How Nashville is addressing overdoses in its booming tourism district

It’s debatable which part of the city provokes the most “Nashville has changed” comments, but Lower Broadway is in the running.

Lauren Morales has been working in the district since she started pouring tea and lemonade for her dad’s catering business in 1986. That became TomKats Hospitality, with Morales serving as its COO. The company opened Acme Feed and Seed — named for a farm supply store that operated in the building for decades — in 2014. 

“I think there were only maybe a dozen bars on Broadway,” she said. “And then it was already changing so fast, and then the pandemic really accelerated it. We attracted a lot of tourists during that post-get-out-of-the-house time.”

The city’s tourism industry has exploded since then, and it now draws about 17 million people annually.

Over the same period, the overdose rate continued growing across Tennessee. The state ranks only behind West Virginia and Washington, D.C.,  for fatal overdose rates according to 2022 data from the Centers for Disease Control and Prevention, and the city sees thousands of nonfatal overdoses every year. 

“Everyone has some awareness of the opioid issue,” Morales said. “Obviously, there is a link between partying and having fun, and the potential for a mistake. When we saw there was a way that we could safely participate in the solution, I mean, immediately, we wanted to.”

Combating overdoses in the tourism district

Catherine Sweeney WPLN News

Acme Feed and Seed opened on Broadway in 2014.

Acme Feed and Seed is one of nearly 100 bars and venues in the area that has overdose reversal boxes installed. They look like first aid kits. But they also have video instructions on how to use its contents: the overdose reversal drug, naloxone, and personal protective equipment, like a CPR mask.

“I don’t want to sound like the harbinger of doom, but it is very bad in the city of Nashville — the overdose epidemic,” said Sgt. Mike Hotz, who heads the Metro Nashville Police Department’s overdose unit.

He monitors the city’s reported overdoses, including where they happen.

“More than 5,000 people a year — that we know of — suffer from nonfatal overdoses,” he said. “We do see a disproportionate amount of people suffering from both fatal and nonfatal overdoses in the entertainment district. We’ve had, unfortunately, a handful of tourists pass away.”

Hotz said this area has a bit of a different problem from other hot spots for overdoses. People are generally under the impression they’re buying stimulants like cocaine, but end up getting a potent depressant instead.  

“They’re most likely somebody who is not suffering from opioid use disorder,” he said. “They ingested something that they didn’t know was fentanyl that actually was.”

The issue is more common in the entertainment district, he said.

“If somebody has one too many Pabst Blue Ribbons on Broadway, their inhibitions go down — with any kind of alcohol,” Hotz said. “And somebody who might not be disposed to recreationally use or purchase illicit drugs may feel more inclined to do so. So, in my personal opinion, having these ONEbox overdose reversal kits at every possible establishment just to have the largest footprint possible, I think it’s a win-win situation.”

He started trying to get business owners to keep naloxone on hand.

“I’m not joking when I say this: I had 0% success,” he said.

Around the same time, Benton McDonough took on a new job. Then-Mayor John Cooper created the Office of Nightlife in 2022 and appointed McDonough as the director. It’s a liaison position between those businesses and the city government. It didn’t take long for McDonough to also hear about overdoses.

“Honestly, probably a few months in, I started to hear about that,” he said. “It would pop up from time to time, and we would see EMS records.”

He was connected with Hotz, then several other people who were concerned about opioid overdoses downtown. So Metro Nashville Police, the Office of Nightlife, city council and the charity arm of the guitar manufacturer Gibson have spent about a year building this program out.

A solution from West Virginia

The program uses a kit called ONEbox. It’s sold by the Drug Intervention Institute, headquartered in Charleston, West Virginia. That’s the only state with an opioid overdose rate higher than Tennessee.

“It was originally designed to tackle a problem here in West Virginia, which was to get naloxone on all of our college campuses,” said the institute’s CEO, Dr. Susan Margaret Murphy.

Murphy spent 26 years as a college administrator before she got involved in harm reduction work about a decade ago.

“I responded to an overdose on a campus where the student did not live,” she said. “It was like 2016, and there was no naloxone in the residence hall.”

Over the next few years, West Virginia did work toward getting simple overdose reversal kits into all of its colleges. But then the pandemic hit. The supply chain issues it created came with a silver lining.

“We were in the middle of COVID, and the box that I was distributing and purchasing, I couldn’t get ahold of anymore,” Murphy said. “My husband was sitting at the end of the table when I was talking about it. He said, ‘Let me see this box.’ And he looked at it, and he said, ‘I think that I can build a box that has video training.’”

Through their work in Nashville, Murphy said distribution of ONEbox kits has grown to about 18,000 boxes in all 50 states, with reports of hundreds of lives saved.

She attributes Nashville’s success to Hotz.

“He goes with his Home Depot bucket, his drill and his screws, and he makes it happen,” she said. “And he’s educating the bar owners at the same time.”

Murphy said the lack of training had been a major complaint about the boxes they previously used.

Morales, at Acme Feed and Seed, said that education was a game changer.

“We don’t have a lot of corporate help and big admin help,” she said. “Really, they did most of the work. They did the training, provided us all the paperwork, suggested where the kits should go based on our square footage. … It was a really easy process.”

Visitors who aren’t partying on Lower Broadway often come for another set of attractions: professional sports. The partnership has been working with major sports teams like the Tennessee Titans to get boxes installed in Nashville’s stadiums and arenas.

The program has gotten some of the same criticism that other tourist-focused services do — that the resources could be going to locals who need help. McDonough agreed it can be a tough balancing act, but he said the city does bear a responsibility for the visitors it invites in.

“I think we always owe them a safe environment,” he said.

This story was produced by the Appalachia + Mid-South Newsroom, a collaboration between West Virginia Public Broadcasting, WPLN and WUOT in Tennessee, LPM, WEKU, WKMS and WKU Public Radio in Kentucky and NPR.