On a recent morning, a co-owner of Revere cafe Chocolafee, Diana Cardona, switched up her 12-hour workday of preparing food, waiting on customers and managing books to meet a nurse who came in for an unusual training.

Cardona was going to learn how to respond if someone in or near her restaurant overdoses on opioids.

The training is part of the city of Revere's efforts to stem the opioid crisis. It's funded with money from nationwide settlements with opioid companies.

Registered nurse Denise Hartley, co-founder of Atlantic Hill Nursing and Wellness, demonstrates to cafe owner Diana Cardona how to administer naloxone. (Jesse Costa/WBUR)

Registered nurse Denise Hartley opened a zippered pouch that looked like a pencil case. She took out two bottles of the overdose-reversal medication naloxone, instructions in English and Spanish and a pair of latex gloves.

She told Cardona what signs to look for to determine if someone has likely overdosed on opioids: The person is nodding off or unconscious. Their lips or fingers might look blueish. And their pupils are likely the size of a pinpoint.

Hartley said the first step is to call 911. She then demonstrated how to administer a dose of the naloxone (also known by the brand name Narcan), by putting the bottle in the person's nostril and pushing the plunger once. She also explained what to do if someone doesn't respond immediately to the medication — or does come to, but then becomes unresponsive again.

Cardona said the training left her feeling prepared to use the medication on someone who appears to have overdosed.

“I think it's very, very well explained, and it's very easy to use," she said. "I hope it doesn't happen, but if it has to happen, I feel like I will be able to help.”

"It's a no-brainer of why we needed to have [naloxone] in the businesses. I mean, you literally can save a life with a spray up the nose."

CarrieAnn Salemme, city of Revere employee

The most recent state data, from 2020 through 2024, show Revere's rate of overdose deaths was higher than the rate for Massachusetts as a whole. In 2022, the year deaths peaked in the city and statewide, 30 people died in Revere and 2,364 across the state.

Cardona, who hosts a video podcast at her cafe in which she interviews local politicians, medical experts and other leaders about various issues, knows all too well how hard opioids have hit Revere.

"We have a client here who lost her son because of the use of drugs in vapes," Cardona said. "He was vaping, and he ended up having fentanyl in the vape.”

Putting opioid settlement funds to use

Massachusetts communities overall have been slow to make use of funds from settlements with opioid companies. The money started rolling out in 2022, after nationwide settlements were reached with several companies that manufactured, distributed and dispensed opioids, including Johnson & Johnson and CVS.

States had claimed in lawsuits that the companies had fueled the opioid epidemic by pushing the medications despite knowing their addictive harms. The agreements are expected to funnel more than $1 billion to Massachusetts by 2038, with more than half of the money going to the state and the rest to municipalities.

Some cities that already had staff and infrastructure to implement substance use abatement programs acted quickly, in some cases spending funds within the first year, according to data compiled by the state Department of Public Health. Others took a long time to start putting the money to use or still have not started using it, with many of those communities reporting to the state that it's taking time to gather required feedback from community residents, hire staff and develop programs.

In fiscal year 2025, Massachusetts cities and towns collectively spent about 12% of the $107.7 million they had on hand from three years of settlement disbursements.

A naloxone box outside of the Revere Beach MBTA station. (Jesse Costa/WBUR)

As of this time last year, Revere had spent 30% of its approximately $664,000 funds. In addition to the business naloxone training program, the city has put up nine naloxone cabinets on city streets, where anyone can grab the medication. City workers do outreach to people experiencing substance use disorder and homelessness. They also provide support to people in recovery.

How businesses can help save lives

CarrieAnn Salemme, program manager for Revere's Substance Use Disorder and Homelessness Initiatives Office, said there's a reason the city asks businesses to be on the front line against fatal opioid overdoses: data the police department sends to the office show a lot of overdoses are happening in or near places like fast food restaurants and gas stations.

"It's a no-brainer of why we needed to have [naloxone] in the businesses," Salemme said. "I mean, you literally can save a life with a spray up the nose."

CarrieAnn Salemme, from Revere's Substance Use Disorder and Homeless Initiatives Office, holds weekly drop-in hours at a police substation for people to get help addressing their needs. (Jesse Costa/WBUR)

The company Atlantic Hill Nursing and Wellness, Inc. contracts with Revere to run the training program. It began as a pilot program at the start of 2025, with a goal of training staff at 30 businesses in six months. But the nurses said the program quickly grew, because the businesses were so receptive.

They've trained workers at 198 establishments — from barbershops and banks to gyms and hotels. They leave one of the small pouches with the naloxone, gloves, medical masks and instructions at each place.

“If there's an overdose happening in a public place in Revere, there should be five people with a naloxone kit saying, ‘I have naloxone. I can respond to this,’ " nurse Kerrin Maloney said.

The nurses will restock any naloxone that gets used. No business in the city has reported it’s used its supply yet, Maloney and Hartley said.

Revere businesses that undergo the training receive small kits with two naloxone doses, instructions, medical masks and gloves. (Jesse Costa/WBUR)

Still, state health officials say programs that distribute naloxone work and have contributed to a drop in fatal opioid overdoses across Massachusetts since the 2022 peak. Preliminary state data show deaths dropped to 978 last year, the first year in more than a decade that there were fewer than 1,000 fatalities.

In Revere, the numbers of both fatal and non-fatal overdoses have declined significantly in that timeframe, as well.

Protection for businesses

On the same day she held the cafe training, nurse Hartley stopped at Wonderland Liquor Store in Revere. Usually, she and her colleagues show up at businesses with no advanced notice; they said they've found that's more successful than calling to try to arrange trainings. In this case, they did arrange them in advance to let the business owners know that some journalists wanted to observe.

Claudia Cabrera of Wonderland Liquor Store in Revere listens to nurse Denise Hartley during the naloxone training. (Jesse Costa/WBUR)

Claudia Cabrera was managing the liquor store her father owns. She said she was on board with administering naloxone, but wanted to make sure she would do it correctly.

"My main concern would be, like, if I would cause harm to the person if I were to do anything, or if I did a step wrong," Cabrera said.

But she said the simple instructions put her at ease.

Hartley pointed out that naloxone isn't harmful if, for example, it's administered to someone who is not under the influence of opioids. She also stressed that Massachusetts has strong good samaritan laws , which means a person or business can't be sued if acting in good faith to help someone.

“Every time we can give this out, it's a life that could possibly be saved. So we’re very, very grateful," Hartley said as she headed out of the store.

This segment aired on July 9, 2026.

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Lynn Jolicoeur Producer/Reporter

Lynn Jolicoeur is a senior producer and reporter.

Lisa Mullins Host, All Things Considered

Lisa Mullins is the voice of WBUR’s All Things Considered. She anchors the program, conducts interviews and reports from the field.