How Is This Different?

Five Things That Look Similar but Aren’t

Overdose response teams sit in a crowded space. EMS already responds to overdoses. Emergency rooms already treat them. Harm reduction programs already distribute naloxone. Mobile crisis teams already handle substance use calls. And law enforcement already shows up when someone overdoses in public.

The question a local leader needs answered is not whether these other resources exist, but what specific function overdose response teams perform that none of those resources can.

The answer comes down to three structural differences: when the team activates (post-crisis, not during crisis), who is on the team (peer recovery specialists with addiction-specific lived experience, not clinicians or officers), and how long the engagement lasts (days to months, not minutes to hours).

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Overdose Response Teams vs. Traditional EMS

EMS handles the emergency. The overdose response team handles what comes after.

When someone overdoses, EMS responds, administers naloxone, stabilizes the patient, and either transports to the hospital or clears the scene. As David Torsell of Escambia County EMS described the traditional outcome: “You’re not going to see them again until they come back for their next overdose.”¹

Overdose response teams review EMS run reports, identify recent overdose survivors, and follow up within 24 to 72 hours.⁷ They bring naloxone, assess readiness for treatment, and offer sustained engagement over days or weeks.

The key operational difference is time. EMS crews must clear calls quickly to remain available for the next emergency. Overdose response teams can spend hours with a single person. Amy Molinski of Milwaukee’s program put it directly: “There’s no limit on the amount of times we’ll go back if they want us to come back.”² That kind of sustained, repeated engagement is not something an ambulance crew can offer, and it is not a limitation of EMS. It is simply a different function.

One exception worth noting: Portland’s Community Health Assess and Treat (CHAT) team does respond to active overdose calls in addition to conducting follow-up visits.³ But even in Portland, the follow-up component is what defines the program. The active response is an added capability, not the core mission.

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Overdose Response Teams vs. Emergency Departments

Emergency rooms and overdose response teams operate at different points in the same timeline, with different capabilities and different constraints.

The ER stabilizes the patient medically, monitors for complications, and discharges. In most cases, the discharge includes a referral slip with a phone number or an appointment date. Torsell described what that looks like in practice: patients get “a little piece of paper that says, ‘Your follow up is this day. Go here. Good luck to you.'”¹ Mary-Rain O’Meara of Portland’s Central City Concern reported that the absence 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.”⁴

Overdose response teams do not replace the ER for patients who need hospital-level care. But they can reduce unnecessary ER utilization significantly. Portland’s CHAT program demonstrated that as of November 2024, 68% of overdose patients could be treated in the field without ER transport, saving an estimated $9 million in healthcare system costs according to Deputy Fire Chief Stephanie Sullivan.⁵ Those were patients whose medical needs could be met by a paramedic in the field, freeing ER beds for patients who actually needed them.

Houston’s Emergency Opioid Engagement System (HEROES) program works from the opposite direction: it identifies candidates through emergency department screening, then delivers the actual follow-up response in the field through home visits.⁶ The ER becomes an intake point rather than the entire intervention.

The distinction matters for cost and capacity. The NACo Opioid Solutions Center reported per-contact costs of $200 to $500 for overdose response team visits, compared to thousands of dollars for an ER visit.⁷

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Overdose Response Teams vs. Harm Reduction and Syringe Service Programs

Harm reduction programs and overdose response teams share a philosophical commitment to meeting people where they are, without requiring treatment readiness as a precondition for engagement. Both distribute naloxone. Both reject the idea that someone must want to quit before they deserve help.

The operational difference is the direction of the engagement. Harm reduction and syringe service programs operate at fixed locations. People come to them. These programs provide clean needles, fentanyl test strips, naloxone kits, HIV testing, and other supplies to anyone who walks through the door. Burlington, Vermont’s Howard Center operates a Safe Recovery program alongside its overdose response team, providing syringe services, HIV testing, and fentanyl test strips.

Overdose response teams go to the person. They actively seek out specific individuals who have recently overdosed, often using EMS data to identify them. Milwaukee’s Overdose Response Initiative (MORI) teams distribute “HOPE Kits” containing naloxone and fentanyl test strips during follow-up home visits, but the kit distribution is part of a broader engagement, not the primary service.

The two models are complementary, not competing. A person connected to harm reduction services through a syringe exchange may never have had an overdose event that triggers an overdose response team visit. A person visited by an overdose response team may be connected to a harm reduction program as part of the follow-up. They serve overlapping populations through different mechanisms and different entry points.

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Overdose Response Teams vs. Mobile Crisis Teams

Mobile crisis teams and overdose response teams overlap in real ways, and some programs deliberately blur the boundary. The structural distinction is still important for design decisions.

Mobile crisis teams (a separate category in the broader alternative response landscape) are dispatched to active behavioral health crises through 911. A licensed mental health clinician and a peer support specialist respond to the scene of a psychiatric emergency, a suicidal episode, or a substance use crisis in progress. They stabilize the situation and connect the person to appropriate care. Their activation is reactive and immediate: someone calls 911, the team is dispatched.

Overdose response teams primarily activate after the crisis is over. The overdose has already happened. EMS has already responded. The person has been stabilized or discharged. The overdose response team reviews the EMS report and follows up days later. Their activation is proactive and delayed: nobody calls for them. They reach out.

The workforce differs as well. Mobile crisis teams require licensed clinicians with the authority to perform psychiatric assessments and evaluate for involuntary holds. Overdose response teams rely on peer recovery specialists whose credibility comes from personal experience with addiction and recovery, not clinical licensure. These are different qualifications serving different functions. The clinician assesses and stabilizes. The peer recovery specialist builds trust through shared experience and helps connect the person to treatment over time.

Where it gets complicated: substance use episodes fall within the scope of both models. Denver’s Support Team Assisted Response (STAR) mobile crisis vans carry naloxone and respond to active overdoses as part of a broader behavioral health mission.⁷ Portland operates both a dedicated overdose response unit (CHAT) and a separate mobile crisis program (Portland Street Response).⁸ Lexington, Kentucky’s Quick Response Team sits at the intersection, housed under community paramedicine with both post-overdose engagement and broader crisis response capabilities.⁹

The National Association of Counties drew the line explicitly, distinguishing post-overdose response teams as programs that “conduct outreach and offer services to people who have experienced an overdose,” not general crisis response.⁷ The defining question is whether the team’s primary function is responding to active crises as they happen or following up after the acute event to provide sustained treatment connection. Programs that do both exist, but the functions remain distinct even when housed under the same roof.

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Overdose Response Teams vs. Addiction Stabilization Units

This distinction is structural rather than philosophical. Overdose response teams are mobile. They go to the person. Addiction stabilization units are facility-based. The person comes to them.

An overdose response team might connect someone to an addiction stabilization unit as a downstream destination, in the same way a mobile crisis team might bring someone to a crisis stabilization center. The team is the bridge; the facility is the destination. They are different components of the same system, operating at different points in the care pathway.

Addiction stabilization units provide what overdose response teams cannot: medication-assisted treatment protocols managed by psychiatrists and physicians, 24/7 medical monitoring, structured multi-day stays, and structured discharge planning with warm handoffs to outpatient treatment. Dr. Belma Andric of Palm Beach County described the facility model as “a one-stop shop where you can see primary care, psychiatrist, pharmacy, therapy, group sessions, connection to any high level of care if necessary.”⁸

Overdose response teams provide what addiction stabilization units cannot: reaching people in their own environments, engaging people who have not presented at a facility and may not be willing to, and maintaining contact over weeks with individuals who are not yet ready for treatment. Connie Priddy of Huntington’s program described that value: “Even if they’re not ready for treatment, they appreciate someone checking in, asking how they are, bringing them resources.”⁹

Florida’s Coordinated Opioid Recovery (CORE) network in Palm Beach County illustrates what it looks like when field-based outreach and facility-based treatment are linked: the network pairs field teams with addiction stabilization units, creating a pipeline from the doorstep to the treatment bed.⁸

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The Gray Zones

Not every program fits neatly into one category. Some programs deliberately span boundaries.

Portland’s CHAT responds to both active overdose calls and conducts post-overdose follow-up, combining the reactive function of EMS with the proactive function of an overdose response team. Houston’s HEROES uses hospital emergency departments as an intake screening mechanism, then delivers the intervention in the field. Buncombe County’s community paramedicine model administers buprenorphine for up to five days in the field, performing a function typically associated with facility-based treatment.¹⁰

Programs adapt to local needs, available workforce, and existing infrastructure. The structural distinctions matter for design decisions (what are we building, and what gap does it fill?) but real programs will often combine elements from multiple models.

If nobody in a community follows up with overdose survivors within days of the event, that gap exists regardless of what other services are available.

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The Bottom Line: Overdose response teams fill a gap that no other part of the emergency system is designed to address: proactive, sustained follow-up with overdose survivors in the days and weeks after the event. EMS handles the emergency. The ER handles the medical stabilization. Harm reduction programs serve people at fixed locations. Mobile crisis teams respond to active crises. Addiction stabilization units provide facility-based treatment. Overdose response teams are the component that goes back to the person’s door, without being called, and keeps coming back. Some programs combine elements across these boundaries, and the strongest systems connect multiple components. But the core function, the post-crisis return, is what makes this model distinct.