbox program, a partnership with Mayor’s Office of Nightlife, the Nashville City Council and the UT SMART Policy Network. “One of my single largest points of pride is that we have 19 confirmed lives saved through the ONEbox program. That’s 19 people who get to go home to their families.”
Decades in the Making
The fact that bartenders and school nurses can now reverse an overdose in minutes is the product of more than fifty years of scientific research and development. Researchers began hunting for a true opioid antidote in 1915, when German pharmacologist Julius Pohl identified the first compound capable of blocking morphine’s effects. For decades, every candidate antidote that followed came with a catch. They worked but produced disorienting and sometimes dangerous side effects.
The breakthrough came in 1960 and 1961, when researchers synthesized a compound that blocked opioids without potentially harmful effects of its own: a “pure” antagonist. The U.S. Food and Drug Administration (FDA) approved naloxone in 1971 for use in hospitals and emergency medical settings as heroin use surged across the country.
“In 2015, the FDA approved the user-friendly nasal spray formulation that we know through the brand name Narcan, and that’s really what made it much easier for a person with a small amount of training to administer naloxone,” said Audi Ritchie, MPH, program advisor at the CDC Foundation and co-grant lead for the Foundation’s Overdose Response Strategy (ORS).
In 2023, the FDA approved nasal-spray naloxone for over-the-counter sale. Consumers today can buy the groundbreaking medication without a prescription at retail pharmacies, convenience stores and online retailers. “That’s really what helped change the game,” Ritchie said of naloxone’s access. “Naloxone has helped save a lot of lives over the last few years.”
In 2015, the FDA approved the nasal spray formulation of naloxone, making it easier and faster to administer doses.
Naloxone works by effectively blocking opioids from binding to GABA receptors in the body, as illustrated here.
The ready accessibility of naloxone has been credited with contributing to reductions in opioid-related deaths in recent years.
From Hospital Shelves to Everyday Carry
The mechanics of the medication are surprisingly simple. Naloxone binds to the same brain receptors as opioids like heroin and fentanyl, which can kill by depressing respiration, knocking the opioids loose and restoring normal breathing within minutes.
Officials credit recent expansions in accessibility to the medication—in particular making naloxone available to the general public—as a contributor to the decline of overdose deaths nationally for three straight years. Provisional CDC data show an estimated 69,973 Americans died of drug overdoses in 2025, down nearly 14 percent from about 81,313 in 2024, which was itself down roughly 27 percent from 2023—one of the largest one-year declines on record.
Bridging Public Health and Public Safety
Bridging the gap between the approaches of both public health and public safety is the goal of ORS, a CDC Foundation program that pairs public health analysts with drug intelligence officers in 61 teams covering all 50 states, Puerto Rico and the U.S. Virgin Islands. The program traces its roots to the same year that nasal spray naloxone was approved by the FDA as a prescription drug in 2015, launched as the Heroin Response Strategy, created under the High Intensity Drug Trafficking Areas program and funded by the Office of National Drug Control Policy, before public health partners joined a few years later and it was rebranded to reflect its broader mission.
“Neither sector can solve the overdose crisis alone,” Ritchie said. “We knew we had to collaborate to save lives.” The teams, she said, “help their community partners share information across public health and public safety to inform a coordinated response and help solve the overdose epidemic at the local level, together.”
In Tennessee, that partnership runs through Kathleen Collins, a public health analyst who works alongside her DIO counterpart with partners such as the Metro Nashville Police Department and the University of Tennessee’s Substance Misuse and Addiction Resource (SMART) Initiative, connecting Tennessee agencies to naloxone supplies, training and funding.
“Naloxone is keeping people alive until they’re at a point where they’re ready to receive help,” said Collins, who has seen attitudes shift, including in the law enforcement community, as officers who’ve lost friends or family to overdose bring that experience to the job. “I think there’s an understanding now that you make more progress when you work together than when you work in silos.”
Naloxone is keeping people alive until they’re at a point where they’re ready to receive help.
Hotz, a former U.S. Army infantryman who saw the drug trade firsthand in Afghanistan before joining Metro Nashville Police Department, doesn’t dispute that naloxone has limits.
“It’s a Band-Aid,” he said. “It doesn’t cure addiction. It stops the bleeding. But I can’t think of anything in this world that has saved more lives.” In Nashville, Hotz’ unit distributed roughly 12,000 overdose reversal kits in 2025 alone—24,000 individual doses—which he says tracks with a 31.5 percent drop in Nashville’s own overdose death rate, by his count.
Kathleen Collins, a public health analyst who works alongside her DIO counterpart with partners such as MNPD and the University of Tennessee’s Substance Misuse and Addiction Resource (SMART) Initiative.
Lt. Mike Hotz installing an opioid overdose kit at the Bridgestone Arena in Nashville.
Lt. Mike Hotz of the Metro Nashville Police Department.
Hotz is blunt about the persistent myth that naloxone enables drug use. “I have run into exactly zero people who’ve told me they started using opioids because Narcan is around,” Hotz said. “Nearly all overdoses are accidental. Nobody goes into it knowing they’re going to die that day.”
ORS is one of several ways the CDC Foundation is working to reduce overdose deaths. Through CDC’s Overdose Data to Action (OD2A) program, the Foundation supported more than 200 field staff across 45 jurisdictions in 2025, equipping health departments with data to guide prescribing practices and connecting people to treatment. And, the Foundation’s work doesn’t stop there. For instance, funding by the Georgia Opioid Crisis Abatement Trust helped form the Georgia Overdose Prevention Partnership, a two-year effort led by the CDC Foundation that applies ORS’s public health-public safety model to 18 rural community coalitions across the state.
An Expanding Effort
The ONEbox program almost didn’t happen. When Hotz first approached honky-tonks along Broadway and Second Avenue North about placing kits in their venues, many balked. It wasn’t until the director of the mayor’s office of nightlife got involved that the effort gained traction. The program has been growing ever since, and has been scaled in Memphis, Chattanooga and cities as far away as Idaho Falls, ID, and Buffalo, NY, where Hotz has coached departments on building their own overdose response units.
As a person who values both action and teamwork, Hotz emphasizes that the success of the ONEbox program is due to the collaborative efforts of the Overdose Unit and community partners. He still keeps his cell number in his email signature, telling partners to call any hour of the day. “Sometimes,” Hotz said, “I feel like the right people are put in the right place at the right time for the right reasons.”
