Does It Work?

What the Evidence Shows, and What It Doesn’t

The evidence base for overdose response teams spans multiple cities that have reported reductions in overdose deaths ranging from 22% to 51%,^{2 4 5 7 8} treatment connection rates from 30% to 92%,^{5 9 10} and healthcare cost savings exceeding $11 million in Portland alone.¹² Nearly all of this evidence is program-reported rather than independently verified, no randomized controlled trial has been conducted on the model, and community-level overdose reductions occurred alongside other interventions.

A local leader evaluating this model should understand both what the data shows and where it falls short. The numbers are real. The caveats are also real. Both matter for making sound decisions.

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Overdose and Death Reductions

Community-level overdose data provides the broadest evidence: cities and counties including Colerain Township, New Britain, Huntington, Austin, Sacramento, and Burlington have reported declines in overdose deaths during periods when overdose response teams were operating as part of broader intervention systems.

The range is wide, and an important caveat applies to all jurisdiction-level outcome data: nationally, drug overdose deaths declined 26.2% in 2024 compared to 2023, with 79,384 deaths recorded (CDC final data, January 2026),¹ meaning that local declines must be read against this broader trend. Sacramento County reported a 32% reduction in fentanyl-related deaths in 2024, with approximately 280 deaths compared to 406 in 2023 (Sacramento County Coroner’s Office final data; an earlier partial-year estimate of 56% was based on incomplete 2024 data).^{2 3} New Britain, Connecticut reported a 51% decline in opioid-related deaths over a comparable period, from 43 to 21.⁴ Huntington, West Virginia, drawing on CDC data, reported a 24% drop in the fatal overdose rate from 2017 to 2018, a 52% decline in nonfatal overdose cases from 2017 to 2019, and a 40% reduction in overdose calls by the end of 2018.^{5 6} Colerain Township, Ohio reported a 42% drop in overdose calls, from 238 in 2017 to 139 in 2019, a seven-year low.⁷ Austin and Travis County reported a 22% drop in overall opioid deaths and a 36% decrease in fentanyl-related deaths in 2024 compared to 2023.⁸ Burlington, Vermont reported its first sustained decrease in monthly overdoses since before the pandemic after launching its program, engaging over 1,200 patients in the first six months.²³ Sterling Heights, Michigan reported a 45% decrease in overdose deaths since launching its Quick Response Team in 2021.²⁴ New Philadelphia, Ohio reported that overdose calls requiring EMS response declined nearly 50% in both the city and county since its team launched.²⁵ In Hancock County, Ohio, overdose deaths dropped from 28 in one year to three confirmed and five suspected the following year after the team began operations.²⁶

These numbers deserve careful interpretation for three reasons.

First, the evidence tier. Every figure listed above is program-reported or drawn from local government data. None comes from an independent academic evaluation with statistical controls. Huntington’s numbers are confirmed by CDC data, which gives them a degree of independent validation, but the CDC data measures the community-level trend, not the program’s isolated contribution. Sacramento’s Division Chief Lori Miller acknowledged the complexity directly: “This reduction isn’t necessarily due to fewer people using fentanyl, but rather a direct result of the comprehensive support systems we’ve implemented.”³ Note the plural: systems, not a single program.

Second, the attribution problem. Overdose death reductions in these cities reflect the combined impact of overdose response teams, expanded naloxone distribution, harm reduction programs, treatment capacity expansion, and in some cases law enforcement actions against drug supply. Attributing community-level reductions solely to overdose response teams would overstate what any single program can claim. This is the same attribution challenge that affects community violence intervention programs: the ecosystem produces the result, and disaggregating the contribution of individual components is difficult without controlled study designs.

Third, the counterfactual. When New Britain’s Republican Mayor Erin Stewart reported a 51% decline and called it exceeding the city’s 30% reduction goal,⁴ the comparison was to the prior period in the same city. This is a direct comparison, but it does not account for national trends, changes in drug supply, or other local factors that may have contributed. CDC final data showed national drug overdose deaths declined 26.2% in 2024 compared to 2023, meaning that some portion of any city’s 2024 decline may reflect this broader national trend rather than local program effects. Some cities without overdose response teams also experienced overdose declines during this period. The strongest evidence would compare communities with these programs to similar communities without them, and that comparison has not been conducted at scale.

Across the programs documented in this resource, each operates in a community where overdose trends improved during the program’s operation.^{7 4 5 8 2} None has reported worsening outcomes. The pattern holds across cities of different sizes, in different regions, with different program designs. But the specific magnitude of each team’s contribution, isolated from other interventions, remains unmeasured.

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Treatment Connection Rates

Treatment connection is the metric most directly attributable to the team’s own work, because it measures something only the team does: following up with overdose survivors and helping them enter treatment.

The reported rates vary enormously, and the variation reflects genuine differences in how programs define and measure treatment connection.

At the high end, Colerain Township’s Assistant Fire Chief Will Mueller reported that of over 400 follow-ups conducted between 2015 and 2019, “80 percent of them have gotten into recovery.”⁹ This is the highest documented rate, and it comes with an important caveat: “gotten into recovery” likely means entered treatment, not necessarily achieved sustained recovery. Long-term outcome data has not been reported for Colerain’s program. Whether “recovery” means someone enrolled in a treatment program, completed 30 days, or maintained sobriety at one year changes what the number actually tells a decision-maker.

Coastal Horizons Center in North Carolina reported meeting with 525 overdose survivors and their loved ones over three years and connecting 485 to treatment, a 92% connection rate.¹⁰ This figure includes family members in the total contact number, and “connected to treatment” encompasses a range of outcomes from referral to active enrollment.

Huntington reported contacting nearly 1,200 overdose survivors since inception, with approximately one-third entering treatment.⁵ A 2025 peer-reviewed study confirmed these figures using interrupted time series analysis. This treatment entry rate likely reflects both Huntington’s conservative measurement (actual treatment entry, not referral or expression of interest) and the reality that the program serves a heavily affected population with high rates of co-occurring conditions and limited local treatment capacity.¹⁷

New York State’s Post-Overdose Response Team pilot reported 148 referrals in its first year and 954 in its first full operational year, a 645% increase in referral volume. The program achieved a 36% overall contact rate.²¹ Louisville, Kentucky’s Quick Response Team has responded to 7,200 calls, distributed more than 3,000 units of Narcan, and referred approximately 250 people to treatment.²⁷

The range spans from approximately 30% (Huntington)⁵ to 92% (Coastal Horizons)¹⁰ depending on how treatment connection is defined, which populations are included in the denominator, and what counts as a successful connection.

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Healthcare System Impact

Portland’s Community Health Assess and Treat (CHAT) program provides the clearest evidence on healthcare cost reduction. In a November 2024 interview, Deputy Fire Chief Stephanie Sullivan reported that “about 68% of the people who we responded to who had opioid overdoses, we were able to treat them in the field and not send them to the emergency department. We’ve saved $9 million in the health care system.”¹²

Sullivan’s figure is program-reported but grounded in a calculation that Portland Fire has made transparent: each patient treated in the field rather than transported to an ER represents an avoided visit costing several thousand dollars.¹² The 68% field treatment rate reflects Portland’s model specifically, which includes field-based buprenorphine administration. Programs without that capability would not achieve the same rate of ER diversion.

The NACo Opioid Solutions Center reported per-contact costs across documented programs in the range of $200 to $500 per overdose survivor visit.²⁰ For comparison, the Agency for Healthcare Research and Quality has placed the average ER visit cost for an opioid-related encounter at approximately $3,000 or more. The CDC has estimated that a fatal overdose represents over $1 million in lifetime productivity losses.¹

These comparisons provide context but should be read as estimates rather than precise calculations. The per-contact cost does not include full program overhead. The ER cost comparison assumes the visit would have occurred without the team’s intervention. The productivity loss figure is a population-level statistical estimate, not a measurable saving from any individual prevented death.

The Buncombe County model adds a different cost dimension: by administering buprenorphine for up to five days in the field,¹⁴ the program bridges the gap between overdose reversal and outpatient treatment enrollment, eliminating the need for an ER visit, a hospital stay, or a multi-week wait for a treatment appointment. Dr. Richard Bruno of Multnomah County described the value: “Being able to provide life-saving medications for opioid use disorder at the time the paramedics respond versus waiting for patients to arrive in the emergency room or following up at a clinic is a promising method to reduce overdose deaths.”¹³

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Federal Recognition

The Department of Justice designated eight overdose response programs as national peer mentor sites in 2020, selecting them to train and support new teams across the country. The designated sites include Huntington, Colerain Township, Philadelphia, Plymouth County (Massachusetts), Lucas County (Ohio), Seattle, Lake County (Illinois), and Los Angeles.¹⁵

Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy, specifically cited Huntington’s program as one that “should be developed as a model, not just for the state of West Virginia, but for the entire country.”¹⁶

Federal recognition does not constitute independent evaluation of outcomes. It reflects a judgment by federal agencies that the model is worth replicating, based on program design and reported results. But it does signal that the programs met a set of criteria for selection from a national field, and it provides a mechanism for quality control as the model spreads.

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Law Enforcement Support

Law enforcement leaders in several documented programs have actively supported and participated in overdose response teams — a pattern that distinguishes this model from the more contested political dynamics around mobile crisis and other alternative response programs.

Milwaukee’s Captain Polachowski described his evolution from frustration to advocacy for the model.¹⁸ Austin Police Association President Michael Bullock has argued publicly that law enforcement should not be the primary responder to overdose calls.²² In Colerain Township, a police officer serves as a formal member of the Quick Response Team alongside a paramedic and an addiction counselor.⁷ In Huntington, a law enforcement member is part of the four-person team.⁵ Polachowski framed the partnership: “Our badge gets us in the door, and then the peer support takes over.”¹⁸

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What We Don’t Know

Five gaps in the evidence base shape what a decision-maker can and cannot conclude from the data above.

No randomized controlled trial has been conducted on the overdose response team model.¹⁵ The broader alternative response field has produced rigorous evaluations — Stanford’s evaluation of Denver’s Support Team Assisted Response (STAR) program and the University of Chicago’s randomized controlled trial of READI — but no equivalent exists for overdose response teams.

No program has published long-term recovery outcomes. Programs report treatment connection and sometimes treatment entry, but sustained recovery rates at six months, one year, or five years have not been documented across the field.^{9 5}

Programs use different definitions and metrics, as the treatment connection data above illustrates. The 2022 Ohio study of 22 Quick Response Teams found wide variation in how programs measured success and what they tracked.¹¹ Most programs track outputs (contacts made, naloxone distributed) rather than outcomes (sustained recovery, reduced recidivism).

Response timing gaps persist. The same Ohio study found that many programs averaged six to eight weeks between interactions rather than the intended 72 hours.¹¹ Polachowski identified the core operational barrier: “biggest barrier, honestly, is making contact” because EMS report information is often incomplete or incorrect.¹⁸

The evidence comes from a specific set of communities. The cities and counties with documented outcomes (Colerain, Huntington, New Britain, Portland, Austin, Sacramento) share identifiable characteristics: political leadership willing to invest, local champions within fire or health departments, and in most cases opioid settlement or federal grant funding.

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The Core Logic Chain: Which Links Have Evidence?

The theory of change behind overdose response teams can be broken into testable links.

Link 1: People who survive a nonfatal overdose are at elevated risk of fatal overdose. A 2019 Massachusetts study of 11,557 nonfatal overdose ED patients found 5.5% died within one year, with the first two days carrying the highest risk.¹⁹

Link 2: The 24-to-72-hour post-overdose period represents a window of engagement opportunity. Practitioners across multiple programs — including Priddy in Huntington and Polachowski in Milwaukee — describe this window consistently, though it has not been independently measured in a controlled study.^{5 18}

Link 3: Teams can reach and engage overdose survivors through proactive follow-up. Contact rates range from 36% (New York State PORT)²¹ to higher rates in programs with dedicated data analysts and hospital partnerships. The 2022 Ohio study documented that the constraint is operational — finding the person — rather than conceptual.¹¹

Link 4: Engagement leads to treatment entry. Treatment connection rates range from approximately 30% (Huntington)⁵ to 92% (Coastal Horizons),¹⁰ depending on how connection is defined and measured.

Link 5: Treatment entry leads to sustained recovery and reduced overdose recurrence. Programs report treatment entry but not long-term outcomes.^{9 5} The addiction medicine literature supports the general claim that medication-assisted treatment reduces overdose risk, but whether the specific pathway of overdose response team engagement produces durable outcomes has not been measured for this model.

Link 6: Sustained recovery at scale reduces community-level overdose burden. Community-level trends are consistent with this claim,^{2 4 7} but no study has traced the causal chain from team engagement through recovery to community-level outcomes.

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The Bottom Line: Overdose response teams operate in communities that have seen reductions in overdose deaths ranging from 22% to 51% (program-reported, not independently verified), connect 30% to 92% of contacted survivors to treatment depending on program and definition, and produce healthcare cost savings by treating patients in the field. The evidence is consistent and encouraging across more than a dozen documented programs. But it is almost entirely program-reported, no randomized controlled trial has been conducted, and community-level overdose reductions cannot be attributed to these teams alone because they operate alongside other interventions. Long-term recovery outcomes are not tracked. Programs use different definitions, making direct comparisons unreliable. A leader deciding whether to invest in this model has strong operational evidence that the teams can reach people and connect them to treatment, and strong theoretical reasons to expect that connection reduces deaths. What does not yet exist is the kind of independent, controlled evaluation that would allow confident claims about the magnitude of the model’s isolated impact.