opiate epidemic response bill, otherwise known as 'chapter 63', into law. this law aims to raise funding to combat the opioid epidemic, specifically in minnesota, via the taxation of pharmaceutical companies, prescribers, and medication distributors. the gathered funds will be deposited into the 'opiate epidemic response account' and allocated by the opioid epidemic response advisory council, created through the bill's legislation. the council will be in charge of distributing the funds throughout the state to ensure the most significant impact on those communities hit hardest by the opiate epidemic. the state hopes to collect upwards of $20 million in fees annually to contribute to funding programs created by the council. missouri in december 2019, the national council on alcoholism and drug abuse (ncada-stl) reported that st. louis had a new high of opioid overdose deaths at 1018. when the covid-19 pandemic occurred three months later, it impacted opioid overdoses incidents significantly, particularly among the black community in north st. louis county, north st. louis city and parts of south city. combatting the intersecting outbreaks, local federally qualified health centers (fqhc) have combined to provide simultaneous narcan, nasal spray naloxone, an opioid antagonist, and increased access to covid-19 resting. nevada by may 2020, nevada experienced a 23% increase in opioid overdose deaths, when compared to 2019. overdose deaths in the state peaked in 2011 but were on the decline ever since, until 2020. over half those deaths involved fentanyl. the nevada overdose to action program reported it was difficult to ascribe the increase to the covid-19 pandemic, but, like health care providers across the country, the group felt that the isolation and stress caused by the pandemic contributed to the increase in mortality. the overdose mapping application program, developed by university of baltimore, has reported an increase in overdose-related mortality, particularly in southern nevada. the deaths, thought to be connected to individuals ingesting opioids when isolated, can be prevented with the use of the opioid antagonist naloxone as recommended by the southern nevada health district. new jersey the state suffered 3021 drug-related deaths in 2019 when 3.99 million opioid prescriptions were dispensed, down slightly from 3102 in 2018 when 4.3 million opioid prescriptions were filled. in the first quarter 2020, drug-related deaths were 789. the coronavirus pandemic has overshadowed another, longer term crisis in the state – the opioid epidemic. detox centers have cut down on accepting patients, people in 12-step programs must meet online, and individuals who successfully complete rehab face more hurdles – unemployment and homelessness. “it’s almost like everything has been stopped in time,” said john pellicane, director of the office of mental health and addiction awareness task force in camden county, new jersey. phone calls to the state's addiction hotline, reachnj, increased from an average 3,500/month to 4,000/month. morris county overdoses increased by 41% in first quarter 2020. there were 100 more overdose deaths in the same period – statewide. bergen county suspended all face-to-face substance use disorder counseling and meetings. the state does not approve of virtual meetings or counseling due to confidentiality concerns and trust issues. in 2020, new jersey attorney general gurbir grewal announced that, during the covid-19 pandemic, all medical personnel were required to prescribe the opioid antagonist naloxone to individuals ingesting higher doses of opioids or those combining opioids with benzodiazepines, such as xanax, an anti-anxiety medication. this regulation, already in the process of being recommended by various state entities, was adopted quickly in response to the coronavirus pandemic and a concomitant increase in overdose mortality. first responders also reported an increase in dispensing naloxone to those suffering from overdoses. it was thought that providing naloxone to individuals whose prescriptions were the equivalent or 90 morphine milligrams would free medical emergency workers and police from responding to overdose exigencies. by may 2020, gov. phil murphy's administration reported that mortality from opioid overdoses had increased 20%. to counter the trend, the state sent 11,000 doses of the nasal spray naloxone. the first shipment went to 178 emergency medical service teams across the state. for more information, see response to the opioid crisis in new jersey. new york the new york state department of health reported that the office of national drug control policy wanted to use new york's police training policy on opioids as a model for other states. additionally, in 2019 nysdoh began the ny state opioid data dashboard, which provides datapoints to educate local opioid-prevention officials and policy makers on the epidemic. the dashboard includes quarterly updates on opioid overdose information like mortality, ed visits and hospitalization by county throughout the state. nysdoh also developed i-stop, a requirement for all prescription-providing health care professionals to report and track their prescriptions for controlled substance drugs, thereby stemming patients from seeing many doctors for prescriptions. the combination of the covid-19 pandemic and the opioid crisis causes unique problems for recovering addicts who rely on community support in a time of social distancing. a binghamton ny addiction resource center, truth pharm, has revamped its naloxone training to a virtual model. additionally, even virtual naloxone training can be more than simply administering a life-saving drug as it provides those struggling with addiction a human contact and the ability to discuss specific needs and issues. in 2020, there was a 25.8% increase in opioid overdose cases and a 38% increase in overdose deaths in the rochester area (monroe county). concern over the overdose growth has led to legislators introducing legislation in the state assembly that would require pharmacies to offer a dose of naloxone to individuals receiving an opioid prescription. naloxone is presently available in new york state without a prescription. the new legislation provides funding for the payment of co-pays or free naloxone if the individual has no insurance. further efforts to combat the opioid epidemic focus on the criminal justice system. opioid intervention courts such as the buffalo drug treatment court (bdtc) seek to connect offenders who are drug-addicted to resources. participants are given the opportunity to receive comprehensive medical rehabilitation. established in 2017, this court program has resulted in the successful recovery of many participants, a key step in preventing recidivism and combating the opioid epidemic. ohio at 24.6 deaths per 1,000 people, ohio has the 5th highest rate of drug overdose deaths in the united states. the governor's cabinet opiate action team (gcoat) was created in 2011 by governor john kasich and is "one of the nation's most aggressive and comprehensive approaches to address opioid use disorder and overdose deaths, including a strong focus on preventing the nonmedical use of prescription drugs". gcoat utilizes partnerships with various state agencies including the ohio board of pharmacy. the strategy suggests regulations that are encompassed under three main categories: (1) to promote the responsible use of opioids, (2) to reduce the supply of opioids, and (3) to support overdose prevention and expand access to naloxone. the legislation reduced the number of opioid doses by over 80 million between 2011 and 2015. also, unintentional drug related overdose deaths involving prescription opioids have decreased from 45% in 2011 to 22% in 2015. however, ohio has not seen a decrease in fentanyl distribution. the coronavirus pandemic of 2020 reduced treatments for those suffering from substance use disorders in many ohio counties, leading to increases in drug overdoses. for example, highland county experienced double the amount of drug overdose calls to the sheriff's department from may 2019 to may 2020. the number of overdoses in franklin county increased by 50% in the first four months of 2020. pennsylvania the city of philadelphia suffers from the highest rate (among all us big cities) of drug overdose in the country, averaging three mortalities per day in 2019, a situation intensified by the 2020 coronavirus pandemic. prevention point philadelphia, the us's largest syringe-exchange organization, doubled the amount of the nasal spray naloxone it distributed in the first month of the city's stay-at-home order. the city's overdose mortality rated remained the same as it was pre-pandemic, providing an indication that more naloxone was being administered to overdose victims. several philadelphia-based public health and criminal justice support groups were providing cell phones to homeless people and inmates recently released from prison so they can experience telehealth healthcare provider visits and renew prescriptions for opioid antagonist medication. the pennsylvania harm reduction coalition (pahrc) initiated a new postal service-based naloxone distribution program that delivers the drug directly to the home. the group also included ppe gloves and face shields with the naloxone kits in an attempt to limit coronavirus dispersal. beaver county pa, after experiencing a decline in opioid overdose deaths from 2017, saw a 30% increase in those deaths since the pandemic began, according to upmc western psychiatric hospital addiction medicine services. the county also suffered from an increase in domestic violence, child abuse, and worsening drug and alcohol use disorder, all attributed to the isolation caused by the pandemic. south carolina the state suffered 1,103 overdose fatalities in 2018. in 2020, state substance use disorder remedial facilities were concerned about the impact of covid-19. they emphasized the importance of group meetings; several have moved the meetings outside. the phoenix center, in greenville, limited large meetings and restricted visitor access to its in-patients. other providers have turned to on-line meetings, but participation is down. the south carolina department of alcohol and other drug abuse services (sc daodas), concerned about the effects of the coronavirus pandemic on state residents suffering from substance use disorder, fears a setback in its battle with the opioid epidemic. the apprehension that self-quarantining and the isolation it brings can cause loneliness, anxiety, boredom, clinical depression or ptsd can lead to enhanced overdose risk. in april 2020, the department provided over 7,000 boxes of naloxone, the nasal spray overdose reversal drug while encouraging afflicted south carolinians to take advantage of the daodas’ system of state-licensed and nationally accredited service providers. the department also encouraged individuals to reach out to friends and family during this crisis. tennessee carter county, tennessee, population 56k, has experienced nearly 60 opioid overdose deaths since 2014, a year in which 8.1 million opioid prescriptions were written in the entire state, population 6.5 million. to stem that consequence of addiction, the county's drug prevention alliance embarked on a controversial policy – providing naloxone distribution training to around 600 children and teenagers. some of the children have taught what they learned to their peers and distributed naloxone at community events where one child handed out 70 doses of the drug. the region is a conservative one where residents, law enforcement and school boards have objected, considering naloxone a “waste of resources” and the training not child-appropriate. a spike in overdoses and overdose deaths due to the covid-19 pandemic led memphis-area baptist hospitals and integrated addiction care (iac), an outpatient rehab group, to set up a 24/7 hotline for individuals struggling with addiction. the shelby county health department stated that people with substance use disorder issues should have access to both the care they need and to naloxone, the nasal spray opioid antagonist. the free hotline is staffed by physician professionals who can provide medical advice or direct callers to an emergency department. texas studies have found that after the implementation of "pill mill laws" in texas, opioid dose, volume, prescriptions and pills dispensed within the state were all significantly reduced. vermont the number of opioid overdoses in burlington, vermont increased by 76% in 2020; the number of nonfatal overdose emergency room visits went up 100% in the same period, according to burlington's police department. but the number of overdose fatalities went down for the first time since 2014. the overdose increases are due to an influx of fentanyl, a synthetic opioid, as well as the pressures of the covid-19 pandemic; the mortality decreases are the result of safety measures, such as the community distribution of naloxone. wisconsin the state of wisconsin established the hope (heroin, opiate prevention and education) agenda to face the opioid epidemic. the enactment of act 262 took place on april 9, 2018. the act focuses on bettering substance use disorder counseling, which is critical in the opioid withdrawal process. utah in 2017, rep. edward redd and sen. todd weiler proposed amendments to utah's involuntary commitment statutes which would allow relatives to petition a court to mandate substance-abuse treatment for adults. washington in february 2017,