nal in place. connecticut first implemented a gsl in 2011, and it has been updated yearly since 2014. some research suggests that connecticut’s gsl has not affected overdose deaths but has resulted in positive behavioral changes with an increase ofin 9 calls; however, deaths may still continue to increase in spite of the increased awareness from gsls. from 2000 to 2014, mcclellan et al. (2018) found that opioid overdose mortality decreased by 14% and 15% when laws increased the engagement of layperson intervention, respectively, through an increase in nals or gsls. nals were related to greater reductions in mortality in black populations, and gsls were related to reductions of mortality in black and hispanic populations. rees et al. (2019) found that nals were associated with a statistically significant decrease in non-heroin opioid-related deaths. the adoption of a gsl resulted in a decrease of 12–19%; early adopters of nals or those that passed nals before 2011 experienced an 18–29% reduction in overdoses. however, it was also found that nals were only effective on the western coast, and the eastern and southern us experienced little impact due to fentanyl not fully reaching the west in 2014. naloxone naloxone (narcan) can be used as a rescue medication for opioid overdose or as a preventive measure for those wanting to stop using opiates. it is an opioid antagonist, meaning it binds to opioid receptors, which prevents them from being activated by opiates. it binds more strongly than other drugs, so that when someone is overdosing on opioids, naloxone can be administered, allowing it to take the place of the opioid drug in the person's receptors, turning them off. this blocks the effect of the receptors. take-home naloxone overdose prevention kits have shown promise in areas exhibiting rapid increases in opioid overdoses and deaths due to the increased availability of fentanyl and other synthetic opioids. many counties offer naloxone training programs with the aim of educating the surrounding community on how to use naloxone. early implementation of programs that widely distribute thn kits across these areas can substantially reduce the number of opioid overdose deaths. additionally, persons at risk for opioid overdose did not engage in riskier, compensatory drug use as a result of having access to naloxone kits. overdose prevention centers despite the illegality of injecting illicit drugs in most places around the world, many injectable drug users a report willingness to utilize overdose prevention centers. those at especially high risk for overdose were significantly more willing. this observed willingness suggests that safe injection sites would be best utilized by people who could benefit most from them. as of 2018, legislation in the us did not allow for the opening of overdose prevention centers; there were no government-sponsored sites but several efforts were underway to try to create them. critics of overdose prevention centers say they enable and exacerbate drug use. data from 2014 suggested that safe injection sites could reduce overdoses while not increasing the number of drug users. needle exchange programs the cdc defines needle exchange programs (nep), also known as syringe services programs, as "community-based programs that provide access to sterile needles and syringes free of cost and facilitate safe disposal of used needles and syringes". nep were first established in the us in the late 1980s as a response to the hiv pandemic. because federal funding has long been banned from being used for nep, their prominence in the us has been minimal. however, in early 2016, in the face of the ever-increasing heroin crisis, congress effectively rolled back those regulations and is now allowing federal funding to support certain aspects of nep. nep are cited by the cdc as a vital aspect of the multi-faceted approach to the opioid crisis. while opposition to nep includes fears of increased drug use, studies have shown that they do not increase drug use among users or within a community. nep have also been known to increase admittance into addiction treatment centers, offer counseling, housing support and help users begin the path to recovery through outreach from trusted staff. in addition, nep that operate on a one-for-one basis help to drastically reduce the amount of discarded needles in public. both the center for disease control and national institute of health support the idea that nep are a crucial aspect to a comprehensive approach to the opioid crisis. use of blue lights public bathroom illuminated with blue lights to deter the use of drugs, supposedly making it harder to find veins as of 2018, some retailers had begun experimenting with the use of blue light bulbs in bathrooms in order to deter addicts from using such spaces to inject opiates. blue lights are said to make finding veins to inject more difficult. however, a 2013 study has found that the use of blue lights are unlikely to deter drugs users from injecting in public washrooms and may increase drug use-related harm. pill mill a "pill mill" is a clinic that dispenses narcotics to patients without a legitimate medical purpose. this is done at clinics and doctors offices, where doctors examine patients extremely quickly with a purpose of prescribing painkillers. these clinics often charge an office fee of $200 to $400 and can see up to 60 patients a day, which is very profitable for the clinic. pill mills are also large suppliers of the illegal painkiller black markets on the streets. dealers may hire people to go to pill mills to get painkiller prescriptions. there have been attempts to shut down pill mills. 250 pill mills in florida were shut down in 2015. florida clinics also are no longer allowed to dispense painkillers directly from their clinics, which has helped reduce the distribution of prescription opiates. since the implementation of pill mill laws and drug monitoring programs in florida, high-risk patients (defined as those who use both benzodiazepines and opioids, those who have been using high opioid doses for extended periods of time, or "opioid shoppers" that obtain their opioid painkillers from multiple sources) have shown significant reductions in opioid use. opiate self-injection paraphernalia trafficking as the number of opioid prescriptions rose, drug cartels began flooding the us with heroin from mexico. for many opioid users, heroin was cheaper, more potent, and often easier to acquire than prescription medications. according to the cdc, tighter prescription policies by doctors did not necessarily lead to this increased heroin use. the main suppliers of heroin to the us have been mexican transnational criminal organizations. from 2005 to 2009, mexican heroin production increased by over 600%, from an estimated 8 metric tons in 2005 to 50 metric tons in 2009. between 2010 and 2014, the amount seized at the border more than doubled. according to the drug enforcement administration, smugglers and distributors "profit primarily by putting drugs on the street and have become crucial to the mexican cartels.": 3 illicit fentanyl is commonly made in mexico and trafficked by cartels. north america's dominant trafficking group is mexico's sinaloa cartel, which has been linked to 80 percent of the fentanyl seized in new york.