Alaska has seen a dramatic rise in opioid use and opioid overdose related deaths. This project will help Alaska's unmet need by increasing the capacity and number of prescribers of Medication Assisted Treatment (MAT), increasing the number served, and augmenting present prevention efforts. There are inadequate resources for MAT, few physicians to prescribe them and only four opioid treatment programs. The project will increase access to treatment, reduce unmet needs, and opioid overdose related deaths. Alaska will focus on the three goals: increase provider capacity for MAT, increase the number of clients receiving appropriate OUD/MAT treatment, and decrease the negative impacts of opioid use. The following objectives will be tracked: number of OUD prescribers trained, number of OUD prescribers receiving buprenorphine waivers, number of OUD prescribers implementing MAT, number of behavioral health providers with training on OUDs, number of people who receive OUD treatment, number of people who receive OUD recovery services, numbers and rates of opioid use, and numbers and rates of opioid overdose-related deaths. This project will strengthen prevention efforts, decrease access to opioid medications through the purchasing and distribution of drug disposal bags, and provide naloxone kits. To build capacity to provide office-based opioid treatment (OBOT) Hub and Spoke treatment approach to target three to five behavioral health agencies in high needs communities. The MAT learning collaborative will help to expand services by increasing the number of physicians, physician assistants, and advanced nurse practitioners willing to prescribe buprenorphine and/or naltrexone. This project will also engage Alaska's expanding system of re-entry coalitions to facilitate access to MAT for individuals returning to the community from the Department of Corrections.

The Alabama Opioid Strategic Targeted Response (STR) project will enhance and expand opioid use disorder (OUD) prevention, treatment, recovery support and related services for unserved and underserved populations and locations in Alabama. Alabama has one of the highest rates of painkiller use in the world. The ADMH will collaborate with its state partners to conduct a needs assessment to identify gaps in the state's system that block access to OUD treatment and related services. The project will expand access to medications approved for OUD; improve retention in care for individuals who have been diagnosed with an OUD; improve the skills of the workforce for delivery of evidence-based services for OUDs; reduce stigma and improve public awareness of opioid misuse and addiction crisis and of treatment options available; increase the availability of Naloxone; and enhance statewide coordinated efforts of the strategic prevention framework. The targets for Alabama's Opioid STR will be (1) individuals who are not able to access OUD treatment or related services because they don't have the money or insurance to cover the cost of such; (2) individuals in areas of the state in which OUD services are not available; (3) individuals in areas of the state with high overdose and death rates; (4) minorities, veterans, and referrals from the criminal justice system who are significantly underrepresented in the state's OUD treatment programs. A 24/7 hotline will be established and a treatment related media campaign will be implemented to promote improved access to care. ADMH will leverage the resources of its partners, including BRSS TACS and the ATTC in securing training for the OUD workforce in evidence-based practices that include Motivational Interviewing and Shared Decision Making. The use of Peer Support Specialists will be utilized in every aspect of this initiative.

Arkansas has the lowest percentage of people with an opioid addiction for which buprenorphine is available. The project will expand the statewide availability of Medication- Assisted Treatment (MAT) in three populations of focus: pregnant and parenting women; individuals re-entering the community from incarceration; and individuals who received naloxone for an overdose as part of the state's PDO prevention efforts. Arkansas is a PDO Prevention Grant recipient, and a statewide comprehensive needs assessment to identify the communities at highest risk of Opioid Use Disorder (OUD) is ongoing. The r assessment will be used to help assess current availability of treatment/prevention resources across the state. STR funding will allow statewide availability of MAT, working together with eight regional treatment centers. The goals of the grant are to: expand PDO prevention efforts by supplying naloxone to first-responder agencies in additional communities and expanding the ongoing media campaign; train families and healthcare providers on recognition of signs of opioid addiction, referrals to treatment, and interventions; increase access to OUD treatment using EBPs; and provide OUD recovery support through peer specialists and recovery coaches. Both target communities for PDO prevention activities and communities of focus for STR initiatives will be selected by an advisory council, which will ensure the creation of a comprehensive and consistent strategic plan for prevention and treatment/recovery activities across the state. Two additional task forces will be created specific to the goals of this grant - the EBP committee, which will focus on collaborative efforts to provide MAT, and the Peer Specialist committee, which will focus on comprehensive peer support to clients during recovery. An additional 375 people per year, or 750 across the life of the grant, will be served at one of the eight funded treatment providers with treatment and recovery services.

The "Taula'i" project aims to build capacity amongst service providers in order to effectively address Opioid Use Disorders (OUD). Data has not captured OUDs in the past, therefore, the prevalence of OUDs in American Samoa is uncertain at this time. Given the trends of other licit and illicit substances, it is imperative that American Samoa have an established infrastructure that is equipped to intervene as early as possible for OUD suspected cases. Five primary goals will be accomplished with this project: (1) to increase awareness and knowledge of the general public, health professionals, and behavioral health service providers about OUD; (2) to conduct a needs assessment that will identify the level of need and readiness of the behavioral health system to address OUDs; (3) to develop a territorial strategic plan for the treatment and prevention of OUD in American Samoa; (4) to effectively identify adult opioid use or OUD in the community through extensive data collection (Behavioral Health Survey) and screening; and (5) implement evidence based practices for the treatment of OUD. The average number of individuals enrolled per annum in the SSA's Substance Abuse, Prevention, and Treatment (SAPT) program is 300. The average number of individuals identified as having an OUD in the U.S. was approximately 9% of all Substance Use Disorders while less than 1% of admissions are comprised of Asian/Pacific Islanders (SAMHSA, 2004). This project will aim to screen at least 1000 adults aged 18-90 throughout the course of the grant and will serve at least 40 adults identified as having an OUD.

The goal of the Arizona Opioid State Targeted Response project is to increase access to Opioid Use Disorder (OUD) treatment, coordinated and integrated care, RSS and prevention activities to reduce the prevalence of OUDs and overdose deaths. The project includes developing and supporting state, regional, and local level collaborations and service enhancements for best practices to comprehensively address the full continuum of care related to opioid misuse, abuse and dependency. The activities include a data-driven decision-making process; expanding modes and type of training; expanding law enforcement access to Naloxone kits; expanding navigation and access to MAT and integrated treatment and recovery systems and increasing the number of high risk individuals served; and increasing the ability to ensure the likelihood of recovery success by expanding peer support services, recovery homes and recovery supports to pregnant and parenting women. Measureable prevention objectives to reduce OUDs and opioid-related deaths will include: equipping law enforcement with Naloxone; expanding access to prescription drug drop boxes; increasing community knowledge and awareness through trainings and evidence-based programs and practice; and increasing access to SBIRT. Measurable treatment objectives to reduce OUDs and opioid-related deaths will include: stigma reduction and knowledge of MAT; enlisting MAT providers; increasing access to peer support services; increasing access to services for MAT; increasing MAT treatment navigation for criminal justice involved individuals; increasing RSS for pregnant and parenting women; and increasing access to MAT in residential and recovery home settings. Target populations are individuals with OUDs; those with OUDs being released from correctional settings; and pregnant and parenting women with OUDs; young adults and older adults.

California's project, "Medication Assisted Treatment (MAT) Expansion", will strategically focus on populations with limited or no MAT access including rural areas, American Indian and Native Alaskan (AI/NA) tribal communities and statewide access to buprenorphine. The grant focuses on two projects, the California Hub and Spoke System (CA H&SS) and the Tribal MAT Project. The MAT Expansion Project is projected to serve 20,892 over the two-year grant period. The goals of the project are to implement the Hub and Spoke model in various areas throughout California which will improve access to Narcotic Treatment Programs (NTPs), Medication Units in counties with the highest overdose rates. The project will also increase the availability of buprenorphine statewide and increase MAT utilization for tribal communities. California's H&SS will be based on Vermont's current Hub and Spoke model, wherein the NTPs will act as the Hubs and the physicians who prescribe buprenorphine in office based settings which will function as the Spokes. Hubs will serve as experts, dispense methadone and buprenorphine, provide care to patients, manage buprenorphine inductions and provide support to the Spokes when they need clinical advice. Spokes will provide ongoing care for patients with milder addiction and will be comprised of at least one prescriber and a MAT team to monitor adherence to treatment, coordinate access to recovery supports, and provide counseling. Patients will be able to move between the Hub and Spoke based on clinical severity. The Tribal MAT Project is designed to meet the specific MAT needs of California's tribal communities. This project will also fund prevention activities and conduct a statewide needs assessment and strategic plan. Learning Collaborative will also be a vehicle used to create the connection that is needed to have an effective network with bidirectional patient movement and team care. UCLA will conduct an evaluation of project efforts.

The Colorado project will address gaps in prevention, treatment, and recovery services through expansion of medication assisted treatment (MAT) and crisis and emergency services; professional trainings; naloxone distribution; transitional housing support for high utilizers; media campaigns; and coordination of services with the criminal justice system. CO-OSTR will focus on high-need populations, who face significant barriers: uninsured/underinsured persons seeking MAT; family members and children of individuals with OUD; persons reentering the community from incarceration; persons who interact with the emergency departments and the state crisis services; individuals seeking treatment in a primary care setting; high-utilizers of the criminal justice or emergency department services with unstable housing. Identified gaps include access to affordable MAT and residential treatment, lack of capacity for providers to prescribe MAT, knowledge of naloxone and other resources to prevent overdose, connection to treatment following crisis, lack of family resources, gaps between the justice system and SUD treatment, and access in tribal communities. Evidenced-based strategies for addressing gaps include identifying and bridging gaps in funding; trainings for primary care providers, law enforcement, and tribal providers; prevention counseling for families; and a communications plan to reduce stigma. Project goals include identifying unmet needs; expanding capacity for prevention, treatment, and recovery services; and data collection and analysis to continue to improve the state systems. Activities will provide treatment and recovery services for 12,793 individuals with OUD in Year 1 and 9,765 in Year 2, serving 22,558 individuals across the life of the grant. OBH will also provide prevention services to 800 families, and train 300 new providers to prescribe medication assisted treatment.

CT's Targeted Response to the Opioid Crisis will reduce the negative impact of opioid use in communities. These targeted responses build on the state's evolving recovery-oriented system of care, helping to continue to shift the focus of care from responding to acute episodes to a prevention and recovery management framework that spans prevention, to pre recovery outreach and engagement, to recovery initiation through active treatment and recovery supports services, to long-term recovery maintenance. These responses include: conducting expansive prevention and early intervention activities; increasing availability of clinic-based medication-assisted treatment (MAT); partnering recovery coaches with hospital emergency departments to initiate MAT; enhancing substance abuse residential programs to be MAT-compatible; supporting existing behavioral health treatment programs by expanding their ability to utilize evidence-based practices and enhance their recovery supports; providing vouchers for treatment; expanding RSS for young adult opioid users and their families; providing MAT to pre-release Department of Correction inmates; supporting courts with diversion and treatment for arrestees with SUD; supporting municipal police departments; expanding faith-based recovery support; and improving timely access to detox and other services by expanding transportation availability. Recent community awareness of opioid problems has galvanized community groups into action. Community coalitions including local government leaders, health professionals, educators, police, and behavioral health experts have formed to address this epidemic. The Connecticut ADPC was charged by Governor Malloy to make recommendations including legislative and policy changes to address the opioid crisis. Governor Malloy also commissioned a comprehensive statewide strategic plan by Yale University resulting in the CORE report. These resources will be used to implement the 13 ADPC goals and the CORE plan.

The District of Columbia Department of Behavioral Health (DBH) will implement the District Opioid Targeted Strategy (DOTS) Project. DOTS activities will address all individuals in the District with or at risk for Opioid Use Disorders (OUDs), but DOTS will specifically target middle-aged heroin-using African-American males because local data indicate they are most affected. DOTS has 5 goals: engage in strategic planning focused on District-wide OUD needs, decrease in the incidence of OUD through prevention, increase access to OUD treatment and improve care coordination for MAT clients, expand RSS for individuals with OUD and enhance recruitment and engagement for individuals with OUDs. To meet these goals, DOTS will: conduct a needs assessment; implement an OUD prevention social marketing campaign focusing on prescription opioids for youth and young adults; expand MAT by providing treatment cost assistance to facilitate methadone-based MAT for 100 enrollees annually; increase Clinical Care Coordinators to ensure treatment linkages for 30 clients; train and certify 25 Recovery Coaches; provide additional RSS to 560 individuals with OUDs annually; recruit 560 individuals with OUD by implementing SBIRT-trained Peer Outreach Teams; improve treatment referrals from the DOC and improve MAT referrals from Family Treatment Court. DOTS will focus on the high-need target population because they play a major role in the DBH-funded OUD treatment system and because the District is expanding buprenorphine-based MAT through other channels.

Delaware's project will make substance abuse treatment readily accessible to those struggling with opiate addiction. To do this, services will be created through the development of three new recovery support centers and the strategic deployment of newly-trained recovery coaches. While the majority of those struggling with opiate addiction are White males, women are increasingly using heroin, including pregnant women. The goals of this grant are to expand the system's treatment capacity and to improve the access and effectiveness of opiate-related treatment for individuals battling with opioid usage. Delaware intends to address the following key touch points to reach those with opiate additions: at the time of an arrest, at the time of release from prison, after admission to emergency room for an overdose, after being revived with naloxone, and when opioid addicted women realize they are pregnant. It is at the aforementioned touch points occur when a person is vulnerable and may be more willing to change their lifestyle. Through the recovery support centers, opiate addicted individuals early in the recovery process will be able to receive recovery services. In order to provide this additional treatment support, Delaware will develop recovery coaches who will assist the individual with gaining access to services that help support ongoing recovery. Recovery coaches also will be used to identify and provide support to those opiate-dependent individuals who are pregnant and provide support following delivery. It is believed that the creation and deployment of the additional resources will enable Delaware to address more efficiently the increased demand for access and to provide more timely delivery of treatment for those battling opiate addiction.

Florida's Opioid State Targeted Response Project is designed to address the opioid crisis by providing evidence based prevention, medication-assisted treatment (MAT), and recovery support services (RSS). The goals of this proposal include reducing opioid-related deaths, preventing prescription opioid misuse among young people, increasing the number of individuals trained to provide MAT and RSS, and increasing access to MAT among individuals with opioid use disorders (OUD). Middle and high school students in high-need rural counties will receive school-based life skills training proven to prevent prescription opioid misuse. Funds will also purchase and distribute naloxone, an opioid overdose antidote proven to reduce opioid overdose deaths. Uninsured/underinsured individuals with OUD will be targeted to receive MAT, RSS, and overdose prevention services. Funding will also be used for methadone and buprenorphine maintenance because controlled trials demonstrate that these services are most effective at retaining individuals in care, reducing opioid use, and reducing opioid-related mortality. Funds will also be used for an extended release formulation of naltrexone that blocks the effects of opioids and is approved for the prevention of relapse to opioid dependence. Preliminary and conservative estimates indicate that at least 2,789 individuals can be served in the first year and a total of 5,578 individuals over the two-year project. Training and technical assistance on MAT and RSS will be provided to a variety of stakeholders, including potential prescribers, peers in recovery, child welfare staff, and court staff. A full-time Project Director will be responsible for overall project oversight and management. An epidemiologist will assist with data analysis; develop reports to inform strategic planning and evaluation activities. Peer specialists will be employed in six regions and Behavioral Health Consultants will train and assist child protective investigators.

The Federated States of Micronesia (FSM) is in a Compact of Free Association with the United States. FSM is comprised of 600 islands situated across the archipelago of the Caroline Islands, located between the Philippines and Hawaii across one million square miles of the North Pacific Ocean. FSM has submitted a project entitled "FSM Response to the Opioid Crisis Grant Application: A System of Health Care Approach to a Medical and Public Health Problem in a Low Resourced Island Setting" (FSM Opioid STR Project) which focuses on addressing an emerging public health crisis. This project is based on both a medical and a public health approach incorporating a system of care approach. The general population will receive preventive health messaging and awareness while those suffering from OUD will directly receive psychosocial counseling and drug therapy. The aim is to prevent further spread of the Opioid situation. This project will adopt the SAMHSA's Opioid Overdoses Prevention Toolkit as it guide in setting up its activities and Pathway to Change curriculum. This project will establish a treatment program for individuals with OUDs. This program is based on science and culturally appropriate practices. This project will use SPF to identify and implement evidence - base strategies and program models that target individual, group and environmental change that are specifically adapted to each state. The goals and objectives are as follows: Build capacity and infrastructure for data driven Opioid abuse prevention, treatment, and recovery; Reduce the onset and /or progression of Opioid use and abuse of other illicit drugs and pathway drugs; Reduce perceived acceptability of Opioid use and other drugs use among the youth and adult population. Activities include strengthen enforcement of laws regarding Opioid and other illicit drugs; Enhance the state PDMP; Establish and /or enhance community-based recovery support systems; and Train OUD prevention and treatment providers.

The Georgia Opioid State Targeted Response project will serve 5,658 persons total (2,350 - year 1 and 4,008 - year 2). An estimated 750 first responders and other stakeholders will be trained in year 1 and 1,500 in year 2. The project will develop a targeted response to the opioid crisis through prevention, treatment and recovery initiatives. There is a focus on addressing gaps in evidence based practices and services and creating a continuum of prevention and recovery oriented treatment. Prevention activities will include: statewide media campaign on opioid misuse/abuse; increase in the number of SPF opioid pilot programs; school transition mentor pilot for opioid/ prescription drug misuse/abuse prevention; and Naloxone education and training. Treatment and recovery activities will include: expansion of detox capacity; increased bed capacity; implementation of peer specialist in hospital ERs; employment of staff to ensure fidelity to recovery housing standards; requiring each treatment provider expand MAT services to have a peer specialist staff to engage/ link individuals to treatment resources; providing training about recovery from OUD for behavioral health, DFCS, corrections, and other stakeholders; implementing a warm line run by peers; implementing MAT via a pharmacy benefit in treatment provider locations and implementation of a Department of Community Supervision MAT Vivitrol pilot. Project goals include: increase awareness about opioid misuse/abuse; provide training for the public; expand detox services for individuals with an OUD; expand access/bed capacity of residential services for individuals with an OUD; incorporate certified peer specialists in identified ER's; support the infrastructure of recovery transitional housing; expand/develop RSS for individuals with an OUD; implement a warm line, run by peers, for individuals with OUD; and, develop MAT clinical based capacity for DEA approved medications.

Hawaii State Targeted Response to Opioids (HI-STR) project leverages prevention and treatment intervention strategies to address rates of opioid use, misuse and fatalities across the state. The HI-STR project is collaborative effort that will expand and enhance Hawai'i's continuum of health promotion, prevention and care for persons at risk of, or suffering from Opioid Use Disorders (OUD). The project moves Hawaii toward realizing its goal of a seamlessly integrated healthcare system that takes a public health approach to addiction. Opioid use and related fatalities, particularly due to opioid prescription misuse, are a growing concern for the state. The HI- STR project will address these concerns through three key activity tracks (1) education and awareness, which will promote public awareness of the dangers of opioid use and provide training to health professionals to better identify and assist persons at risk or suffering from opioid use disorders; (2) care coordination and integration which will target more efficient and effective ways to integrate primary and behavioral health care to reduce risk and better treat persons affected by opioid misuse and abuse; and (3) policy shaping which targets policies and protocols aimed at improving access and expanding proven interventions and prevention strategies such Medication Assisted Treatment (MAT). By the end of the project, Hawaii will have increased access to opioid treatment for over 400 individuals. The project will result in expanded services to areas in the state with the most un-met need and the implementation and expansion of proven and effective policies and strategies related to opioids, such as use of a PDMP. Through linking and leveraging a wide range of resources and efforts already underway, the project will serve to expand and enhance the State's efforts to ensure a statewide system of care that is substantially more integrated, effective and accessible.

The Iowa Opioid State Targeted Response project will expand capacity of the existing regional prevention and treatment provider network with a focus on accessible opioid treatment. A thorough assessment and strategic action plan involving local stakeholders will provide the foundation for implementation of evidence-based practices, including medication assisted treatment (MAT). The focus of this project is to build community capacity for a successful community response to the opioid crisis through the following goals: o Build an enhanced, statewide infrastructure to address opioid misuse in Iowa o Increase awareness of opioid risks through statewide prevention efforts o Increasing the use of medication assisted treatment and other evidence-based practices in Iowa The Iowa Opioid STR project will leverage the service improvements gained through other opioid grants, making these evidence-based practices more accessible to the community of focus (18-44yr olds) and other Iowans affected by opioid use disorder across the state. Prevention efforts will include localized information dissemination and statewide environmental efforts through a media campaign to raise awareness of the risks of prescription drugs and heroin use. Goals include increasing the awareness of naloxone availability and promoting utilization of the Prescription Monitoring Program. Expanded opioid treatment capacity will benefit Iowans across the state through regional, community-based, or telehealth partnerships with medical service providers.

Idaho's Response to the Opioid Crisis (IROC) will address the opioid epidemic which Idaho is currently facing using a multifaceted approach that seeks to expand access to Medication Assisted Treatment (MAT), reduce access to opioids through prevention efforts, enhance the recovery oriented system of care, and reduce opioid-related deaths.

IDHS/DASA is the Illinois Single State Authority (SSA) for SUD issues. Illinois has been impacted by the opioid crisis as evidenced by increased primary opiate clients among IDHS/DASA-funded treatment admissions, increased need for MAT for persons with OUD, increasing numbers of opiate overdose deaths, and increasing numbers of opiate-related emergency department visits and general hospital admissions. Evidence is also provided of the relative lack of MAT and Naloxone overdose reversal services in large areas of the state. This project proposes a comprehensive array of OUD treatment and RSS that includes: expanded outpatient methadone treatment and recovery home services; several primary healthcare-based outreach, linkage, MAT, and case management services; Vivitrol injection and linkage services for county jail prisoners and drug court offenders with OUD; community-based outreach, linkage, and recovery management services; hospital ED-based screening, recovery coaching, and linkage services; Suboxone education, consultation and support for general hospital medical staff; and establishment of an Illinois Opioid Crisis Line. The prevention services include: expanded Naloxone purchase, training, and distribution services in counties of high need and for EMS personnel; opiate-related enhancements to the Illinois Prescription Monitoring Program; opioid awareness activities for Illinois high school coaches and athletic directors; establishment of a statewide opiate awareness campaign; and development of an automated reporting system for the Illinois Drug Overdose Prevention Program. A data collection plan is provided that describes data collection, management, analysis, and reporting in response to federal requirements and a local decision to administer the SAMHSA/GPRA tool to persons admitted to the expanded OMT and recovery home services.

Indiana's Integrated Response to the Opioid Epidemic will expand existing prevention, treatment, and recovery services for OUDs, identify and implement new evidence-based programs across the continuum of care to address OUDs and opioid use in general, and focus on providing intensive support to areas with limited access to treatment and related services. The project will focus particularly on the needs of underserved populations throughout the state Programming will focus on individuals that are especially at risk from OUDs or for whom the impact of an OUD is disproportionately severe, including pregnant women, adolescents, and individuals leaving the criminal justice system and reentering the community. The project focus on the following: expansion of Residential/Inpatient Detoxification and Treatment; Deployment of Mobile Crisis Teams focused on overdose reversal, referral to treatment, crisis management, and short-term therapeutic solutions; Development and Implementation of I-ECHO; Development of a Recovery Coach Initiative that will engage peers and professionals with individuals who are in emergency rooms for OUD overdose to ensure systematic engagement with all aspects of the spectrum of care; Expansion of Provider Access to Integrated Prescription Drug Monitoring and Electronic Health Records; and Undertake Statewide Social Marketing and Health Communications Campaigns. These strategies will increase the number of people in who receive OUD treatment; increase the number of people who receive OUD recovery services; increase the number of providers implementing MAT; increase the number of OUD prevention and treatment providers trained; reduce numbers and rates of opioid use, and; reduce numbers and rates of opioid overdose-related deaths.

Kansas has developed a project to deal with the increase in both use and overdose rates regarding opioids. Kansas will utilize epidemiological data to inform a regional approach to the proposed implementation plan. The project will focus on four regional projects and one special project with specific emphasis on medication-assisted treatment being provided at the nine methadone clinics. This approach will allow for each region to conduct a comprehensive needs assessment and create implementation plans to meet the specific needs, gaps, access concerns, as well as risk and protective factors specific to their geographic, demographic and cultural differences. Kansas has been affected by the prescription and heroin poisoning epidemic that has plagued the United States in recent years. From 1999 to 2014, drug poisoning death rates have tripled-placing deaths from poisoning the leading cause of injury related deaths in Kansas. Drugs, including prescription, over the counter and illicit drugs, account for more than 80% of all poisoning deaths. Along with an increase in heroin and synthetic opioid deaths, Kansas has seen an increase in the number of individuals age 26 and older who report having misused a prescription opioid pain reliever within the past year. BRFSS data indicate that 59% of individuals age 18 and older report misusing pain medication for pain relief. These increases in opioid related drug misuse and deaths parallel the increase in prescription opioid availability. According to data from the Kansas prescription drug monitoring program there were over 4.2 million Schedule II-IV prescriptions and over 256 million pills dispensed in Kansas in 2014. Furthermore, more than 100,000 Kansas patients had overlapping prescriptions for opioids and benzodiazepines and more than 75,000 patients had more than 90 morphine milligram equivalent per day of opioid prescriptions in 2014. According to experts Kansas is the 16th highest opioid prescribing state in the country.

With over 1,200 overdose deaths in 2015, opioid use disorder has reached epidemic levels in Kentucky. Addressing this epidemic is a top priority across all levels of government and public and private partners. While Kentucky has made great strides, much work remains. Guided by the Recovery-Oriented System of Care Framework, the purpose of the Kentucky Opioid Response Effort (KORE) is to implement a comprehensive targeted response to Kentucky's opioid crisis by expanding access to a full continuum of high quality, evidence-based opioid prevention, treatment, recovery, and harm reduction services and supports in high-risk regions. Informed by data on populations most in need, the KORE will focus on three primary populations: pregnant and parenting women, individuals re-entering society upon release from criminal justice settings, and adolescents and young adults. A composite risk index identified nine geographic regions at highest-risk for OUD including the greater Lexington area, the greater Louisville area, Northern and Eastern Kentucky. The KORE offers the state an opportunity to dedicate much needed resources to address five overarching goals: (1) preventing opioid misuse and abuse; (2) increasing access to OUD treatment services, including Medication- Assisted Treatment; (3) increasing the availability of recovery support services designed to improve treatment access and retention and support long-term recovery; (4) increasing availability of naloxone; and (5) enhancing statewide coordination and evaluation of healthcare and public safety strategies targeting opioid misuse and overdose. A comprehensive performance assessment system will support ongoing evaluation of progress against proposed goals, objectives, and activities and guide continuous quality improvement efforts. Though a multifaceted and complex response is necessary, Kentucky's singular focus is to end the opioid epidemic and to save lives!

The Louisiana STR Initiative will enhance existing statewide prevention, treatment, and recovery support services offered for individuals experiencing or at risk for opioid use disorder (OUD). The priority populations to be served by this grant are: the under- and uninsured, individuals living in areas with high prevalence rates of overdose or opioid overdose deaths and the criminal justice population. In addition, African American males represent a sub-population of those disproportionately affected by this epidemic due to increased opioid use and will be a population of focus. The goals of the Louisiana Opioid STR Initiative include: increase public and professional awareness and education for prevention and treatment of opioid use, misuse, and abuse; increase by 1,670 the number of individuals with a OUD diagnosis who are being treated with EPBs; and increase recovery support services for 600 OUD clients. Prevention, intervention, treatment and recovery support activities will be supported by the grant. The prevention priority for this grant is to utilize the existing SPF-based infrastructure as a basis to prevent prescription drug misuse and abuse through an awareness and education campaign, with special activities planned within each of Louisiana's Local Governing Entities and coordination with the Opioid Treatment Programs. Activities will be based on the strategies outlined in SAMHSA's Opioid Overdose Prevention Toolkit, including public education through a media campaign and provider training, with an intervention strategy of Naloxone education and distribution to target populations. OBH will enhance and expand the existing OUD treatment availability by building the capacity of the local OTPs and other behavioral health provider networks to provide access to EBPs, particularly MAT and education and training on non-opioid alternatives. This comprehensive approach will help to address the myriad of problems in Louisiana associated with illicit opioid use.

Unintentional opioid overdose (OD) has been a leading cause of death in Massachusetts since 2005. This project will allow MA to employ strategies that utilize a framework of recovery-oriented systems of care (ROSC) to provide a comprehensive method for prevention, treatment and recovery service system. The project will serve 10,312 individuals through implementing the following activities: prevention: Overdose Education and Naloxone Distribution expansion in communities with a significant opioid overdose problem; first responder post-overdose follow-up initiative after 911 calls for an overdose, and offer assistance accessing other available services; overdose prevention training and technical assistance for health and human services providers; and convening a Pharmacy Workgroup to further define and address systemic barriers to accessing naloxone, culminating in the development of a guidance document. The following treatment and recovery services programming will include: Office Based Opioid Treatment (OBOT) expansion to at least seven new community-based sites; re-entry treatment and RSS pre-release including MAT induction, treatment planning, and post-release linkages to recovery support, coaching and case management; Recovery Support Center-based peer support model for pregnant, post partum and parenting women; three treatment and recovery focused training and TA initiatives (OBOT T&TA, Opioid ECHO telehealth and capacity building sites to support and enhance the provision of services for PPW and their families). Overall, the MA Opioid-STR grant activities will improve, expand and enhance access to treatment, support sustained recovery, and prevent opioid misuse, abuse and overdose to achieve life-saving results.

The M.O.R.R. - Maryland Opioid Rapid Response will increase access to and enhance services for individuals with an Opioid Use Disorder (OUD) through reducing unmet treatment need and enhancing prevention efforts. This will be accomplished through implementation of a strategic plan to fill the gaps in evidence-based services, design of primary and secondary prevention methods and more emphasis on peer and other recovery support. M.O.R.R will use social media campaigns to educate about the harms of opioids, create harm reduction and community outreach programs, and reduce stigma associated with substance related disorders (SRD). By creating crisis services with care coordination and expanding lower level of care beds will both move individuals into treatment and reduce unintentional deaths. The expansion of naloxone distribution with training for providers and consumers will reduce deaths also. Support for primary care providers through consultation on SRDs and TA regarding prescribing will increase quality for and the number of providers providing EBP treatment. Workforce development and training across the treatment system including Trauma Informed Care (TIC) and technology transfer to provide the skills, knowledge base, and confidence desired by treatment providers and peer support staff. The goals for this program are to reduce OUD and opiate related deaths by strengthening prevention efforts through reducing over prescription of opiates and improving public understanding of OUD, supporting providers through the availability of consultation, TA and workforce development and training, and expanding services needed by individuals with OUDs through expansion of treatment and care services, peer support, recovery, naloxone distribution, harm reduction outreach, crisis services and lower intensity 3.1 facilities. Our plan is to serve an additional 21,000 individuals annually and 42,000 over the two years. We will also train over 1,400 individuals each year.

The Maine Opioid STR will serve up to 270 uninsured adults and youth with opioid use disorder (OUD) over the two-year grant period by providing evidence based Medication Assisted Treatment (MAT) through existing or new MAT models. The program will prioritize pregnant and parenting women and IV drug users. The focus for treatment in urban areas will be based on wait lists and demonstrated ability to increase capacity from existing providers and provider networks. The focus for treatment and capacity building in rural areas will be uninsured adults and youth with opioid use disorder living in the Western Public Health District (Androscoggin, Franklin and Oxford Counties), Downeast Public Health District (Washington and Hancock Counties), and Aroostook Public Health District (Aroostook County). The rural community of focus also prioritizes pregnant and parenting women, IV drug users, and includes individuals transitioning from correctional facilities to the community, and tribal members living in these counties. The goal of the Maine Opioid STR project is to improve outcomes for uninsured adults in Maine who receive MAT for opioid use disorder. This will be accomplished by implementing Opiate Health Homes and a "hub and spoke" model of service delivery, where services will be delivered through existing systems of care, including Federally Qualified Health Centers, hospitals and hospital systems and existing community partnerships. In addition, existing contracts will be leveraged for education and training of prescribers of medication assisted treatment and psychosocial interventions. Prevention interventions will include opioid misuse community education sessions and implementation of Prime for Life curriculum in community settings. Vendors contracted as "hubs" will be required to work with local recovery supports through explicit and verified links.

The purpose of the Michigan Opioid STR project is to increase access to treatment; reduce unmet treatment need; and reduce opioid overdose related deaths through the provision of prevention, treatment and recovery activities for OUDs. To achieve this purpose, the Office of Recovery Systems of Care will: improve the state infrastructure for individuals with an OUD; train Prepaid Inpatient Health Plan and provider administration on infrastructure improvements, and training provider staff on evidence based interventions and fidelity measures; implement evidence based prevention and treatment interventions with accompanying fidelity instruments; improve access to psychiatric services and psychotropic medications to individuals with an OUD; expand the availability and use of specially trained peers for MAT; expand outreach and engagement activities to primary care and law enforcement; increase supports to the prisoner re-entry population with an OUD; expand the use of peers in emergency departments and primary care settings; expand overdose education and naloxone distribution; and disseminate a statewide media campaign. The Michigan Opioid STR initiative will: improve awareness of the risks associated with using opioid based medications as well as illegal opioids; increase the availability of prevention focused EBP's; educate physicians on the CDC Prescriber Guidelines for responsible opioid prescribing; increase access to MAT, withdrawal management, and residential treatment services for individuals with OUDs; increase availability of treatment and RSS to individuals with OUDs; improve the quality of services for individuals with OUDs; increase treatment and support services available to individuals re-entering the community from prison; and revise policy and contractual language to reflect standards of care as identified in Michigan's Medication Assisted Treatment Guidelines for Opioid Use Disorders.

The MN Opioid STR grant proposes collaborative planning efforts between the Minnesota Department of Human Services Alcohol and Drug Abuse Division, Health Care Administration and Office of Indian Policy along with the Minnesota Department of Health. The MN Opioid STR expedites opioid treatment and recovery resources and supports integration of services at each point in the continuum. The MN Opioid STR is a comprehensive effort that recognizes urgent need to provide immediate response for the following target populations: American Indian; African American; Women/Pregnant Mothers and infants with Neonatal Abstinence Syndrome. Proposed activities include: Increasing access to "Rule 25" assessments and expediting access to treatment for those experiencing opioid use disorder; increasing opioid-specific peer recovery and care coordination specialists; piloting of Parent Child Assistance Program peer mentoring for pre- and post-natal support of mothers experiencing opioid use disorder and infants with Neonatal Abstinence Syndrome; expanding Office Based Opioid Treatment/Medication Assisted Treatment (OBOT/MAT) in both the number of providers and their geographic reach, supported by launch of an Opioid-focused Minnesota Project ECHO; Expanded access to naloxone for Opioid Treatment Programs and EMS teams; Implementation of a statewide media campaign that expedites access to treatment resources through web-based tools such as an opioid-treatment "Fast-Tracker" and an Opioid Prescribing Improvement Program: Prescriber Education Campaign. Minnesota expects to serve 109,852 individuals in the through the proposed MN Opioid STR. Measurable outcomes include reducing the number of opioid related deaths overall and reducing disparities for identified target populations, increasing retention in care, reducing opioid misuse for all age groups, increasing opioid-specific treatment and recovery services options and geographic locations throughout the State of Minnesota.

The Missouri Opioid State Targeted Response (Opioid STR) project will expand access to integrated prevention, treatment, and recovery support services (RSS) for individuals with opioid use disorder (OUD). Primary focus will be on multidisciplinary training and education on Medication Assisted Treatment (MAT) and the provision of evidence-based treatment services to uninsured individuals with OUD. Primary prevention activities will focus on increased awareness and decreased availability of opioids, led by local agencies in high risk areas. Prevention of overdose deaths will be accomplished through training clinical providers and at-risk individuals on Overdose Education and Naloxone Distribution practices, and providing telemedicine didactic and consultation services to primary care providers treating chronic pain. RSS will be provided in the form of Recovery Community Centers, recovery housing and management checkups. The State of Missouri Department of Mental Health will lead the project, with administration, implementation, and evaluation activities provided by the Missouri Institute of Mental Health- University of Missouri, St. Louis, as well as healthcare agencies, other academic institutions, and experts. The primary goals of the Opioid STR project include: increase provider and student-focused opioid use and overdose prevention initiatives and programs; increase access to MAT for uninsured individuals with OUD through provider training, direct service delivery, healthcare integration, and transitions of care; increase the number of individuals with an OUD who receive RSS; and enhance sustainability through policy and practice changes. Combined with coordinated interagency collaboration and evaluation, the Opioid STR project will transform the system of care for OUD in Missouri. This will be accomplished by developing evidence-based protocols, implementing professional training and consultation programs, and delivering effective services to individuals in need.

The Community Guidance Center, under the Commonwealth Healthcare Corporation, also the designated Commonwealth of the Northern Mariana Islands Jurisdiction and State Primary and Behavioral Health System has proposed a project to respond to the opioid crisis. This project provides the opportunity for the Community Guidance Center to obtain much needed resources to strengthen current substance use disorder prevention and treatment level of care and efforts to provide an inter-clinic and prevention unit platform towards the related priorities established within the Wellness Clinic, Recovery Clinic, and the Prevention Unit which focuses on providing a continuum of wellness and recovery intervention services, substance use/abuse prevention services to include mental health promotion contingent to available resources obtain through State and Federal support. Identified within the project proposal, efforts to increase clinical and program capacity in hopes of having these designated personnel and clinicians provide macro, mezzo, and micro efforts to engage prevention and treatment intervention strategies specific to the Opioid Crisis experienced throughout the nation, territories, and affiliates. The project name is the Family and Community Driven Care, Addressing the Opioid Crisis, in the CNMI. CGC currently has the strength and ability to have mental health, substance use treatment, and substance abuse prevention within one agency. Individuals, families, and community organizations within the CNMI will be included to address the current gaps of services identified within primary care and the community. The proposed project will be established within the CGC Wellness Clinic, Recovery Clinic and the Prevention Unit.

Mississippi is poised to respond to the opioid crisis through the Mississippi State Targeted Opioid Project (mSTOP). Over two years, mSTOP will serve an estimated 1500 persons who use opiate medications or heroin and are at risk for misuse/abuse and overdose, primarily Caucasians between the ages of 18 and 45 in the top seven counties where opioid use disorder (OUDs) is prevalent. The media campaign will impact approximately 300,000 additional citizens. Other populations of focus are pregnant women, returning veterans and their families, and individuals re-entering the community from correctional facilities. mSTOP aims is to enhance prevention, treatment and recovery services. Goal 1: Prevent and manage opioid overdose; Goal 2: Implement and expand clinically appropriate evidence-based treatment service options and availability; Goal 3: Prevent opioid misuse and abuse; and Goal (4) Use evaluation science and surveillance to improve success. Optimize and expand data sources. Evidence-based psychosocial interventions will be used to address the specific needs of the population of focus: Screening, Brief Intervention, Referral to Treatment (SBIRT) and the Community Reinforcement Approach (CRA). At least four Community Mental Health Centers will receive funding to provide these evidenced-based treatment programs for persons with OUDs. A statewide communications campaign will be developed that includes targeted opiate-related health education. Under the leadership of the Mississippi Department of Mental Health (DMH) Bureau of Alcohol and Drug Services (BADS), mSTOP will leverage existing resources and programs to maximize project effectiveness. The project will make use of partnerships and collaborations to bridge resources of health care, public health and law enforcement to enhance professionals awareness about prevention and treatment methods, create an environment that facilitates sharing of data and increases the likelihood of sustainability.

The Montana Opioid STR will fund training and infrastructure development for the hub and spoke model of opioid use disorder (OUD) treatment, medication assisted treatment (MAT), peer support & recovery services, naloxone/narcan training & distribution, and opioid disposal bag education & distribution. The project will focus on the following populations: American Indians, pregnant women, veterans and individuals involved in the criminal justice system. American Indians comprise the largest racial minority in Montana with 6.3% of residents identifying as Native American. These groups suffer from disproportionately high rates of substance use disorder, including OUD, which is often criminalized instead of treated medically. It is estimated 90% of the individuals in jail are there for SUD related offenses. To improve Montana's response to the opioid epidemic the project will focus on two primary goals: support OUD prevention programs and services in Montana and develop comprehensive, evidence-based services for OUD treatment in Montana. Prevention programs and services will focus on OUD needs assessment and strategic plan, increase access to and training on naloxone/narcan use for emergency medical systems and law enforcement providers, and increase access to disposal bags among individuals receiving an opioid prescription. The project will implement six Hub and Spoke models for OUD treatment, with Hubs agreeing to implement MAT and Peer Support and Recovery Services and contract with at least two smaller Spoke sites to implement these services with the assistance of the MAT providers at the Hub sites. Montana intends to serve 2,215 clients with MAT treatment at 18 Hub and Spoke Sites by the end of the project period, with 90% of these individuals (1993 total) receiving peer support and recovery services.

The Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMHDDSAS) of the North Carolina Department of Health and Human Services (NC DHHS), the State Mental Health Authority (SMHA) and the Single State Authority (SSA) for substance use will serve North Carolinians at highest risk for Opioid Use Disorder (OUD) through the proposed project, the NC State Targeted Response to the Opioid Crisis (NC Opioid STR). Opioid use disorders are pervasive throughout North Carolina, due to the use of illegal opiates such as heroin, as well as misuse of prescription opioids; as such, this proposal will identify the areas of highest need with the intent of serving as many individuals and areas as funds will allow. Over the past several years, North Carolina has experienced an increase in opioid and heroin use, misuse and overdose. In response, the state has developed strategies and implemented several initiatives to address the problem. The Cures Act provides the opportunity to consolidate those efforts, as well as enhance and expand services and supports to meet the needs of the citizens of North Carolina. Given the impact on our state, the governor has made this a top priority of his administration. Under the leadership and direction of the Office of the Governor, the Office of the Attorney General and the Secretary of DHHS, this project will strengthen the foundation for prevention, treatment and recovery services, an essential component of North Carolina's broader efforts to address this challenge and ensure the health and safety of individuals, families and communities in our state.

The purpose of North Dakota's State Targeted Response to the Opioid Crisis Grant project is to address gaps and increasing access to evidence-based treatment and recovery services for opioid use disorder (OUD) and reducing opioid overdose related deaths through the provision of primary and secondary prevention. The first goal is to increase evidence-based treatment and recovery services for individuals with OUD, with a focus on individuals reentering communities from criminal justice settings. The following objectives are identified to achieve this goal: (1) increase utilization of Medication-Assisted Treatment (MAT); (2) Increase access to peer and other evidence-based recovery support services. The second goal is to increase implementation of evidence-based primary and secondary prevention strategies. The following, summarized, objectives were identified to achieve this goal: (1) decrease access to unneeded prescription opioid medication; (2) increase availability and utilization of naloxone. The third goal is to increase utilization of effective treatment services for Opioid Use Disorder (OUD) by increasing communication efforts to reduce stigma surrounding Opioid Use Disorder (OUD), Medication-Assisted Treatment (MAT) and needle exchange/syringe service program. To address the state's capacity needs, and to effectively implement evidence-based strategies across the full continuum of care, the Division has developed a hybrid system design to implement evidence-based strategies that will most rapidly address needs and gaps from both the state and community levels. This project has the potential to impact the entire state, which has an estimated population of 756,927. Evaluation data will be collected to answer the evaluation questions posed in the FOA including data required by SAMHSA and additional measures as needed to successfully evaluate the project.

The Nebraska's Opioid STR program will reduce the incidence of abuse of prescription and illicit opioid drugs through ongoing collaboration between practitioners, experts and leaders across the continuum of care. The Department of Behavioral Health (DBH) will lead the project. The program will work to mitigate the effects of opioid use disorders (OUD) by identifying statewide needs, increasing access to treatment, including Medication Assisted Treatment (MAT), and reducing prescription drug overdose deaths. The goals include completing a needs assessment; developing a comprehensive strategic plan; implementing prevention initiatives; implementing clinically appropriate evidence based practices (EBPs) for OUD treatment including training providers in the ECHO model, funding access to Naloxone, enhancing the utilization of MAT through the funding of Suboxone, creating an Addiction Medicine Fellowship, and developing a curriculum supplement to the peer support curriculum specific to opioids; assistance to patients with treatment costs by providing funding for Suboxone; and training treatment providers who serve consumers transitioning from criminal justice settings or other rehabilitative settings. DBH intends to serve the entire population of the state through training and prevention initiatives, while targeting high burden areas of the state for outreach, training and technical assistance. Nebraska proposes to increase the number of clients served by DBH in the opioid replacement therapy service by 5% each year, resulting in approximately 36 more individuals receiving this service over course of the project period. Nebraska further intends to supply 1000 Naloxone kits to high risk clients each year, resulting in 2000 Nebraskan's having access to this life-saving drugs. Finally, Nebraska intends to serve approximately 340 individual's receiving assistance with treatment and in support of their path to recovery by providing funding for MAT through the use of Suboxone.

New Hampshire's project will be a comprehensive approach to address OUD crisis through various prevention, treatment, and recovery services targeted at high-risk populations. Populations have been selected due to their high risk of substance use, OUD, and overdose events and fatalities. The identified target populations of focus include pregnant women with OUD and parents in recovery, youth in recovery, children and families involved with the Division of Children due to substance use, and incarcerated men and women scheduled to re-enter the community. NH anticipates serving approximately 988 individuals. NH plans to implement selective prevention services, treatment services, and peer recovery support services. NH has chosen EBPs that are designed for the populations of focus and will implement those practices with selected community-based providers and organizations that can demonstrate willingness and readiness to engage in this specialized work. Unique to this proposal is the emphasis on a strong collaboration between a multitude of DHHS and other state agencies, all of which are experiencing the challenges of the state's opiate crisis for the populations they serve. NH will use these funds to open access to critical services that may not be accessible for the target populations due to insurance coverage barriers, as well as services that are not yet part of any benefit plan. Examples of these services include; family peer support, youth peer support, enhanced care coordination, support services that increase treatment engagement (childcare, transportation), and parenting education. NH is eager to partner with other STR funded states to participate in SAMHSA's national evaluation and is committed to working alongside SAMHSA's priorities for this funding as a means to increase access to treatment, reduce unmet treatment need, and reduce opioid overdose related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder.

The New Jersey State Targeted Opioid Response Initiative (STORI) will address the opioid crisis using a variety of strategies. The objectives are to increase access to treatment, reduce unmet treatment need and reduce opioid related deaths. A new fee-for-service treatment initiative will be developed that will include a wide range of levels of care and the use of evidenced based practices, particularly medication assisted treatment (MAT). STORI will focus on individuals with Opioid Use Disorder (OUD) and other overdose survivors, veterans, individuals released from incarceration in last 60 days, and young and older adults. Prevention efforts will focus on community education programs for older adults with the goal to reduce demand for and misuse of opiate prescriptions. Additional training on naloxone will be provided to schools, jails and prisons, and naloxone kits will be distributed. STORI services will encompass training of primary health and behavioral health care practitioners on best practices for the prescribing of opiates and expanded use of MAT. STORI will provide peer training for volunteers. New Jersey has a number of initiatives dealing with these issues intends to leverage all these initiatives with this current grant opportunity to maximize its efforts. Family support will be provided through the development of three regional Family Support Centers. Anticipated outcomes of the STORI include: reduction/abstinence from drugs and alcohol, increase in employment, reduced criminal justice involvement, increase in stable housing, increased social connectedness, and increased percentage of individuals completing treatment at the recommended level of care. Additional outcomes include: reducing opioid overdoses, increasing retention in treatment, reducing the length of time to relapse and prolonging recovery, and increasing number of individuals receiving MAT. STORI will serve 8,671 individuals annually and 17,342 individuals over the two-year project.

In 2014, New Mexico had the second highest drug overdose death rates in the country, with almost half of these deaths caused by prescription opioids. The purpose of the NM Opioid STR Initiatives is to address this tremendous opioid crisis by expanding access to treatment, reducing unmet treatment need, and reducing opioid overdose-related deaths through the provision of prevention, treatment and recovery services for Opioid Use Disorders (OUDs) in New Mexico. This includes prescription opioids, as well as illicit opioids such as heroin. The NM opioid STR Initiative will be overseen by the NM Behavioral Health Services Division (BHDS), which is the Single State Drug and Alcohol Authority (SSA) in the state, and will expand access to quality services by: supplementing and expanding existing OUD prevention, treatment, and recovery activities currently managed by BHSD, and developing and incorporating new successful implementation models and approaches to support expanded services and ensure long term sustainability. Enhancing and expanding access to prevention, treatment and recovery services for OUD is critical for all NM communities because it will improve outcomes for persons with OUD and support a strong and sustainable OUD prevention and treatment system. Expanding access to comprehensive OUD services will be achieved through the following goals: (I) develop a comprehensive response to the opioid epidemic; (2) implement a coordinated and sustainable approach to OUD service expansion; (3) expand the OUD prevention services array; (4) expand the OUD treatment services array; (5) expand the OUD recovery services and supports array; and (6) utilize an ongoing Continuous Quality Improvement (CQI) framework to ensure data informed decisions. We anticipate reaching a total of 9,850 individuals annually, for a total of 19,700 individuals over the two-year grant period.

The opioid crisis in Nevada can be classified as a public health epidemic. Nevada's Governor has been instrumental in bringing awareness to the crisis, convening state and national experts to develop policy and practice to address the issues, and supporting the implementation of prevention, intervention, and treatment solutions. In 2015, Nevada expanded access to naloxone, requiring use of the Prescription Drug Monitoring Program, and the implementation of a Good Samaritan Law. In 2017, Nevada will establish prescribing standards of care, increase education for prescribers, and monitoring of overdose related emergency room and inpatient admissions. The expansion of Medicaid has made healthcare widely available to individuals who previously did not have access. Opioid treatment programs remain under capacity for the numbers of individuals they are capable of providing treatment to. Yet despite these efforts and resources, the epidemic continues to grow. Nevada consistently demonstrates some of the highest rates of drug overdose mortality in the country. Data shows that Nevada has one of the highest rates of prescription painkillers sold and drug overdose deaths per capita. Nevada's vast geography and healthcare provider shortage make a challenging environment to implement community based strategies. Stigma and lack of knowledge about available services prevent individuals to seek treatment and physicians from linking and referring individuals to OUD treatment and recovery supports despite availability. This project will address the needs of its communities and establish a recovery-oriented system of care using the Collaborative Opioid Prescribing Model, overdose response and treatment engagement programs, overdose education and naloxone distribution, prescriber education and expansion of office based opioid treatment, recovery communities and peer supports, enhanced data collection, and information sharing while maximizing resources including Medicaid reimbursement.

The New York State Office of Alcoholism and Substance Abuse Services (OASAS) in partnership with the Research Foundation for Mental Hygiene, Inc. (RFMH) will undertake a multi-pronged approach to address the issues of Opioid Use Disorders in the unserved and underserved areas of the State. OASAS has identified high need areas in the state and through its existing infrastructure will enhance treatment and recovery services. OASAS's proposal is to develop Centers of Treatment Innovation in high need areas which will include developing Tele-health capacity; increasing the number of prescribing practitioners for medication assisted treatment via training and mentoring; having care managers to bridge the gap between behavioral health and primary care; use of locally placed Peer Recovery Support Staff to improve treatment engagement and retention; enhanced clinical staff; and providing reentry support for individuals being released from jails/correctional facilities. OASAS will also utilize a multi-level prevention approaches including delivery of evidence-based prevention services to underserved, hard-to-reach youth and other at risks populations, foster care settings and permanent supportive housing; provide training and distribution of Naloxone kits; and a targeted media campaign. To support a growing recovery community OASAS will develop a youth and young adult statewide recovery network and local community networks. OASAS looks to establish a social media campaign that promotes health, recovery and wellness, establish peer supports and to provide technical assistance and support to local communities and networks of young people across New York State.

Unintentional drug overdose continued to be the leading cause of injury-related death in Ohio with opioids being the driving factor. Ohio's Opioid STR Project goals focus on building a community system of care (prevention, early intervention, treatment and recovery support) that emphasizes service integration between physical health care, emergency health care, behavioral health care, criminal justice, and child welfare. Strategies and activities undertaken for this effort build upon Ohio's on-going efforts to address the opioid epidemic and are designed to reduce overdose deaths and enhance the ability of individuals with opioid use disorder to receive treatment using evidence-based approaches. A three-pronged approach is adopted to operationalize the identified strategies and activities. This includes 1) department-directed strategies and activities focusing on counties of the state with highest opioid overdose deaths and treatment need, 2) department-directed strategies and activities to be deployed statewide, and 3) Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Boards identified projects consistent with the goals and objectives of the Ohio Opioid STR Project. Ohio's Opioid STR Project emphasizes evidence-based practices throughout the needed continuum of services and interventions: PAX Good Behavior Game and Botvin Lifeskills for primary prevention, Screening, Brief Intervention and Referral to Treatment (SBIRT) for early intervention, and Medication-Assisted Treatment (MAT) for opioid use disorder, using the ECHO model and other training methodologies to expand treatment capacity. Additional evidence-based practices include Sobriety, Treatment and Recovery Teams (START) for child welfare and Trauma Informed Care to address the vicarious trauma experienced by professionals in multiple systems and families who are facing the consequences of Ohio's opioid epidemic on a daily basis.

The Oklahoma Opioid STR Integrated System of Care (ISOC) will serve persons with, or at risk for OUD statewide. The ISOC will include promotion, prevention, early intervention, treatment, and recovery supports. The goal is to provide treatment to 2,200 people over two years, and to distribute 7,000 naloxone kits available to help those in need. The ISOC will provide early and easy access to services through: outreach; early identification and linkage to appropriate levels of treatment; crisis intervention and linkage to appropriate level of treatment; and recovery support services, all of which will save lives today. Measurable goals and objectives include: Develop and disseminate messages aimed to prevent abuse of opioids; Mobilize community outreach workers to deliver training, disseminate material, drive service referrals, and increase local action on opioid prevention; Train the primary care workforce in non-opioid alternative to pain management; Train workforce in best practices; Implement a model of practice facilitation in selected areas focusing on uptake of opioid prescribing guidelines; Enhance the PDMP; Expand overdose education and naloxone distribution; Engage comprehensive treatment agencies and crisis units to fill gaps and provide a fuller array of services; Employ strategies to increase access to treatment for persons with or at risk for OUDs; Identify, refer and provide treatment for those coming out of jails and prisons; Identify those most in need of treatment; Require comprehensive treatment agencies to maintain waivered prescriber on staff; Provide additional 60 slots of high intensity residential services; Expand capacity for peer recovery support providers; Train all levels of staff in EBPs; Provide consultation for prescribers of MAT; and Conduct comprehensive evaluation of all activities.

The OR-Opioid STR aims to enhance state and community-level efforts to advance public health interventions that reduce PDO and problematic prescribing of controlled substances; increase the number of DATA-waived providers in Oregon who are actively prescribing FDA approved medication for OUD; enhance and expand the provision of peer support services design to improve treatment access and retention and support long term recovery; provide treatment transition and coverage for patients reentering the community from the criminal justice system; implement access to FDA approved medication for MAT in combination with social interventions; establish statewide public education campaign on opioid; and establish a more robust network of recovery resources in places most affected by opioid epidemic in Oregon. The project will overall aim to increase access MAT across the state, with a special focus on Oregon's Tribal communities. The project will also keep a focus on rural and frontier counties. Despite a high need in rural areas there is significant low access to MAT in these regions. A significant proportion of this population also turns to heroin once opioid becomes too expensive for individuals living with chronic pain. This is true in certain urban areas as well. In Oregon, OUD is primarily an access, training, and education issue. Only 30% of the DATA waived providers actually prescribe MAT medication. The project will train providers on CDC's prescribing guideline, and community engagement and outreach. In addition, the Oregon PDMP will also be enhanced to get at least 95% of the high prescribing providers. This will allow for more accurate and targeted needs assessments. The project will collaborate with Department of Public Health, county health departments, criminal justice system, and regional Medicaid providers. Several components, such as ongoing evaluation, technical support, policy model, and sustainability plans, are already in place.

Pennsylvania proposes to address the opioid crisis by increasing access to treatment, reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment, and recovery activities for opioid use disorder (OUD). The project will support a comprehensive response to the opioid epidemic using a strategic planning process to conduct needs and capacity assessments. The results of the assessments will identify gaps and resources from which to build upon existing substance use prevention and treatment activities. Initial strategies have been developed and will include the following: provide clinically-appropriate treatment services to 6,000 individuals who are uninsured or underinsured; expand treatment capacity for Medication Assisted Treatment for OUD; Expand treatment capacity for underserved populations by targeted workforce development and cultural competency training; improve quality of prescribing practices through prescriber education; increase community awareness of OUD issues and resources through public awareness activities; expand implementation of warm hand-off referral practices to increase the number of patients transferred directly from the emergency department (ED) to substance use treatment; increase the number of youth receiving evidence-based prevention and life skills education programs; improve identification and referral of students for assessment and treatment by providing training to school personnel; and, expand Pennsylvania's integration of its Prescription Drug Monitoring Program (PDMP) data at the point-of-care, promoting ease-of-use of this data in clinical decision making.

The MHAASA PR Opioid STR project is for populations in use of opioids and at risk of overdose. The project will focus on improving the infrastructure PDMP and opioid overdose surveillance systems; transition to treatment of opioid using inmates; four new methadone dispensing sites integrating the RTSH EBP; TND EBP secondary prevention for adolescents, and; media education and provider/responder training. The summarized goals are as follows: 1. Develop a needs assessment to identify high prevalence areas, existing providers, funding sources, and gaps in opioid prevention and treatment; 2. Develop a PR strategic plan to address data infrastructure and opioid use prevention, treatment and recovery gaps; 3. Implement proven EBP's in secondary prevention of opioid misuse in adolescent populations; 4. With collaborative partners, expand access to EBP opioid treatment in public and private provider systems; 5. With Corrections system, link inmates with opioid use history to treatment upon release; and 6. Train providers and responders on overdose prevention and opioid treatment topics. Annually, the project will serve 350 unduplicated opioid users in treatment/recovery services; 200 in primary and secondary prevention; and 500 through provider and responder training. Over lifetime of the project 900 opioid users are projected to be served.

Palau Project RX Monitoring aims to address the emerging Opioid Crisis by engaging with community, asses needs, build capacity, and implement evidenced based practices to support prevention, treatment, and recovery from opioid addiction.

The RI State Targeted Response (STR) will address the strategies including increasing access to treatment, reducing unmet treatment needs and reducing overdose deaths through prevention, treatment and recovery support initiatives. The RI-STR will ensure that all federal, state and private funding is synchronized and is alleviating identified gaps. The goals are to reduce the number of prescription drug/opioid overdose-related deaths and adverse events among individuals 18 years of age and older; increase access to treatment, reduce unmet need and opioid overdose related deaths through the provision of prevention, treatment and recovery activities for prescription and illicit drugs; and support a comprehensive response using a strategic planning process and needs and capacity assessment epidemiological data. The state will increase the number of DATA waivered health providers; increase access to behavioral healthcare and psychiatry in high risk communities primary care settings; enhance access to psychiatrists in the current OPT Health Homes and providing fentanyl testing assistance; increase access to recovery housing and specialized MAT peer support specialists; incorporating opioid and prescription drug misuse outreach, education into current prevention task forces; finally, through the distribution of naloxone to community based outreach teams and individuals leaving the Department of Corrections. The initiatives will increase integration of behavioral healthcare into health settings with the goal of increasing DATA waivered clinicians. Reduce recidivism of overdose incidents by enhancing access to psychiatrists in the OPT-Health Homes, testing for Fentanyl, and the provision Recovery Housing with staff that is trained in recovery supports and MAT. Prevention strategies will leverage systems to increase access to Naloxone, develop a communication plan that will be implemented at a grass roots level through the regional prevention task forces.

The South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS) is requesting funds to address the opioid crisis by increasing access to treatment, reducing unmet treatment needs, and reducing opioid overdose-related deaths through the provision of prevention, treatment, and recovery activities for opioid use disorder (OUD). DAODAS has partnered with Behavioral Health Services Association of South Carolina Inc. (BHSA) and all 32 county alcohol and drug abuse authorities that provide SUD prevention, intervention, treatment, and recovery-support services statewide; S.C. Association for the Treatment of Opioid Dependence and its members that operate Opioid Treatment Programs in all regions of the state; Medical University of South Carolina; S.C. Department of Health and Environmental Control; S.C. Department of Corrections; S.C. Pharmacy Association; and Faces and Voices of Recovery South Carolina. The proposal is a comprehensive response to the opioid epidemic by conducting a thorough needs assessment that will be the basis for strategic and sustainability plans; addressing stigma and need for action through a statewide campaign; expanding and enhancing the state's Prescription Drug Monitoring Program; expanding and enhancing the state's Opioid Overdose Prevention Program; providing financial assistance to indigent South Carolinians for medications and talk therapy; expanding access to clinically appropriate, evidence-based practices for OUD treatment; enhancing and expanding provision of peer support and other recovery-support services; providing assistance to individuals returning to their communities from criminal justice settings; and partnering with MUSC to expand medication-assisted treatment/OUD services across the state. The initiative will include developing a resource website, expanding the use of the MUSC Center for Telehealth, academic detailing, expansion of the SBIRT program, and the implementation of the Project ECHO model.

South Dakota's State Targeted Response to the Opioid Crisis will create a responsive strategic plan to implement prevention, treatment, and enhanced recovery support services statewide, through medication-assisted treatment (MAT), naloxone distribution, telehealth access to care, and workforce development. The South Dakota Department of Social Services will lead the project in collaboration with the South Dakota Department of Health (through Centers for Disease Control Data-Driven Prevention Initiative funding focused on prescription drug overdose), the Division's State SBIRT Implementation grant, and community providers to identify, leverage, and enhance community-based resources in the areas of prevention, treatment, recovery, and peer support services. Key outcomes of this two-year project will include an outcome assessment dashboard for ongoing performance metric evaluation, a statewide strategic plan to address opioid use/misuse, empowered and engaged communities with increased awareness of the opioid issues, culturally responsive materials and strategies that can impact our most vulnerable populations (most notably Native Americans, who have higher-than-average incidences of opioid use in the state), better equipped first responders to incidences of opioid overdose, extensive provider, prescriber and physician training in the areas of prevention and evidence-based treatment models, capacity building and planning for statewide MAT access through telehealth delivery, and a statewide virtual support 'hub' and 'spoke' model for enhanced workforce training and staffing of complex OUD cases. An estimated 22,000 individuals are projected to be served by the project through the provision of treatment services and connection/referral to community-based resources and providers.

The Tennessee Opioid STR Grant will reduce the number of overdose related deaths through naloxone distribution, train professionals and key stakeholders on opioid overdose disorders, implement an Opioid Overdose Rapid Response System, improve access and availability of clinical treatment and recovery services, expand access to medication assisted treatment, and implement new strategies for pregnant women and supplement existing resources. This project will focus on individuals at high risk for overdose and individuals with a diagnosis of opioid or heroin use disorder. Research shows that Tennesseans are three times more likely to identify prescription opioids as their primary substance of abuse than the national average while heroin treatment rates have grown more than four times in the past five years in metropolitan counties. Over the past decade, we have seen a rise in the incidence of babies born with NA. Infants with NAS stay in the hospital longer and often have serious medical and social problems. Universal prevention strategies will be used to reach the targeted population. The unduplicated number of individuals to receive treatment and recovery services will be 3,408 the first year and 3,408 the second year. Prevention objectives include culturally tailoring Harm Reduction training material to targeted areas; provide opioid overdose trainings and medical forums; conduct a statewide Media Campaign; distribute Overdose Safety Kits and naloxone to targeted areas; utilize the Opioid Overdose Rapid Response System; conduct Train the Trainer on the Stanford Chronic Pain Self-Management Program. The treatment objectives are to enhance clinical treatment services by providing buprenorphine and VIVITROL injections; expand capacity and number of individuals served though outpatient tele-treatment; improve access and availability to clinical treatment and recovery services; and provide engagement, retention and detox, when appropriate, for pregnant women.

The Texas Targeted Opioid Response (TTOR) program will expand prevention and treatment efforts that promote recovery and early intervention for populations identified as high risk for opioid use disorders (OUD). This program will enhance outreach and education for the public, provide training to enhance workforce, and target individuals at risk of developing OUDs, or a potential overdose. TTOR will focus on three populations at highest risk for OUD: people who live in major metropolitan areas; women who are pregnant and postpartum; and people who have a history of prescription opioid misuse or are at risk of developing an opioid issue. The Texas Statewide Behavioral Health Strategic Plan identified access to treatment, unmet treatment needs, fortifying re-entry services, and increasing recovery support services (RSS) as essential for behavioral health planning. TTOR will serve approximately 14,710 persons over two years. TTOR will partner with the state agency representatives in addition to consumers, advocates, and provider members to ensure stakeholder input is incorporated. TTOR will also provide a comprehensive approach to treatment, access to housing, employment, immunization and testing. In addition to traditional prevention activities, TTOR will provide training and technical assistance to peers, providers, and prescribers working in settings ranging from primary care to jails. Topics will include opioid use and misuse, the importance of evidence-based practices with a focus on Medication Assisted Treatment, overdose prevention, and RSS. TTOR funding will also allow for enhanced Mobile Crisis Outreach Teams and the addition of peer supports outreach teams focused on intervention, prevention and supports. These additions will enhance early identification and service connections for opioid users in crisis and/or seeking treatment options. Finally, TTOR will expand opiate treatment capacity to address waitlist and access constraints.

The UT Opioid STR will address the opioid crisis through the provision of evidence-based prevention, treatment, and recovery support services (RSS) for unfunded, underserved youth (age 12-17) and adults (18+) at risk, or with an opioid use disorder (OUD). The UT Opioid STR will enhance prevention activities, improve access to care, strengthen RSS and expand Naloxone distribution and needle exchange initiatives. Project goals are to: prevent/reduce opioid misuse, reduce overdose deaths; expand access to evidence-based treatment; increase partnerships with physical health; and, promote recovery. The rate of Utah drug poisoning deaths has increased at an alarming rate and is fourth in the nation for opioid overdose. The Utah Statewide Epidemiological Outcomes Workgroup will develop a needs assessment to identify high need geographic areas and will use this to drive the development of Utah's strategic plan. Prevention activities will be implemented using the Strategic Prevention Framework and designed to reduce risk factors and enhance protective factors for OUD. Funds will be used to expand the number of community coalitions using the evidence-based Communities that Care operating system and provide resources to coalitions to address the opioid crisis locally. UT Opioid STR will create projects that will require partnerships with physical healthcare providers. An Area Plan Process will allow local communities to develop plans to address treatment gaps and enhance existing services. Treatment opportunity will be expanded and the quality of service will be enhanced through the use of evidence based practices such as Medication Assisted Therapy. The UT Opioid STR will strengthen the statewide recovery community network, expand capacity and enhance the quality of RSS for individuals and families. UT Opioid STR will also increase training and distribution of Naloxone and expand the Needle Exchange programs.