The opioid overdose epidemic is a growing concern for first responders on the front lines. Yet, limited knowledge exists regarding the psychological impacts from repeated exposure to overdose events. Using a scoping review approach, authors searched scholarly databases for a combination of related keywords including first responders, mental health, and opioid epidemic. Twenty-three (23) peer reviewed articles met criteria for inclusion. Six (6) additional non-refereed reports were also included. Frequently cited concerns included increased/unmanageable workloads, burnout, compassion fatigue, safety, negative attitudes/cynicism, cumulative/repeated exposures, and frustration with lack of resources. Several resources described proactive measures to mitigate the consequences. One such measure is a Behavioral Health Access Program (BHAP), a comprehensive, specialized program designed to address the mental health needs of first responders. Opioid settlement funding should be utilized to support the development of BHAPs in all first responder organizations to mitigate the negative mental health impacts inflicted by the epidemic.