Grants Dashboard

Through the MATTER Project (MAT Therapy Engagement Recovery), the Public Health Trust/Jackson Memorial’s MAT Clinic seeks to expand access to Medication-Assisted Treatment (MAT) and comprehensive psychosocial services to persons with opioid use disorder (OUD) living in Miami-Dade County. MATTER will work proactively to identify, link, treat, and engage persons with OUD in their recovery, and expand access to preventative health care. Opioid misuse and abuse is an ongoing health crisis in Miami-Dade, leading to preventable fatalities, hospitalizations, incarcerations, and socioeconomic trauma to individuals and communities. County-wide interventions have slowed the increasing rate of opioid overdose deaths, opioid-related emergency department visits, and neonatal abstinence syndrome birth defects, but overall numbers have not decreased. Recent data suggests an increase in opiate use in Miami-Dade County going into 2020. Since January 2017, Jackson MAT Clinic has provided outpatient MAT through partnerships with the drug court, Miami Police, and mental health and substance abuse service providers. Referrals are primarily from sources that mandate treatment, even though voluntary participation is critical to patients’ long-term engagement and recovery. MATTER seeks to expand the Clinic to reach persons with OUD who will voluntarily participate in treatment before becoming involved in mandated treatment. Goals include increasing referrals to and enrollment in MATTER; increasing participants’ engagement in recovery; decreasing participants’ illicit opioid use and prescription opioid misuse; and improving project capacity for recruiting, enrolling, and retaining participants. MATTER will serve 188 individuals during the five-year grant, beginning with 24 in Year 1 and increasing each year. As part of the county’s public safety-net health system, MATTER’s focus population will reflect county demographics and disparities, including undocumented, homeless, uninsured, and/or vulnerable residents. Access to this pre-existing network also means that MATTER is well-placed to respond to the co-occurring mental, physical, and polysubstance abuse issues facing residents with OUD. In addition to outpatient MAT, MATTER will provide detoxification, clinical and needs assessments, cognitive behavioral therapy, recovery support, coordination with psychiatric and physical health interventions, and links to community resources. MATTER will build on existing partnerships with JHS Corrections Health Services and Thriving Mind South Florida to strengthen and streamline referral protocols. MATTER will also incorporate Pear Therapeutics’ prescription digital technology reSET-O to better engage and assist participants and increase recruitment, engagement, and linkages to resources by hiring a Peer Specialist and Case Manager. Behavioral Services Research Institute (BSRI) will serve as the MATTER Evaluator to ensure program compliance and effectiveness.

Hi-Tech Charities (HTC) – St. Louis MAT-PDOA Expansion Grant project Project Abstract Summary Hi-Tech Charities (HTC) – St. Louis, Missouri’s Behavioral Health Clinic, Medication-Assisted Treatment - Prescription Drug and Opioid Addiction (MAT-PDOA) Expansion Grant project is an innovative Home & Community Health Team (HCHT) approach, focused on expanding our existing Home & community based mental health, drug abuse treatment, Recovery Support, and Home Health by expanding access to Medication-Assisted Treatment (MAT) services for persons with an Opioid Use Disorder (OUD) seeking or receiving MAT, focusing mostly on medically uninsured and underinsured individuals in St. Louis City and County, St. Charles, and rural counties of Jefferson, Ste. Genevieve, St. Francois. Target population include Active Military and Veterans and their families; African Americans; Latino-Hispanics; LGBTQ youth and young adults; the homeless; and those suffering serious mental illness (SMI) and/or substance use disorders (SUD), including opioid use disorders; drug users in the street; and individuals with co-occurring mental and substance disorders (COD); all will receive comprehensive, integrated, coordinated, culturally, linguistically appropriate MAT services. We offer MAT in combination with comprehensive OUD psychosocial services, including counseling, behavioral therapies, recovery support services (RSS), and other clinical services that help achieve and maintain abstinence from opioids. Hi-Tech Charities is a 501(c)(3), nonprofit community development corporation that provides employment training, housing assistance, social services and healthcare programs that keep healthy as well as empower individuals, families, businesses and communities. HTC has served over 100,000 individuals and families and over 500 hundred, small rural businesses, women and minority businesses in its 22 years of existence. HTC partners with individuals, families, businesses, governments and communities in the counties we serve. Certified in 2016 by Missouri Department of Mental Health as a community-based Mental Health, Drug and Alcohol Outpatient Clinic, HTC has served the community with dedication, and for this program will implement evidence-based models of care that are less susceptible to diversion for illicit purposes, including Medication-Assisted Treatment (MAT); Targeted Naloxone Distribution; Eliminated Prior-Authorization Requirements for Medications for Opioid Use Disorder; Screening for Fentanyl in Routine Clinical Toxicology Testing; Recovery Support; Supported Employment; Screening, Brief Intervention, Referral, and Treatment (SBIRT); and Housing First. HTC HCHT team include psychiatrist physicians, Nurse/Health Educators, Peer/Recovery Specialists, licensed behavioral health clinicians, case managers, and a medical director psychiatrist, and partners and collaborators. Project Goals are: (1) Increase the number of individuals with OUD receiving MAT; (2) Reduce adverse health outcomes for MAT consumers with behavioral health and co-occurring medical conditions; and (3) Increase capacity to promote consumer-driven recovery goals through the provision of peer support and rehabilitation services. Measurable Objectives are: (1) Engage 150 consumers in MAT; (2) Provide wraparound and peer support services to 150 MAT consumers; (3) Conduct primary health screening, treatment and monitoring for 98% of clients; (4) Provide behavioral health assessments and treatment; and (5) Assist 95% who have the need to obtain permanent housing, employment, and/or enrollment in education programs. HTC will serve minimum of 150 unduplicated clients annually and minimum of 750 over the 5-year grant period. Each patient will receive multiple services.

Project Title: Supporting Medication Assisted Recovery & Trauma (SMART) program Applicant Name: Gateway Rehabilitation Center (GRC) GRC-SMART program will expand and enhance access to medication-assisted treatment (MAT) services for individuals 18 years of age or older with an opioid use disorder (OUD) seeking or currently receiving MAT through collaboration with other local agencies and corresponding peer recovery supports. The GRC-SMART programs will be anchored at the main campus Aliquippa in Beaver County, located in southwestern Pennsylvania approximately 30 miles from Pittsburgh and sharing a border with Ohio and West Virginia. In 2020, GRC served 5324 unduplicated individuals throughout (their entire footprint—identify what this encompasses) and of those, 2489 (47% of total served) were diagnosed with an OUD of which only 894 (36% of OUD) participated in a MAT program. GRC currently does not have MAT supportive services available in Beaver County despite the need. Though Beaver County was ranked in the top 20 (top 1%) nationally for opioid overdose deaths in 2016 with 102 incidents, the rates had declined to 41 deaths in 2018 but 2020 saw an increase of 56% with 64 deaths (https://www.overdosefreepa.org/know-the-facts/death-data-overview/). In addition, there were 763 overdose-related emergency calls in 2020, an increase of 38% from 554 in 2019 (Beaver County Emergency Services). ). These high rates of overdose coupled with limited resources for residents to engage in treatment or support services make addressing these needs both timely and vital. The GRC-SMART program expects to increase the overall number of individuals receiving MAT by 116% from Year 1 (n = 290) to Year 5 (n = 630) as a part of their efforts to support the first year of recovery by expanding available conjunctive services to include Recovery Housing for men, an Outpatient facility offering both in-person and telehealth treatment programs such as Intensive Outpatient (IOP), Outpatient Group (OPG) and Outpatient Individual (OPI) and Family Programming while also introducing a community-based Recovery Support Service (RSS) led by PA-certified Peer Recovery Specialists. Across the five years of the program, the GRC-SMART program will utilize advancements in technology to engage and retain 2300 individuals in services. Through offering a full continuum of care and utilizing evidenced based treatment curriculum focused on addressing barriers to recovery (i.e., impact of trauma, co-occurring mental health, family of origins issues, etc.), restoring an individual’s innate resiliency skills and introducing strategies for adapting to the new challenges of early recovery. The GRC-SMART program expects to progressively and ultimately decrease the overall number of individuals misusing opioid’s, illicit or prescription. This will be measured for everyone at 1, 3, 6 and 12-month intervals. The unduplicated # of individuals to be served each year is noted below: Service Year 1 Year 2 Year 3 Year 4 Year 5 Total Recovery House for Men 10 15 20 25 30 100 Outpatient Facility 240 280 320 360 400 1600 Recovery Support Service 40 80 120 160 200 600

The Summit County Medication-Assisted Treatment Expansion (SC-MATx) will enhance and expand services by providing robust, trauma-informed, evidence-based, and coordinated medication-assisted treatment (MAT) within Community Health Center Addiction Services (CHC) for community persons 18 years and older with opioid use disorder (OUD) and co-occurring mental health disorders in Summit County, Ohio. There is a great demonstrated need for OTP service expansion in Summit County. Notably, Ohio has been at the center of the opioid pandemic with the Ohio Attorney General warning in January 2021, that the pandemic is only getting worse as a result of COVID-19. Drug use among Summit County’s residents has continued to rise with the 2019 Summit County Community Health Assessment finding that abuse of both legal and illegal drugs, especially opiates, has sharply increased overdose death rates (76 in 2013 to 310 in 2016). Additionally, a community health needs assessment conducted by Cleveland Clinic Akron General (2019) reported that deaths due to “accidental poisoning by and exposure to drugs and other biological substances” have been increasing across the state with the rate in Summit County now exceeding the Ohio average by over 50 percent. In 2019 and 2020, CHC provided MAT to over 700 patients each year, yet the need for MAT is greater and in 2020 turned away approximately 500 patients seeking MAT. The goals of SC-MATx are (1) Provide MAT services, using FDA-approved medications, combination with comprehensive and evidence-based psychosocial services to at least 350 (50 in the year one, and 75 each for years two through five) additional patients, including an expansion of services through an office-based opioid treatment model; (2) Conduct clinical assessments to determine patients meeting eligible criteria for MAT; (3) Check the PDMP for each new admission to prevent medication diversion; (4) Conduct screenings and assessments for co-occurring substance use disorders and mental health disorders and ensure adequate delivery and coordination of services; (5) Establish and implement a diversion plan to ensure appropriate medication use by MAT patients; (6) Develop outreach and engagement strategies to at-risk diverse populations that increase access to and participation in MAT; (7) Ensure all applicable practitioners obtain a DATA waiver; (8) Build funding mechanisms and service delivery models with rural and resource-limited areas/municipalities and organizations to provide robust treatment and RSS to effectively identify, engage, and retain individuals in OUD treatment and facilitate long-term recovery; (9) Use telehealth services or other innovative interventions, as clinically appropriate, to reach, engage, and retain OUD patients in treatment; (10) Provide RSS, including peer recovery services, designed to improve access to and retention in MAT and facilitate long-term recovery for MAT patients

Western New York Regional 24-7 Virtual On-Call MAT Center The goal of this initiative is to expand, enhance, and sustain access to medication-assisted treatment (MAT) services and recovery supports for persons with opioid use disorder (OUD) seeking or receiving MAT in the Western New York Region. Three measurable objectives that align the region’s needs and treatment gaps will be capable of serving 456 people over 5 years (starting with 48 in year 1 and reaching 120 annually by year 5): Obj. 1: Implement/Sustain Telemedicine 24/7 MAT Initiation to expand the number of individuals with Opioid Use Disorder (OUD) receiving MAT (engage & start MAT); Obj. 2: Implement/Sustain Cascade of Care Framework to connect 24/7 initiation to long-term recovery supports (retain over 6 months with eventual remission); and Obj. 3: Progress Reporting, Performance Evaluation, & Sustainment. The project catchment area is the western end of New York State, comprised of two metropolitan counties (home to Buffalo, NY and Niagara Falls, NY) surrounded by six rural counties, with an estimated 1.5+ million population. The area has over 72,000 persons with opioid use disorder involving non-medical or illicit use of opioids. Over the last two years there has been a spike in both opioid overdose deaths (57%) and opioid related ED visits (58%) along with growing treatment gaps due to COVID shutdowns. The approach is founded on the evidenced-based use of MAT via the deployment of an existing pool of University at Buffalo x-waivered trained practitioners including nine physicians Board-Certified in Addiction Medicine who will work on-call in a new regional 24-7 Virtual MAT Center (Obj. 1). Adapting the “ED-initiated buprenorphine with facilitated transitions” evidence-based practice, our initiative will modify the model to a virtual Telemedicine approach. To further address treatment gaps, the regional On-Call MAT Center will also serve as the rapid access front-end for an evidence-based Value Network Cascade of Care Framework (Obj. 2) that will connect MAT initiated cases to long-term recovery supports. This is a Behavioral Health Care Collaborative of over 85 partners that serve patients in all 8 counties of Western NY. In this proposal, the Telemedicine MAT-Initiation model (On-Call MAT Center) will be connected to this SUD treatment agency collaborative via navigators. This proposal also uses other revenue sources realized from the delivery of services to establish and sustain the program. The call-time expense of the on-call physicians staffing the Virtual On-Call MAT Center is anticipated to be supported by revenue over the project period. Lastly, performance-based program assessments will drive adjustments to fully sustain the On-Call MAT Center beyond the grant (Obj. 3).

In Brooklyn, NY, prescription and illicit opioid use continues to increase as treatment programs struggle to meet this increased need. LSA Recovery will provide MAT and other evidence-based practices to reduce opioid misuse among four currently underserved populations individuals leaving jail, families, Orthodox Jewish individuals, and existing patients with co occurring mental health disorders, serving 60 new patients annually (300 total) over five years. The proposed project will be led by Interborough Developmental and Consultation Center, dba LSA Recovery, referred to as LSA in this proposal). We propose to address the persistently high need for effective opioid treatment in Brooklyn, NY by expanding our existing opioid dependency treatment services to four currently underserved populations. These include expansion of two of our current services: our reentry program for inmates released from NYC jails in collaboration with the Department of Corrections and Community Supervision and our program to serve families with opioid dependent members in collaboration with the NYC Administration for Childrens Services. We also propose two new services: outreach to the Orthodox Jewish community, where MAT engagement is extremely low; and inreach to existing mental health patients with opioid dependence in our licensed mental health clinics where MAT for OUD is not currently provided. Each of these groups are in need of opioid treatment services. Brooklyn has the second highest number of overdose deaths of any NYC borough. Individuals leaving jail are 12 times more likely to overdose compared to the general population. In NYS, 28 of every 1,000 children are affected by the opioid epidemic. Brooklyn is home to the largest Orthodox Jewish population outside of Israel, and opioid use and overdose are common but under-reported in this community due to the stigma associated with drug use. Our own existing mental health patients also have unmet needs for opioid dependency treatment. Eligible participants will be opioid-dependent adults living in (or planning to live in, for jail prisoners awaiting release) Brooklyn, NY. LSAs catchment area for the proposed project include the Brooklyn neighborhoods of Canarsie, Crown Heights, Coney Island, Flatbush and Williamsburg; all neighborhoods affected by the ongoing opioid epidemic. Project goals include delivering MAT and other evidence-based practices to each of these populations, and to decrease opioid use and prescription opioid misuse within six months for all participants. We propose to engage and screen 900 individuals and provide MAT and other evidence-based services to 300 of these individuals over the course of the five year grant project, increasing our MAT capacity ten-fold. Evidence-based MAT includes Vivitrol and Suboxone, and other evidence-based intervention include Motivational Interviewing, Cognitive Behavior Therapy, Trauma-Informed Care, Community Reinforcement and Family Training, and Recovery Coaching.

Bridges Healthcare’s Bridges MATT Van Expansion Initiative will expand its pilot Mobile Addiction Treatment Team (MATT) van program, which has demonstrated remarkable success in its first two years serving persons at high risk of opioid addiction or overdose, to cover evenings and weekends, increase van deployment locations and subpopulations served, and increase options for group and individual therapy, so as to improve six-month client outcomes. Populations served/clinical characteristics. The program provides services in Milford, West Haven, and New Haven, Connecticut to clients who come from a large region. The program’s focus is on (1) persons in low-income neighborhoods, who statistically have a higher rate of opioid use disorder, (2) individuals recently released from prison, (3) persons identified with recent opioid-involved medical emergencies, and (4) individuals who need or prefer the kind of immediate, anonymous care the van provides. The three towns targeted have sustained a level of opioid overdose in recent years that typically exceeds both Connecticut and national rates, often by a factor of 2 or 3. The need for MAT among those recently released from incarceration is clear: The Connecticut Dept. of Corrections estimates that about 25% of jail and prison inmates have opioid abuse disorder (OUD) -- about 225 per year in the Greater New Haven area. SAMHSA estimates that “within 3 months of release from custody, 75 percent of formerly incarcerated individuals with an OUD relapse to opioid use.” A recent study of persons who presented to hospital emergency departments with a non-fatal opioid overdose and were discharged found that 5.5% were dead within a year, with a fifth of those dying within a month. The population of low-income residents in these towns is high (almost 50% in New Haven). Low-income neighborhoods are targeted by the van, along with known sites of high drug trafficking. Proposed Project: The program’s general strategy is to deploy the van, staffed by a prescriber and a peer recovery coach, in locations of high need – including prison release and hospital locations -- where it offers peer engagement (with Motivational Interviewing), anonymity, immediate supervised Buprenorphine induction as appropriate, and assistance in enrollment in long-term clinic-based MAT. Clients receive continued MAT support until long-term treatment is established. Goals/objectives. Goal I. Increase the number of individuals with OUD receiving MAT among at-risk individuals in the targeted area. Obj. 1. Engage an additional 100 clients first year, then 150 annually (total 700). Objective 2. Initiate treatment for an additional 50 clients first year, then 75 annually (total 350). Goal II. Decrease illicit opioid drug use and prescription opioid misuse at six-month follow-up. Obj. 1. Retain 35% of clients in treatment six months. Obj. 2. 50% of clients participate in and 30% complete an Intensive Outpatient Program using IDDT. Obj. 3. 40% of family contacted through van outreach will participate in a Smart Recovery Friends and Family group. Obj. 4. 50% of clients are abstinent after 6 months. Obj. 5. Fewer than 25% of clients have an overdose within six months.

Summary: The Fort Peck Tribes (FPT) Medication-Assisted Treatment Program (MATP) has been designed to address the opioid crisis facing the Fort Peck Indian Reservation (FPIR) from the growth of opioids and opioid addiction on the reservation. Project Name: The Fort Peck Tribes Medication-Assisted Treatment Program Population to be Served: The geographic catchment area is the FPIR which encompasses four counties - Roosevelt, Valley, Daniels, and Sheridan, and the bordering counties of McCone and Richland Counties. Approximately 66% (6,818) of the reservation population are American Indian. Our project will target community members with an Opioid Use Disorder (OUD) and co-occurring disorders within our service area. Project Objectives: The following are our three (3) project objectives: Objective 1: By the end of month three in year one, the FPT MATP will hire, contract with, and provide orientation to one Project Director, (is it just 1 or more than one?) Mental Health Specialist, two Peer Support Specialists, and a Clinician. This team will spend 100% of their time focused on implementation of MATP to individuals with OUD on the FPIR. Objective 2: During the project period of September 30, 2021 to September 29, 2026, the FPT MATP will provide access to MAT and Mental Health Services (MHS) to at least 20 individuals with OUD per year (100 total) with at least 80% (16 per year) who will successfully complete MAT and MHS therapy as measured by GPRA Core Client Outcome Measures data elements at baseline, discharge, and 6-month follow-up. Objective 3: During the same project period, the FPT MATP will provide peer support services in the Spotted Bull Recovery Resource Center and throughout the community to at least 20 individuals with OUD per year (100 total) with at least 80% maintaining sobriety (16 per year) as measured by GPRA Core Client Outcome Measures data elements at baseline, discharge, and 6-month follow-up.

Brookhaven Memorial Hospital Medical Center DBA Long Island Community Hospital will utilize funding from SAMHSA to expand and enhance access to Medication Assisted Treatment (MAT) services for people with diagnosed Opioid Use Disorder (OUD) residing in the Town of Brookhaven, New York, an area hard hit by the opioid epidemic. Over five years, Long Island Community Hospital will identify through SBIRT screenings and other evidence-based practices at least 155 patients suffering from OUD who present in the Hospital's emergency department or medical and surgical floors and provide them with MAT services and at least one of the following: individual counseling, group counseling, education, or Peer support services through the Hospital's Outpatient Treatment Program. Long Island Community Hospital will monitor individuals for at least six months’ post intake, ensuring that they attend outpatient treatment following successful MAT induction, and will conduct data collection again at discharge. During year one, 15 OUD patients will be assisted; 20 OUD patients during year two; 30 OUD patients during year three; 40 OUD patients during year four; and 50 OUD patients during year five. At the six-month follow-up, individuals will report significant decrease in illicit opioid use and/or prescription drug use and successful retention in treatment. At discharge from outpatient treatment, patients will report significant decrease in and/or abstinence from illicit opioid use and/or prescription drug use.

El Centro Family Health, a non-profit Federally Qualified Health Center (FQHC) founded in 1972 in Espanola, New Mexico, proposes to reduce illicit opioid and prescription drug misuse and increase the number of individuals gaining MAT services in northeastern New Mexico, targeting adults who are experiencing Opioid Use Disorder (OUD) as the focus population. ECFH provides integrated health care services to more than 21,000 patients through almost 90,000 encounters via a network of primary care clinics that consist of 3 dental clinics, 9 school-based health centers, and 13 medical clinics. ECFH’s MAT program was launched about 13 years ago and served 925 unique patients in 2020 (many of whom are long-term program participants). The project will support ECFH to launch a dedicated Integrated Addictions Department that will be led by an 0.5 FTE Department Director / Project Director to oversee department and staff activities. The new department will also borrow from ECFH’s Behavioral Health (BH) Department model by hiring/assigning Regional Clinical Supervisors who are dedicated to managing IA Dept. staff to include Counselors, LADAC's, PSS, BH Support Specialists, interns and serving as a community liaison. MAT program services will be available through all 13 ECFH primary care clinics located throughout the seven-county region, as well as through telehealth. Complementary counseling, behavioral therapies and recovery support services are a cornerstone for ECFH MAT program activities.

BOOM!Health South Bronx MAT Program Abstract: The BOOM!Health Medication-Assisted Treatment Program for Opioid Use Disorders (MAT OUD) will be located at an existing high volume syringe exchange program in the South Bronx and will conduct outreach and accept clients from across NYC. The low-threshold program will serve adults age 18 and older who are anticipated to be 100% diagnosed with OUD, 73% male, 75% Hispanic of any race, 15% non-Hispanic Black, and 10% non-Hispanic White. At least 50% are anticipated to have co-occurring additional substance abuse and/or mental health disorders. The program will serve 160 unduplicated persons in each full year of operation and at least 720 unduplicated persons over the five-year project period. The program goal is to expand access to effective low-threshold MAT services for unserved or underserved persons with an OUD. The objectives are: 1) reach an on-going caseload of 120 persons receiving MAT services during the second project year; 2) provide 50% of clients with assessment and service linkage for other SUD, co-occurring mental health disorders, and/or other support services (medical, HIV/HCV, housing, employment, education); and 3) achieve a 60% decrease in illicit opioid drug use and prescription opioid misuse at six-month GPRA follow-up. The program will use evidence-based strategies that include: proactive outreach, low-threshold access to MAT at the site of a syringe exchange program, telehealth, individualized assessment, shared decision-making, Stages of Change to assess client willingness for different program activities, assist clients with support service linkages, integrate mental health and polysubstance use treatment into MAT care, outreach education to reduce stigma against MAT that discourages people from seeking care, mitigate barriers to receiving MAT such as transportation and hours of operation, provide pre-visit planning for patient-centered visits with empathetic communication, measure outcomes and identify specific quality improvement initiatives, and continuously evaluate need for revised policies, workflow procedures, and patient education practices. Retention is the outstanding problem of MAT programs. To address this need, the program will conduct a client satisfaction survey with every client to identify barriers and facilitators to effective care. Survey findings will be reviewed on an on-going basis to support continuous quality improvement and develop a program model that maximizes retention. The proposed program will be leveraged by and integrated into a wide range of support resources available from BOOM!Health and its parent organization, Argus Community. These include syringe exchange, health insurance enrollment, HIV/HCV services, health care coordination and navigation, services for homeless persons (clothing, showers, laundry, meals, and access to supportive housing), mobile van outreach, staff and client MAT OUD education at substance abuse treatment agencies, evidence-based treatment services for substance abuse and co-occurring mental health disorders, High School Equivalency programs, pre-vocational training, and supported work experience for unemployed adults.

New York Harm Reduction Educators (NYHRE) will conduct services in Manhattan and the Bronx. The proposed program’s target population is highly marginalized people who use drugs (PWUD) whose opioid use makes them suitable candidates for medication-assisted treatment (MAT). Approximately 80% of program participants will be Black, multiracial, or Hispanic (with over 20% hailing from Puerto Rico or Dominican Republic) and although we expect that over 70% of participants will be men, our target population includes adults of any gender. A significant portion of our target population will present with a co-occurring substance use disorder (SUD) and at least one mental illness, and over 80% will report histories of trauma. We will provide individuals seeking SUD with access to MAT; by expanding our clinical team to include a psychiatric practitioner, will we also be able to treat individuals with co-occurring SUD and mental illnesses. GOAL 1 (G1): To increase access to and engagement in low threshold Medication Assisted Treatment (MAT) for people with Opioid Use Disorder (OUD) in the South Bronx and East Harlem, NYC. GOAL 2 (G2): To decrease opioid misuse among people with Opioid Use Disorder (OUD) in East Harlem and the South Bronx, NYC. GOAL 3 (G3): To increase access to and engagement in integrated treatment for comorbid mental health conditions among drug users in the South Bronx and East Harlem, NYC. OBJECTIVES: G1 Objective 1: Increase MAT prescriber hours at NYHRE’s onsite HUB Clinic by 219% (16 hours per week to 51 hours per week). G1 Objective 2: Identify at least 40 participants with OUD per month in the HUB Clinic, provide them all with OUD treatment options, and prescribe MAT onsite to 10-15 of them per month. G1 Objective 3: Provide case management to at least 25 participants with OUD per month whether they are prescribed MAT or not in order to provide support for social determinants of health (e.g., housing, food) and encourage continued engagement in their self-identified recovery process. G2 Objective 1: Conduct Harm Reduction counseling and encourage regular attendance in Seeking Safety groups with all case management participants (at least 25 per month) in order to reduce opioid misuse. G2 Objective 2: HUB Clinic staff conduct urine toxicology screens and discuss opioid misuse and diversion with every MAT participant at induction and at maintenance visits every two weeks. G3 Objective 1: Screen at least 40 Hub Clinic participants per month for PTSD, Anxiety, and Depression co-occurring with drug use. For those screening positive, diagnostic interviews follow. G3 Objective 2: Provide diagnosis and treatment options for all who meet DSM-5 criteria for PTSD, Anxiety, and/or Depression. Treat onsite for at least 10 people per month to reduce mental health symptoms by 10% at 6-month post-test.G3 Objective 3: Provide case management and seeking safety groups for at least 10 participants per month to promote recovery.

Red Rock (RR) Behavioral Health Services will expand its Medication-Assisted Treatment (MAT) for adults (18+) with opioid use disorders (OUD) in a catchment area of three counties in western Oklahoma: Canadian, Grady, and Pottawatomie. Covering 2,804 square miles, the area has a total population of 276,732 (Census, 2019). Two hundred and sixty (260) unduplicated individuals will be served over five years. RR provides mental health (MH), substance use (SU), and co-occurring disorders (COD) treatment and recovery-oriented services in a 16-county service area. RR will build on its strengths to expand MAT services to meet critical needs. Goal 1: Through the delivery of MAT and integrated COD treatment, improve the capacity of persons with OUD and COD to achieve sustained recovery from COD and to reduce health risks associated with opioid abuse. Objective 1-1: By year 1, month 3 year begin operations in one standalone MAT clinic in Canadian County with one standalone clinic opening in each of Pottawatomie and Grady Counties in year 2 and 3 respectively; Objective 1-2: By year 1, month 3 provide comprehensive person-centered MAT and supportive services using evidence-based practices (EBP) that include SAMHSA TIP 43 for MAT, Trauma-Informed Cognitive Behavioral Therapy (TI-CBT) and Contingency Management; Objective 1-3: By year 1, month 3 expand telehealth infrastructure for MAT maintenance and ongoing client monitoring through the purchase and distribution of 20 iPads to clients and staff; Objective 1-4: After 6 months of MAT enrollment, 45% of MAT clients will demonstrate clinically significant reductions in opioid and polysubstance use as measured by SAMHSA required GPRA data; Objective 1-5: After 6 months of enrollment, 25% of clients enrolled in MAT and integrated COD treatment will demonstrate clinically significant improvements in psychosocial functioning and/or life satisfaction as measured by the Addiction Severity Index (ASI); and Objective 1-6: After 6 months of enrollment, 15% of MAT clients will demonstrate improvements in clinical measures of chronic health conditions associated with polysubstance abuse, as measured by ASI. Goal 2: Reduce stigma and MAT resistance and increase and improve MAT quality and client engagement. Objective 2-1: To assure fidelity to MAT evidence-based practices (EBP), within 3 months of hire, all new clinical staff will receive TI-CBT and Contingency Management training, and within 3 months of project initiation, all MAT staff will receive Motivational Interviewing (MI) training. Training quality will be assured through pre and post-tests measuring acquired knowledge and skills; Objective 2-2: Within 3 months, provide 2 community presentations per quarter focusing on the benefits of MAT, stigma reduction, and support for the MAT model; and Objective 2-3: During year 2, undertake a certification process to become a Wellbriety Certified Treatment Center to better serve Native Americans.

The population of focus is American Indian and Alaskan Natives (AI/AN). The target of focus maintains a culture within a culture that requires specific treatment and recovery services. The Muscogee (Creek) Nation (MCN) is the fourth largest federally recognized Tribe in the United States with a total population of 91,053 tribal citizens – more than half of whom live within the tribal reservation. The goal of the grant is to enhance medication-assisted treatment (MAT), provide education, training, and recovery support service (RSS) activities. Goal 1: Enhance the process to identify, screen, assess, and refer opioid use disorder (OUD) patients. Goal 2: Increase access to evidence-based treatment for those suffering from opioid use disorder Goal 3: Develop opioid misuse tracking activities. MCNDH will utilize funds from this award to identify, screen, and refer IHS beneficiaries suffering from OUD to MAT services with the tribe’s reservation. The award of this project will ensure that MCNDH can offer a comprehensive OUD recovery and pain management clinic for those patients with limited or no access to MAT services. It will also ensure that IHS beneficiaries will access these services without additional costs that they may experience elsewhere within the reservation. As part of this total service population, MCNDH plans to serve no less than 3,840 IHS eligible patients throughout the life of the project.

The Lynn Community Health Center (LCHC) is proposing a High Risk MAT Project focusing on populations at highest risk of opioid-related overdose deaths: individuals with opioid use disorders (OUD) who are experiencing homelessness or recently released from incarceration. “An Assessment of Fatal and Nonfatal Opioid Overdoses in Massachusetts (2011-2015)” reports that individuals experiencing homelessness have an opioid-related overdose death rate that is 16 to 30 times higher compared to the rest of the adult population, while persons released from incarceration in prisons and jails have an opioid-related overdose death rate that is 120 times higher compared to the rest of the adult population. There is significant overlap amongst the highest risk populations. Of homeless individuals, two in five have a diagnosis of serious mental illness and 20% have been recently incarcerated. Of persons released from incarceration, three in five are considered homeless and over half have serious mental illness. Our geographic catchment area is Lynn, Massachusetts, a highly diverse city located just north of Boston with a population of 94,300.

The Coastal Bend Wellness Foundation (CBWF) proposes to implement Project ROAD (Recovery from Opioid Addiction and Dependence) at their Federally Qualified Community Health Center to expand/enhance access to medication-assisted treatment (MAT) services for adults who meet DSM-5 criteria opioid abuse or dependence and who would benefit from MAT and recovery support services. The desired outcomes for this program are: 1) an increase in the number of individuals with OUD receiving MAT, 2) a decrease in illicit opioid drug use and prescription opioid misuse at six-month follow-up, and 3) an improvement in the quality of life of patients receiving MAT at CBWF’s clinic. Project ROAD will achieve these outcomes by expanding its use of Buprenorphine/naloxone, an FDA approved medication for the maintenance treatment of opioid use disorder, and collocating MAT, primary health, mental/behavioral health, and recovery services at CBWF’s clinic. Project ROAD will allow enhancement of services by using extended release, long-acting injectable buprenorphine formulations. CBWF seeks funding with the ultimate goal to develop and sustain the organizational structure to enhance and expand their current MAT program. CBWF will expand and enhance its MAT program by accomplishing the following measurable goals: 1) By January 30, 2021, strengthen agency capacity, workforce, partnerships, and review/modify policy/procedures necessary to expand and enhance services. 2) By December 30, 2021, Project ROAD will begin community engagement and project promotion, targeting opioid users, as well as primary care providers. 3) By September 29, 2026, Project ROAD will have provided 150 new opioid users with MAT and support services at CBWF’s clinic. 4) By September 29, 2026, Project ROAD will conduct MAT in-service/training to 250 healthcare workers in the community. 5) By December 30, 2021, and biannually thereafter, evaluator and PD will implement a Quality Improvement Plan to determine if the desired goals are achieved and if adjustments need to be made. To accomplish these goals and fulfill the purpose of the grant, CBWF will implement the following evidence-based practices: Cognitive Behavioral Therapy, Living in Balance, and Seeking Safety. Project ROAD will assign/hire experienced and competent staff that includes a Medical Director, Project Director, Project Coordinator, Licensed Chemical Dependency Counselor, a Registered Nurse, a Recovery Coach, and an experienced external evaluator.

Title: Partnership to Address Opioid Epidemic and Save Lives in Western New York Through Medication Assisted Treatment Spectrum Health and Human Services, a Certified Community Behavioral Health Clinic, and Evergreen Health Services, a Federally Qualified Health Center Look-Alike (Partners), will collaborate to: expand access to medication assisted treatment (MAT) for opioid use disorder (OUD) through outreach and engagement of high risk populations; increase the number of data-waived providers; and expand telehealth. Our population of focus is adolescents and adults with OUD, substance use disorder, co-occurring mental and substance use disorders, and those living with or at risk of HIV and hepatitis C due to injection drug use. Within the Partner’s large, mostly rural, Western New York 10-county catchment area, we will broaden our jail outreach to additional counties and streamline care coordination at the time of reentry, as well as grow our social media marketing to both potential referring providers and individuals and families seeking OUD treatment. We will increase the number of providers with data waivers each year of funding and expand MAT service to our two syringe exchange programs (SEPs), which are the only SEPs in Western New York, via telehealth. Our robust evidence-based practices complement medication treatment. The project’s goals are to increase the number of clients receiving MAT, increase linkage to and maintenance of complementary behavioral health services, and ultimately prevent overdoses. The Partners will measure progress towards those goals through monitoring the number of newly data-waived providers, the volume of patients in both our low-threshold and main MAT program, the percentage of patients maintained on MAT and connected to ancillary services, and the percentage of clients with co-occurring disorders whom we engage through a peer. We will track the number of overdose deaths in our aggregate client population. Each year we will serve an additional 200 patients, for a total of 1,000 additional patients served by the end of the grant.

The Bridges to Recovery will expand and enhance service capacity throughout the Memphis and Shelby county area through the expansion and enhancement of Medicated Assisted Treatment for adult African- American men and women struggling with opioid use disorders. Serenity will provide substance use disorders treatment, peer support, and a continuum or care to 230 individuals to with the goal of enhancing access and engagement for those who experience barriers to services. The project will serve 30 individuals in the first year and 50 individuals in years two- five. The program will collaborate with community partners for full access to medical, psychiatrist and all forms of Medicated assisted medications as well as full continuum of care for substance use disorders, including tele-health services.

Medication-Assisted Treatment for Homeless Individuals with Opioid Use Disorder who are Exiting Incarceration in Suffolk County, Massachusetts Recognizing the high prevalence of opioid use disorder among incarcerated individuals and their dramatically elevated risk of fatal overdose upon release, this project is a partnership between a federally qualified health center and two county jails in Suffolk County, MA, to effectively bridge incarcerated individuals to community-based opioid treatment upon release. About two-thirds of inmates are non-white; about 89% are male; the average age is 35 years. Project goals: (1) Expand access to MAT services for individuals with OUD and unstable housing who are exiting incarceration in Suffolk County; by providing peer recovery coaching and case management to ensure participants are effectively bridged to community-based OUD treatment post-release; facilitating enrollment in insurance coverage prior to jail exit; and providing comprehensive, team-based MAT services and care coordination. (2) Reduce illicit opioid use & prescription opioid misuse, as well as overdose deaths, among post-incarcerated individuals in Suffolk County; by providing peer recovery coaching; providing case management to support reentry, identify community resources, and connect participants to services post-release; and aiming to achieve a 50% rate of abstinence from illicit opioid use and prescription opioid misuse at 6-month follow-up. (3) Foster a seamless continuum of OUD care for those involved in the criminal justice system by improving collaboration between pre- and post-release opioid treatment providers; by strengthening partnerships with community-based opioid treatment programs; facilitating transitions of MAT care upon participants’ exit from custody; and supporting the replication of this continuum of OUD care throughout MA; and (4) Ensure program participants are connected to care for co-occurring medical and behavioral health conditions, and receive case management for legal issues that may prevent them from accessing care; by screening participants for co-occurring conditions; providing psychiatric medication bridging or initiation; ensuring they have received services for HIV/AIDS & hepatitis C; providing legal case management; and connecting participants to post-release appointments with primary care, behavioral health, and specialty care, if clinically indicated. The project will serve a total of 65 unduplicated individuals per year over 5 years, totaling 325 unduplicated individuals over the 5-year grant period.

Oaks Integrated Care (Oaks) is seeking to expand capacity of the provision of our Medication Assisted Treatment (MAT) services in Burlington, Camden, and Mercer Counties in New Jersey to individuals who present with an Opioid Use Disorder (OUD). Oaks' expansion of MAT services will continue to fill a strong need for indigent Burlington, Camden, and Mercer residents who seek treatment, by enabling us to significantly increase the amount of MAT we are able to offer to these critical populations. New Jersey has seen an increase in overdose rates within the past year due in part of the pandemic, but also the presence of fentanyl and other synthetic opiates that are much more lethal and present in the substances being used. Oaks has identified the 3 counties as its target populations based on the criteria that: 1) there is a significant population of individuals with an OUD in these 3 counties who will benefit from MAT services; 2) there are existing service gaps, including a lack of MAT availability and reluctance of inpatient prescriptions stemming from a lack of linkage to community providers, which serve as major barriers to access of care for individuals with an OUD; 3) there is an existing need to ensure proper transition and coordination of care for individuals entering and exiting the Emergency Department (ED), Jail systems, and inpatient facilities who are induced on or reliant on MAT services for their care and recovery. The goal of Oaks' MAT Capacity Expansion is to ensure access that is as immediate as possible without compromising the quality of care. The expanded capacity afforded through this funding will serve an additional 120 unduplicated individuals annually, or 600 unduplicated total individuals throughout the 5-year project period. This number is project from the number of consumers that we currently provided MAT services to within these 3 Counties.

The population of focus is the residents of the rural Evangeline, Lafayette, and St. Landry Parishes in the Acadiana region of Louisiana. The total population of the area is 167,713 people, of whom 84,134 (50.2%) are low-income. SWLPHC is a Federally Qualified Health Center serving the general and homeless populations. In 2020, regional homeless numbers spiked from 417 people in January to 759 people in October. SWLPHC has integrated primary care, mental health, and substance abuse service sites in all three parishes. SWLPHC already provides primary care, mental health, and substance use disorder services, including MAT in the service area. Therefore, SWLPHC's focus is to expand access to MAT therapy and add new recovery support services and community health worker services to screen and address social determinants of health (SDoH). SWLPHC has substance abuse counseling that will be integrated into this program in kind.

The Fortune Society (Fortune) is proposing a new program in response to the US Substance Abuse and Mental Health Services Administration (SAMHSA) Funding Opportunity Announcement (FOA) for Medication-Assisted Treatment – Prescription Drug and Opioid Addiction (MAT-PDOA). Drawing on our expertise as one of the nation’s preeminent reentry organizations, Fortune will expand access to MAT for justice-involved individuals aged 16 years and above and reduce the risk of relapse and/or overdose for justice-involved adults with OUD through, “MAT services for Justice-Involved Populations.” Fortune proposes serving at least 100 justice-involved individuals each year for the duration of this program, except for the first year in which we propose serving at least 75 individuals, given the time needed for program startup. Fortune will engage our target population through “inreach” and outreach, promoting our MAT program among a wide range of partners and providers, and strengthening proactive referral pathways from departments within Fortune that see high numbers of clients with SUD/OUD, such as Admissions/Benefits Access, our Individualized Corrections Achievement Network program for discharge planning (I-CAN) and housing (both permanent and emergency/transitional). Fortune will partner with NYC Correctional Health Services (CHS), which provides MAT on Rikers Island, as well as the nurses in the Discharge Planning Unit (DPU) at the Department of Corrections and Community Supervision (DOCCS), which provides healthcare referrals for state releases, to receive referrals for continuation of MAT upon these patients’ release. Fortune will use evidence-based screening tools and practices to screen and assess eligible clients for needed MAT services, including both induction and continuation of MAT, providing abuse-deterrent formulations such as buprenorphine and/or buprenorphine with naloxone (e.g. Suboxone) to justice-involved clients throughout the duration of this program and referring to provider partners, including H+H and Montefiore Transitions Clinics, for clients seeking or in need of methadone-based MAT services or requiring MAT services during off-peak hours (i.e. evenings and weekends). In order to ensure long-term recovery and continuation of MAT through the reentry process, Fortune will leverage resources from across the entire agency. Dedicated OUD counselors with training and/or certification in Substance Use Counseling (such as a CASAC certification from NYS) will support all MAT clients with counseling and any other psychosocial supports needed, including warm handoffs and connections to services. Furthermore, recognizing the invaluable role that peers with lived experience, including experience with substance use treatment and recovery, can have in motivating those with criminal justice histories, all clients will be connected to Fortune’s NEST, a peer-driven supportive services program that will give MAT clients a safe space to engage with peers who have been through what they have. NEST provides clients with opportunities for individual mentoring and coaching, as well as peer support groups, which Fortune anticipates will prove a critical aspect of ensuring adherence to MAT over the long-term. All participants will also be provided with $10 and $20 gift cards at their 3- and 6-month check-ins to better incentivize completion of the 6-month GPRA evaluation and to promote uptake of treatment in the long-term. Furthermore, Fortune will ensure that clients are supported holistically, including in housing, employment, connections to primary/ behavioral health services, food and nutrition, and more, recognizing that instability in any one of these areas can potentially trigger a relapse or lead to an environment not conducive to long-term treatment. Fortune prides itself on a commitment to lifetime aftercare and will exemplify this dedication by ensuring that program participants are supported in recovery.

Collier County Medication Assisted Treatment Services Population of focus for Collier County Medication Assisted Treatment Services (Collier MAT) shall be persons with an opioid use disorder (OUD) seeking or receiving MAT. The desired outcomes are an increase in the number of Collier County residents with OUD receiving MAT and a decrease in illicit opioid drug use and prescription opioid misuse at six-month follow-up. 380 unduplicated clients will be served. Collier MAT will increase MAT access among rural Collier County residents as well as jail inmates with a history of OUD who will be released from custody in four months or less. Program goals and objectives include: Goal 1: Increase the number of individuals receiving MAT services with pharmacotherapies approved by the FDA for the treatment of opioid use disorders. Objective 1.1: Establish the baseline number of Collier County residents receiving MAT pharmacotherapeutic services from DLC during 2020. Objective 1.2: Increase the number of Collier County residents receiving MAT pharmacotherapeutic services annually by at least 10% above baseline in year 1 and 25% above baseline in years 2-5. Goal 2: Increase the number of individuals receiving integrated care. Objective 2.1: Establish the baseline number of Collier County residents receiving integrated care - pharmacotherapy in tandem with either therapy, peer recovery support and/or case management services - during 2020. Objective 2.2: Increase the number of Collier County residents receiving integrated care annually by at least 10% above baseline during year 1 and 25% above baseline in years 2-5. Goal 3: Decrease illicit drug use at 6-month and post treatment follow-ups compared to pre-treatment. Objective 3.1: Establish baseline using data from year 1 participants. Objective 3.2: Decrease by at least 5% from baseline in years 2-5. Goal 4: Decrease the use of prescription opioids in a non-prescribed manner at 6-month and post treatment follow-ups, compared to pre-treatment frequency of use. Objective 4.1: Establish baseline using data from year 1 participants. Objective 4.2: Decrease by at least 5% from baseline in years 2-5. Collier MAT will utilize only FDA-approved medications for the maintenance treatment of opioid use disorder. Medications include naloxone, buprenorphine products including sublingual tablets or film, buccal film, and extended release, long-acting injectable buprenorphine formulations; and injectable naltrexone. A plan will be implemented to mitigate diversion risk of buprenorphine. MAT will be provided in combination with comprehensive OUD psychosocial services, including counseling, behavioral therapies, recovery support services, and other clinically indicated services provided by Collier MAT and community partners. Collier MAT will report performance on the number of clients served, diagnosis, specific medications prescribed and duration of treatment with those medications, abstinence from illicit drug use and alcohol misuse, housing and employment status, criminal justice system involvement, and access to and engagement with services,

Overview and Target Population: Zepf Center, in partnership with Health Partners of Western Ohio (HPWO; a federally qualified health center), Mercy Health: St. Vincent Medical Center and St. Charles, The University of Toledo Medical Center’s Ryan White Program, and Alvis present the MATTER Project, targeting 100 unduplicated individuals in need of medication-assisted treatment (MAT) for opioid use disorder (OUD) in Year One; 580 individuals over the five-year grant period. Clinical and Demographic Considerations: Ohio is still in the midst of an opioid epidemic, rising rates of suicide, and like everywhere else, is still battling through COVID-19. Ohio is grappling with the fourth highest overdose death rate in the United States (Ohio Dept. of Health, April 2018), and Lucas County is in the second-highest tier with 24.1 deaths per 100,000 people. Health is affected by bio-psycho-social factors, including poverty, chronic disease, environmental stress, acute crisis, and access to care. Income inequality may further perpetuate or exacerbate health disparities. The nature of the problem as it relates to access to MAT continues to be related to poverty levels, continued stigma surrounding substance use disorder and mental health disorder treatment, little to no insurance coverage for the target population, and low education levels which are barriers to needed services for residents in the catchment area. Experience with providing MAT: Zepf Center offers Methadone, Sublocade, Vivitrol, Subutex, and Zubsolv as forms of MAT through its OTP program. This expansion will create an OBOT (Office Based Opioid Treatment Program) in the Junction Neighborhood of Toledo. Zepf Center utilizes several regimens for MAT, including those that are less susceptible for diversion. Zepf employs strict oversight practices of all medications to minimize diversion. Project Goals and Objectives: The goal of The MATTER Project is to expand access to MAT services for persons with an OUD seeking or receiving MAT. Outcomes include:(1) Increase the number of individuals with OUD receiving MAT; and (2) Decrease in illicit opioid drug use and prescription opioid misuse at six-month follow-up. Objective 1: 50% of program participants receiving MAT will complete their assigned level of care (e.g. IOP or OP), per recommendations from the clinical assessment. Objective 2: 50% program participants will who complete treatment will report no illicit opiate use at their six- month follow up. Objective 3: 10% of participants who do not complete treatment will report no illicit opiate use at their six-month follow up. Objective 4: 60% of participants will work with a peer support specialist, recovery coach or sponsor to assist them with maintaining their recovery; Objective 5: 90% of eligible participants will enroll in benefits and improve their resources; Objective 6: 75% of participants will report improvement in mental health symptoms and MH recovery. Objective 7: 50% of participants who express a need for recovery housing (RH) will be linked within 30 days of admission to treatment.

ACCESS, an FQHC, serves more than 175,000 low income patients annually in the Chicago region—an area with some of the highest opioid-related death rates in the nation. This project will improve access to trauma-informed MAT services through expanded partnerships, the addition of a 15th site to our program, and enhanced recovery services. Over five years we plan to increase our MAT capacity by 26 percent and serve a total of 1,988 unique patients. Populations to be served: ACCESS will expand and strengthen our MAT program model for our low income, predominately minority patients in the city of Chicago, suburban Cook County and DuPage County. Some communities in the target area have an opioid-related overdose death rate nearly four times that of the nation overall, with even higher rates seen among Black individuals aged 45 to 64 years. The COVID-19 pandemic has further exacerbated the opioid epidemic in the Chicago region. There was a 20 percent increase in opioid-related overdoses in 2020 but a decrease in the availability of treatment and recovery resources. The communities impacted are highly impoverished with significant health inequities and high rates of trauma and violence. Project Goals: 1. Ensure continued access to MAT services during the COVID-19 pandemic; 2. expand access to MAT services in the hardest hit communities; 3. lower the risk of fentanyl-related overdoses; 4. expand partnerships to ensure seamless transitions of care from institutional settings such as hospitals and the criminal justice system; 5. ensure patients receive the right level of care at the right time at ACCESS, including active treatment, intensive outpatient programs, and recovery services; 6. strengthen the infrastructure of the program at ACCESS to include dedicated program oversight and evaluation to sustain high quality care. Project Strategies: These goals will be achieved by: (a) Expanding telehealth to include group therapy and introduce injectable buprenorphine; (b) opening a new MAT program at an ACCESS health center which is co-located with a safety net hospital in a community with one of the highest opioid-mortality rates in the nation; (c) updating provider education on overdose prevention and increasing the availability of naltrexone to all ACCESS sites; (d) expanding partnerships with hospital systems and community partners; (e) integrating peer recovery specialists, chaplaincy, and level two services into the program and expanding group services to special populations such as women; and (f) hiring a dedicated manager and evaluation staff. Number of People to be Served: The projected unduplicated number of patients served will be: Year 1: 725; Year 2: 755; Year 3: 785; Year 4: 835; and Year 5; 875—a total of 1,988 patients over the five-year project period, which assumes some patients will stay in the program for more than one year. Patients will receive patient-centered, trauma-informed, evidence-based interventions within the primary care setting. Using a harm reduction approach that addresses patients’ individual circumstances, we will reduce opioid use and improve overall health outcomes.