The Connecticut Department of Mental Health and Addiction Services, in partnership with four treatment providers, proposes to launch CT MATx to fill a major gap in availability of buprenorphine and naltrexone clinic based medication-assisted treatment (MAT). Over 500 persons, over the three year grant period, with opioid use disorders will be connected to MAT, recovery coaching, evidence-based practices, and other support services. One suburban and two rural areas have been identified as among those with the highest per capita rates of opioid use and overdose deaths in the state, and have little or no MAT availability: the Torrington/Winchester area in Litchfield County; the town of Windham and surrounding towns in southern Windham County; and several towns around New Britain and Bristol in central Hartford County. In order to help these communities overcome this problem, CT MATx will: (1) employ evidence-based screening and clinical assessment, and focused engagement techniques to connect opioid- dependent individuals with buprenorphine or naltrexone plus individualized recovery coaching and support; (2) provide evidence-based prescribing, high quality and assertive case management, Motivational Interviewing, Cognitive Behavioral Treatment, 12-step facilitation, peer support, and naloxone kits; and (3) develop a statewide MAT network to identify needed changes in policy and practice to address needs for sustainable, statewide access to MAT. In years 1 and 3 of the grant, we propose to convene statewide MAT conferences in an effort to continue the attack on substance use disorder stigma and other barriers to treatment and promote MAT-specific evidence based practices. CT MATx involvement is expected to lead to reduced substance use, criminal justice involvement, and HIV risk behavior; improved housing and employment outcomes; and social networks more supportive of sobriety in these and all populations.