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The State of Alaska Office of Substance Misuse and Addiction Prevention (OSMAP) Project HOPE (Harm reduction, Overdose Prevention and Education) works directly with 127 community, tribal, and governmental partners to distribute Naloxone across the largest state with the most remote communities in the nation. Through these partners, Project HOPE has distributed 41,820 kits resulting in no less than 300 lives saved since 2017. Project HOPE will enhance its programming through PDO Advisory Council strategic direction of naloxone distribution, comprehensive training curricula, and community grants to agencies serving people at high risk of overdosing to link them to care. One goal of this project is to increase cost-effectiveness of naloxone distribution by improving strategic direction of Project HOPE infrastructure using data-informed approaches. The objectives to reach this goal revolve around developing a comprehensive needs assessment and a multi-sectorial PDO Advisory Team; and using the PDO Advisory Team to create a strategic approach to increasing access of naloxone and treatment to those most at need through the Alaska naloxone distribution and overdose death prevention plan (ANDODP). The second goal is to prevent overdose, overdose morbidity, and overdose mortality from occurring by implementing a sustainable opioid overdose prevention education and training campaign across providers, emergency responders, and the community. Aims to reach this goal include developing two different curricula, one for professionals and the other for people living with risk of overdose and those who surround them; conducting a train-the-trainer for these curricula across existing Project HOPE stakeholders; and distributing the training. The final goal of this project is to decrease overdose morbidity and mortality by increasing access of naloxone and treatment. Objectives targeted to support this goal ensure purchasing and distribution of naloxone to those serving high risk people and in high needs areas; as well as awarding community grants to agencies who serve people at high risk for linkage to treatment. Expected results of the enhanced Project HOPE are for at least 1000 people to be served annually, and a total of at least 7000 people to be served by the end of this project.

The New York State Office of Addiction Services and Supports (NYS OASAS) Prevent Prescription Drug/Opioid Overdose-Related Deaths Project, titled Prevention of Overdose through Outreach to Families (POOF) will expand and enhance overdose prevention services in New York. To that end, OASAS will collaborate with the Partnership to End Addiction to create a comprehensive overdose prevention training. Over the course of five years, OASAS will partner with the New York State Department of Health (DOH) and the New York State Office of Children and Family Services (OCFS) in order to provide this training and naloxone to their frontline staff in programs such as OCFS managed domestic violence shelters, Healthy Families New York home visiting program, and the Maternal and Infant Community Health Collaboratives. Furthermore, The SAMHSA toolkit for opioid overdose prevention will be utilized to guide this process. Through this work, we hope to reach underserved populations by focusing on nontraditional treatment settings, including but not limited to pregnant and parenting women, LGBTQ+ identified persons, tribal communities, and persons experiencing intimate partner violence. It is expected in the first year of the grant to train a total of 750 individuals in overdose prevention. In year two, this number will increase to 3,000, and thereafter 4,000 people will be trained per year for a total of 15,750 unduplicated persons trained by the end of year 5. OASAS will develop systems and procedures deemed necessary to sustain theses proposed services beyond the five-year grant period to continue expanding prevention services. Specific goals of the Prevention of Overdose through Outreach to Families include: (1) identify areas of greatest need in relation to prescription drug/opioid overdose in New York, (2) increase access to opioid and prescription drug overdose and knowledge of overdose training in New York, (3) increase the number of opioid overdose prevention Master Trainers in nontraditional settings, (4) increase access to overdose prevention trainings and resources in nontraditional, non-OASAS settings, and (5) increase access to and awareness of treatment services.

The Mental Health and Anti-Addiction Services Administration of Puerto Rico will implement a Preventing Prescription Drug/Opioid Overdose-related Deaths (PR-PDO) Project to reduce overdose deaths among at risk adults by training traditional and new first responders (FR) and key community sectors on prevention strategies, including management and use of naloxone, creating a stakeholder Advisory Council. trainings of Trainers (ToT) will help reach a broader audience. The project is to be implemented territory-wide emphasizing areas of high overdose prevalence. The goals and objectives demonstrate annual and project lifetime numbers of persons to be served: Goal 1 - Prevent prescription drug/opioid overdose deaths by preparing FR and service providers of community sectors (elderly caregivers, pre-service clinicians, school and university counselors and social workers, among others) to recognize symptoms and administer naloxone injections. Objective 1.1 - Train 750 in Yr 01 and 1,000 FR and key sectors representative in Yrs 0-04 in areas of need identified in a needs assessment to be carried out in the first quarter of Yr.01. Objective 1.2 - Provide 40 trainings annually to BH and medical professionals, pre-service clinical students, state security and corrections officials, municipal EM staff, school and university counselors, elderly home staff and CBO staff who work with at risk populations. Objective 1.3 - Provide ToT to 12 professionals a year in setting serving prescription drug/opioid users. Objective 1.4 - Achieve that 85% of trainees report knowledge and skill increases on naloxone use. Objective 1.5 - Distribute 1,500 naloxone kits a year to trained FR in targeted communities of high need. Goal 2 - Reduce number of overdose deaths of individuals who misuse medications by educating individuals, families and associates on risks, treatment alternatives and intervention strategies. Objective 2.1 - Educate, through community outreach, 200 family members and caregivers of populations at risk, per year, about overdose prevention and response using naloxone kits. Objective 2.2- Achieve linkage to SA tx of 25% of FR-identified persons with an opioid drug addiction. Objective 2.3 - Develop a Service Navigation Unit to receive referrals and connect persons to SA Tx. Goal 3 - Strengthen prevention capacity ad infrastructure at the state and community levels. Objective 3.1- Disseminate, culturally/linguistically appropriate protocols for overdose interventions. Objective 3.2 - Create and facilitate a PDO Advisory Council of Governor appointed members. Objective 3.3 - Achieve, by YR 03, legislation permitting distribution of naloxone by local pharmacies. Objective 3.4 - Provide capacity building services to CBOs starting their own overdose education and naloxone administration programs. Objective 3.5 - Monitor, updating the current surveillance system, number of fatal and non fatal opioid events by municipality; number reversed; and referrals for, and use of, SA treatment after events. Objective 3.6 - Identify alternate and stable funding sources to ensure program sustainability. The project is for five years, requesting $850,000 per year for a contracted staff and supplies.

Missouri's PDO 2.0 project will prevent overdoses by training and equipping overdose first responders - primarily Peer Specialists and Community Health Workers - to administer naloxone, interact compassionately and effectively with people who use drugs, and connect people to appropriate treatment and recovery services. This project will also expand an novel mail-based naloxone program, reaching high-need individuals in Missouri's rural and low resourced areas. In 2018 and 2019, more than 60% of Missouri's overdose deaths occurred in one of three metropolitan regions (St. Louis, Kansas City, and Springfield). An additional 25% occurred in a high-need predominantly rural corridor running along Missouri's Interstate-44. Initial figures suggest COVID-19 has caused a devastating 30% increase in overdose deaths from 2019 to 2020. The proposed project, PDO 2.0, will reduce the number of fatal opioid overdoses in Missouri and facilitate treatment and recovery service referrals for overdose survivors. The primary population served will be individuals who use opioids and are most ad-risk of experiencing or witnessing an overdose. In Missouri, this highest risk group includes people who are Black (particularly Black makes who have the highest overdose rates of any group in Missouri), those living in one of the six urban or 11 rural counties with the most overdose deaths, and people who lack access to financial, housing, healthcare, and transportation resources. We plan to reach these individuals largely by working through the expanding workforce of Peer Specialists and Community Health workers, hiring expert consultants with lived substance use experience to train others and conduct street outreach work, and expanding a mail-based naloxone program. The five primary goals of the PDO 2.0 program are to: 1) Identify gaps: Assess and identify existing infrastructure and gaps, referral capacity, and training needs of overdose first responders and frontline workers in Missouri, especially in regions with the largest number of overdose deaths; 2) Create new training: Develop and implement new in-person and virtual drug user health, harm reduction, and skills training for Peer Specialists and Community Health Workers; 3)Disseminate existing training: Expand dissemination of existing in-person and virtual OEND training curriculum for broad audiences of overdose first responders; 4) Distribute naloxone: Increase naloxone distribution in high-need areas with insufficient access through direct supplies and a mail-order program; 5) Facilitate service referrals: Increase knowledge and capacity for referrals to appropriate treatment and recovery services for overdose survivors and others at-risk of adverse events. Per year, we plan to train over 1,950 people (9,400 total), distribute over 4,200 naloxone kits (22,000 total), contribute to over 600 naloxone administrations (3,000 total), and refer 135 people to substance use services (675 total). The Missouri Department of Mental Health will lead this program in partnership with the University of Missouri-St. Louis-Missouri Institute of Mental Health, Prevented, the Missouri Network for Opiate Reform and Recovery, and community partners across the state.

Substance Abuse Prevention (OSAP) will implement the Prevent Prescription Drug/Opioid Overdose-Related Deaths (PDO) in four high-need counties in New Mexico. The project aims to prevent overdose death through: 1) the purchase and distribution of naloxone for overdose reversal, and, 2) training first responders, family and friends to administer naloxone. The proposed project will provide naloxone through numerous partners and increase overdose prevention knowledge, within traditional first responder and health initiatives, and particularly among lay people who live with or are closely associated with people who use licit and illicit opioids. Community lay people are the "real" first responders in a rural state like New Mexico, where long response times by law enforcement and emergency medical services render overdosed individuals more vulnerable to death. The goal is to substantially increase overdose reversals by training and providing naloxone to at least 6.000 persons over five years. The project will strengthen existing partnerships with New Mexico's Department of Health, Public Health Division, Harm Reduction Program, and its Epidemiology and Response Division, and local partners in communities o high need and burden - in Bernalillo County, Dona Ana County, Rio Arriba County, and Santa Fe County. These four counties have 58% of the state's unintentional overdose deaths and 60% of all opioid-related emergency visits. Local PDO projects are located in each of these four counties. New Mexico's project will enhance and implement naloxone distribution and training plans to meet gaps in the state's current system and grassroots needs in agency and non-agency settings. New Mexico will use the $850,000 annually for five years to impact New Mexico's overdose problem -the 12th highest overdose death rate in the nation. While New Mexico has made progress in preventing overdoses through a range of efforts in recent years, The National Center for Health Statistics' rapid release provisional data shows a 21% increase in fatal overdoses in the state from June 2019 to June 2020. OSAP will convene the PDO Advisory Council to create a strategic plan and oversee the project. With membership from New Mexico's major health agencies, the Council will see to enhance and expand overdose prevention and related services to more at-risk individuals and additional parts of the state through better coordination of federal and state substance abuse prevention, intervention, and harm reduction efforts.

Project Name: Washington State Project to Prevent Prescription Drug/Opioid Overdose (WA-PDO) Project Summary: The Washington State Project to Prevent Prescription Drug/Opioid Overdose (WA-PDO) is a statewide network of organizations mobilizing communities, providing opioid overdose response training, and distributing naloxone through syringe services programs in five high need areas to lay first responders to reduce overdose risk and deaths among people who use opioids. Project Abstract: The Washington State Project to Prevent Prescription Drug/Opioid Overdose ((WA-PDO) will be a collaborative five-year project between the Washington State Health Care Authority's (HCA) Division of Behavioral Health and Recovery (DBHR) and the Washington State Department of Health (DOH) with the purpose of preventing opioid overdose and deaths from opioid overdose, and sustaining and building local infrastructure to plan, implement, evaluate, and fund opioid overdose prevention efforts in the long-term. WA-PDO will develop a network of opioid overdose experts and interventions to efficiently extend core opioid overdose prevention expertise and centralized resources at DBHR and DOH to five diverse high need areas (HNA) across the state. WA-PDO will reach adults who use opioids, lay person and community members who may be the first responders at an opioid overdose event. Core interventions include stakeholder engagement, opioid overdose prevention and response training, and naloxone distribution. Objectives include: 1) develop opioid overdose prevention strategic plane in five HNAs; 2) equip at least 7,400 lay responders per year with naloxone; 3) educate at least 2,400 laypersons per year on identifying an opioid overdose and naloxone administration; 4) facilitate coordination in five HNAs among local and regional stakeholders and with state agencies; 5) build and harmonize data infrastructures in inform resource allocation, maintain opioid overdose surveillance, and measure outcomes; and 6) create knowledge translation infrastructure to disseminate emerging data, best practices, training, and technical assistance. Over the five-year project, our activities will reach 13,000 lay responders and individuals at community organizations across Washington State with opioid overdose response training and 37,000 lay responders with lifesaving naloxone. We estimate that we will service 20,000 unique individuals over the life of the five-year grant and provide services to up to 37,000, a combination of unique individuals and those returning for services.

Project Freedom South: Preventing Opioid Overdose-Related Deaths is training first responders - public safety, fire, and EMS personnel - in south Alabama to prevent opioid overdose-related deaths. Goal 1: Increase access to naloxone, reduce the number of adverse opioid-related events, and increase awareness of substance use treatment services in the catchment area, by reducing the number of opioid overdoses and opioid overdose deaths in the catchment area by 5% by the end of the project; distributing >5,000 naloxone kits and determining the number of opioid overdose reversals within the catchment area across the 5 years of the project; maintaining a 100% referral rate for substance use treatment services among patients who experience an opioid overdose reversal; and maintaining a > 50% treatment initiation rate across the 5 years of the project for individuals who are referred to substance use treatment services; Goal 2: Increase knowledge about opioid overdose primary/secondary prevention strategies within the catchment area, by offering the following in each year of the project >=30 trainings on overdose death prevention strategies, training >=12 medical professional agencies on the risks of overprescribing, training >=24 first responder agencies on overdose reversal drugs, and >=6 open community trainings on opioid overdose prevention strategies; ensuring that >=50% of participants at trainings report learning new information/skills; determining whether>=50% of the participants at the trainings plan to use the information/skills learned, feel confident in using the skills learned, and can identify overdose symptoms; and maintaining a >=50% success rate in opioid overdose reversals on first responder service runs for opioid overdose. Goal 3: Describe how, where, and by whom various naloxone types are used in the catchment area, by reporting in each year of the project the number and type of naloxone kits used in each administration of naloxone, the dollar amount and percentage of the total budget used to purchase naloxone products, the number of referrals to a kit prescriber following the successful reversal of an opioid overdose, the number of persons administering naloxone by community affiliation, demographics, number of prior administrations, and Census tract, the number of naloxone patients in our catchment area by location of administration, demographics, number of prior administrations, and Census tract, and the number of naloxone kits distributed in each zip code by request/response status, whether or not the distribution was to a household, dosage amount, type of recipient, and type of kit. Goal 4: Identify neighborhoods in the catchment area with the highest opioid overdose rates, by determining hotspots of opioid overdose first responder service runs in the catchment area in each year of the project using geographic information system (GIS) software and latitude/longitude data for each service run. The unduplicated training count will be 780 annually for a total of 3,900 individuals, including first responders, medical and treatment professionals, and family members over the five-year project period.

The Oklahoma Prescription Drug/Opioid Overdose-Related Death (PDO) initiative aims to prevent opioid overdose-related death and adverse events among individuals 18 years of age and older through a comprehensive approach to overdose prevention education and naloxone distribution (OEND) and organizational/community capacity building in ten high-need counties identified through a data-driven process. Oklahoma has successfully implemented comprehensive overdose prevention strategies with the 2016 PDO project. All ten previous PDO counties saw a reduction in annual overdose deaths 4 years after implementation. The PDO project will use a combination of maintaining and expanding successful OEND strategies to reduce overdose in high-need areas and implementing innovative strategies and partnerships to reach high-need populations. High-need populations for this project include: those with substance use disorder; those using opioids after a period of abstinence; rural residents living long distances from hospital settings; and patients on opioid therapy. The Oklahoma PDO will serve approximately 2,500 people per year with OEND services in the 10 counties identified as ranking highest in the state for opioid overdose risk. An additional 1,000 emergency responders will receive OEND services across the state per year. In total, approximately 13,500 people annually will receive overdose prevention, recognition, and response education and naloxone. Oklahoma will approach the PDO project with the following guiding values: (1) overdose is preventable; (2) laypersons, professionals, and people with substance use disorder are capable community responders; (3) all are deserving of intervention; and (4) sustainability is critical.

The goals of Maine’s PDO project are to decrease opioid-related morbidity and mortality by enhancing statewide overdose prevention infrastructure through increased collaboration across state government, community-based organizations and local partners; and to increase the capacity of local communities to reduce opioid-related drug overdose deaths by implementing evidence-based strategies in areas of the state most impacted by the opioid epidemic. Maine CDC’s 2018 Vulnerability Assessment identified five sub-state areas that need greater access to overdose prevention interventions: Kennebec County, Penobscot County, the Portland area of Cumberland County, Somerset County, and Washington County. The PDO project will focus on these sub-state areas and through the required needs assessment, determine the areas of highest need within these communities. Weekly overdose death data, which allows the state to identify in almost real time where the resources need to be focused, will be utilized. Guided and supported by the Governor’s Executive Order and the Director of Opioid Response, this project will build upon efforts that Maine has implemented thus far. This coordinated approach will further develop a sustainable infrastructure for the state to prioritize strategies, funding allocations and ensure strategic plans are aligned and not duplicative. State-level efforts will focus on cross-sector collaborations instead of siloed interventions, and will work to align system-level efforts related to policy, data systems, training and education, consumer engagement and implementation strategies, identifying opportunities where state level partnerships can be leveraged to encourage local level engagement. Building community capacity is a primary goal of Maine’s PDO project. We have learned over many years that coalitions are best suited and most effective at tackling public health problems. Through an RFP process, four to six community level partners located in the highest need areas will be chosen. Community partners will create and strengthen a community overdose prevention coalition. Using SAMHSA’s Overdose Prevention Toolkit as a guide, by January 2023, 100% of funded coalitions will have developed a comprehensive overdose prevention plan based on local needs. By the end of the five year grant period, Maine expects 2,170 members of the high need communities will be trained in overdose prevention strategies; 1.3 million people will be reached through mass reach health communications; 75% of non-fatal drug overdose who received follow-up from the community response team, will be successfully linked to harm reduction, recovery, treatment and/or needed services; 80% of naloxone will be distributed in high need communities; and five percentage reduction in fatal drug overdoses of the rolling 3-year average.

The primary purpose of the South Carolina First Responders Overdose Prevention Project is to increase the number of first responders trained throughout the state in the Law Enforcement Officer Naloxone (LEON) program and the Reducing Opioid Loss of Life (ROLL) program for fire fighters. The first responders will be trained to administer naloxone on an emergency call for a suspected overdose, the response time for law enforcement and fire departments is generally faster than EMS in our rural state. Another population that will be reached with the grant funding are patients who have survived a recent overdose and their caregivers. The goal of the Community Outreach by Paramedic Education (COPE) program is for a team comprised of a paramedic and a substance disorder counselor or peer support specialist to visit the patient within a few days of the overdose to check on their health and well-being and to provide information and resources for referral to treatment and recovery services. Naloxone training and medication will be provided to the patients and caregivers through the process of obtaining treatment and recovery services.

The MS Department of Mental Health, with the MS Public Health Institute, MS Center for Emergency Services, and Bartkowski & Associates Research Team, proposes ARIES-PDO (hereafter ARIES), MS’s Active Response Implementation and Evaluation System for prescription drug/opioid overdose prevention. ARIES will train and educate at least 7000 persons (first responders, healthcare workers, other staff, and residents) in naloxone knowledge and skills, focusing primarily on a designated high-need geographical area. ARIES will also implement an aggressive naloxone distribution and utilization tracking program. MS leads the nation in negative social indicators (e.g., poverty, health disparities, medical underservice), and has unusually high overdose and overdose fatality rates due largely to the availability and abundance of high-potency opioids within the state. ARIES’s goals are these: Goal 1: Improve the naloxone education and distribution process over the course of five project years, to include a one tenth (Obj. 1.1) reduction in the rate of intentional, unintentional, and undetermined intentional opioid overdose; (Obj. 1.2) reduction in the number of opioid overdose-related deaths; (Obj. 1.3) increase in the number of opioid overdose reversals; (Obj. 1.4) increase in the number of referrals to substance abuse treatment services; (Obj. 1.5) increase in the number of individuals receiving treatment or recovery services following successful overdose reversal administration; and (Obj. 1.6) increase in the number of naloxone kits that reached high-need communities. Goal 2: Enhance education and training programs for 7000 individuals, meeting or exceeding projected annual numbers of (Obj. 2.1) trainings conducted on opioid overdose death prevention strategies; (Obj. 2.2) medical professionals trained on overprescribing risks; (Obj. 2.3) first responders trained on using overdose reversal drugs; (Obj. 2.4) participants per session by type of participant; people reporting (Obj. 2.5) learning, (Obj. 2.6) using, and (Obj. 2.7) having confidence in training knowledge/skills; (Obj. 2.8) individuals accurately recognizing overdose symptoms; and (Obj. 2.9) improved rates of successful administration of overdose-reversing drugs tracked in real time. Goal 3: Improve naloxone utilization, to include a one tenth increase in the (Obj. 3.1) number of naloxone kits used in each administration and by type of kit; (Obj. 3.2) total amount and percentage of funds spent to purchase naloxone products; (Obj. 3.3) number of referrals to kit prescriber or other medical professional post-administration for replacement resources, etc.; (Obj. 3.4) number of persons administering naloxone by type, disparity demographics, number of prior administrations, and census tract; (Obj. 3.5) number of naloxone patients by location of administration, disparity demographics, number of prior administrations, and census tract; and (Obj. 3.6) number of naloxone kits distributed by zip code, request vs. response, household, dosage amount, type of recipient, and type of kit.

North Carolina Department of Health and Human Services, Division of Mental Health, Developmental Disabilities and Substance Abuse Services (NC DHHS, DMHDDSAS) proposes to serve up to ten communities at high risk of prescription drug and opioid overdose-related deaths through a request for applications process. High risk communities are defined as communities that have above average rates of PDO related emergency department visits and deaths, above average rates of opioid pills dispensed per person or percent of opioid related deaths due to heroin or fentanyl and counties that had reported at least 4 community naloxone reversals. Selected high need communities will receive up to $50,000 to conduct prescriber and dispenser education training, paramedicine, naloxone distribution to community groups and first responders, linkage to treatment/recovery services, and NC Lock Your Meds campaign work with the overarching goals of Goal 1: Reduce the rate of opioid overdose; Goal 2a: Identify and train over 4600 first responders and others in the use of naloxone; Goal 2b: Supply naloxone for first responders and high need community members; Goal 2c: Refer individuals to treatment and recovery services; Goal 3a: Work with medical professionals on the risks of overprescribing to young adults; Goal 3b: Raise awareness about the dangers of sharing medications.

The Michigan Project to Prevent Prescription Drug/Opioid Overdose-Related Deaths (MI-PDO) aims to reduce prescription drug/opioid overdose-related deaths and adverse events among residents 18+ in Calhoun, Genesee and Wayne Counties. Project goals include increase capacity of the high need communities to address the project's purpose, reduce access to opioids through implementation of safe prescribing, and enhance opioid education and naloxone distribution. The Michigan Department of Health and Human Services, Office of Recovery Oriented Systems of Care (OROSC) will lead the project and partner with Prevention Network for implementation of a mini-grant program to address opioid overdose prevention efforts in the identified communities of high need. Wayne State University School of Social Work for data collection, performance measurement, and quality improvement. Organizations selected as part of the mini-grant program will conduct opioid education and naloxone distribution, provide referral to substance use disorder services and follow up contacts, identify hot spot areas to place a community naloxone box, and utilize and promote the OpiRescue application for near real time collection of naloxone administration. OROSC, along with its training contractor, will seek out community healthcare partners to participate in a peer prescribing education program. Overall, the MI-PDO project intends to serve 250 unduplicated individuals for the first year and 500 individuals for the subsequent years for a total of 2,250 by the grant end.