The administration of naloxone by fire first responders was initiated in Vancouver and Surrey in response to increasing opioid related overdose incidents along with the inability of first responders’ to administer an antidote treatment. The naloxone administration protocol was implemented in February 2016 and this study discusses the experiences to date in both cities. Overall, the initial training and subsequent follow-up was favourably received by members and prepared them for administering naloxone in overdose situations. This study examines, within the current context, lessons learned and opportunities for future engagement with members to support, at the highest level possible, proactive approaches to pre-hospital patient care. Given the current context, fire first responders represent a crucial aspect in any opioid overdose response.