Milwaukee Overdose Response Initiative (MORI)
The Milwaukee Overdose Response Initiative (MORI)
The Crisis That Built the Program
A fatal overdose occurs in Milwaukee County every 16 hours.[1] Fire Captain Dave Polachowski watched his crews respond to the same addresses, the same people, the same overdoses, month after month. Responders “know these addresses by heart. Third call this month. Fifth call this year. They save the life, pack up their gear, and know they’ll be back.” The emotional toll was severe. Polachowski acknowledged that “there have been tears shed in this building and in cars.”[2]
The frustration was not abstract. It was operational: traditional EMS responded to the overdose, administered naloxone, transported to the hospital or left the person on scene, and moved to the next call. Nobody came back. Nobody connected the person to treatment. Nobody addressed the underlying addiction that would produce the next overdose call from the same address next week.
MORI launched in 2019 as a partnership between the Milwaukee Health Department, the Milwaukee Fire Department, and Community Medical Services.[1]
How It Works
| Design Question | Milwaukee’s Answer |
|—|—|
| How is the team activated? | Post-911 follow-up. The team reviews EMS run reports from recent overdose calls and contacts survivors at their homes. |
| Who is on the team? | Firefighter/paramedic paired with certified peer support specialist. |
| Where does it live? | Partnership between the Health Department and the Fire Department, with Community Medical Services. |
| What population does it serve? | Anyone who has experienced an overdose in Milwaukee County. No eligibility restrictions. |
| What does the team do on scene? | Follow-up visits, naloxone distribution (HOPE Kits with Narcan and fentanyl test strips), treatment connection, sustained engagement, wraparound service connection. |
| How is it funded? | Grant-funded partnership supplemented by opioid settlement funds (Wisconsin expects approximately $780 million through 2038, with distributions accelerating in 2025). |
The program expanded from one car operating four hours a day to two cars operating seven hours a day. Polachowski described the growth as driven by demand: “How come you can’t see what you are doing?” was the question that initially drove his frustration with the lack of follow-up. The answer became the program.
The People
Captain Dave Polachowski supervises MORI and has become its most visible champion. His evolution from frustrated fire captain to national overdose response advocate mirrors the model’s development. He described the peer specialist partnership in operational terms: “Our badge gets us in the door, and then the peer support takes over.”[1] On the enabling criticism: “People call it enabling. We don’t look at it like that. We say it’s enabling you to stay alive until you are willing to get treatment.”[2]
Polachowski was candid about the barriers. On making contact: “Biggest barrier, honestly, is making contact” because EMS reports contain incomplete or incorrect addresses and phone numbers.[3] On housing: housing is “one of the biggest barriers that MORI encounters,” particularly for people on methadone maintenance who need daily dosing at specific clinics.[1]
Amy Molinski is a peer support specialist on the team.[5] She described the commitment that defines the model: “There’s no limit on the amount of times we’ll go back if they want us to come back.”[1] She also identified the geographic barrier that undermines treatment access: “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 distance becomes a barrier to recovery that has nothing to do with the person’s motivation.[1]
Ryan Gorman is a recovery counselor and former drug user who works with MORI. He described the mechanism that makes peer specialists effective: they connect “in ways others cannot because they’ve been there.”[2] Gorman also reported on the changing drug supply: “The prevalence of actual heroin is almost nonexistent from what we see in urinalysis and just word on the street.”[2] Fentanyl has replaced heroin entirely, and it has appeared mixed into crack cocaine, methamphetamine, and other substances.
The Drug Supply Challenge
Milwaukee County data showed xylazine, a veterinary sedative that does not respond to naloxone, was involved in approximately 27% of opioid overdose deaths in 2023, up from 1% in 2020.[4] Xylazine causes severe necrotic tissue wounds and complicates both overdose reversal and follow-up care.
Polachowski described the demographic range the program encounters: fatal overdoses in Milwaukee County range from “teenagers to an 83-year-old. Combat veterans. High school seniors. Young mothers.”[4]
The HOPE Kit
MORI distributes “HOPE Kits” during follow-up visits.[1] Each kit contains naloxone (Narcan) and fentanyl test strips.
What the Data Shows
Milwaukee’s documented outcomes are operational rather than independently evaluated. The program expanded from one car to two, from four hours to seven, driven by demonstrated demand and institutional buy-in from both the fire department and health department. The 16-hour fatal overdose rate provides the baseline context: the crisis is severe enough that any reduction in repeat calls or any successful treatment connection represents lives preserved.
The program has not published treatment connection rates comparable to those reported by Colerain (80%, 2015-2019) or Huntington (approximately one-third, cumulative). The available data is operational: coverage hours, team size, kit distribution, and qualitative accounts from staff.[1]
The Institutional Structure
The three-way partnership between the Health Department, Fire Department, and Community Medical Services distributes both capability and risk. The Fire Department provides the EMS infrastructure, vehicles, dispatch integration, and the institutional credibility that Polachowski described as opening doors. The Health Department provides the epidemiological data, treatment system connections, and public health framing. Community Medical Services provides the peer specialist workforce and addiction treatment expertise.
This structure means no single agency bears the full cost or the full political risk. But it also means coordination across three organizations, three budgets, and three chains of command. Milwaukee’s program has sustained this partnership since 2019, demonstrating that the coordination is manageable. Whether it would survive a major budget dispute between the partner agencies has not been tested.
Honest Limitations
MORI operates two cars for seven hours a day in a county where a fatal overdose occurs every 16 hours.[1] Nights, weekends, and holidays are uncovered.
The program depends on EMS data that Polachowski described as the primary barrier to effective operation. Incomplete addresses, disconnected phone numbers, and people who have moved or are experiencing homelessness make the intended 24-to-72-hour follow-up window difficult to achieve consistently.
Housing and treatment capacity constrain what the team can deliver. Molinski’s description of the geographic barrier to methadone treatment illustrates a system-level problem that the team cannot solve: connecting someone to treatment that is geographically inaccessible is not a successful connection.
The program’s funding depends on grants and opioid settlement funds, both of which are time-limited.[4] Wisconsin’s approximately $780 million settlement provides a longer runway than most grant-dependent programs, but the program’s operational costs require annual budget allocations that compete with other city and county priorities.[4]
**Why Milwaukee Matters:** MORI represents the standard model for overdose response teams: fire department partnership, paramedic-plus-peer staffing, post-911 follow-up activation. Its value as a case study is in the candid documentation of both the model’s strengths (relational trust through peer specialists, institutional credibility through fire department partnership) and its operational barriers (data quality, contact timing, coverage hours, housing and treatment capacity). Polachowski, Molinski, and Gorman provide the most detailed first-person accounts in the field of what the work actually looks like day to day.
Sources
[1] Wisconsin Examiner, Isiah Holmes, “Perspectives on addiction and recovery in a city plagued with overdose deaths,” May 30, 2023. Fatal OD every 16 hours; Polachowski “badge” quote; Molinski “no limit” quote; housing barriers; methadone distance. https://wisconsinexaminer.com/2023/05/30/perspectives-on-addiction-and-recovery-in-a-city-plagued-with-overdose-deaths/
[2] PBS Wisconsin, “Milwaukee, suburbs fight to contain wave of opioid overdoses,” May 4, 2023. Polachowski repeat addresses, tears, enabling reframe; Gorman quotes on heroin disappearance and peer connection. https://pbswisconsin.org/news-item/milwaukee-suburbs-fight-to-contain-wave-of-opioid-overdoses/
[3] PBS Wisconsin, “Dave Polachowski on firefighter responses to drug overdoses.” Polachowski on HIPAA protections and contact barriers. https://pbswisconsin.org/news-item/dave-polachowski-on-firefighter-responses-to-drug-overdoses/
[4] WTMJ, “Xylazine presence in drug overdoses increases in Milwaukee County,” February 23, 2024. Dr. Ben Weston, Milwaukee County Chief Health Policy Advisor: 134 xylazine-involved deaths of 502 opioid deaths in 2023 (~27%), up from 1% in 2020. https://wtmj.com/news/2024/02/23/xylazine-presence-in-drug-overdoses-increases-in-milwaukee-county/
[5] TMJ4, “How people who’ve beat opioid addiction are helping others in Milwaukee find treatment,” July 25, 2023. Molinski background; Polachowski “dad talk” quote. https://www.tmj4.com/news/local-news/how-people-whove-beat-opioid-addiction-are-helping-others-in-milwaukee-find-treatment