Nashville officials say One Box naloxone program helped save lives as overdoses shift toward xylazine-adulterated fentanyl

Chair Evans convened the Public Health & Safety Committee and heard an update April 14 on the city’s One Box naloxone program and recent overdose trends from Metro Nashville Police Department officials and the Office of Nightlife.

Sergeant Michael Hotz, who leads overdose outreach work for the police department, told the committee that "we saw a 31.4 percent reduction in overdose fatalities in Nashville" in calendar year 2024, then warned that 2025 figures have trended up, with a sharp March spike that briefly doubled the week-to-week average.

The spike in March included a week in mid‑March when the city’s weekly average of overdose events rose from an annual average of about 8.3 to as many as 23 incidents, Hotz said. He said the department identified widespread powdered fentanyl in several colors (white, green and purple), indicating multiple sources, and reported an increase in xylazine adulteration: "we estimate that there is significant quantities of xylazine enough to produce a narcotic effect in over 80% of the fentanyl supply that's on our streets," Hotz said.

Hotz clarified the clinical implications: "There is no agonist that'll reverse a xylazine overdose," and while naloxone will reverse the opioid portion of a mixed overdose,…