What Calls Does This Handle?

The Primary Trigger

The entry point for an overdose response team is a single event: someone has overdosed. The substance involved, the person’s housing status, their insurance situation, their history with the criminal justice system, whether they have overdosed before, and whether they are currently interested in treatment are all irrelevant to eligibility. Programs serve anyone who has experienced a drug overdose, period.

Every documented program operates on this principle. Services are free to users, with no billing, copays, or insurance requirements.¹ Teams assist with insurance enrollment as part of the follow-up.

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How People Enter the System

Most overdose response teams do not receive calls the way a 911 dispatcher does.¹ The activation mechanism differs from nearly every other alternative response model.

The most common entry point is the post-911 follow-up. An EMS crew responds to an overdose call, administers naloxone, generates a run report, and moves on. The overdose response team reviews that report within 24 to 72 hours and goes to the person’s last known address. Colerain Township, Milwaukee, Huntington, Dallas, and South Shore, Massachusetts all use this model.¹ The person being visited did not ask for the team’s help. The team shows up because the EMS data identified them as someone who recently survived an overdose.

This matters because the people most in need of follow-up are often the least likely to seek it. Fear of legal consequences, fear of child protective services involvement, fear of probation violations, and simple distrust of systems all suppress help-seeking behavior. Milwaukee’s Polachowski stressed the team’s approach to this barrier: “We don’t share anything with law enforcement… They’re protected by their HIPAA rights.”²

A smaller number of programs use other entry points. Houston’s Emergency Opioid Engagement System (HEROES) identifies participants through emergency department screening for substance use disorder, then delivers follow-up in the field through home visits.³ Sacramento County uses data-driven proactive outreach, identifying high-risk individuals through overdose data systems. Portland’s Community Health Assess and Treat (CHAT) responds to active overdose calls in addition to conducting follow-up visits.⁴ Crawfordsville, Indiana provides 24/7 direct response to overdose calls.

Most programs combine multiple entry mechanisms.¹ The defining entry point is the post-crisis return: nobody called; the team went looking.

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Who the Teams Are Reaching

The population served by overdose response teams has changed as the drug supply has changed. What began as a response to the prescription opioid and heroin epidemic now operates in a landscape dominated by fentanyl.

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.”⁵ In Connecticut, fentanyl was involved in 84% of overdose deaths in 2023 and approximately 77% in 2024.⁶ In Austin, police found fentanyl mixed into crack cocaine, methamphetamine, and marijuana.¹⁴

The demographic range has expanded accordingly. Polachowski described fatal overdoses in Milwaukee County affecting people “ranging from teenagers to an 83-year-old. Combat veterans. High school seniors. Young mothers.”⁷ Connie Priddy of Huntington’s Quick Response Team described the same pattern: “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.”⁸

Polachowski and Priddy’s descriptions illustrate a population that crosses income, age, and neighborhood lines.^{7 8}

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The Secondary Population: Families

Programs consistently report that family members and loved ones are a large part of the population they serve. When the overdose survivor cannot be located at the follow-up visit, or is not willing to engage, teams leave naloxone, information about treatment options, and contact numbers with whoever is at the address.

Huntington’s program, which includes faith leaders on the team, explicitly serves families affected by overdose, including those who have lost someone. 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.”⁹

In programs where the overdose survivor is unreachable on the first visit, family contact becomes the primary mechanism for eventual connection. A family member who has naloxone and knows how to reach the team may be the person who calls when the next crisis occurs, or who makes the introduction when the survivor is eventually ready to talk.

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Co-Occurring Conditions

The majority of overdose survivors present with needs that extend well beyond addiction treatment. Mental health conditions, chronic pain, homelessness, and criminal justice involvement are common and interconnected. Sustainable recovery rarely depends on addressing addiction alone.

Teams navigate these co-occurring needs as part of their engagement. Claire Hubbard of Buncombe County’s program described the philosophy: “A core tenet of the program is that team members let people choose the level of help they get.”¹⁰ A person who is not ready for treatment but needs housing assistance can receive help with housing. A person who needs insurance enrollment can receive that without committing to treatment. The team works with whatever the person is willing to accept.

Milwaukee’s program identified housing as “one of the biggest barriers.”¹¹ Amy Molinski described the practical challenge: “When you have an individual that lives on the North Side of Milwaukee and you’re asking them to travel to West Allis every single day” for methadone treatment, the geographic distance becomes a barrier to recovery independent of the person’s motivation.¹¹ Teams encounter these structural barriers constantly and work around them, but they cannot solve them. The overdose response team exposes gaps in the treatment and housing systems; it does not fill those gaps on its own.

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The Bright Lines

Despite the broad scope of who overdose response teams serve, there are clear boundaries on what they handle.

Active overdoses in progress require EMS, not an overdose response team. If someone is currently overdosing, that is a 911 call. The overdose response team follows up after the acute event has been handled. Dispatching an overdose response team to an active overdose in progress is a category error with potentially fatal consequences.

Active behavioral health crises without an overdose component are the scope of mobile crisis teams, not overdose response teams. A person in a psychotic episode, a person threatening suicide with no substance involvement, or a person in acute psychiatric distress needs a licensed clinician, not a peer recovery specialist. The populations overlap (many people with substance use disorders also have mental health conditions), but the presenting situation determines which team responds.

Medical emergencies beyond overdose require traditional EMS and hospital care. Overdose response teams carry naloxone and basic medical supplies. They are not equipped for cardiac events, serious injuries, or other acute medical conditions.

Situations involving weapons, active violence, or credible threats of harm exceed the scope of any unarmed civilian response team.

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The Gray Zones

The clearest gray zone is the overlap between overdose response and mobile crisis for substance use situations. A person found unresponsive in a park might be overdosing (EMS call), intoxicated but not in medical danger (potentially a sobering center referral or ambassador response), or experiencing a co-occurring psychiatric and substance use crisis (mobile crisis territory). The presenting symptoms do not always sort neatly into one category at the point of initial contact.

Programs that operate both mobile crisis and overdose response functions (such as cities with both Denver Support Team Assisted Response-type programs and separate overdose follow-up teams) manage this overlap through dispatch triage. The initial call determines which team responds. The overdose response team’s post-crisis follow-up function is separate from the 911 dispatch system entirely.

Another gray zone involves repeat contacts. Some individuals are visited by overdose response teams dozens of times without entering treatment. The question of whether sustained engagement with someone who repeatedly declines treatment constitutes success or failure is a genuine values question. Programs operating on a harm reduction philosophy treat each contact as providing value independent of treatment entry: the person receives naloxone, medical monitoring, human connection, and the knowledge that help is available when they are ready. Programs with treatment-entry metrics may view the same pattern differently. Both perspectives have legitimate policy implications, and communities answer this question differently based on their values and priorities.

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What the Team Actually Does on Scene

When an overdose response team conducts a follow-up visit, the encounter can include any combination of the following, depending on what the person needs and is willing to accept:

Naloxone distribution and education on how to use it. Fentanyl test strips and other harm reduction supplies (Milwaukee’s Overdose Response Initiative, or MORI, distributes “HOPE Kits” during visits).¹¹ Assessment of readiness for treatment, without pressure. Treatment connection and warm handoffs to programs that have openings. Field-based buprenorphine administration in programs with that capability (Portland CHAT, Buncombe County).^{4 10} Help with insurance enrollment, housing applications, and other service navigation. Support for family members present at the visit. Spiritual support in Huntington’s model, where clergy team members participate.⁹

And time. Teams can spend hours with a single person, sitting through withdrawal symptoms, answering questions about treatment options, or simply being present. The Recovery Resource Council in Dallas described their approach: teams “follow the lead of the individual to guide the frequency, type, and amount of follow-up services provided.”¹² Priddy described what even a brief contact provides: “We are the one that will connect them to treatment, but we’re also just there to check on them to make sure they’re OK… and I think that’s mattered.”¹³

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The Bottom Line: Overdose response teams serve anyone who has survived a drug overdose, regardless of substance, insurance status, housing situation, or readiness for treatment. The primary entry point is proactive follow-up triggered by EMS data, not a call for help. The population has expanded with the fentanyl crisis to include people across every demographic and income level. Teams also serve families and address co-occurring needs including housing, mental health, and criminal justice involvement. The bright lines are clear: active overdoses go to EMS, active psychiatric crises go to mobile crisis teams, and situations involving weapons or violence go to law enforcement. Between those boundaries, overdose response teams work with whatever the person is willing to accept, for as long as it takes.