Community Health Assess and Treat (CHAT) — Portland, Oregon
The Community Health Assess and Treat (CHAT) Program
The Clinical Innovation Frontier
Portland’s CHAT program, launched as a pilot in 2023 at Portland Fire and Rescue Station 1, initiates medication-assisted treatment in the field immediately after reversing an overdose.[1] [2]
The program also responds to active overdose calls through direct dispatch, in addition to conducting post-overdose follow-up.[2]
How It Works
| Design Question | Portland’s Answer |
|—|—|
| How is the team activated? | 911 direct dispatch. The team responds to active overdose calls from Station 1. |
| Who is on the team? | Fire department-based team with clinical support. |
| Where does it live? | Portland Fire and Rescue, Station 1. |
| What population does it serve? | Anyone experiencing an overdose within the team’s response area during operating hours. |
| What does the team do on scene? | Naloxone administration, field-based buprenorphine initiation, treatment in the field without ER transport, follow-up engagement. |
| How is it funded? | $389,577 from CareOregon (Medicaid coordinated care organization) through June 2025. |
The program operates Monday through Thursday, 8 a.m. to 6 p.m.[2]
Field-Based Buprenorphine
The defining innovation is field-based buprenorphine administration. When a paramedic reverses an overdose with naloxone, the standard sequence in most cities is: revive, stabilize, transport to ER or leave on scene, move to next call. The person wakes up, potentially in withdrawal, with no treatment connection. If they want help, they need to find a treatment provider, get an appointment (often weeks away), and maintain their motivation across that gap.
The team can initiate buprenorphine in the field immediately after overdose reversal.[1] [2] 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.”[1]
Dr. Richard Bruno, the Multnomah County Health Officer, described the clinical 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.”[1]
Buncombe County, North Carolina has pushed this further: their community paramedicine program can administer buprenorphine for up to five days in the field, bridging the person to formal outpatient treatment without an ER visit or inpatient stay.[2] Portland’s CHAT and Buncombe County together represent the leading edge of what field-based addiction treatment can accomplish.
The capability requires specific regulatory authorization. Paramedics must have scope-of-practice approval to administer buprenorphine. A medical director must oversee the protocol. State pharmacy regulations and DEA requirements apply. Programs pursuing field buprenorphine must work through these regulatory layers before the first dose can be administered.[5] Portland’s success demonstrates that the regulatory path is navigable, but it is not automatic.
The 68% Field Treatment Rate
Deputy Fire Chief Stephanie Sullivan provided the most concrete outcome data in a November 2024 interview: “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.”[3]
Sullivan’s 68% field treatment rate means that more than two-thirds of the people CHAT responded to received complete medical treatment on scene without an ambulance transport to the emergency room.[3]
Sullivan reported the 68% field treatment rate and $9 million savings estimate in a November 2024 interview.[3] The savings calculation is based on the number of avoided ER visits multiplied by the average cost of an overdose-related ER encounter.[3]
The CareOregon Funding Model
Portland’s funding structure is as distinctive as its clinical model. The $389,577 from CareOregon, a Medicaid coordinated care organization, represents a payment from the healthcare system for a service that reduces healthcare costs.[1] This is the economic logic that could eventually make overdose response teams self-sustaining: the people who pay for ER visits fund the program that prevents ER visits.
The funding runs through June 2025. As of January 2026, CareOregon remained a funder, joined by Health Share grants and one-time city allocations. A January 2026 KPTV report described the program as dependent on “yearly allocations, cobbling together one-time spending from the city, grants from CareOregon, and now Health Share.”[5] Two team members departed for a neighboring agency in late 2024 citing instability.[5] The cumulative savings figure has risen to over $11 million since 2021.[5]
The limitation of this model is what Angela Kimball of Inseparable, a national mental health advocacy organization, has described as the capacity-versus-encounter gap: CareOregon’s payment covers the clinical encounters the team conducts. It does not cover the institutional infrastructure that makes those encounters possible: the fire station, the vehicles, the dispatch integration, the training, the supervision, and the paramedics’ time between calls. Portland Fire and Rescue absorbs those costs through its baseline budget. The CareOregon funding supplements; it does not sustain independently.
Portland’s Two Programs
Portland operates two alternative response programs that serve different populations through different mechanisms. CHAT (overdose response) and Portland Street Response (mobile crisis) are separate units in different operational contexts. CHAT is a fire department program based at Station 1 that responds to overdose calls and provides field-based addiction treatment. Portland Street Response is a mobile crisis program that responds to behavioral health calls.
The two programs share the fire department’s institutional infrastructure but serve distinct functions. A person in active overdose gets CHAT. A person in mental health crisis on the street gets Portland Street Response. The distinction is clinical (addiction vs. behavioral health broadly), temporal (CHAT also does post-crisis follow-up), and operational (CHAT carries buprenorphine; PSR does not).
The fact that Portland operates both illustrates the broader principle that overdose response and mobile crisis are complementary, not interchangeable. A city that builds a mobile crisis team has not addressed the post-overdose follow-up gap. A city that builds an overdose response team has not addressed the broader behavioral health crisis response gap. Both are needed.
Honest Limitations
Coverage is the primary limitation. The program operates Monday through Thursday, 8 a.m. to 6 p.m. — 32 hours per week.[2]
The 32-hour window means the direct-dispatch advantage (the team that reverses the overdose provides the follow-up) only applies to overdoses that occur during operating hours. An overdose that occurs on Friday night is reversed by standard EMS with no CHAT involvement. The post-crisis follow-up opportunity, if it happens at all, comes from a team that was not present at the acute event.
The CareOregon funding’s initial contract ran through June 2025. As of early 2026, CHAT continues to operate and is actively hiring nurses and Community Health Responders, indicating the program has survived its initial pilot phase. The program relocated its headquarters to a new East Portland facility in August 2024 and expanded from its original Station 1 footprint to cover downtown, Old Town, and southeast neighborhoods.[4] Portland Fire and Rescue’s website reports cumulative healthcare system savings exceeding $11 million since 2021 (KPTV, January 2026). The aftercare teams now operate six days per week. Funding comes from a combination of CareOregon grants, Health Share grants, and one-time city allocations, but the lack of permanent funding remains the program’s primary structural vulnerability.
The program’s outcome data is program-reported.[3] The 68% field treatment rate and savings estimates have not been independently evaluated, which is the case for most overdose response data.[3]
Portland’s broader context complicates interpretation. The city faces a severe homelessness and addiction crisis that extends well beyond what CHAT can address. The program operates within a system that includes Portland Street Response, multiple social service agencies, and an ongoing political debate about how to address visible drug use and homelessness. CHAT’s clinical innovation is real, but it operates in a context where the scale of the crisis dwarfs the scale of the response.
**Why Portland Matters:** CHAT represents the clinical frontier of overdose response: field-based buprenorphine that eliminates the gap between overdose reversal and treatment initiation. The 68% field treatment rate and cumulative savings exceeding $11 million provide the cost-effectiveness data in the field. The CareOregon funding model demonstrates a potential path to healthcare-based sustainability, and the program’s apparent survival past its initial pilot phase and expansion to multiple neighborhoods suggests the model can persist. The program’s honest limitations (initially limited hours, program-reported data, broader crisis context) illustrate the gap between clinical innovation and operational scale that every community pursuing this model will need to close.
Sources
[1] Portland.gov, “CHAT MOUD and ORT Pilot Programs.” CareOregon $389,577, Mon-Thu 8am-6pm, Station 1, Dr. Richard Bruno quote on field-based buprenorphine. https://www.portland.gov/fire/community-health/moud-ort
[2] NACo, “Post-Overdose Response Teams,” Opioid Solutions Center. Buncombe County: buprenorphine for up to five days in the field. https://www.naco.org/resource/osc-port
[3] KPTV, “Portland Fire CHAT responds to opioid crisis,” November 12, 2024. Sullivan: “68% treated in field… saved $9 million.” 19 overdose calls per day average in 2023. https://www.kptv.com/2024/11/12/portland-fire-chat-responds-opioid-crisis/
[4] KOIN, “Portland Fire expands ‘life saving’ program to underserved East Portland,” August 9, 2024. Sullivan: “Once you overdose once, the odds of you overdosing again skyrockets.” Expansion to East Portland. https://www.koin.com/local/multnomah-county/portland-fire-expands-life-saving-program-to-underserved-east-portland/
[5] OPB, “Portland’s first responders will give immediate opiate treatment after overdoses,” January 18, 2024. Commissioner Gonzalez on program limitations; Holly Ilg on withdrawal; buprenorphine cost ~$1/dose. https://www.opb.org/article/2024/01/18/portlands-first-responders-will-give-immediate-opiate-treatment-following-an-overdose/