Why Does This Exist?

The Gap Between Saving a Life and Saving a Person

In Milwaukee County, as of 2023, a fatal overdose occurs every 16 hours.² Fire Captain Dave Polachowski described what that means for the crews responding to those calls: they “know these addresses by heart. Third call this month. Fifth call this year. They save the life, pack up their gear, and know they’ll be back.” He acknowledged the toll directly: “There have been tears shed in this building and in cars.”³

The problem overdose response teams exist to solve is not the overdose itself. EMS handles that. The problem is what happens after. And for most of the country, the answer is: nothing.

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The Status Quo: Treat the Emergency, Ignore the Person

The traditional emergency response system treats an overdose as an isolated medical event. Paramedics arrive, administer naloxone, stabilize the patient, and either transport to an emergency room or clear the scene. The ER reverses the overdose, monitors for complications, and discharges the patient. In most cases, the person leaves with a referral slip and no follow-up appointment.

David Torsell of Escambia County Emergency Medical Services described the result: “Nobody is following up. They get a little piece of paper that says, ‘Your follow up is this day. Go here. Good luck to you.'” The person returns to the same conditions, the same environment, the same cravings. “You’re not going to see them again until they come back for their next overdose.”⁴

This is not a failure of any individual responder. Paramedics are trained and equipped to handle acute medical emergencies. They are not trained to provide addiction counseling, treatment referrals, or the sustained engagement that recovery requires. And they cannot stay on scene for hours with one patient when the next call is already waiting. Emergency rooms face the same constraint at a larger scale. Portland’s Mary-Rain O’Meara, director of community development at Central City Concern, reported that the lack of follow-up services “forces Central City Concern’s current stabilization center to send one-third of the 3,000 people it serves back to the streets after they leave detox.”⁵

The system is designed for acute episodes. Addiction is a chronic condition.

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The Revolving Door

The consequence of treating each overdose as a standalone event is a cycle that EMS crews, emergency departments, and law enforcement know well.

Polachowski described it from the fire department’s perspective: the same addresses, the same patients, the same calls, week after week. “People call it enabling,” he said of the skeptics. “We don’t look at it like that. We say it’s enabling you to stay alive until you are willing to get treatment.”³

The cycle costs more than time and morale. Every repeat overdose call deploys a paramedic crew that could be responding to a cardiac arrest, a car accident, or a stroke. Every ER visit for an overdose that could have been prevented with treatment connection costs thousands of dollars and occupies a bed needed for other patients. Portland’s Community Health Assess and Treat (CHAT) program demonstrated that 68% of overdose patients could be treated in the field without ER transport, saving an estimated $9 million in healthcare system costs as of November 2024, according to Deputy Fire Chief Stephanie Sullivan.⁶ Those savings represent ER capacity freed for emergencies that actually require hospital-level care.

For law enforcement, the toll takes a different form. Austin Police Association President Michael Bullock has argued publicly that law enforcement should not be the primary responder to overdose calls, a position consistent with his broader advocacy for reducing non-criminal demands on officers.⁷ The time officers spend on overdose-related calls is time not spent on the public safety work they are trained and equipped to do.

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The Fentanyl Shift

The opioid crisis that created the original need for overdose response teams has changed fundamentally in the past decade.

Fentanyl has replaced heroin as the dominant opioid in most of the country. Milwaukee recovery counselor Ryan Gorman reported that “the prevalence of actual heroin is almost nonexistent from what we see in urinalysis and just word on the street.”³ In Connecticut, fentanyl was involved in 84% of overdose deaths in 2023, declining to approximately 77% in 2024.¹¹ In Austin, police found fentanyl mixed into crack cocaine, methamphetamine, and marijuana.²⁰

The demographics have shifted accordingly. Polachowski reported fatal overdoses “ranging from teenagers to an 83-year-old.” He listed the people his crews encounter: “Combat veterans. High school seniors. Young mothers.”⁸ Connie Priddy, the registered nurse who coordinates Huntington’s Quick Response Team, described the same realization: “Even in 2017, I think we had in our mind what we thought was a stereotypical client. And we quickly realized that we could go into an area that somebody might be living in an abandoned house with a dirt floor, and then the next minute, we’re going into a million-dollar home.”¹³

The population affected by overdose no longer fits any single profile. The crisis is broader, more lethal (fentanyl’s potency makes overdose more likely and harder to reverse), and complicated by new adulterants. Xylazine, a veterinary sedative that does not respond to naloxone and causes severe tissue wounds, was involved in approximately 27% of opioid overdose deaths in Milwaukee County in 2023, up from 1% in 2020.⁸ New Britain’s public health chief Sam Bowen described the challenge of “trying to address the latest craze, xylazine” while fentanyl was already “in everything.”⁹

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The Window

A 2019 Massachusetts study found that the first month after an overdose, and particularly the first two days, is the highest-risk period for a subsequent fatal event.¹ The period immediately following an overdose, particularly the first 24 to 72 hours, represents both maximum vulnerability and, according to Priddy in Huntington and Polachowski in Milwaukee, a period when some people are more open to accepting help than at any other time.

But that window does not stay open indefinitely, and it does not open on anyone else’s schedule. Becky Tinney, special projects director at the Recovery Resource Council in Dallas, framed the stakes plainly: “We can’t rehabilitate somebody who’s dead. Somebody who dies from an overdose doesn’t have an opportunity to learn from their mistake. We have to start thinking of different ways to address this epidemic.”¹⁴

The traditional system has no mechanism to reach people during this window. EMS has moved on to the next call. The ER has discharged the patient. The person’s next scheduled contact with the healthcare system, if one exists at all, may be weeks away. By then the window may have closed.

Overdose response teams exist to fill that specific gap. They are the part of the system that goes back.

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Who Is Affected

The impact of the revolving door extends well beyond the person who overdosed.

Families bear an enormous burden. Programs in Huntington and Milwaukee report that families are often the team’s first point of contact, because the overdose survivor has left or cannot be found. Teams leave naloxone and information with family members, but families are also dealing with their own grief, exhaustion, and fear. Huntington’s clergy team members reported that their involvement helps them “feel less helpless after burying so many people, ranging from young to old, rich to poor and everyone in between.”¹²

First responders carry the weight of repeated calls to the same addresses with the same outcomes. Polachowski’s description of tears in fire stations is not an isolated anecdote. Huntington’s QRT added clergy members in part because paramedics and law enforcement on the team were experiencing compassion fatigue from visiting the same people repeatedly.¹² Portland firefighters responded to an average of 19 overdose calls per day in 2023.¹⁰

Emergency departments absorb the cost of treating a chronic condition through an acute care system. Portland’s CHAT team treated 68% of overdose patients in the field as of November 2024, according to Deputy Fire Chief Sullivan.⁶

Communities experience the crisis through its secondary effects: public overdoses in parks and business districts, discarded needles, the visible presence of addiction in public spaces, and the fear and frustration that come with watching the same cycle repeat without resolution. These effects are real and they drive the political demand for alternatives, but the core problem remains medical: a chronic condition treated only through emergency intervention, with no mechanism for sustained engagement between episodes.

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What Changed

What changed was that specific programs demonstrated a workable alternative.

Colerain Township, Ohio launched the first overdose response team in July 2015, pairing a police officer, a firefighter/paramedic, and an addiction counselor to follow up with overdose survivors.¹⁵ The model spread because it was concrete and replicable: review EMS reports, identify overdose survivors, go to their homes within days, offer help. It did not require new legislation, new facilities, or massive budgets. It required a paramedic, a peer recovery specialist, and the institutional willingness to let them do the work.

By 2020, the Department of Justice had designated eight programs as national mentor sites to train new teams across the country.¹⁶ Ohio alone had expanded to over 80 of its 88 counties.¹⁵ West Virginia coordinated programs across 33 counties.¹⁷ Cities as different as Portland, Milwaukee, Houston, Burlington, and Austin had built their own versions.

The opioid settlement funds that began flowing in the early 2020s provided a new funding mechanism specifically designated for this kind of work. Wisconsin expects approximately $780 million through 2038 from combined opioid settlements.⁸ Connecticut expects roughly $600 million total.¹¹ Travis County, Texas allocated $860,000 from its opioid settlement for overdose response services.¹⁸

Austin Mayor Kirk Watson described the shift: “We are no longer in Austin and Travis County reacting to a crisis. We are building a system that prevents it.”¹⁹

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The Bottom Line: Overdose response teams exist because the traditional emergency system treats overdoses as isolated events, with no mechanism for follow-up or treatment connection. The person is revived, discharged, and returned to the same conditions that produced the overdose. The cycle repeats, consuming paramedic time, ER capacity, and lives. These teams fill the specific gap between the acute emergency and sustained recovery, reaching people during the 24-to-72-hour window when they may be most open to accepting help. The fentanyl crisis has made the need broader and more lethal. The opioid settlements have made the funding available. Most communities still have nothing in place to fill the gap.