What Are the Risks?

Honest Accounting

Across the programs documented in this resource, none has reported a serious safety incident during follow-up visits, and none has been linked to an increase in overdose deaths.^{1 2} The model does not generate the political opposition that mobile crisis or community violence intervention programs face.

But the absence of dramatic failures does not mean the model is free of risk. The risks and limitations of overdose response teams are structural rather than spectacular: they fail slowly, through funding erosion, workforce attrition, operational gaps between design and reality, and the mismatch between what teams can do and what the surrounding system can absorb. These are the failure modes that a local leader needs to understand before investing, because they are the ones that will determine whether a program survives its third year.

---

The Response Timing Gap

Overdose response teams are designed to contact survivors within 24 to 72 hours of the overdose event, capitalizing on the window when the person may be most open to accepting help. Ohio research on the state’s Quick Response Teams found that many programs averaged six to eight weeks between interactions, not the intended 72 hours.¹

Milwaukee’s Captain Polachowski identified the root cause: “Biggest barrier, honestly, is making contact.”² EMS run reports, the primary data source for identifying overdose survivors, often contain incomplete or incorrect contact information. Addresses are wrong. Phone numbers are disconnected. The person has moved or is experiencing homelessness and has no fixed address.

Programs with dedicated data analysts, real-time EMS data integration, and hospital partnerships achieve faster contact, according to the 2022 Ohio study.² But the gap between design intent and operational reality persists: a program that advertises 72-hour follow-up but routinely takes six weeks to make contact is not delivering the service it promises.²

Programs that invested in data infrastructure and dedicated intake staff before expanding the field team achieved faster contact. The bottleneck is not the number of people available to make visits. It is finding the people who need to be visited.

---

Coverage Limitations

Most overdose response teams operate during business hours despite overdoses occurring around the clock. Portland’s Community Health Assess and Treat (CHAT) pilot runs Monday through Thursday, 8 a.m. to 6 p.m.³ Most programs documented in the knowledge base follow a similar schedule: weekday daytime hours, with evenings, nights, and weekends uncovered.

Crawfordsville, Indiana provides 24/7 coverage.² But most programs do not. Portland’s CHAT operates Monday through Thursday, 8 a.m. to 6 p.m.³ Milwaukee’s MORI operates two cars for seven hours a day.⁵

The coverage gap has a specific consequence for overdose response teams: the 24-to-72-hour follow-up window does not pause for weekends. An overdose that occurs on Friday night may not trigger a follow-up visit until Monday or Tuesday, by which time the window may have closed. Programs that operate only on weekdays effectively miss a portion of the population they are designed to reach.

This is the same coverage gap challenge that affects mobile crisis teams, crisis stabilization centers, and other alternative response programs. The National Research Institute (NRI) 2024 survey found that 70% of mobile crisis programs nationally claim 24/7 availability but only 40% actually staff all shifts.¹¹ The gap between claimed capability and operational reality is a national pattern across alternative response, and overdose response teams are not exempt.

---

The Workforce Constraint

The peer recovery specialist workforce is the binding constraint on program scale. Polachowski described the challenge: the job requires people who are both stable in their own recovery and willing to do emotionally demanding field work involving daily exposure to the crisis they personally survived.² Gorman, who is in recovery himself, described the relational dimension that makes the role effective: connecting “in ways others cannot because they’ve been there.”⁴

Programs compete for a limited number of qualified peer specialists, and the competition extends beyond overdose response. Harm reduction programs, addiction treatment centers, recovery housing programs, and community health organizations all recruit from the same pool.¹

---

The Treatment and Housing Bottleneck

Overdose response teams connect people to treatment. But the team’s ability to follow through depends entirely on whether treatment capacity exists, has openings, and is accessible to the person being connected.

Polachowski identified housing as “one of the biggest barriers that the Milwaukee Overdose Response Initiative (MORI) encounters,” particularly for people on methadone maintenance who need daily dosing at specific clinics.⁴ Molinski described the geographic dimension: “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 treatment, the distance becomes a barrier independent of the person’s motivation.⁴

Huntington’s Priddy described the same constraint in rural Appalachia: thin treatment infrastructure means connecting someone to treatment when the nearest facility has a waiting list is a different challenge than connecting someone in a larger city.¹⁰

---

The Grant Cliff

Federal COVID-era grants that funded many overdose response programs are expiring. The Trump Administration revoked roughly $11.4 billion in COVID-era funding for grants linked to addiction, mental health, and other programs in March 2025.¹² Programs built on time-limited federal funding face a countdown: when the grant ends, the program ends unless alternative funding has been secured.

Grant instability creates a cascade of secondary problems. Staff who see the funding expiration date leave for positions with more stable employers before the money actually runs out. Losing experienced staff mid-program undermines the relationships that make the model work. Recruiting replacements for a position with a known expiration date is difficult. The program degrades before the grant technically expires.

Opioid settlement funds provide a buffer. Wisconsin expects approximately $780 million through 2038 from combined settlements, with state distributions jumping from $8 million in fiscal year 2024 to $36 million in fiscal year 2025.⁵ Connecticut expects roughly $600 million total.⁶ Travis County allocated $860,000 from its settlement.⁷ These funds are designated for overdose-related work and operate on multi-year payment schedules independent of federal budget decisions. But settlement funds are finite, and communities that treat them as permanent funding rather than bridge funding will face the same cliff years from now.

CAHOOTS, the 36-year-old civilian crisis response program in Eugene, Oregon, collapsed in April 2025 after its nonprofit operator suffered financial failure.^{6 5} Angela Kimball of Inseparable articulated the underlying mechanism: cities fund police and fire for the capacity to be ready, whether or not a call comes in a given hour; crisis programs are funded only for active response.⁵ The unfunded gap — training, supervision, travel time, community relationship-building, staff availability time — explains the pattern. Overdose response teams relying on a single grant stream are exposed to the same structural risk.

Programs embedded in existing fire or health departments survive funding disruptions better than standalone grant-funded initiatives, because the institutional infrastructure (dispatch, vehicles, facilities, HR) already exists and is funded through the department’s baseline budget. The program adds staff; it does not build infrastructure from scratch. The fire department institutional home matters for survival, not just convenience: when grant funding is cut, the program’s dispatch, vehicles, and supervision still exist because the department pays for them independently.

---

The Evolving Drug Supply

The drug supply that overdose response teams were designed to address has changed, and it continues to change in ways that challenge the model’s assumptions.

Xylazine, a veterinary sedative that does not respond to naloxone, was involved in approximately 27% of opioid overdose deaths in Milwaukee County in 2023, up from 1% in 2020.⁵ Xylazine causes severe necrotic tissue wounds and complicates both overdose reversal and follow-up care. 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.”⁸

The practical implication is that training, protocols, and supplies must be continuously updated. A team trained and equipped for opioid overdose reversal may encounter patients whose symptoms do not respond to naloxone because xylazine is the dominant substance. Field-based buprenorphine, one of the model’s most promising innovations, addresses opioid use disorder specifically and does not treat xylazine dependence. The drug supply evolves faster than training protocols, and programs that do not build in continuous adaptation will fall behind.

---

Privacy and Trust Barriers

Overdose survivors’ willingness to engage with follow-up teams is shaped by fear. Fear of legal consequences if drug use is reported. Fear of child protective services if the team sees children in the home. Fear of probation or parole violations. Fear of eviction if a landlord learns about the overdose.

Polachowski stressed the team’s commitment to confidentiality: “We don’t share anything with law enforcement… They’re protected by their HIPAA rights.”² But the fear persists, particularly in communities where the line between health services and enforcement has historically been blurry. Trust takes time, and peer specialists with lived experience build it faster than uniformed responders or people with institutional titles. Even so, some overdose survivors will refuse engagement regardless of who is at the door.

Programs that include law enforcement as a formal team member (Colerain, Huntington) face a specific version of this tension. The officer’s presence may open doors in some communities through institutional credibility, but it may close doors in others where residents associate police with prosecution. The Huntington and Colerain models have reported success with the multi-agency approach, but their experience may not generalize to communities with deeper distrust of law enforcement.

---

The Evaluation Gap

No randomized controlled trial has been conducted on overdose response teams.¹ Nearly all outcome data is program-reported. Community-level overdose reductions cannot be attributed to the teams alone because they operate alongside naloxone distribution, treatment expansion, and other interventions.

Programs use different definitions of success. Colerain’s 80% “gotten into recovery” (2015-2019 data)⁹ and Huntington’s approximately one-third treatment entry (cumulative, confirmed by 2025 peer-reviewed study)¹⁰ measure different things with different denominators and different timeframes. The 2022 Ohio study found wide variation in metrics and definitions across the state’s 22 programs.¹

The DOJ designated eight programs as national peer mentor sites in 2020, signaling federal endorsement of the model’s design.¹ But federal recognition reflects a judgment about program design and reported results, not an independent evaluation of outcomes.

---

What Has Not Gone Wrong

Across the programs documented in this resource, teams enter homes, shelters, and encampments regularly without police escort, and the safety record is clean.² The enabling argument — that providing post-overdose support sustains drug use — has not been supported by outcome data from any documented program. The KFF 2023 tracking poll found that 80% of voters supported creating Quick Response Teams, and no community that adopted the model has reversed course because of poor results.¹¹

---

The Bottom Line: The risks of overdose response teams are structural rather than dramatic: response timing gaps that undermine the 72-hour window, coverage hours that miss nights and weekends, a peer recovery specialist workforce too small for the demand, treatment and housing bottlenecks that limit what connections the team can actually deliver, grant funding that expires on a known timeline, a drug supply that keeps changing, trust barriers rooted in fear of consequences, and an evidence base that lacks the rigor to make confident causal claims. No documented program has produced safety incidents or worsened outcomes. The model’s failure mode is not catastrophe but erosion: the slow degradation of service when funding runs out, staff burn out, and the system around the team cannot absorb the connections it creates. Leaders considering this investment should plan for the infrastructure the team will need to succeed, not just the team itself.