Grants Dashboard

Northampton Health Department: Expansion of the Drug Addiction and Recovery Team Opioid overdose and deaths related to polysubstance use continue to be the main driver of substance related deaths in Massachusetts. Since 2014, the presence of fentanyl in the drug supply has increased dramatically, contributing to the rising rates of opioid and polysubstance overdose death. According to the Massachusetts Department of Public Health, 9 out of 10 deaths involving polysubstance use include opioids. The Northampton Health Department (NHD), located in Western Massachusetts (WMA), plays a key role in addressing the opioid crisis by serving as a lead convener throughout the region. NHD has garnered national accolades for it's innovative Drug Addiction and Recovery Team (DART) program. DART is a public safety/public health collaboration providing free support for people with substance use disorder (SUD) and their families -- such as after an overdose, for police response due to SUD, post-incarceration, self-referral, or by referral from community agencies. Strong administrative infrastructure for DART includes dynamic training and technical assistance and a customized, electronic case management system for overdose reporting, electronic case referral, robust data collection, and secure communication between team members. DART was originally piloted through a 2017 SAMHSA FR-CARA award and quickly expanded to serve county wide as a connective hub. The overall goal of this project is reducing opioid overdose deaths in WMA through the following three goals: (1)Ensure all first responders and other key community sectors are equipped with and trained to use Naloxone. This project will engage new police and EMS departments who currently do not carry and distribute Naloxone. We will increase access to harm reduction tools by distributing Naloxone, Naloxboxes, and fentanyl test strips to people who use drugs and their social networks. (2)Ensure all DART member departments and agencies, along with key community sectors, are provided training on topics such as polysubstance use, stimulants, fentanyl, and other drugs of concern. We will enhance NHD's Recovery Friendly Workplace Toolkit, currently in development, by creating additional accompanying tools and resources. (3) Establish processes to integrate EMS providers into DART and create a mobile induction of medication for opioid use disorder protocol. Through DART's expansion, we expect to serve 1000 DART participants throughout the four years of the project and will train a minimum of 900 DART members, community members, and professionals in varying sectors. This project will serve as a model by offering a robust evaluation plan, frameworks for training, protocols, templates for public relations, and will contribute to the development of evidence based practices.

The Kenosha County Overdose Response Initiative's (KORI) approach to combating the opioid crisis is through collaborative, data-driven, decision making. Our goal is to reduce the number of fatal opioid-related overdoses and fatalities. Strategies for accomplishing this goal are to expand and promote Kenosha County Public Health's Narcan Distribution Program and implement a Mobile Overdose Response Team that provides referral to treatment services and recovery support. Kenosha County (population 169,561) is located in the Southeast corner of Wisconsin, midway between Chicago Illinois and Milwaukee Wisconsin. Kenosha County includes 12 municipalities and has the 4th largest city (Kenosha) in Wisconsin. Kenosha County has been hit hard by the opioid epidemic. The stress, anxiety, and isolation created by the COVID-19 pandemic, in addition to the disparities brought to light during recent civil unrest in our community have impacted the magnitude of the opioid epidemic in Kenosha County. In 2020, toxicity death reports from the Kenosha County Medical examiner’s office show that 28% of the toxicity deaths were between the ages of 41-50, 26% between the ages of 51-60, 22% between the ages of 31-40, and 16% between the ages of 19-30. 65% were male and 34% female. Our data also shows that 91% were Caucasian, 4% Black/African American, 2% Hispanic, and 2.04% are Veterans. There was a 63% increase in toxicity deaths in 2020. Those deaths include a 52% increase in opioid-related deaths and a 50% increase in fentanyl analog/fentanyl-related deaths. KORI will integrate and expand Kenosha County's current Narcan Program that serves to make Narcan available to first responders, and community members as well as educate them on recognizing the signs of an opioid overdose and how to administer life-saving naloxone. KORI will expand the training to include additional key sectors such as judges, court personnel, teachers, and business owner in high risk communities. We will also include education on the safety around fentanyl, carfentanil, and other illicit and dangerous drugs. Trainings will be tailored to help ensure we provide the educational needs of each key sector we train. In addition, KORI will implement a mobile overdose response team. Public Health staff will streamline referrals into local resources, educate survivors on harm reduction, MAT, and administering Narcan. The Certified Peer Support Specialists provides models of self-care, help in managing day-to-day life, and provides referrals for patients. KORI will leverage relationships and build off the infrastructure and progress made to date by the Narcan Program and the Kenosha County Opioid Task Force, a multi-sector coalition addressing opioid misuse addiction, and overdose deaths in Kenosha County. KORI will serve 700 people annually and 2,800 throughout the four years of the program, with the potential to serve more as we reduce barriers to treatment and strengthen community participation.

Maine EMS is the lead regulatory entity responsible for the oversight of the Emergency Medical Services (EMS) system within the State of Maine (State). As a result, EMS clinicians (EMTs, Advanced EMTs (AEMTs), and paramedics) throughout the state respond to medical emergencies related to persons experiencing Substance Use Disorder (SUD) including those that experience an overdose event. The State, in collaboration with community, local, regional, state, and federal partners, continues to work strategically to address the national opioid epidemic and ensure that Mainers have access to the widest array of resources possible. The rural nature of Maine means that often there are some communities that have fewer assets than others when it comes to support mechanisms for persons experiencing SUD. Throughout the State in 2020, there were over 30 overdose events per every 10,000 people in the state. These numbers correlate to national trends from 2020 that suggest that we still have significant hurdles ahead of us in managing the ongoing opioid crisis. To help bridge this gap, Maine EMS is submitting this proposal that aims at providing education, support, and connectivity to programs throughout the state. Our program will increase the capacity of the Maine EMS system to provide medical guidance and treatment modalities that are novel and cutting edge by bringing on increased medical director resources to the EMS office. Investing additional time in physician support will not only improve the quality of emergency care across the State, but it will also provide additional resources for the office to offer educational and outreach opportunities related to care of patients experiencing a SUD. The funding will significantly invest in training and educational support that will deliberately target stigmatization, naloxone administration training, and pathways to connect patients via their treating EMS clinicians to treatment options available within their communities. The program will bring on a staff member to assist in outreach coordination and project management as well as contractual support for monitoring and evaluation. The program will work collaboratively with existing programs and systems to support the long term sustainability of the project including partnerships with the University and or community college system, the Office of Behavioral Health and the Attorney Generals Office. These strategic partnerships will ensure the long term sustainability of the program and connectivity to existing resources rather than being duplicative and replicating similar programs that already exist within the State. The overarching goal of this program to better equip EMS clinicians with resources, knowledge, and skills not only treat patients who are experiencing an overdose related event connected to illicit substances, but also those with generalized SUD. Connecting these individuals with resources that are available throughout the state and providing an off ramp to existing resources is essential to minimizing EMS clinician burn out and compassion fatigue if there isn't an endpoint. This program is proposed to encompass four years of performance beginning on September 30, 2021 through September 30, 2025 and will require 766,726.21 annually to support this program.

The Rio Arriba County Naloxone Enhancement and Training project will enable the county’s health and human services department to leverage the existing Opiate Use Reduction (OUR) network to enhance naloxone supply and training amongst its member agencies throughout the county. Rio Arriba County is a high desert rural community located in northern New Mexico with an estimated at 38,921 residents, it is one of the poorest counties in the state of New Mexico, with a nationally ranked 3rd highest poverty rate in the nation. Located within the County are three tribal jurisdictions: Santa Clara Pueblo, Ohkay Owingeh Pueblo, and Jicarilla Apache Reservation. This project will fund naloxone distribution, education, outreach and training to over 400 individuals including the elderly and recently released inmates utilizing a comprehensive community-based approach.

MS-CORP aims to strengthen MS’s opioid use continuum of care by expanding and enhancing EMS-based naloxone access for persons experiencing a suspected opioid overdose. A three-pronged, team-based approach to care will incorporate Community-based Care Management (CBCM) teams [consisting of: a DOJ COSSAP-funded Peer Support Specialist (PRSS), a MS-CORP-funded Social Worker (LCSW)]; EMS service providers; and the Mississippi Public Health Institute to employ a collaborative, coordinated continuum of care approach utilizing evidence-based interventions that establish client-provider partnerships and equitable access for the whole population. MS-CORP providers will make naloxone more widely available for emergency reversal of known or suspected opioid overdose in prioritized high-need, low-capacity rural MS counties. The CBCM will provide follow-up care for patients receiving naloxone to provide addiction and treatment education; facilitate warm hand-offs to treatment providers, including behavioral/mental and physical health services; and motivate clients to sustain engagement. The CBCM will facilitate recovery by assisting clients in securing stable housing and employment and in reestablishing interpersonal relationships. MS-CORP intends to (1) increase naloxone access through service providers for individuals suffering from a nonfatal opioid overdose and facilitate the referral process to connect individuals receiving opioid overdose reversal drugs to services; (2) increase awareness of opioid use disorder, naloxone distribution, and safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs; and (3) establish and implement evaluation processes to assess project effectiveness and ensure sustainable gains. The objectives for MS-CORP are as follows. Objective 1: By the end of year 1, foster naloxone-focused infrastructure enhancement at state and community levels through the establishment of MS-CORP key positions (Project Director and Project Evaluator), an Advisory Council, a coordinated care approach, and a naloxone-specific training curriculum; Objective 2: Enhance service providers’ knowledge of opioid overdose response within the six (6) predetermined geographic regions, with emphasis on culturally responsive implementation designed to address treatment needs of focal population, by offering a minimum of four (4) naloxone training sessions among service providers annually, ultimately reaching a minimum of 50 service providers during year 1; Objective 3.1: By the end of year 1, conduct a rigorous evaluation to ensure compliance with all data collection and reporting requirements while fostering naloxone distribution-related quality improvements, as indicated by the completion of required data collection tools and dissemination of related reports; Objective 3.2: By the end of quarter 1 of year 1 (M4-PY1), complete all required grant management activities effectively, as indicated by documented and executed implementation, quality improvement, and sustainability plans; meeting attendance; and partnership agreements MS-CORP evaluators will collect and report performance data using the GPRA Tool and other instruments. It is anticipated that the number of naloxone kits provided to individuals receiving services will reach 600 in year 1; 1,200 in year 2; 1,800 in year 3; 1,800 for year, for a total of 5,400 across all funded years.

The Oklahoma FR CARA project will work in 3 rural high need communities in Oklahoma to reduce opioid overdose deaths by increasing access to naloxone and other devices, training and education, and referrals to treatment. The FR CARA approach will create new systems and leverage existing systems in identified communities to ensure that people at risk of opioid overdose have access to naloxone during an overdose, fentanyl test strips, factual information to increase their health and wellness, community supports, and referrals to treatment. To accomplish this, the FR CARA program will use a two-pronged approach. First, engaging first responders and community members likely to witness an overdose through overdose education, education on safety around licit and illicit drugs, and naloxone distribution. Second, by creating outreach teams working in hospital emergency room and other outreach settings to provide education, naloxone and fentanyl test strip distribution, referrals to treatment, and connections to existing community supports. This will be accomplished through strategic planning at the state and local level; collaborating with state agencies, tribes, and the pharmaceutical and medical communities to increase overdose education, naloxone distribution, and referrals to treatment; engaging key community partners including emergency rooms, harm reduction programs, and the local business community; and using the OKImReady communication campaign at the state and local levels to educate Oklahomans on substance use prevention, treatment, and recovery with a special focus on opioid use disorder. The Oklahoma Department of Mental Health and Substance Abuse Services, as the Single State Agency, is well-positioned and equipped to effectively coordinate the SPF Rx2, and has demonstrated success in preventing and reducing substance use problems.

The population of focus for the proposed Jefferson County Strategies for Coordinating Overdose Prevention Efforts (JC SCOPE) project is approximately 540 first responders (FRs) including emergency medical technicians (EMTs), paramedics, firefighters, and law enforcement officers from up to 22 emergency medical service (EMS) and fire departments. These departments are in direct contact with individuals of all ages who experience a non-fatal overdose or who have an opioid use disorder (OUD) and are at risk of overdose in Jefferson County, OH. Compared to other Ohio counties, Jefferson County (JC) has been particularly hard hit by the opioid epidemic and FRs are on the front lines of the response. The purpose of the JC SCOPE Project is to change the practice of EMS departments so all individuals encountered by targeted FRs will experience a decreased risk of overdose in the future. The project will address seminal barriers to linking overdose patients to emergency department and substance use disorder treatment and to sustaining the role of EMS as a significant resource for reducing overdoses. JC SCOPE training and evaluation goals and objectives include increasing and evaluating FR knowledge and skills to (1) use naloxone to treat known or suspected opioid overdoses in a stigma-free environment; (2) leave behind naloxone and resources with all individuals at risk of an opioid overdose; (3) ensure FR safety and appropriate identification of and response to fentanyl, carfentanil, and other dangerous illicit drugs and illicit drugs exposure; and (4) use motivational interviewing (MI) and trauma-informed care to screen and conduct referrals to appropriate treatment and nontreatment resources. Over four years, 540 unduplicated FRs will be trained resulting in 95% carrying and utilizing naloxone. By the end of the program, 80% of patients who encounter a JC FR due to an overdose will be screened for OUD with 10% referred to treatment and nontreatment resources. Further, naloxone will be left with every person identified at risk for overdose, and real-time data characterizing the services provided will be collected for all encounters by all trained FRs.

IDPH is renewing its proposal entitled Empowering and Equipping Law Enforcement and Communities in Rural Illinois to Reduce Opioid Overdose, in response to SAMHSA Funding Opportunity Announcement (FOA) #TI-21-009, First Responders Comprehensive Addiction and Recovery Act (FR-CARA) to address the opioid-overdose crisis in the proposed 24-county catchment area. For this funding cycle, IDPH proposes adding an additional six counties to the catchment area, an increase 18 counties to 24 and adding two new initiatives: Leave-Behind Naloxone Distribution with interested law enforcement agencies and strengthen the care coordination activities by emphasizing a public safety supported post-overdose outreach program approach. IDPH intends to decrease overdose deaths in the Catchment Area by (1) making the opioid overdose reversal medication naloxone available to be carried and administered by law enforcement officers, (2) training and providing resources for law enforcement officers on carrying and administering naloxone, (3) implement Leave-Behind Naloxone Distribution with interested law enforcement agencies and (4) establishing processes, protocols, and mechanisms for referring individuals experiencing opioid overdose to appropriate treatment and recovery communities through Public Safety Support Post Overdose Outreach programs; (5) ensure that implementation activities of the proposed project are effective and data-driven. The proposed catchment area is composed of all counties in the previously funded catchment area (27% of the non-MSA rural population) and 6 other non-MSA rural counties (additional 15% of the non-MSA rural population) where the opioid-overdose death rate has increased. The addition of the 6 new counties shows an opioid-overdose death rate of 10.94 for the period 2018-2020, which is slightly higher than the rate of 10.81 for the period 2015-2017.The Rural Set Aside grant extending coverage to an additional 15% of the non-MSA rural population is a critical strategy in the mitigation of the opioid-overdose crisis. The Catchment Area encompasses some of the most sparsely resourced areas in Illinois. In order to address overdose deaths in these areas, it is critical that IDPH focus on efforts to increase the capacity of law enforcement to prevent and respond to opioid overdoses by implementing Naloxone Leave Behind Distribution and Public Safety Supported Post-Overdose Outreach. Placing naloxone in the hands of people who use drugs, and their friends and family, saves lives by shortening overdose response times and increasing the number of people who seek treatment for a substance use disorder. Through this funding IDPH intends to train 1,040 law enforcement officers in overdose prevention and provide post-overdose outreach services to at least 20 individuals over the course of the project.

Pinellas County's Overdose to Care Connections (OCC) Project will be a new partnership between Emergency Medical Services (EMS) and Human Services (HS) to enhance the current first responder's Naloxone program throughout Pinellas County by creating additional training opportunities, increasing community access to a drug or device for opioid reversal, and by increasing connections and engagements in community substance use treatment services. Pinellas County's data will be evaluated through the FR-CARA program's evaluation activities to identify actionable intelligence that will inform grant funded outreach staff allowing them the opportunity to connect individuals revived by EMS on scheduled intervals and to seek connection and engagement in community treatment. Outreach efforts will employ motivational interviewing techniques and occur at 7 day intervals to allow for rapport development. Efforts will occur for up to 90 days post-overdose.

NH Department of Safety seeks this grant to continue an opioid use disorder (OUD) project and expand it to include other licit and illicit drug education and services. Project goals are to increase first responders and members of key community sectors trained to respond to a licit or illicit drug emergency; establish a statewide first responder-facilitated referral process to treatment and recovery; and increase first responders and members of key community sectors that can provide naloxone kits and resources to at-risk individuals and their support networks. Goals will be met through education on licit and illicit drugs, cardiopulmonary resuscitation (CPR), naloxone, compassion fatigue and mental health awareness, cultural humility, and recovery support. Services include naloxone kit and SUD resource distribution to first responders, members of key community sectors, at-risk individuals, and support networks. The population of focus is the State of NH, with increased focus on areas with high rates of substance misuse emergency room and treatment admissions, EMS Narcan administrations, and rate of overdose fatalities. NH anticipates serving approximately 300 individuals each year, totaling 1,200 individuals in 4 years. NH DOS will collaborate with the NH Bureau of Drug and Alcohol Services (NH BDAS), NH Governor Christopher P. Sununu's Offices, the 13 NH Public Health Networks, NH Association of Fire Chiefs, NH Chiefs of Police, and other private and public stakeholders to ensure proper project implementation and performance evaluation. Unique to this proposal is the strong collaboration between NH DOS and NH BDAS to deliver services and a first responder's ability to connect with their communities at a street level. This connection and interactions establishes a unique opportunity to deliver lifesaving skills and supplies to sustain a life while waiting for Emergency Medical Services (EMS) arrival. It provides first responders with a prime opportunity to refer individuals to treatment and recovery via resources and supportive communication, reducing the strain on emergency systems and costly ambulance transports. NH believes mere delivery of a medication without supportive measures, such as CPR and naloxone education, protective devices, and referral to systems of care, is not effective and does not offer the best chance of recovery. NH will use this grant to provide education and naloxone kits and resources to first responders and members of key community sectors. Trained first responders will provide naloxone kits, education, and recovery resources to individuals to reduce overdoses and overdose deaths. This funding will establish a first responder-facilitated referral process to the Doorway-NH (Doorway), providing a single regional point-of-entry of help for individuals.

The Contra Costa County pilot Opioid Multiagency Response Initiative (OMRI) will provide resources, training, and support to paramedics distributing leave-behind naloxone kits and administering buprenorphine and naloxone in the field and establish seamless referral pathways to connect individuals with opioid use disorder (OUD) to outpatient medication-assisted treatment (MAT) and other resources for recovery.

The Fall River FR-CARA project’s goals include preventing and reducing opioid overdoses by purchasing overdose reversal drugs, training first responders and members of key community sectors to carry/administer them, and developing processes, protocols, and mechanisms for outreach and referral to treatment and recovery support services. The project will target the City of Fall River, Massachusetts, and the nearby communities of Somerset, Swansea, and Westport. While Fall River, which is at the epicenter of the Commonwealth’s Opioid Crisis, will be the lead municipality for the project, the communities of Somerset, Swansea, and Westport will also be served. These neighboring communities differ from Fall River demographically. However, they are also experiencing Substance Use Disorder and a high incidence of residents purchasing dangerous and illicit drugs in nearby Fall River. The City of Fall River is the Commonwealth’s 10th largest city with a population of 89,388; but in each of the past five years it has been in the top five communities with the highest rates of overdose and opioid-related overdose deaths, according to the Massachusetts Department of Public Health. Fall River, has significant risk factors for opioid use, including low income and chronically high unemployment, conditions that have been exacerbated by the recent Covid-19 pandemic. According to the FRPD, the city has seen an increase in overdoses over the last few years (2017-2020) with a total of 3,524 overdoses and 62 fatalities. According to 911 calls in the first quarter of 2021, there have been 13 suspected overdose deaths, 141 known overdoses, 141 additional substance use calls, 232 mental health calls and 15 suicide attempts. The purpose of the four-year FR-CARA project is to provide our communities’ first responders and key community sectors with the resources and education needed to reduce the rate of overdoses and the number of opioid overdose related deaths in the Greater Fall River Area. Each year, the City of Fall River and its partners (clinicians, social workers, and recovery coaches) will train and provide resources to 500 first responders and others that work with specific populations, such as Portuguese and Hispanic/Latino communities, and high-risk groups, such as homeless, women, veterans, and former inmates. Training will include carrying/administering an overdose reversal drug, cultural competency, and licit and illicit drug safety. Each year, 1,700 doses of an overdose reversal drug will be distributed by first responders and others who will carry and administer the drug. Fall River’s Project will address and fill existing service gaps and, perhaps most importantly, a FR-CARA grant will create the first working continuum of care across a multi-agency scope serving the Greater Fall River Area.

The Alaska Native Tribal Health Consortium's (ANTHC) Training Organizational and Community First Responders to Respond to Adverse Opioid-Related Incidents project will focus on the development of a trained network of workplace naloxone use programs in rural Alaska communities. The primary target population of this grant is the user population of the Alaska Tribal Health System (ATHS), which includes 16 regional health consortia and 17 tribal and/or local health programs. The most recent user population count is roughly 189,000 people, which includes both AN/AI consumers (89%) and non-Native consumers. In rural areas, substance abuse and opioid misuse are particular hard to address due to limited resources for prevention, treatment, and recovery. Factors contributing to the abuse of these substances are low educational attainment, unemployment, and high-risk behaviors, as well as isolation and poverty. The goals of this project are to: 1) Design a workplace naloxone use program that includes policies, procedures, training, and referral protocols, 2) Increase in the number of trained key community sector members/organizational first responders in recognizing suspected opioid overdose, administering opioid reversal medication, and following referral to treatment protocols, and 3) Increase in capacity for trained first responders in opioid overdose reversals in rural Alaskan organizations and communities statewide. In Year One of this grant, the project will focus on distributing naloxone and training key community members and organizational first responders on the Alaska Native Health Campus (ANHC) in recognizing suspected opioid overdose, administering opioid overdose reversal medication, and following referral to treatment protocols. In addition, we will establish the policies, protocols, and mechanisms for referral to treatment and recovery support services for a workplace naloxone use program. We will also create educational materials regarding safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs. In Years Two through Four, the project will expand into three rural communities per year. The primary target of the workplace naloxone use programs will be connected with the Tribal Health Organizations (THO) and interested rural communities, key community members and first responders in the ATHS. Other rural and remote community emergency response organizations invited will include behavioral health clinics, shelters, and organized volunteer groups to further increase access to these life-saving services for AN/AI people in rural communities across Alaska. It is anticipated that the project will train 750 organizational first responders in Year One and 450 per year in Years Two through Four, totaling 2,100 trainees over the lifetime of the grant.

The Indiana First Responder - Comprehensive Addiction and Recovery Program will: 1) provide resources through the Indiana Naloxone Distribution Program for the first responders in rural communities; 2) train and provide resources to rural first responders and other identified key community sectors on carrying and using naloxone; and 3) expand the Regional Recovery Hub project for referral to appropriate treatment in recovery communities, including 49 rural counties that represent 22.3% of Indiana's total population. These rural counties account for 18.1% of all opioid overdose deaths in Indiana. Various social determinants of health demonstrate the increasing need for support in these counties, with many rural counties experiencing higher rates than the Indiana average of the percent of population living in poverty, percent of the population without a high school diploma, and higher proportions of underserved populations. Higher rates of naloxone use are also seen in these rural counties according to EMS Registry reports. In 2020, 20% of naloxone uses that were reported through the EMS registry occurred in rural counties. Goal 1: The Naloxone Distribution Program for First Responders aims to expand capacity by distributing naloxone in rural areas to first responders through a grants process. Applications will be collected on a rolling basis through the online program RED Cap. Applicants will be required to report data through the IDOH and Emergency Medical Services (EMS) registry. IDOH will partner with Indiana University to include a postcard survey that must be returned after an overdose event. The measurable objectives include expanding naloxone distribution/use and increasing program capacity by promoting the program across multiple platforms. Goal 2: The IDOH train first responder agencies on naloxone administration, stigma, Indiana naloxone legislation, and the risks of illicit/prescription opioids. The measurable objectives include the number of naloxone trainings to first responders and attitudes behaviors around naloxone through the pre/post questionnaire. The IDOH plans to train 800 unduplicated first responders over the entire four years of the grant. Goal 3: The Regional Recovery Hub project will focus on expanding current referral to appropriate treatment programs in recovery communities in the identified catchment area. These expansion efforts also include, but are not limited to, receiving referrals from community partners as well as making referrals to community supports sand services, increasing connections and partnerships with community corrections county jails, substance use and/or mental health treatment providers, opioid treatment providers, and obtaining and distributing naloxone. The measurable objectives include the number of referrals and expansion projects successfully completed, and the number of responses to requests for services.

The Choctaw Nation of Oklahoma, or CNO, is an American Indian Tribe federally recognized by the United States Secretary of the Interior located in extremely rural, southeastern Oklahoma, there is no major metropolitan city within its boundary. The communities to be served are all those that fall within the boundaries of CNO's 10.5 county tribal service area, or TSA, which includes Atoka, Bryan, Choctaw, Coal, Haskell, Hughes, Latimer, Leflore, McCurtain, Pittsburg, and Pushmataha counties. In total, these counties encompass about 15 percent of the state's total area at 10,922 square miles. This rural region struggles with extreme poverty, unemployment, and low educational attainment. The CNO TSA has a population that has struggled with Opioid Use Disorder, or OUD, for several years. In Oklahoma, opioid prescription painkillers are the most common drugs involved in unintentional poisoning, or UP, deaths. In fact, more Oklahoma adults, ages 25-54, die of UP than of motor vehicle crashes or suicide. Per the CDC, five counties within the Choctaw Nation of Oklahoma's 10.5 county service area have experienced higher rates of UP deaths involving at least one prescription opioid. These unusually high rates of UP death within the CNO TSA have been despite a consistent effort to treat these concerns. From 2015 to 2019, according to the Choctaw Nation Health Services Authority, or CNHSA, The Behavioral Health department has seen a 58 percent increase in adult patients. The Addressing Opioid Overdose Death Program, or AOOD program proposes to educate first responders about the signs and symptoms of an overdose, and how to safely administer Naloxone to prevent overdose deaths. Each first responder who completes the program will receive a Food and Drug Administration approved intranasal Naloxone kit before they are released. The program will also distribute a certain number of leave behind kits to community stakeholders who would possibly encounter people suffering with opioid use disorder. The program will draft hand outs for first responders to use as reference and handouts to be distributed to patients and the community from healthcare clinics.

The Beaufort County First Responders Project will serve the entire county of Beaufort in South Carolina, a population of 186,000 (69% white, 11% Hispanic, 3% Asian, and 18% African American). Special consideration will be given to those populations identified as at greater risk for prescription painkiller use and ultimately overdoes (senior citizens, veterans, individuals in jail, and low-income populations). The project will employ three distinct phases: 1) increase access to naloxone to first responders throughout the county; 2) education responders as well as the general community with regards to availability of naloxone, its function, and administration protocol; 3) conduct training to first responders with regards to safe handling of dangerous substances including carfentanil; and 4) secure staffing to conduct outreach, education, training, and implementation of Community Outreach Paramedic Education Teams (COPE) comprised of first responders and treatment professionals to conduct home visits within 3 days of an overdose event to offer support and referrals, with the goal of securing recovery services to individuals with opioid misuse disorder.