Where Is This Happening?

The National Landscape

Overdose response teams have spread faster and with less political friction than most other alternative response models. The first program launched in Colerain Township, Ohio in July 2015.¹ Within seven years, over 80 of Ohio’s 88 counties had adopted some form of the model.¹ West Virginia coordinated programs across 33 counties.² The Department of Justice designated eight programs in eight states as national mentor sites to train new teams.³ Programs now operate in cities, suburbs, and rural areas across at least a dozen states, housed in fire departments, health departments, community organizations, university medical centers, and multi-agency partnerships.

Overdose response teams do not replace police or compete with them for calls. They extend existing EMS infrastructure rather than creating a parallel system. Opioid settlement funds provide a dedicated funding stream that did not exist for earlier alternative response models.^{14 6 10}

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Statewide Systems

Two states have achieved something close to statewide implementation, offering the clearest picture of what scale looks like for this model.

Ohio is the national leader. The Recovery Ohio initiative has supported overdose response teams in more than 80 of the state’s 88 counties.¹ The state invested $51 million in a statewide youth program that also funds Mobile Response and Stabilization Services. Franklin County operates the REACT program. A study of 22 Ohio programs found them distributed across urban (7), rural (7), and suburban or partially rural (8) communities, demonstrating that the model operates across community types and population densities.¹ Ohio was also the first state to produce research on operational challenges, including the finding that many programs averaged six to eight weeks between contacts rather than the intended 72 hours.¹

West Virginia coordinates programs across 33 counties through the state Department of Health and Human Resources.² The Huntington Quick Response Team, which launched in December 2017 after 26 to 28 people overdosed in a four-to-eight-hour period without a single one receiving follow-up care,⁴ became both a state model and a national one. The White House Office of National Drug Control Policy director Dr. Rahul Gupta 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.”⁵

Connecticut coordinates through its Department of Mental Health and Addiction Services, with the state expecting roughly $600 million in total opioid settlement funds.⁶ New Britain’s program has reported a 51% decline in opioid-related deaths.⁷ New York State launched its Post-Overdose Response Team pilot, which grew from 148 referrals in its first year to 954 in its first full operational year.

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Major City Programs

Programs in several major cities have produced operational data.

Milwaukee launched its Overdose Response Initiative in 2019 as a partnership between the Health Department, Fire Department, and Community Medical Services.⁸ The program expanded from one car operating four hours a day to two cars at seven hours a day.⁸ Milwaukee County experiences a fatal overdose every 16 hours, creating persistent demand for the service.⁸

Portland launched its Community Health Assess and Treat (CHAT) overdose response team in 2023, based at Fire and Rescue Station 1.⁹ The program operates Monday through Thursday, 8 a.m. to 6 p.m., and has demonstrated two capabilities that distinguish it from most other programs: direct response to active overdose calls (not just post-crisis follow-up) and field-based buprenorphine administration.⁹ Portland also operates Portland Street Response as a separate mobile crisis program; CHAT is a distinct unit within the fire department.

Austin and Travis County operate an overdose response system as part of a broader alternative response infrastructure. Travis County Judge Andy Brown allocated $860,000 from opioid settlement funds.¹⁰ The city also runs EMCOT for mobile crisis response; the two programs serve overlapping but distinct populations.

Burlington, Vermont launched its program in early 2023 through the Fire Department. Burlington Fire Chief Michael La Chance described a team of firefighters and paramedics that “responds to suspected overdoses and unresponsive patient calls” to “help patients break the ongoing cycle of addiction” and “free up resources to respond to more needs in the city.”¹⁶ The team engaged over 1,200 patients in its first six months. The Burlington City Council extended the pilot based on the results.¹⁶

Louisville, Kentucky operates a Quick Response Team that receives daily referral lists from Louisville Metro EMS, Louisville Fire, and area police departments. The Louisville Courier Journal reported the team has responded to 7,200 calls since launch, distributed more than 3,000 units of Narcan, and referred approximately 250 people to treatment.¹⁷

Seattle operates what Fire Chief Harold Scoggins described as a “one-of-a-kind overdose response unit” staffed by two firefighters and a social worker who respond to overdose calls, stay with the patient rather than rushing to the next call, and conduct follow-up visits in the days afterward.^{3 18} Seattle is one of the eight national BJA peer mentor sites.

Sacramento County runs its program through the Department of Health Services. Final 2024 data from the Sacramento County Coroner’s Office showed a 32% reduction in fentanyl-related deaths compared to 2023, with approximately 280 deaths versus 406.¹¹

Houston’s Emergency Opioid Engagement System (HEROES) program, operated through the University of Texas Health Science Center, uses a distinctive entry mechanism: emergency department screening identifies candidates, and teams then conduct home visits with a licensed peer recovery coach and a paramedic who can provide field buprenorphine.¹²

Detroit operates a Quick Response Team that connects with people after overdose events through referrals from the Detroit Police Department and through street outreach at emergency rooms, bus stops, and transit centers. The city also coordinates with homeless outreach and street medicine teams, creating a referral network that identifies people at risk of overdose before the next event occurs.¹⁹ Sterling Heights, a Detroit suburb, reported a 45% decrease in overdose deaths since launching its QRT in 2021; Police Chief Andy Satterfield attributed the decline to the team, telling Fox2: “The old ways of just arresting someone and getting them in the system… we didn’t give them any solutions.”²⁰

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Suburban and Multi-Jurisdictional Programs

The model has adapted to suburban and multi-county settings.

Colerain Township, the birthplace of the Quick Response Team model, is a suburban community in Hamilton County, Ohio. Its program pairs a police officer, a firefighter/paramedic, and an addiction counselor from the Addiction Services Council of Greater Cincinnati.¹ The township has conducted over 400 follow-ups since 2015 and serves as a DOJ BJA national mentor site.^{3 4}

The Recovery Resource Council in Dallas operates across multiple jurisdictions: Dallas, Denton, McKinney, Plano, and Hunt and Tarrant counties.¹³ Becky Tinney, Recovery Resource Council’s special projects director, described the motivation: “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.”¹³

Delaware County, Pennsylvania launched a team composed of “a paramedic and a certified recovery specialist” who stabilize overdose patients and then transport them directly to one of four treatment center locations. U.S. Congresswoman Mary Gay Scanlon, who helped secure funding, cited the urgency: “someone in Delaware County overdoses every seven to nine minutes.” Dr. Daniel Neff described why the rapid treatment connection matters: a patient who survives an overdose “often has post-traumatic stress disorder from it” which can fuel rather than reduce a substance use disorder.²¹

South Shore, Massachusetts operates Quick Response Teams consisting of a health department representative, a police or fire member, and a peer support specialist.³ Plymouth County, also in Massachusetts, is one of the eight BJA national mentor sites.³

Lake County, Illinois and Lucas County, Ohio are additional BJA mentor sites operating in suburban and mid-size city contexts.³

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State-Level Expansion

Beyond Ohio and West Virginia’s statewide systems, several states have expanded the model through settlement funds and state investment.

Michigan Attorney General Dana Nessel announced that opioid settlement funds would create ten new Quick Response Teams statewide, expanding on earlier programs in Saginaw County (launched 2020), Genesee County (2021), and Bay City (2021).²² Bay City’s team includes a peer recovery coach, a family recovery coach, and a police officer.²²

North Carolina has deployed Post-Overdose Response Teams (PORTs) across multiple counties. Carteret County’s PORT has a hospital partnership that “allows them to provide services in their emergency room and throughout the facility” and conducts follow-up wellness checks at two days, one week, two weeks, one month, and three months after initial contact. Orange County’s PORT provides “medication on a daily basis for up to seven days” after an overdose event. Mecklenburg County operates a PORT composed of two paramedics and two counselors.²³

Hamilton County, Tennessee launched a first-in-the-state overdose prevention team, a joint effort between the Health Department and EMS, composed of “a paramedic and a certified peer support specialist” who deploy in Quick Response Vehicles directly into neighborhoods.²⁴

New Philadelphia, Ohio reported that “overdoses requiring EMS response are down nearly 50 percent in both the city and the county” since launching its Quick Response Team, according to Safety Director Kevin Milligan.²⁵

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Rural Implementation

The rural access gap is real but not absolute. Programs exist in rural settings, though they face distinct challenges: longer travel distances, fewer treatment facilities to connect people to, and smaller populations that make dedicated teams harder to justify fiscally.

Ohio provides the most documented data on rural implementation. Of 22 programs studied, seven operated in communities classified as rural by the Ohio Department of Development.¹ The 2022 Ohio study found these rural programs faced operational constraints: workforce recruitment, thinner treatment capacity, and higher per-contact costs from travel time and smaller caseloads.¹

West Virginia’s 33-county system includes many rural counties. Huntington itself, while a small city, serves surrounding rural Cabell County, and the program’s team model was built for a region where treatment options are scarce and distances are long.

Crawfordsville, Indiana provides 24/7 overdose response coverage, demonstrating that round-the-clock availability is feasible even in smaller communities, though the staffing and cost implications differ from urban programs.

Knox County, Tennessee was in planning stages for a program specifically designed to increase outreach to underserved populations.

Rural programs represent a smaller share of overall implementation than urban and suburban programs in the available data.¹

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The BJA Mentor Network

The Department of Justice’s Bureau of Justice Assistance designated eight programs as national peer mentor sites in 2020.³

Huntington, West Virginia. Colerain Township, Ohio. Philadelphia, Pennsylvania. Plymouth County, Massachusetts. Lucas County, Ohio. Seattle, Washington. Lake County, Illinois. Los Angeles, California.³

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University and Campus Programs

Overdose response has extended to college and university campuses, including UC-Irvine, UC-Berkeley, UC-Davis, Oregon State University, the University of Utah, and the University of Washington.¹⁵

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What the Map Shows

The geographic pattern reveals several things about where this model has taken root and where it has not.

Opioid settlement money is an accelerant. States and counties receiving large settlement allocations (Wisconsin at approximately $780 million through 2038,¹⁴ Connecticut at roughly $600 million,⁶ Texas through its Opioid Abatement Fund Council)¹⁰ have the dedicated funding stream that makes program launch easier. Communities without access to settlement funds face the same grant dependency that threatens other alternative response models.

Fire departments are the institutional home for the majority of documented programs.^{1 3} Programs in Milwaukee, Portland, Seattle, Colerain Township, and Buncombe County all operate through or in partnership with fire departments.^{8 9 3}

The model spans the political spectrum. Programs operate in cities with progressive leadership (Portland, Austin, Milwaukee), conservative leadership (New Britain under Republican Mayor Stewart, Huntington under Republican-leaning governance), and nonpartisan contexts (Ohio’s county-level programs). The opioid crisis does not sort neatly by political ideology, and the model’s design avoids the political fault lines that complicate other alternative response programs.

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What the Map Doesn’t Show

No complete national count of operating overdose response programs exists. The data available documents programs that have attracted media attention, received federal designation, or published outcome data. Many programs operate without appearing in any national inventory.

The gap between documented programs and actual programs is likely large. Ohio alone has over 80 county-level programs, most of which are not individually profiled in national databases. The CDC’s Overdose Data to Action initiative funds 49 state and 41 local health departments, many of which support overdose response teams that are not separately cataloged.

Coverage hours remain limited in most programs. Portland operates Monday through Thursday, 8 a.m. to 6 p.m. Most programs operate during business hours despite overdoses occurring around the clock. Crawfordsville’s 24/7 coverage is the exception, not the rule. The gap between marketing (the program exists) and operational reality (the program is available when someone needs it) applies to overdose response teams just as it does to mobile crisis and crisis stabilization.

Rural coverage remains thin relative to need. The opioid crisis affects rural communities at rates equal to or exceeding urban areas, but program density is concentrated in urban and suburban settings where the infrastructure, workforce, and treatment capacity to support teams already exists.

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The Bottom Line: Overdose response teams have spread from a single Ohio township in 2015 to programs in at least a dozen states, with Ohio alone operating in over 80 of 88 counties and West Virginia coordinating across 33 counties. Eight federal mentor sites train new programs nationally. The model operates across urban, suburban, and rural settings and across the political spectrum. Opioid settlement funds have accelerated expansion. But no national count exists, most programs operate limited hours, and rural coverage remains thin relative to need. A community considering this model can find comparable programs in similar settings, but should plan for the coverage, workforce, and treatment capacity constraints that most programs still face.