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The SOR Project is designed to address our state's opioid epidemic by implementing the Washington State Opioid Response Plan (Plan), comprised of four goals: (1) Prevent opioid misuse and abuse; (2) Identify and treat opioid use disorder; (3) Reduce morbidity and mortality from opioid use disorder (OUD); and (4) Use data and information to detect opioid misuse/abuse, monitor morbidity and mortality, and evaluate interventions. The Washington State Health Care Authority/Division of Behavioral Health and Recovery will implement the SOR Project through strategies related to Goals 1 and 2 in the Plan. Goal 1 (Prevention): fund up to 13 Community Prevention and Wellness Initiative (CPWI) coalitions; expand prescriber education across the state; host an Opioid Summit to raise understanding of the continuum of care for OUD; enhance the Starts with One statewide opioid prevention campaign; fund 10-15 communities for prevention, safe storage promotion, and/or environmental strategies; and support the statewide naloxone distribution plan. Goal 2 (Treatment): fund 15-19 Opiate Treatment Networks (OTNs) that will expand treatment access to providers for Medication Assisted Treatment (MAT); provide training and technical assistance to new OTNs; connect OTNs with a tobacco cessation program; provide entities with payment assistance to support underinsured and uninsured individuals; provide MAT inductions to incarcerated individuals before release and expand referrals to reduce recidivism and overdose; and provide tribal opioid prevention/treatment grants to address unmet needs of tribal communities. Goal 2 (Recovery Support): expand access to recovery support services by linking community-based recovery programs with MAT facilities and providing peer recovery coaches to support people in recovery. Key populations of focus will include: Prevention - communities/schools with elevated risk scores including opioid prevalence; opioid prescribers for adolescents and adults; tribal communities; youth; pregnant and parenting women; parents; and older adults. Treatment/Recovery: individuals with OUD; substance use disorder treatment providers; individuals with OUD reentering the community from adult correctional facilities; individuals with OUD living in rural/frontier communities; and tribal communities. DBHR expects to serve more than 20,000 Washington state residents within the initial year of the grant, and 40,000 over two years. In addition, the project will reach hundreds of thousands of residents through local and statewide media campaigns and trainings.

The purpose of Nebraska's State Opioid Response program is to substantially reduce the incidence of abuse of prescription and illicit opioid drugs in Nebraska through ongoing collaboration between practitioners, experts and leaders across the continuum of care. The program will work to mitigate the effects of opioid use disorders (OUD), including both prescription opioids and illicit drugs, such as heroin, by identifying statewide needs, increasing access to treatment, including Medication Assisted Treatment (MAT), and reducing prescription drug overdose (PDO) deaths through the provision of prevention, treatment and recovery activities. The Division of Behavioral Health (DBH) will partner with other agencies to provide services to underserved populations statewide without duplicating efforts. Nebraska's goals include: assessing tribal opioid needs, implementing prevention initiatives including, opioid prescribing guidelines, opioid awareness media campaigns, safe drug disposal initiatives, funding community coalitions to provide OUD prevention EBPs in communities of need, and provide Naloxone to at risk populations and providers; 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 Buprenorphine, creating and maintaining an Addiction Medicine Fellowship, and developing a curriculum specific to opioids; and providing assistance to patients with treatment costs by providing funding for Buprenorphine. 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.

The District of Columbia's Opioid Response (DCOR) initiative will focus on increasing access to medication assisted treatment (MAT), reducing unmet treatment needs, and reducing opioid overdose related deaths in DC through the provision of prevention, treatment, and recovery support services (RSS) to individuals with opioid use disorder (OUD). The District will implement a Hub and Spoke model with multiple access points (including a 24-hour intake and assessment site) to a coordinated network of treatment and RSS providers who will collaborate around the assessment, stabilization, and ongoing treatment of individuals with OUD. The Hub will facilitate communication and provide education. SBIRT and motivational interviewing will be used to facilitate getting individuals access to treatment through the network. Peer support specialists (PSS) will be used for outreach and throughout the continuum of care to foster engagement and service connection. Training, technical assistance, and Extension for Community Healthcare Outcomes (ECHO) consultation using HRSA's opioid use treatment curriculum, will be used with providers, health care professionals, and peers to increase their ability to address the needs of more challenging clients. The Draft District of Columbia Strategic Plan to Reduce Opioid Use, Misuse, and Related Deaths will be a guide for accomplishing the work of DCOR. The specific goals of the grant are to continue to develop teams that are implementing the City-wide Strategic Plan; ensure equitable and timely access to high-quality substance use disorder treatment and through RSS a network of treatment services that is adequate to meet demand consistent with the criteria of the American Society of Addiction Medicine; educate District residents and key stakeholders on the risk of opioid use disorders and effective prevention and treatment; engage health professionals and organizations in the prevention and early intervention of substance use disorder among District residents; support the awareness and availability of, and access to, harm reduction services in the District consistent with evolving best and promising practices; develop and implement a shared vision between the District's justice and public health agencies to address the needs of individuals who come in contact with the criminal justice system; and prepare for program sustainability through evaluation, planning, and performance monitoring and training.

Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), Division of Substance Abuse Services (DSAS), will work to enhance current prevention, treatment, and recovery activities in response to the opioid epidemic through TN SOR: Changing Behavior, Coordinating Care, and Restoring Lives. TN SOR will increase access to medication-assisted treatment (MAT), reduce unmet treatment need, and reduce opioid overdose related deaths. The populations of focus for TN SOR are Individuals at High Risk of Overdose and Individuals with a Diagnosis of Opioid or Heroin Use Disorder. According to reports from the Centers for Disease Control (CDC), more individuals died from drug overdoses in the United States in 2016 than during any previous year. In the current National Survey on Drug Use and Health it is estimated that in Tennessee there are 82,965 Tennesseans with an OUD . In addition, a significant number of Tennesseans have no insurance or insurance with very limited coverage – particularly coverage for substance use services. Through medication assisted treatment in combination with clinical and recovery activities, TDMHSAS estimates that it will serve 1,080 individuals annually and 2,160 individuals through the lifespan of the grant who have an OUD. TN SOR aims to: (1) increase awareness of the dangers of opioids, (2) educate key stakeholders on preventing overdose, (3) reduce the number of overdose related deaths through naloxone distribution; (4) train health professionals to assess and treat individuals with OUD, (5) implement an Opioid Overdose Rapid Response Team; and (6) expand access to MAT, clinical treatment and recovery services through a Hub and Spoke model.

The overarching goal of the Arizona Opioid State Opioid Response project is to increase access to MAT treatment, coordinated and integrated care, OUD recovery support services and opioid prevention activities to reduce the prevalence of OUDs and opioid-related overdose deaths. The project approach includes developing and supporting state, regional, and local level collaborations and service enhancements to develop and implement best practices to comprehensively address the full continuum of care related to opioid misuse, abuse and dependency The proposed activities within the Arizona Opioid State Opioid Response project will work synergistically with existing efforts to reduce OUDs and opioid-related deaths by: (1) sustaining and enhancing naloxone distribution; (2) increasing localized community opioid prevention efforts; (3) expanding trauma-informed care prevention, treatment and recovery efforts; (4) expanding navigation and access to MAT through 24/7 access points, Medication Units, new OTPs and extended hours OTPs; (5) expanding access to recovery support services - including housing, peer supports, job assistance and supportive recovery programming; (6) increasing public access to real-time prevention, treatment and recovery resources to create a ""no wrong door"" approach to opioid resources in Arizona. Measureable objectives to reduce OUDs and opioid-related deaths will include: number of naloxone kits disseminated; MAT utilization and retention; use of the CSPMP; rates of opioid prescribing; rates of individuals in prescribed doses in excess of 50 MEDDs; rates of new opioid prescriptions in excess of five day supplies; community knowledge and prevention behavior; ED utilization; and rates of fatal and non-fatal overdose. Target population will, at minimum, serve: individuals re-entering the community from correctional settings; individuals in rural and isolated areas; individuals experiencing homelessness; tribal populations; veterans, military service members and military families; pregnant women and parents with OUD; and individuals who have experienced trauma, toxic stress or adverse childhood experiences (ACEs).The project will serve one million unduplicated individuals between year one and year two under prevention activities and serve 7,604 unduplicated individuals with treatment and recovery services in year one and an additional 8,872 unduplicated individuals in year two, for a total project reach of 16,476 unduplicated individuals.

The proposed project plans to serve North Carolinians with Opioid Use and Co-occurring Disorders to address the opioid crisis in the state. The initiatives and services to address the opioid crisis are founded on the NC Opioid Action Plan, and focus on activities that can realistically be accomplished within the two-year time frame of the grant. Of the seven over-arching goals of the Plan, those selected for this project include (1) Increase community awareness and prevention; (2) Make naloxone widely available and link overdose survivors to care; (3) Expand treatment and recovery-oriented systems of care; (4) Measure and assess the impact of the project on participants. The proposed project plans to serve a minimum of 2,000 unduplicated participants in Year 1 and an additional 1000 in the second year of the grant. Because it is anticipated that some participants that began treatment in Year 1 will continue in treatment into Year 2, the number of new participants in Year 2 is decreased. This will allow adequate funding in order that first year participants may continue in treatment as long as necessary. Additionally, it is anticipated that an additional 500 individuals will be served through the proposed pilot initiatives each year. The total number of unduplicated individuals to be served over the course of the two-year grant period is 4,000.

South Dakota’s State Opioid Response will expand upon infrastructure and capacity built through the State Targeted Response efforts in support of increased access to medication-assisted treatment, life-saving naloxone distribution, telehealth access to care, and workforce development and training. As the Single State Authority, the South Dakota Department of Social Services, Division of Behavioral Health, will lead the project in collaboration with ongoing efforts 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 (Screening, Brief Intervention, and Referral to Treatment) Implementation grant, and community providers to identify, leverage, and enhance community-based resources in the areas of prevention, treatment, recovery, and peer support services. The project will be led by Division Director Tiffany Wolfgang, with enhanced project management through a contracted State Opioid Coordinator, supported by integration with a multidisciplinary team – the Opioid Abuse Advisory Committee – and key personnel to assess, identify, and support the implementation of strategies that directly address these broad goals. Key outcomes of this two-year project will include an enhanced outcome assessment dashboard for ongoing performance metric evaluation, an understanding of needs specific to Tribal communities in the state, empowered and engaged communities with increased awareness of the opioid issues within our state, culturally responsive materials and strategies that can impact our most vulnerable populations, better equipped first responders to incidences of opioid overdose, extensive multidisciplinary training and curriculum supports in evidence-based prevention and treatment models, continued supports for enhanced access to Medication-Assisted Treatment through telehealth, and enhanced supports for virtual support ‘hub’ and ‘spoke’ models (teleECHO® clinics) to support staffing of complex OUD cases. An estimated 28,500 individuals are projected to be served by the project through training, the provision of treatment and/or peer recovery support services, and/or through connection/referral to community-based resources and providers. As an estimate for broad-based media campaign impact is not attainable, this estimate does not include that. The vision is to ensure every individual being served or serving patients with OUD is impacted by this project in South Dakota.

In 2016, 2,376 individuals died from a drug overdose in Michigan. Opioids were involved in 75% of these deaths. Between 1999 and 2015, opioid involved overdose deaths increased more than 10 times, and have increased sharply since 2012. In 2016 the American Indian/Alaskan Native population had the highest rate of death due to opioid involved overdose. During the same year, adults aged 25 to 34 showed the highest overdose death rated, and males overdose death rates were higher than female. The purposed of the Michigan State Opioid Response (SOR) project is to increase access to medication-assisted treatment for the three FDA-approved medications; reduce unmet treatment need; and reduce opioid overdose deaths through the provision of prevention, treatment and recovery activities for Opioid Use Disorders (OUD). Michigan aims to accomplish these goals with the following objectives: 1. improving the state infrastructure for individuals with an OUD; 2. training regional administration on infrastructure improvements, and training clinical staff on evidence based interventions and fidelity measures; 3. implementing evidence based prevention and treatment interventions with accompanying fidelity instruments to ensure that the quality of the intervention is consistent across the provider network; 4. train providers in addiction medicine to increase provider capacity; 5. expand overdose education to include harm reduction methodologies; 6. educate high level opioid prescribers, surgical and dental specialists on proper prescribing protocols; 7. implement a service delivery model to stabilize OUD patients in a specialized treatment setting focused on the care and treatment of OUD and associated conditions such as mental and physical illness; 8. expanding the availability of Medication-Assisted Treatment in rural communities through telehealth support; 9. increasing supports to the jail and prisoner re-entry population with an OUD; 10. expand the use of peers in federally qualified health centers and primary care settings; 11. increase recovery housing and peer support services for individuals with OUD; and 12. disseminate a statewide media campaign for the purpose for public education and stigma reduction. The Michigan SOR initiative's primary target is 25-34 year olds with an OUD. Additional populations of focus are American Indian/Alaskan Natives, youth and older adults. Michigan's SOR will: improve awareness of the risks associated with using opioid based medications as well as illegal opioids; increase the availability of prevention focused evidence based interventions; educate physicians on the CDC Prescriber Guidelines for responsible opioid prescribing; increase access to Medication Assisted Treatment, residential treatment and recovery support services for 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. Wayne State University, School of Social Work, will serve as the evaluator for the project.

The State of Alabama is requesting $13,544,925 per year for two the two-year State Opioid Response project. Alabama proposes to serve over 24,000 individuals with an array of services. The overall goal of Alabama’s SOR is to reduce the number of deaths in Alabama that are related to opioid overdose by 30% over the two-year project period. To reduce opioid related morbidity and mortality, Alabama will focus on reducing disparities and expanding the use of evidence-based practices. The focus of the SOR funding is: 1) expansion of Medication Assisted Treatment, particularly in populations/areas where disparities in access exist or where OUD is most prevalent; 2) outreach to providers to participate in MAT; 3) continuation of prevention efforts in the STR strategic plan 4) introduction of publicly funded evidence-based recovery housing; 5) improvement in the state’s coordination efforts and data analytics to better plan and implement its strategic response to the crisis. All individuals served by SOR funding will have access to the full range of treatment offered by ADMH, which includes a full spectrum of services at all ASAM levels. By coordinating existing funded activities and augmenting them with SOR activities, Alabama expects to lower the rate of overall opioid overdose deaths and increase rates of sustained recovery. The project will be statewide, with a focus on a continuation of strategies that have worked well in urban areas, and the use of a hub and spoke model to expand MAT services in the most rural region of Alabama. The Alabama Department of Mental Health’s Division of Substance Abuse Services is the designated Single State Agency for SAMHSA SOR services and will administer this project. Alabama has one of the highest rates of Opioid prescribing in the US, and while progress is being made, there is a significant unmet need for treatment for tens of thousands of Alabamians with limited access to care. Alabama will engage a wider workforce of health care providers to step up to the front lines of care for individuals struggling with opioid addiction by focusing on recruiting and training more medical physicians and nurse practitioners to become DATA waivered and provide MAT. Alabama will offer, for the first time, public support for recovery housing, a strategy which is key to long term, sustainable recovery for thousands of individuals. ADMH will take a strategic, evidence-based approach by focusing on proven strategies designed to lower morbidity and mortality from opioid abuse and addiction. These include use of the Strategic Prevention Framework, workforce development and training around MAT, expanded access to care, particularly for veterans and minority populations who experience significant disparities in accessing treatment and sustaining recovery, and use of proven recovery supports including peer support and recovery housing.

The Minnesota Department of Human Services (DHS), Behavioral Health Division (Single State Authority) proposes a comprehensive Minnesota State Opioid Response to the Opioid Crisis (“MN Opioid SOR”). The proposed MN Opioid SOR expedites opioid treatment and recovery resources and supports integration of services at each point in the continuum (e.g. behavioral treatment and Office Based Opioid Treatment (OBOT)/ (MAT) Medication Assisted Treatment). In 2015, Minnesota ranked first among all states when measuring the age-adjusted disparity rate ratio (DRR) of deaths due to drug poisoning among American Indians/Alaska Natives relative to Whites (out of 16 states for which data are available) and Blacks relative to Whites (out of 38 states for which data are available). The MN Opioid SOR is a comprehensive effort that recognizes urgent need to provide immediate response for the following target populations: American Indian; African American; and Populations with Justice Involvement. Minnesota also recognizes that greater Minnesota and the Twin Cities metro area have different demographics related to opioid use and require different strategies to address service gaps. For prevention efforts, Minnesota draws upon the Strategic Prevention Framework (SPF) to guide planning and implementation of activities. Proposed activities include: Increasing access to comprehensive assessments and expediting access to treatment for Minnesotans experiencing opioid use disorder (OUD); increasing opioid-specific recovery services, including housing, a peer-initiated and peer-based recovery supports, peer mentoring for pre- and post-natal support of mothers experiencing opioid use disorder; increasing OUD workforce through training mental health practitioners on OUD, training secondary students with the Substance Abuse Prevention Skills Training (SAPST) curriculum to become a Certified Prevention Professionals: expanding Office Based Opioid treatment/Medication Assisted Treatment (OBOT/MAT) in both the number of providers and their geographic reach, supported by expanding the Opioid-focused Minnesota Project ECHO (Extension for Community Healthcare Outcomes); Provide additional resources for MN proposed 1115 Substance Use Disorder demonstration waiver that looks to extend Medicaid funding for 9 new treatment programs that would provide ""one-stop shopping"" for opioid use disorder treatment; Expanded access to naloxone for Opioid Treatment Programs; Minnesota expects to serve 9,456 unduplicated individuals in the State of Minnesota through the proposed MN Opioid SOR. 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 goal of the New Jersey State Opioid Response (NJ-SOR) is to address the opioid crisis confronting the state using a variety of strategies. The key objectives are to increase access to medication assisted treatment (MAT), reduce unmet treatment need and reduce opioid related deaths. To address these objectives, the New Jersey Division of Mental Health and Addiction Services (DMHAS) will develop infrastructure support to provide buprenorphine in standard outpatient and intensive outpatient substance use disorder (SUD) treatment as well as a low-threshold buprenorphine induction program. In addition, a public information, education, and training campaign will be launched to reduce discrimination and promote MAT as the evidence-based practice (EBP) for opioid use disorder (OUD). A new fee-for-service (FFS) ambulatory treatment network will be developed to offer more opportunities for MAT, and a training will be developed for EMS workers to help them motivate overdose victims to enter treatment to reduce the gap between the number of individuals reversed who enter treatment. Prevention efforts will include expanding the target groups that receive naloxone training and kits through the Opioid Overdose Prevention Network (OOPN) and Opioid Overdose Prevention Program (OOPP), as well as expanding the nationally recognized Alternative To Opioids (ALTO) program in New Jersey's emergency departments. Recovery activities will include a continuation of the Opioid Overdose Recovery Program (OORP), the Support Team for Addiction Recovery (STAR) program, and the Telephone Recovery Support (TRS) program. Anticipated outcomes of the SOR 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. It is estimated that SOR will serve 19,575 individuals during the first year and 39,775 individuals over the two-year project.

Oregon State Opioid Response Oregon, as many other states across our nation, is implementing multiple cross-sector concerted efforts to address the opioid crisis and increase access to treatment for individuals. According to the American Medical Association’s Opioid Task Force 2018 Report, Overdose Deaths and Opioid Prescribing are in a steady downward trend in Oregon. Oregon, in partnership with substance use disorder (SUD) providers and other statewide partners, is focusing on, higher workforce capacity and access to, Medication Assisted Treatment, especially in rural and frontier areas of the state. In addition, Oregon is consistently coordinating federal and state resources, both opioid and other behavioral health resources, to provide OUD and other SUD services (prevention, treatment, and recovery) to all Oregonians in a comprehensive manner. Oregon’s proposed plan for the State Opioid Response to opioid crisis targets 1) high need communities, especially in rural and frontier areas to increase access to MAT: by increasing the DATA waived workforce, and by expanding OTP services 2) Naloxone distribution and training, in counties with high Naloxone rescue and overdose death rates. This will include CMHPs coordinating with law enforcement and EMS to implement Naloxone training, 3) working with individual tribes within the state to address community specific needs and gaps 4) implementing peer delivered services (PDS) in emergency rooms for individuals who undergo Naloxone rescue or overdose. Oregon Health Authority is partnering with the rural SUD providers in Oregon, especially those who are also applying to the National Health Services Corps to be an NHSC site. NHSC just released $105 million funds for rural outpatient SUD providers, MAT providers, and OTPs to be NHSC sites. These rural NHSC SUD sites will be able to utilize: the SOR funds to build the infrastructure to provide OUD services to rural communities including outreach and wraparound services, and combine the NHSC funds to attract and retain the workforce to serve the rural and frontier communities. In April 2018, the Oregon legislature passed a HB 4143 which allocated $2 million for OHA to conduct four pilot projects in four different counties. These pilots include employing certified SUD Peers in emergency rooms for individuals who are being discharged after being treated for an opioid overdose. The SOR grant will be utilized to expand these pilot projects into other rural and frontier counties with the highest rates of overdose related hospitalizations and overdose related deaths. Finally, we will be collaborating with our Tribal partners to identify the needs and gaps in the system affecting each Tribal community and how they can be addressed comprehensively. This will require creating a joint plan to establish evidence based practices within the framework of Tribal Best Practices while being culturally responsive of the historical trauma that affects Tribal outcomes in a unique way.

Overall, the number of opioid overdose deaths in Massachusetts rose 567% between 2000 (379 deaths) and 2016 (2149 deaths). As a result of recent state legislation , a variety of government data sets are now linked and analyzed to help better understand the opioid epidemic, inform policy and programming. With SOR funding the Massachusetts Department of Public Health, the applicant organization, will serve individuals affected by the opioid crisis, specifically targeting the highest risk populations including individuals between the ages of 25-44, ethnic and racial minorities, pregnant and parenting women, persons with history of incarceration, persons with co-occurring disorders, individuals experiencing homelessness, and veterans. We seek to serve 11,420 individuals annually over the two-year project period through implementing the following activities: 1) Overdose Education and Naloxone Distribution expansion in high-priority communities with a significant opioid overdose problem; 2) Post-overdose follow-up initiative to provide in-person, home-based outreach and support after 911 calls for an overdose, and offer assistance accessing other available services; 3) HIV outbreak response targeting people who inject drugs, including screening, prevention education, and referrals to treatment and services; 4) Office Based Opioid Treatment (OBOT) expansion to six community-based sites to engage high-risk, high-need populations; 4) Treatment and recovery support services for individuals with criminal justice involvement that includes MAT induction, treatment and recovery planning, and post-release linkages to services and recovery support, case management and recovery coaching; 5) Programming targeting pregnant and parenting women and their dependent children and families that includes wrap-around supports, peer recovery coaching, and access to MAT; 6) Expand the Access to Recovery program which facilitates client choice by providing coordinated, voucher-based options to support sustained recovery; and 6) Collaborative and transitional program models to increase access to MAT and bridge gaps in care and services. We also propose to: 7) Enhance existing state data analysis and reporting capabilities and improve web-based platforms to disseminate timely and accurate information to address the opioid crisis; 8) Implement wide-spread workforce development capacity building and training activities targeting a variety of sectors and audiences; and 9) Develop and expand on strategic communication and media campaigns targeting high-risk populations and high-need geographic regions in the Commonwealth to increase knowledge about addiction, decrease stigma, and improve awareness on how to prevent overdose and how to access treatment and recovery supports. We anticipate the MA SOR 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.

Every region of New York State has been seriously impacted by the opioid epidemic. The most serious consequence is the 90% statewide increase in opioid overdose over a three-year period. Under the guidance of the Governor’s Opioid Steering Committee, the state has responded aggressively to the crisis, and OASAS manages and coordinates state and federal funds to combat the epidemic. Evidence-based practices are used throughout the delivery system in prevention, treatment, and recovery services. Through the State Opioid Response grant, OASAS will expand its efforts across the state. The initiatives proposed will provide a continuum of support services for adolescents, pregnant and parenting women; individuals transitioning back to the community; and others seeking services to address Opioid Use Disorder (OUD). OASAS will expand the use of Medication Assisted Treatment (MAT) and collaboration across systems to increase access to OUD services. Emergency departments, primary care practices, 24-hour open access centers, mobile treatment units, housing programs, clubhouses and recovery communities are among the places New Yorkers will be able to access OUD information, treatment, and support services as a result of the SOR initiatives. The projects reach beyond treatment of OUD to include increasing prescriber capacity, raising awareness and destigmatizing MAT, supporting transitions in care, providing support to families dealing with addiction, training the wider population in OUD, and creating safe places in the community for youth and adults to encourage recovery. Each of these multi-pronged initiative target aspects of the opioid crisis and aim to reduce the human and social costs of the epidemic.

The Wyoming State Opioid Response (SOR) Grant aims to prevent the opioid epidemic experienced in other states through three strategies: 1) Provide access to Medication Assisted Treatment (MAT), 2) Expand opportunities to reach more people through integrated behavioral health and partnerships with the criminal justice system, and 3) Reduce opioid overdose related deaths through the provision of treatment and recovery activities for opioid use disorder (OUD). Efforts for this mostly frontier state will be supported through data-driven prevention, treatment, and recovery processes that continue to build capacity and infrastructure, including culturally appropriate training, technical assistance, data gathering, and implementation of evidence-based programs, practices, and policies through an outcomes based funding model. This effort complements existing services within the community mental health and substance use disorder centers which are available in every county in Wyoming and expands partnerships with primary care and the criminal justice system. The project will reach 253 Wyoming residents with opioid use disorder diagnosis over the next two years.

South Carolina Opioid SOR Application Abstract The South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS) as the Single State Authority for substance use disorder (SUD) services, is requesting $14,047,719 a year for two years from SAMHSA’s Center for Substance Abuse Treatment and Center for Substance Abuse Prevention under RFA# TI-18-015 to address the opioid crisis by building on the needs identified in the state’s State Targeted Response (STR) Strategic Plan. DAODAS will develop and provide opioid misuse prevention, treatment, and recovery support services for the purposes of addressing the opioid abuse and overdose crisis in South Carolina through a strategy that is supportive and enhancing of existing efforts. DAODAS will: • Enter into consultative relations with and assess the needs of the Federally-recognized Catawba Nation, and develop strategies to address OUD needs. • Ensure all available resources for services within the state or territory are leveraged for substance use prevention, treatment, and recovery support services and will coordinate activities with other funding sources for States and providers of these services to avoid duplication of efforts. • Coordinate opioid misuse response efforts with other state agencies that address the needs of individuals impacted by opioid misuse. • Implement service delivery models that enable the full spectrum of treatment and recovery support services that facilitate positive treatment outcomes and long-term recovery. • Ensure the implementation and enhancement of evidence-based prevention and education strategies and services. • Train healthcare professionals on the assessment and treatment of OUD. • Train peers and first responders on recognition of opioid overdose and appropriate use of the opioid overdose antidote naloxone. • Developing evidence-based community prevention efforts, including evidence-based strategic messaging on the consequence of opioid misuse. • Purchase and distribute naloxone and train on its use. • Provide transition support and treatment coverage for inmates and patients with OUD reentering communities from criminal justice settings or other rehabilitative settings. • Provide assistance to patients with treatment costs and develop other strategies to eliminate or reduce treatment costs for uninsured or underinsured patients.

The proposed program, State of Maryland Opioid Response (MD-SOR) is designed to increase the capacity of local service delivery systems to provide coordinated and integrated evidence-based prevention, treatment and recovery services to individuals with a substance use disorder. It will improve access to and enhance services for individuals with an Opioid Use Disorder by reducing unmet treatment need, creating links to somatic health care, designing of primary and secondary prevention methods with an emphasis on peer and other recovery support. MD-SOR will be implemented statewide with special emphasis on areas in which our data clearly reveals demonstrated need. In 2016, Maryland experienced an opioid related overdose death rate of 38 per 100,000 population. Sixty-five percent of the deaths occurred in 4 jurisdictions. Seven jurisdictions had overdose death rates higher than the State rate with great variation across counties. Overall, opioid prescriptions dropped by 15%. However, prescription opioids continue to contribute to Maryland’s high opioid intoxication death rate. The Maryland Department of Health’s Behavioral Health Administration worked with a variety of partners to seek advice in determining the best use of the funding to have the most impact for the population. We have determined that the goals for the program are to prevent overdose fatalities through enhanced screening, referral to treatment, walk-in services and recovery supports; Increase early identification of substance use through increased education and training of school personnel on substance use and opioid related disorders; and expand access to recovery services through peer supports and increasing recovery housing. We seek to enhance public and provider awareness of causes and resources available for solutions; improve screening, intervention and referrals for treatment; create a welcoming array of services that are locally available through providers who utilize medication assisted treatment; increase the capacity to handle crises through crisis walk-in centers, crisis beds and safe stations; and provide individualized recovery services across the age spectrum with the assistance of peers and increased housing choices. Maryland was one of the first State behavioral health authorities in the country to recognize the opportunities and promise offered by Evidence Based Practices (EBP) to positively impact the quality of behavioral health services. We will maintain this emphasis on EBPs and quality utilizing a continuous quality improvement and a data-driven decision-making framework. Maryland is committed to a strategic approach to availability of quality services while reducing and eliminating opioid use. The MD-SOR grant will give us an unprecedented opportunity to make a tremendous difference in individuals’ lives. Numbers of individuals served in prevention services: Year 1 – 76,849 , Year 2 – 49,254. Numbers served in treatment and recovery services: Year 1 – 8,796, Year 2 -12,592. Specific counts by project are provided in the budget narrative.

The Montana State Opioid Response (SOR) grant will be implemented statewide to expand prevention, treatment and recovery support services among five target populations: American Indians, pregnant women/women of childbearing age, veterans, justice system involved persons and older adults. The SOR grant will build upon activities initiated under the Opioid State Targeted Response grant, substantially increasing access to treatment for the target populations. The SOR grant focuses on three primary goals and related objectives, proposing to serve 3,226 unduplicated individuals through MAT, Naloxone training, and Peer Support training. The first goal, increases access to MAT of OUD for underserved target population, will be accomplished by increasing the number of Hubs and Spokes offering MAT, increasing the number of waivered providers offering MAT, and ensuring that 100 percent of state approved treatment providers are educated in the value of MAT and their role in treating OUD. Montana estimates 1,800 unduplicated individuals from the underserved target populations will received MAT for OUD during the two-year grant period. The second goal focuses on reducing overdose deaths through prevention and recovery activities. Objectives include: providing Best Practices Naloxone training to 1,386 individuals in 56 counties; ensuring access to Naloxone for those trained; including at least one Peer Support Specialist in each contracted Hub and Spoke team; and developing a health communications plan for delivering targeted messages to identified audiences. The third goal is to enhance collaborations to support state and health providers to meet grant goals and Montana's OUD strategic plan objectives. This will be accomplished by establishing and Advisory Workgroup to develop a MAT integration plan addressing MAT delivery within criminal justice and hospital and primary care settings. Also addressing this goal, the State Opioid Coordinator will develop a workforce development plan to guide training, academic detailing, and technical assistance. To ensure that MAT service begin within the first three months of the project, planning and preparation activities will begin prior to the grant start date of September 30, 2018. Sustainability is a critical component to ensure that activities under the project continue after the grant period. One strategy for sustainability is to develop a cadre of qualified trainers to self-sustain the training capacity. Partner organizations will be involved to help build MAT and OUD expertise and educational materials and encouraged to incorporate ongoing support into their individual purpose statements and strategic plans. Finally, the Montana Department of Public Health and Human Services will continue to work with federal and state agencies to maximize and innovatively braid funds available through various sources, as well as work with state legislators for resources or changes to Montana law, to improve and protect the health, wellbeing, and self-reliance of all Montanans.

The Iowa Department of Public Health will use SAMHSA's SOR grant funds to support prevention, treatment, and recovery support activities. The State Opioid Response in Iowa project will further expand capacity of the existing regional substance use disorder prevention and treatment provider network with a focus on building access for all Iowans in need. An updated community assessment specific to opioids and involving local stakeholders will continue the momentum for implementation of evidence-based practices, including medication assisted treatment (MAT). The focus of this project is to increase community capacity for a successful local response to the opioid crisis through the following goals: Goal 1: Expand statewide infrastructure and access to MAT services Objective 1.1 Assign a State Opioid Response Project Director Objective 1.2 Update community needs assessment and statewide strategic plan Objective 1.3 Expand capacity and access to MAT and recovery support services Goal 2: Increase awareness of opioid risks through statewide prevention efforts Objective 2.1: Continue support for the prescription monitoring program (PMP) Objective 2.2: Continue overdose prevention education and naloxone availability Objective 2.3: Expand and disseminate a statewide media campaign Objective 2.4: Training and professional development The SOR Iowa project will leverage the service improvements gained through other opioid grants, making these evidence-based practices more accessible to Iowans affected by opioid misuse and opioid use disorder across the state. Optional service enhancements will provide additional opportunities to partner with stakeholders such as emergency departments and correctional facilities. Prevention efforts will include support for the prescription monitoring program, overdose prevention education with naloxone availability, and a media campaign to raise awareness about opioids and recovery. Expanded opioid treatment capacity will benefit Iowans across the state through regional, community-based, or telehealth partnerships with medical service providers. Support services will help people maintain their recovery.

West Virginia will employ the State Opioid Response (SOR) grant statewide to curtail its opioid crisis by increasing access to medication-assisted treatment (MAT) and expanding evidence-based prevention, treatment, and recovery activities for opioid use disorder (OUD). SOR will boost the whole state's MAT delivery and OUD continuum of care by using the hub-and-spoke strategy to grow MAT expertise and developing an array of identification, engagement, treatment, and MAT-sensitive recovery services. Priority will be placed on high-risk populations and geographic areas hardest hit by the opioid crisis. Strategic social marketing and outreach will address the public and professional stigma stymying OUD and MAT treatment.

Hawaii State Opioid Response (HI-SOR) The Hawaii State Opioid Response (HI-SOR) project integrates prevention, treatment and recovery support systems to address rates of opioid use, misuse and fatalities across the state. The HI-SOR project collaborates effort between the Substance and Mental Health Administration (SAMHSA), Hawaii's state agencies, community organizations and healthcare providers that will expand and enhance Hawaii's continuum of health promotion, prevention and care for persons at risk of, or suffering from Opioid Use Disorders (OUD). The project advances Hawaii toward a seamless cohesive model of care delivery that engages a public health approach to addiction. Opioid use and related SUD fatalities, particularly due to opioid prescription misuse, continue to be a concern for the state of Hawaii. The HI- SOR project will mitigate these concerns through three key activity tracks (1) increased treatment access, through organization and coordination of primary and behavioral health systems of care, connecting and synchronizing these systems in a manner that lowers or diminishes the barriers of access to care; (2) training and edification, with the goal of training healthcare providers regarding MAT implementation while providing community education to reducing the stigma surrounding OUD, resulting in improved access to care and improved identification and support for persons at risk or suffering from opioid use disorders; 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). As a result of this project, access to opioid treatment and recovery support services in Hawaii will be expanded to more than 400 individuals. Additionally, this project will deliver services to rural areas in the state and meet challenges associated with service delivery in those areas such as Lanai, Kauai Island, and rural areas of Hawaii Island. The Hawaii SOR project also see the continued expansion and utilization of proven and effective policies and strategies related to opioids, such as use of a Prescription Drug Monitoring Program (PDMP). Prevention education and training will result in increased awareness of available resources and community support, further eliminating the effects of negative stigma surrounding opioid and other substance use disorders. Through coordination and integration of the available resources, organizations and activities, this project will continue to unite the systems and result in the continued expansion of services as well as the reduction of barriers to access of such services. In this effort to link and synchronize these systems, the State intends to build a sustainable, flexible system of care that is integrated in the delivery of services when, where, and how the residents of Hawaii need it.

Project name: Georgia State Opioid Response Project Population to be served: individuals with opioid use disorder (OUD) in high need areas of the state where service capacity is possible, and infrastructure exists to implement SOR funded treatment and recovery services for the population of focus. Number to be served: It is estimated that 1,500 persons with OUD will be served each year of the two-year project for a total of 3,000 persons. In addition, approximately 750 first responders and other stakeholders will be trained in year 1 and 1,500 in year 2 for a total of 2,250. Summary: Building on the infrastructure and the prevention, treatment and recovery services implemented through the Georgia Opioid State Targeted Response (STR) project, the Georgia Opioid State Opioid Response (SOR) project will expand the continuum of prevention and recovery oriented treatment services in high need areas of the state that have providers with capacity and expertise related to OUD. Medication Assisted Treatment (MAT) will be implemented in other areas of Georgia not currently covered by the State Targeted Response Project. Like treatment and recovery services, Georgia SOR prevention services will build on activities that have been implemented as part of the State’s STR project. Activities will include an expanded media campaign, implementing four Prevention Clubhouses that focus on preventing use and misuse of opioids by youth, expanded Naloxone first responder training, implementing a College Adopt a School program, a law enforcement education and training partnership, and implementation of Sources of Strength program statewide, and implementing a statewide opioid prevention community involvement showcase series. Project goals include: Goal 1: Expand treatment and recovery support services in high need areas that contain providers with capacity and expertise related to OUD. Goal 2: Expand recovery support services for individuals with OUD. Goal 3: Provide training and education for new MAT providers. Goal 4: Expand naloxone distribution to include systems statewide not currently included in current naloxone provision and training. Goal 5: Increase awareness and education about Georgia’s opioid epidemic, preventing opioid abuse and misuse, best practices, and use of naloxone. Goal 6: Increase youth protective factors, reduce risk factors, and improve resistance to substance use and abuse among middle and high school youth. Goal 7: Create a partnership with the City of Atlanta to implement opioid focused projects.

The State Opioid Response (SOR) funding will enhance the Idaho’s Response to the Opioid Crisis (IROC) program. IROC provides opiate use disorder (OUD) treatment and recovery support services, including Medication Assisted Treatment, to uninsured Idahoans with an OUD that have an income under 200% of the Federal Poverty Level (FPL) and do not qualify for Medicaid. Idaho will 1) Coordinate statewide efforts to fight the opioid crisis; 2) Provide OUD services, including medication assisted treatment (MAT) to eligible participants; 3) Expand access to MAT, especially in rural and frontier communities; 4) Provide community-based recovery support services; 5) Train providers on Evidence-Based Practices (EBPs) specific to OUD; 6) Distribute Naloxone kits; 7) Disseminate materials to educate the public on the dangers of opiates and how to manage an OUD; 8) Coordinate services between emergency departments and treatment providers; 9) Pilot a pre-sentencing diversion program; 10) Collaborate with the five federally recognized Tribes in Idaho to address the individual needs of their communities; and 11) Develop a program for transition from jail and/or prison that can be implemented during year two. Idaho’s goals and objectives are to: 1) Increase access to OUD services for eligible participants. Community-based providers will deliver OUD services to 505 individuals during year 1 and year 2 for a total of 1,010. The number of OUD service providers in the provider network in rural areas will increase by 10% in year 1 and year 2 for a total of 20%. The Project Director will engage at least one (1) DATA 2000 waivered physician to become part of the OUD network in each of the seven (7) regions each quarter for years 1 and 2, for a total of 56 contacts. The Project Director will coordinate one (1) EBP training per year in years 1 and 2 for a total of two (2) EBP trainings. 2) Promote recovery and resilience. At least 70% of project participants will report being socially connected after six (6) months of admission to the project. At least 60% of participants will report abstinence from alcohol or illegal drugs in the past thirty (30) days after six (6) months of entry into the project. At least 75% of participants will report no arrests in the past thirty (30) days after six (6) months of entry into the project. 3) Reduce the number of opiate related deaths. The Office of Drug Policy will disseminate 100 Naloxone kits during year 1 and 50 during year 2 for a total of 150. Idaho RADAR will disseminate educational materials regarding OUD and MAT to stakeholders at least quarterly. 4) Develop a collaborative approach to providing services and supports. The Project Director will compare outcomes of diversion participants to non-diversion participants two (2) times per year during years 1 and 2 for a total of four (4). At least 60% of project participants will avoid readmission to Emergency Department settings within twelve (12) months of entry into the project. The Project Director will hold the first program development meeting for the Jail/Prison Transition pilots within six (6) months of project start date. Funding will be available to the tribes within sixty (60) days of project start date.

Kansas State Opioid Response Grant (SOR) TI-18-015 The purpose of the State Opioid Response Grant is to address the opioid crisis by increasing access to medication-assisted treatment using FDA-approved medications for the treatment of opioid use disorder, reducing unmet treatment needs and reducing opioid overdose related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder(OUD) including prescription opioids, heroin and illicit fentanyl and fentanyl analogs. SOR-Kansas will be administered by the Kansas Department for Aging and Disability Services (KDADS), which serves as both the State Mental Health Authority(SMHA and Single State Agency (SSA) for Substance Abuse in Kansas . Our state has developed a solid foundation for this project at both the state and local levels. The Kansas RX advisory Committee was established in 2016 and is currently active. The committee created a strategic plan that was finalized and adopted this year. SOR-Kansas will utilized the strategic plan and build upon existing opioid efforts and tools to combat the opioid epidemic, including our current SAMHSA State Targeted Responses to Opioid Crisis (STR) grant. Prevention Framework, (SPF) model. Partnership for Success (PFS) an initiative for underage drinking and prescription drug misuse prevention and prescription drug overdose. Data- Driven Prevention Initiative (DDPI) cooperative agreement with the CDC to prevent escalation of the opioid crisis in Kansas by improving data collection and analysis. The Kansas STR project has increased access to opioid treatment for over 500 individuals. The project implemented and expanded services to areas in the state with the most un-met needs. The prevention services included : Over 4000 doses of Naloxone was purchased and distributed in counties of high needs to Law Enforcements, EMS personnel, Recovery Houses, etc. STR funding was used for opioid prevention and educational awareness activities and to establish a statewide opiate awareness campaign utilizing It Matters materials. Approximately 400 trainings were provided to community sectors. The opioid Care Coordinators continue to connect with patients through Zoom Tele-health services. Work continues with physician recruitment, training with recovery coaches and engaging pharmacies within all four regions. The STR program staff continues to collaborate with communities and other state organizations. Kansas priority is to continue to act on preventively. The Kansas STR project experienced some challenges. The southeast area of Kansas is comprised mostly of rural and semi rural population centers. A consequence of this is that many patients do not have reliable access to MAT providers, or sometimes even to medical providers who are informed and dully engaged in the ear against Opioid addiction. This is a critical gap. SOR funding will be use to continue to provide financial support and incentives for providers to educate themselves about Opioid treatment and become waivered so they are able to provide Medication Assisted Treatment (MAT) The Regional Coordinators in these areas will continue to spend time visiting hospitals, clinics, and other likely treatment venues, making certain that providers are aware of the need, and encouraging them to become a part of a network of providers. All of theses efforts are critical elements as we work to close the rural area gaps and barriers. Kansas will utilize current STR data as well as epidemiological data to inform a regional approach to our proposed SOR implementation plan. A Request for Proposal process will be initiated upon grant award regional projects. This will allow for each region to conduct a comprehensive needs assessment and create implementation plans to meet specific needs, gaps, access concerns, as well as risk and protective factors specific to geographic, demographic and cultural difference.

State Opioid Response Grants Funding Opportunity Announcement (FOA) No. TI-18-015 ABSTRACT The State Opioid Response (SOR) program will allow the Texas Health and Human Services Commission (HHSC) to address the opioid crisis by reducing both unmet treatment need and opioid overdose death through the provision of integrated opioid misuse and overdose prevention, medication assisted treatment, and medication assisted recovery support activities. This program will enhance efforts to prevent opioid misuse and support safe prescribing practices, increase meaningful use of the Prescription Monitoring Program (PMP), make available safe drug disposal of opioid medications, increase community awareness of opioid misuse and associated disorders and prevent overdose deaths through provision of overdose prevention education and overdose reversal medications. This initiative will expand capacity for opioid treatment services including treatment for comorbid conditions and expand geographic access to office based opioid treatment. It will increase the workforce of peer support for individuals seeking recovery from opioid use disorders and boost recovery capital through the provision of employment, housing, and re-entry programs. Finally, this initiative will ensure continuity of care through integrated emergency response, pre-arrest diversion, and community access programs. Texas has identified four groups at highest risk for opioid use disorder (OUD) and its consequences: 1) people living in major metropolitan areas, 2) pregnant and postpartum women, 3) justice-involved individuals, and 4) people with a history of prescription opioid misuse or at risk of developing OUD. The Texas Health and Human Services Commission (HHSC) will continue to partner with the Texas Department of State Health Services (DSHS) to identify areas with high overdose death rates, as well as university partners to track overdose reversals throughout the state. Additionally, HHSC will coordinate with other system agency partners receiving both state and federal opioid specific funding to focus on more rural areas of the state and efforts to reduce maternal mortality. Through partnerships with both community agencies and governmental entities including those in academic settings and local city and county governments, SOR will serve approximately 140,000 persons each year. SOR will partner with the state agency representatives on the Texas Statewide Behavioral Health Coordinating Council in addition to consumers, advocates, and provider members that serve on the Behavioral Health Advisory Council to ensure stakeholder input is incorporated and to coordinate and ensure efficient use of resources. SOR will ensure a comprehensive and integrated approach to prevention, treatment and recovery support for populations of focus.