In gas stations, libraries and high school hallways across the New River Valley, a video-guided naloxone kit is turning bystanders into first responders. What the ONEbox rollout means for Roanoke, where overdose deaths have been cut in half but still take a life almost every week.

Roanoke, VA

Author: Roanoke Rambler Staff

Published: 9:57 AM EST September 2, 2026

Edited: 9:59 AM EST September 2, 2026

The box on the wall

You've walked past it a hundred times without noticing: the small white cabinet screwed to the wall next to the fire extinguisher, an unblinking green cross above it, a defibrillator inside. In the New River Valley this month, a second box has started to appear next to it. This one is purple. Pull the tab and a screen inside starts a one-minute video in English and Spanish. A calm voice tells you what to look for — the blue lips, the shallow snore, the cold skin — and walks you, step by step, through the seconds that can decide whether the person on the floor lives or dies.

Inside the box are two doses of naloxone nasal spray, a CPR face shield, a pair of gloves and alcohol wipes. That is all. It costs the business or school where it hangs nothing to install.

On September 1, the New River Valley Regional Commission and the New River Health District announced that, working together as the NRV Recovery Ecosystem, they have bought 460 of these ONEboxes and are putting them into public spaces from Floyd to Giles to Pulaski. In August alone, the commission's Community Health Team installed more than 200 — in bars and gas stations, movie theaters and vape shops, libraries and schools. They have named the campaign "Paint the NRV Purple."

The Roanoke Valley is next door to that effort geographically. It is also next door to it statistically. And even though the ONEbox program is a New River Valley initiative, the numbers behind it and the science of what a purple box on a wall can do are the story of Roanoke's decade, too.

What a ONEbox actually is

The ONEbox was invented by Joe Murphy, a West Virginia native and guitarist who watched fentanyl carve through his hometown and decided to design a piece of emergency furniture for the epidemic. His company, Murphy Media, developed the kit, and the West Virginia Drug Intervention Institute, a Charleston-based nonprofit, manages its distribution. Boxes are assembled by West Virginians in recovery. (West Virginia Drug Intervention Institute; WV DHHR)

The pitch is deliberately simple: make naloxone as banal, as public, and as unremarkable as an AED. Pull a tab, hear the instructions, save the person on the floor. Bloomberg profiled the invention in 2023. Since then the boxes have spread to college campuses in West Virginia, North Dakota and North Carolina, to Virginia Tech's residence halls, and now, for the first time at scale, across a five-locality region of Southwest Virginia. (Virginia Tech News; NDSU; Elon University)

Each unit is designed to sit next to the AED and the Stop the Bleed kit — three cabinets, three flavors of emergency, one wall. That co-location is not incidental. Public-health researchers who study bystander intervention have found for years that the largest single variable in an overdose survival is whether naloxone reaches the victim within the first few minutes. Cardiac arrest science teaches the same lesson about defibrillators; the AED programs of the 1990s and 2000s are the direct template.

"We want to make naloxone just as accessible and familiar as other emergency response equipment," Anna Champion, the NRVRC's program administrator for community health, said in the announcement. "By placing ONEboxes where people live, work, learn, and play, we can give our communities another tool to respond when every second matters."

That sentence is the philosophy of the entire modern harm-reduction movement, condensed. It is also, quietly, an argument that the war on overdoses will not be won inside hospitals.

Who is paying for it, and why

The 460 ONEboxes were purchased with two pools of money.

The first is local: direct investment from Floyd, Giles, Montgomery and Pulaski counties and the City of Radford — the five member localities of the New River Valley Regional Commission. The second is a much larger check from Richmond. Under a June 2025 award, the Virginia Opioid Abatement Authority granted Montgomery County, acting as fiscal agent for the five NRV localities, roughly $3.3 million to launch the Opioid Ecosystem of Recovery for the New River Valley. In June 2026, the OAA renewed the ecosystem for another year at $2,412,966. The ONEbox rollout is one line item inside that larger cooperative grant. (OAA June 2025 release; OAA June 2026 release)

The Opioid Abatement Authority is a Virginia oddity worth understanding, because it is now one of the largest single funders of substance-use response in the state. It is an independent body created to spend the Commonwealth's share of the national opioid settlements — the multibillion-dollar payouts extracted from Purdue Pharma, Johnson & Johnson, the big three drug distributors and others. Virginia law requires at least 50 percent of those settlement dollars to flow back to cities and counties. In the OAA's most recent cycle, the authority announced more than $35.2 million in awards for the 2027 performance period across 150 projects statewide. (OAA About page)

Roanoke residents have a direct stake in this pot. In that same June 2026 cycle, the OAA approved a suite of Roanoke City–led awards worth well over $1.3 million, including $371,582 to build and expand a collaborative regional recovery ecosystem, $207,800 in new money to support the Bradley Free Clinic's HOPE Initiative, $181,445 in new funding for On Our Own Roanoke Valley, $154,800 to continue the Four Truths Recovery program for pregnant and postpartum women, $51,520 for harm reduction, $54,490 for the Roanoke City Schools Teen Outreach Project, $46,183 in new funding for a RAM Opioid Abatement Program, and $25,050 for certified peer recovery specialists. Roanoke County received $161,500 for its Partnership for Community Wellness. (OAA June 2026 release)

In other words: the same settlement stream that is bolting purple boxes to Pulaski County high school walls is funding peer recovery specialists inside the Roanoke City jail, harm-reduction supplies at the Bradley Free Clinic, and a maternal-health initiative for pregnant women fighting addiction on Patterson Avenue.

Why this story matters in Roanoke

Here is the number that should sit at the center of any Roanoke story about opioids: nearly 80.

That is the number of Roanoke Metro residents — Roanoke City, Roanoke County and Salem — who died of unintentional overdose in 2024, according to the Virginia Department of Health's January 2026 "Peaks and Valleys" report. The majority of those deaths, the report says, were fueled by fentanyl. (VDH Peaks and Valleys)

Nearly 80 in a year is one dead neighbor every four and a half days.

And that is after a dramatic improvement. The same VDH report finds that overdose deaths in Roanoke Metro have fallen roughly 50 percent since a 2022 peak — a peak the report attributes to the compounding pressures of the COVID-19 pandemic and the tightening grip of illicit fentanyl. In Roanoke City specifically, where the fatality rate had been among the nation's highest, the drop is also about 50 percent. Statewide, VDH's preliminary 2025 data show 1,197 drug overdose deaths, a 23-percent decline from 2024, and continuing a downward trend that the department, the Roanoke Valley Collective Response and outside analysts credit in part to expanded naloxone access. (VDH Peaks and Valleys; VDH Drug Overdose data page)

But the report also carries two warnings that reframe the good news.

The first: emergency-department visits for unintentional overdose in Roanoke Metro remain more than twice the state average. Men are twice as likely as women to visit the ED for an overdose; adults ages 30–44 face the highest rates. (VDH Peaks and Valleys)

The second: for the first time in five years, Black residents of Roanoke Metro are more likely than white residents to die of an overdose. That is a bright, unwelcome flare in a public-health graph, and it is the same disparity the Virginia Opioid Abatement Authority is trying to address through its Operation STOP! funding stream, which channels money to localities where fatal overdoses disproportionately affect Black residents. (VDH Peaks and Valleys; OAA June 2026 release)

The Roanoke Valley is winning the fight. It is also still burying its neighbors.

Who is putting the boxes up

The most quotable voice in the NRV rollout is Robert Graham, superintendent of Pulaski County Public Schools. His schools are among the first in the region to install ONEboxes.

"As superintendent, there is no greater responsibility than doing everything we can to protect the lives of our students and staff," Graham said in the September 1 announcement. "Bringing the OneBox into our schools gives our team another critical tool to respond quickly in an emergency, and if it helps us save even one life, it is a very important resource for us to have."

The New River Valley Regional Commission has also made available for interview Jason Brauns, owner of the Blacksburg bars Top of the Stairs and Bottom of the Stairs, who has installed ONEboxes at his establishments — a signal that the campaign is deliberately reaching the venues, from nightlife to gas stations, where public-health messaging has historically struggled to land.

That range — a public-school superintendent and a college-town bar owner mounting the same purple box on the same week — is the argument of the whole strategy. Overdoses do not happen in one demographic or one setting. Neither, now, does the response.

Does a box on the wall really work?

The evidence from parallel programs is suggestive rather than conclusive, but it is trending in one direction.

Virginia Tech installed ONEboxes in every residence hall, including fraternity and sorority housing, beginning in 2024, placing them next to existing AEDs and Stop the Bleed kits. The university's health-services office reports the boxes have become part of resident advisers' routine emergency training, and other campuses that have adopted the model — Elon in North Carolina, West Liberty in West Virginia, and a network of colleges in North Dakota — describe similar integrations. (Virginia Tech News; Elon University; West Liberty University; NDSU)

More broadly, VDH itself credits "the increasing use of overdose-reversing naloxone and other public health strategies" as a possible contributor to Virginia's declining fatal-overdose numbers. The Commonwealth's fentanyl-overdose fatality rate has fallen from 23.9 deaths per 100,000 residents at the 2021 peak to 12.2 per 100,000 in provisional 2024 data — a 45-percent decline in one year, and the largest state-level decline in the country over the November 2023 to November 2024 window tracked by CDC, according to a policy analysis for the General Assembly. (HJR 41 policy report; VDH)

You cannot draw a straight causal arrow from a single wall-mounted kit to a state-level fatality graph. But you can note that Virginia's opioid response has become dense, layered and unusually well-funded — a $47-million-a-year settlement engine plus federal money plus a growing network of nonprofits — and that the ONEbox is the piece of that machinery most likely to be visible to an ordinary person going to a movie or getting gas.

How to get one, and where they are going

The NRV Recovery Ecosystem is still installing the remaining boxes from the initial 460-unit order. Businesses, schools, congregations, restaurants, hotels and other public spaces inside the New River Valley — Floyd, Giles, Montgomery and Pulaski counties and the City of Radford — can request a free ONEbox from the Regional Commission's Community Health Team through the online request form on the NRVRC website or by emailing cht@nrvrc.org.

The commission's target list from August's installations gives a useful map of where public-health workers believe the boxes matter most: public libraries, schools, gas stations, bars, restaurants, hotels and motels, convenience stores, movie theaters, and vape and tobacco shops. It is a list of places where a person might overdose and where, until now, no one on shift had the tool to help.

Roanoke Valley residents who want a similar response tool in their own workplace or venue currently have to go through different channels. The Bradley Free Clinic's HOPE Initiative distributes naloxone in Roanoke; the Roanoke Valley Collective Response runs training and referral programs; the Virginia Department of Health's statewide standing order allows any Virginian to obtain naloxone without a prescription; and the Health District posts distribution events regularly. (VDH standing order; OAA June 2026 release)

The obvious question for Roanoke's elected officials, business owners and school administrators is whether the city's own settlement dollars ought to fund a purple-box program of its own. The 2026 OAA award to Roanoke City for "Building & Expanding a Collaborative Regional Recovery Ecosystem" ($371,582) leaves the door explicitly open. And Roanoke's harm-reduction line item — modest at $51,520 — could be structured to include AED-style public naloxone stations if the city decided to model the New River Valley program. (OAA June 2026 release)

That would be a political choice, not a technical one. The infrastructure exists. The money exists. The proof of concept, in the next valley over, is being drilled into walls this week.

The larger frame

There is something both hopeful and unnerving about the ONEbox. On one hand, a wall-mounted overdose kit in a gas station is a piece of physical evidence that America has quietly accepted a new normal: that fentanyl is around, that anyone can walk into an emergency, that a stranger with 90 seconds of on-screen coaching can do the work that used to require a paramedic. On the other hand, that acceptance is itself the reason the death curve is bending. Naloxone in the hands of neighbors is what "harm reduction" means once you strip the jargon off.

The Roanoke Valley knows this arithmetic in a way most places do not. Its residents have spent more than a decade at the top of the state's overdose tables. They have also, in the past three years, driven the fastest sustained decline in fatalities the region has ever seen. Roanoke did not fix that alone. It did it with settlement money, with peer specialists, with a Bradley Free Clinic outreach van, with the Collective Response, with paramedics who now carry naloxone as a first-line drug, and with ordinary residents who learned to recognize a blue-lipped snore.

The purple box on the wall of a Pulaski County bar is another line in the same argument. Every one of the 460 boxes going up across the New River Valley is a bet that the person who happens to be nearby when the moment comes will be a little better prepared than they otherwise would be. In a region where the difference between a survivor and a statistic is often measured in minutes, that is not a small bet. It is, arguably, the whole game.

Anna Champion put it most plainly.

"When every second matters."

The boxes are on the walls. The naloxone is inside them. The rest is up to whoever is walking past.

For readers who want to help — or use it

• Request a free ONEbox (New River Valley locations only, for now): online at nrvrc.org or email cht@nrvrc.org.
• Get free naloxone in Roanoke: The Bradley Free Clinic HOPE Initiative and the Roanoke Valley Collective Response distribute naloxone at no cost. Any Virginian can also obtain naloxone at participating pharmacies without a prescription under the Virginia Department of Health's statewide standing order.
• Recognize an overdose: slow or shallow breathing, cold or clammy skin, blue or gray lips or fingertips, unresponsiveness, a deep gurgling snore. Call 911, then administer naloxone if available.
• If a ONEbox is available: pull the tab. The video will play in English or Spanish. Follow the steps. Virginia's Good Samaritan protections apply.

Contact for interviews on the NRV rollout: Anna Champion, Program Administrator for Community Health, New River Valley Regional Commission, 540-639-9313 x206, achampion@nrvrc.org. Additional interview subjects made available by NRVRC: Jason Brauns, owner, Top of the Stairs/Bottom of the Stairs, Blacksburg; Rob Graham, superintendent, Pulaski County Public Schools; Mary Cheverton, director of student services, Pulaski County Public Schools.