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Guided by the Recovery-Oriented System-of-Care framework, the Kentucky (KY) Opioid Response Effort (KORE) will implement a robust array of evidence-based prevention, harm reduction, treatment, and recovery support services for individuals with opioid and/or stimulant use disorder (OUD/StimUD). Priority populations include: 1) Overdose survivors; 2) Justice-involved individuals; 3) Pregnant/parenting women; and 4) Black, Indigenous, and People of Color. Goals and annual objectives are driven by a needs assessment and strategic plan. The Prevention goal is to decrease OUD and StimUD by implementing evidence-based initiatives addressing behaviors that may lead to a use disorder or overdose. Objectives include implementing evidence-based programming to 220,000 children, adolescents, and transition-aged youth; supporting 75 hospitals in implementing opioid stewardship standards; and supporting 14 regional prevention centers to increase drug take-back and safe drug storage/disposal. The Harm Reduction goal is to reduce overdose fatalities and other negative impacts of opioid and stimulant use through expansion of harm reduction strategies and principles. Objectives include distributing 58,316 naloxone units and 275,000 fentanyl test strips alongside overdose education; utilizing partnering agencies to deliver risk reduction training/resources to community partners; expanding the capacity of 40 Syringe Service Programs to deliver harm reduction services; and delivering anti-stigma campaigns prioritizing inclusive and diverse representations of recovery. The Treatment goal is to increase equitable availability and accessibility of evidence-based treatment that includes the use of FDA-approved Medications for Opioid Use Disorder (MOUD). Objectives include supporting 13 Quick Response Teams to provide outreach, engagement, and service linkages for at least 1,200 persons who experience an overdose; expanding programs in 25 hospitals to provide buprenorphine inductions and care navigation to 2,000 persons with OUD or StimUD; providing 500 justice-involved individuals with MOUD; providing MOUD and behavioral health services to 1,200 persons in primary care clinics; supporting four mobile MOUD programs to expand treatment capacity and availability for 250 at-risk Kentuckians; serving 600 individuals through treatment linkages and retention services delivered by recovery coaches; providing MOUD and recovery supports to 500 PPW; reducing barriers for 450 individuals with OUD for residential treatment and 800 individuals for methadone treatment without payment options; providing re-entry services for 500 individuals following incarceration; and supporting at least ten BIPOC-led agencies to increase utilization of harm reduction and MOUD services. The Recovery goal is to increase the number of individuals with a history of OUD and/or StimUD who enter and remain in remission and recovery. Annual objectives include delivering recovery support services to 2,000 individuals through 12 recovery community centers and to serve 1,000 individuals through the Access to Recovery program; providing funding and fidelity support for 100 Oxford-house model residences; certifying 25 recovery residences to comply with quality recovery housing standards; providing employment supports to 1,500 individuals with OUD/StimUD; and supporting delivery of at least 60 weekly mutual aid groups inclusive of individuals taking MOUD. Overall, KY proposes to serve 103,200 individuals in Year 1 and 184,800 in Year 2, for an unduplicated total of 288,00 individuals over the course of the grant. Through the 2022 SOR, KORE will reduce overdose death as well as unmet harm reduction, treatment, and recovery support needs in the Commonwealth of KY.

Pennsylvania proposes to address the opioid crisis and the increase of stimulant use by increasing access to treatment, reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment, and recovery activities for opioid use disorder (OUD) and stimulant use disorder. The project will support a comprehensive response to the opioid epidemic and stimulant use increase using strategies to address identified needs along with the required activities of the grant. Strategies will include: An increase in community awareness of OUD and substance use disorder (SUD) issues and resources through public awareness activities such as media outreach and stigma campaign. Expansion of evidence-based prevention initiatives to educate 30,575 (61,150 during the project) parents and children; Expansion of health promotion and harm reduction services to 126,312 (252,624 during the project) by supporting the Naloxone for First Responders Program. Provide clinically appropriate treatment services to 3,500 individuals (7,000 during the project) who are under/uninsured; Expand access to medication for opioid use disorder (MOUD) throughout the Commonwealth and to individuals within the criminal justice system to serve a combined 2,300 individuals (4,600 during the project); Increase recovery support services by establishing case managers to assist 2,855 individuals (5,710 during the project); Provide funding to the Single County Authorities to support individuals diagnosed with OUD and stimulant use disorders with obtaining and maintaining housing with the goal of supporting recovery to serve 2,000 individuals (4,000 during the project); and expanding support services for veterans with SUD to serve 968 veterans (1,936 during the project). Estimated number of people to be served as a result of the award of this grant: 337,020.

Project Title: State Opioid Response Program (SOR) Applicant: Behavioral Health, Alcoholism & Drug Dependency Services USVI Department of Health, 3500 Estate Richmond, Christiansted, VI 00820 Gesil Ramos, MS Tel: 340-643-8991 Email: gesil.ramos@doh.vi.gov The purpose of this program is to address the opioid overdose crisis by providing resources to states and territories for increasing access to FDA-approved medications for the treatment of opioid use disorder (MOUD), and for supporting the continuum of prevention, harm reduction, treatment, and recovery support services for opioid use disorder (OUD) and other concurrent substance use disorders. The Virgin Islands Division of Behavioral Health and Drug Dependency Services (VI BHADDS) is a division within DOH's Public Health Services charged by Act 4039, Title IXX, V. I. Code with establishing, administering and regulating programs designed to offer prevention, treatment and recovery intervention in the areas of substance abuse prevention, substance abuse treatment, Behavioral health and residential services to our Territory's adults and children. Health care, public education and social services are provided as entitlements, by the USVI Government, to all residents of the USVI. Under this cooperative agreement, the VI BHADDS will: - To provide comprehensive prevention and treatment intervention services to clients, including children, who have behavioral challenges and who abuse substances; - To foster self-management and wellness behavior that would promote and sustain recovery. BHADDS serves as the lead organization in a continuum of services to support prevention, early intervention, treatment and recovery support services for youth and adults with behavioral health needs. BHADDS prioritize services that meet the needs of the individual, family, and community. Unlike many US states, BHADDS not only establishes, administers and regulates behavioral health services in the Territory but also functions as a direct provider of a number of services in the service delivery continuum. The Territory leverages partnerships and local funding as key components in building a broad system of treatment, prevention and recovery supports that meets the behavioral health needs of its residents.

Palau SOR Project Phase 2 aims to build capacity for opioid use disorder prevention, treatment, and recovery through strengthening evidence based programs for addiction and mental illness.

The Guam Opioid Response Project (GORP) is designed to increase access to substance use treatment, recovery support services, and prevention activities to reduce the prevalence of substance use disorders (SUD) and opioid use disorders (OUD) amongst our adult population ages 18 years and older. GORP intends to enhance the SUD treatment and prevention programs. GORP will launch a Substance Abuse Prevention Campaign that will focus on youth ages 12-17. This Youth Campaign will focus on increasing the awareness the local middle and high schools, to reduce high risk behaviors of students that use substances, to include tobacco and vape use. Measurable prevention objectives to reduce SUDs and OUDs and opioid related deaths will include: increasing community knowledge and awareness through trainings and evidence-based programs and practice; and increase access to SBIRT services. Measurable treatment objectives to reduce OUDs and opioid related death will include: stigma reduction and knowledge of Medication for Opioid Use Disorders (MOUD); and increasing access to peer support services. Target populations will include adults ages 18 years and older with an SUD and/or OUD and youth ages 12-17 in local middle and high schools.

South Dakota's State Opioid Response will expand upon infrastructure and capacity built through the State Targeted Response and Opioid Response efforts to date in support of increased access to medication-assisted treatment, life-saving naloxone distribution, telehealth access to care, prevention service delivery, and expanded access to recovery support services. As the Single State Authority, the South Dakota Department of Social Services, Division of Behavioral Health, will lead the project in collaboration with ongoing efforts with the South Dakota Department of Health (through Centers for Disease Control Data-Driven Prevention Initiative funding focused on prescription drug overdose), and community providers to identify, leverage, and enhance community-based resources in the areas of prevention, treatment, recovery, and peer support services. More than 2,200 individuals are anticipated to be provided direct treatment or recovery support services throughout the grant, and an additional 1,500 individuals provided direct prevention services.

Mississippi's SSA, The State Department of Mental Health, Bureau of Behavioral Health (DMH) has been charged with the implementation of the State's Opioid and Stimulant Use Disorder Services (OSUD). DMH has nearly fifty years of experience in addressing the State's Mental and Substance Use needs. In a state that is predominantly rural state, with 51% of its residents living in areas considered under served and having a direct link between poverty, mental health, and substance, 65 of MS's 82 counties are rural. MS's population is estimated at 2,949,965 in 2021 and is projected to increase annually by an average of 1% over the next 30 years. Approximately 25% of the MS population is under 18 years old and 14% are age 65 or older; 59% of MS's population is non-Hispanic white, and 37% is African American. The non-Hispanic minority population is considered the highest proportion among any of the US States. Fifty-one percent of the state are female and 3.5% of the state's population are LGBT. MS has a federally recognized tribe, i.e., 12,990 members of the MS Band of Choctaw Indians. MS is ranked seventh in prescribing rates for opioids, with 76.8 prescriptions per 100 persons. The number of buprenorphine prescriptions increased by 58% between 2012. MS has seen significant increases in extremely potent high-MME (morphine milligram equivalent) prescriptions (mostly oxycodone). Prescription duration (days supply) is also unusually high. This combination has created serious overdose risks for MS residents. There were 10.9 opioid related overdose deaths per 100,000 persons reported to the Mississippi Bureau of Narcotics (MBN) in 2020. Drug overdoses in MS increased by 133% between 2011 and 2018. Also, coroner's report drug poisoning deaths rising from 256 in 2017 to 342 in 2018 and MS Poison Control fielded over 304 opioid-related calls and 268 amphetamine-related calls. Emergency Medical Services (EMS) data revealed that naloxone, an opioid overdose reversal medication, was administered 2,540 times during 2021, which is 52.5% since 2019 at (1,334). Ranked atop nearly every negative US social indicator, MS is often aptly compared to less developed nations. MS has the lowest ranking of any state on the Human Development (HD) Index (0.866), a numerical measure of health, education, and income. MS's current HD score is behind that of the US in the late 1980s. MS has the lowest life expectancy of any state, the highest rate of adults 25 or older who have not completed high school or earned a high school equivalency degree, and among the lowest average per capita income ($23,121 vs. $32,397 for the US). An estimated 20% of the state's population and 30% of its children live in poverty and 15.4 % of the population do not have insurance. Poverty is racialized in MS, with 46% of African American MS children in poverty vs. 15% white. Despite the vast gaps in services, MS will continue to build on the MS STR, SOR I and II Grants, to continue the fight against the disparities that hinder our communities, workforce, and service system. It is the intent of MS-SOR III to sustain the efforts that have made positive impacts on the OSUD crisis in MS, while continuing to reduce gaps in treatment via a variety of MAT services. MS will continue to be innovative in overcoming service disparities through recovery housing, contingency management, treatment retention and a renewed TeleMAT.

The Illinois Department of Human Services, Division of Substance Use Prevention and Recovery (IDHS/SUPR), submits this application in response to SAMHSA FOA # TI-22-005, SOR-III. Through this SOR-III grant, IDHS/SUPR will provide a comprehensive array of SUD evidence-based prevention, treatment, harm reduction and recovery support services that build upon the knowledge and learnings gained through previous SOR grants. Evidence of the multiple impacts of the opioid and stimulant crisis among Illinois residents is provided in the population of focus and needs assessment. Evidence of increased primary opioid clients among IDHS/SUPR-funded treatment admissions, increased need for medication for Opioid Use Disorder (MOUD) for persons with opioid use disorder (OUD), increasing numbers of opioid overdose deaths and poly-substance deaths, increasing numbers of persons using methamphetamines and other stimulants, and increasing numbers of opioid-related overdose reversals. A strategic plan, needs assessment and naloxone saturation plan are attached. The services supported and expanded through this SOR grant include: MAR-NOW, 24/7 treatment referrals and connection to care in the community; National Assn. of Recovery Residences best practices and capacity expansion; Recovery Community Organization (RCO) expansion to include recovery support services including coaching, vocational training, employment supports, transportation, and childcare. RCOs will also increase their capacity to provide housing supports including application fees, deposits, rental assistance, utility deposits and utility assistance. certification training on the Community Reinforcement Approach and Contingency Management; community-based linkage and referral services provided by peer outreach workers; SUD Leadership Centers to disseminate expertise in stigma reduction, rural health, community capacity building; access to MOUD Hub and Spoke services; SUD services in the healthcare system including SBIRT; integration and increased MOUD services provided by Federally Qualified Health Centers; MOUD integration for criminal justice-involved populations; housing stabilization for persons with OUD; enhanced treatment services for pregnant and postpartum women with OUD; recovery housing services for persons with OUD; enhancements to the Illinois Prescription Monitoring Program (PMP); and, expansion of the Illinois Opioid Helpline. The prevention services that are proposed include: Naloxone purchase, overdose education, training, and distribution services in counties of high need, through OTPs and through our naloxone saturation plan; Illinois prevention provider contracts to support implementation of the OUD-focused program for adolescents; and, expansion of our statewide opioid awareness campaign. A data collection plan is provided that describes data collection, management, analysis, and reporting in response to federal requirements. This includes administration of the SAMHSA/CSAT GPRA tool to our unduplicated count of at least 6,000 persons served over the two years of funding at admission, six-month follow-up, and at discharge from services, and refresher training of all providers. A process and outcome performance measurement plan will be implemented online through the REDcap web application. The organizational experience, resources, and qualifications of IDHS/SUPR and our major partner organizations are described. Biographical sketches for the Illinois SSA, the Project Director, the Project Coordinator, and other grant staff are provided. A line-item budget and narrative justification is proposed for $37,187,828 for each of the two years of this SAMHSA funding opportunity.

The purpose of North Dakota's State Opioid Response (SOR) grant is to address the opioid overdose crisis by increasing access to FDA-approved medications for the treatment of opioid use disorder, and for supporting the continuum of prevention, harm reduction, treatment, and recovery support services for opioid use disorder and other concurrent substance use disorders. The North Dakota Department of Human Services Behavioral Health Division (BHD) plans to approach this by enhancing services and capacity statewide and community-specific, while also focusing on several priority areas. Overdose deaths in North Dakota have increased from 68 deaths in 2017 to 114 deaths in 2020 (CDC Wonder). The percentage of individuals receiving treatment through the public behavioral health system or reimbursed through the state's Substance Use Disorder (SUD) Voucher program who report use of opioids range from 5% to 33% (ND TEDS [2021], ND SUD Voucher active clients [June 2022]). There are four licensed Opioid Treatment Programs in the state and the combined census increased from 733 in January 2021 to 802 in May 2022 (ND Central Registry). To accomplish the first goal to prevent substance (mis)use with a specific focus on opioids and stimulants, the following, summarized objectives were identified: (1) Increase the reach of messaging for Parents Lead and Opioids Fill with Care to nearly 295,000 North Dakotans; and (2) Deepen the impact of the ONE Program by screening 3,000 individuals at participating pharmacies. To accomplish the second goal to reduce harm related to opioids and stimulants, the following, summarized objectives were identified: (1) Disseminate over 7,800 naloxone kits to individuals most likely to witness an overdose and in locations where they are most likely to occur; and (2) Develop a fentanyl distribution plan by December 1, 2022. To accomplish the third goal to improve access to evidence-based treatment, the following, summarized objectives were identified: (1) Enter into an agreement with an entity to provide navigation support for individuals re-entering the community from a correction setting; and (2) Train, at minimum, 20 behavioral health treatment professionals on implementing contingency management. To accomplish the final goal to increase access to recovery support services, the following, summarized objective was identified: (1) Enter into an agreement with a healthcare provider to integrate peer support specialists into their practice. To accomplish all goals and objectives, the BHD will partner with the state's Health Equity Office (HEO) to address the needs of diverse populations throughout all efforts. The BHD will review the state's SOR proposed strategies with the HEO to ensure strategies and activities will promote behavioral health equity. The BHD has a long-standing history of partnering with North Dakota tribes on behavioral health initiatives. The BHD has specifically offered funding and resource to the four tribal nations in the state with previous iterations of the SOR grant and will continue to do so with the upcoming SOR award. Tribal nations in the state will be able to apply for funds to implement strategies aligning to the statewide SOR plan and also taking into consideration local needs and cultural differences.

Maine has the 9th highest age-adjusted death rates due to fatal overdose in the nation and remains in the top 5th state with self-reported heroin use and overall illicit drug use nationwide. Current NSDUH data indicate an average of 16.35% of adults needed substance use treatment but were unable to access it, in comparison to an average of 14.65% of adults throughout the US. The Office of the Chief Medical Examiner reports that 504 deaths were caused by drugs in 2020, which is a 33% increase over 380 in 2019. Programs and services established through SOR-III will support the state's overall goal to reduce the negative health and economic impacts of substance use disorder and opioid use disorder on individuals, families, and communities in Maine. Funding stimulant use treatment programming and community prevention interventions are embraced by Maine DHHS, as it increases the ability to positively impact the polysubstance use issues currently experienced in the state. Specifically, SOR-III funds will be used to meet the need for expanding access to MOUD, including transitional services for individuals exiting carceral settings, naloxone distribution and harm reduction services, peer recovery supports, with special outreach and engagement of members of historically disadvantaged populations, and primary prevention programs to curb substance use among youths.

ADMH will address populations across the continuum to ensure opioid and stimulants use problems are met. Statewide initiatives will focus on individuals across the lifespans and communities that have been identified as at risk populations for prevention, treatment and recovery services. ADMH SOR3 target populations as related to treatment or recovery support services is all individuals statewide, diagnosed with an opioid or stimulant use disorder and in need of treatment or recovery support services. The target population will include those individuals who cannot afford substance use treatment either with or without MOUDs. Regarding prevention services, the targeted regions will have a high concentrations of individuals with significant health disparities, elevated levels of substance use, poverty, and less access to care resulting in poorer behavioral health outcomes. The populations of focus will be across the lifespan, with particular focus on young adults aged 18 to 25 and older adults aged 50+ with a specific focus on underserved rural areas within the state. Over the course of the two year project, ADMH will served 4000 individuals in treatment, 200 in recovery support services, and 490,319 in prevention services. The goals of the program are: 1) prevent and reduce opioid and stimulant misuse in communities with health disparities and improve prevention capacity, coordination and infrastructure at state and community levels; 2) increase access to and knowledge of MAT and treatment of stimulant use disorders; 3) increase the number of specialty populations receiving treatment and recovery support services; 4) expand peer and recovery support services in rural and urban target areas; 5) improve data collection for OUDs and stimulant use disorders by implementing a new data system and by increasing the data contained within the CDR; and 6) expand the use of harm reduction interventions including naloxone and fentanyl test strip distribution.

The purpose of the Nebraska State Opioid Response (SOR) program is to increase access to FDA-approved medications for the treatment of Opioid Use Disorder (OUD) and support prevention, risk reduction, treatment, and recovery services for OUD and other concurrent substance use disorders (SUD) including stimulant use and misuse. The Nebraska SOR program achieves this through our ongoing collaboration with healthcare and community-based service providers, subject matter experts, stakeholders, and key leaders across the care continuum. Additionally, the SOR program aims to mitigate the effects of OUD and SUDs including the use and misuse of stimulants, prescription opioids and illicit drugs by identifying needs, increasing access to treatment including Medication-Assisted Treatment (MAT) and naloxone, providing OUD and stimulant education, and reducing drug overdose and stimulant deaths through the provision of prevention, risk reduction, treatment, and recovery activities. The Division of Behavioral Health (DBH) intends to partner with agencies and key community sectors to provide services to underserved and at risk populations living in both rural and urban communities statewide. The SOR intends to assess needs, provide opioid and stimulant education and awareness, and reducing stigma surrounding OUD, stimulant use and misuse, and concurrent SUDs. FDA-approved MAT medications will be provided in addition to the distribution of naloxone to communities of need, at-risk individuals, first responders, and others. Nebraska's focus on treatment includes implementing clinically appropriate EBPs for OUD and stimulant use treatment including training providers in the ECHO model; enhancing the utilization of MAT through the funding of Buprenorphine; providing training and education to peer support specialist on opioids and stimulants; and assisting patients with treatment and recovery costs. SOR funding will also assist in providing recovery-oriented care through supportive housing and trauma-informed care. DBH will work with community coalitions and regional behavioral health authorities to implement EBPs targeting Nebraska schools aged children. Over the anticipated two year time period of the SOR grant, DBH intends to reach approximately 230 individuals with treatment services, 550 recovery support services and 1,000,000 through targeted prevention activities.

The Utah State Opioid Response (UT SOR3) Grant, administered by the Office of Substance Use and Mental Health (SUMH) identifies youth ages 12-17 and adults ages 18 years and older, who have a current, or are at risk for, an opioid use disorder (OUD) or stimulant use disorder (SUD) as the population of focus. Priority populations include individuals who are pregnant, individuals who use drugs intravenously, individuals with HIV, and/or Hepatitis C (HCV), and those seeking services who are unfunded or uninsured. SOR3 projects will be implemented or continued throughout the state. The estimated number of people to be served as a result of the award of this grant is 720 per grant year. Name- Utah State Opioid Response (UT SOR3) Grant Population to be Served- Youth ages 12-17 and adults ages 18 years and older, who have a current, or are at risk for, an opioid use disorder (OUD) or stimulant use disorder (SUD). Priority populations include individuals who are pregnant, individuals who use drugs intravenously, individuals with HIV, and/or Hepatitis C (HCV), and those seeking services who are unfunded or uninsured. Strategies and Interventions- Prevention and harm reduction; Improve capacity and structure; Increase access to quality care and services; Improve health outcomes. Project Goals and Measurable Objectives- Goal 1: Prevent and reduce opioid and stimulant misuse and abuse among youth and adults. Goal 2: Reduce overdose deaths and the prevalence of HCV and HIV among individuals with Opioid Use Disorder (OUD) and Stimulant use Disorder (SUD). Goal 3: Expand access and usage of the three medications approved by the FDA for the treatment of OUD. Goal 4: Expand partnerships between physical health providers and local substance abuse authorities to ensure an integrated treatment approach. Goal 5: Promote health, recovery-oriented service systems, and peer support for individuals and families in recovery from opioid or stimulant use disorders.

The Montana State Opioid Response (SOR III) Project will support the implementation of evidence-based prevention, treatment, and recovery strategies for individuals with Opioid and/or Stimulant Use Disorders in Montana (OUD and StUD). The project will emphasis the development of a statewide Opioid Education and Naloxone Education Program, expansion Contingency Management services, and provision of MOUD services to vulnerable populations, including AI/AN, rural communities, and the criminal justice system. American Indians are Montana's largest racial minority and face a more than 20-year disparity in life expectancy compared to white Montanans, partially attributable to higher rates of substance use. Justice system involvement for individuals with OUD and StUD is on the rise in Montana with an estimated 90% of individuals in Montana being held for substance abuse related offenses. Key strategies funded under this application include the development of a mobile MOUD unit, comprehensive support for Contingency Management services at 11 provider sites, and the provision of technical assistance and training related to DATA Waivers, implementing MOUD, naloxone use, and how to successfully refer an individual to treatment. The goals and objectives for the Montana SOR III project include: Goal 1: Increase access to evidence-based treatment for underserved populations with OUD and StUD in Montana. Objective 1.1: By 9/29/2024, 100 Montanans will receive OUD services from mobile MOUD unit. Objective 1.2: By 9/29/2024, 300 Montanans with StUD and OUD will receive Contingency Management services. Objective 1.3: By 9/29/2024, 150 Montanans receiving MOUD services in local detention centers will receive continuity of MOUD services upon discharge to the community. Goal 2: Increase access to evidence-based prevention services for OUD and SUD in Montana. Objective 2.1: By 9/29/2024, 25,000 units of naloxone kits will be distributed to key partners. Objective 2.2: By 9/29/2024, Montana's 56 counties and seven tribal reservations with have at least 1 Master Trainer. Objective 2.3: By 9/29/2024, six regional Opioid Education and Naloxone Distribution Programs (OENDP) will be established. Goal 3: Increase access to evidence-based recovery services for OUD and StUD in Montana. Objective 3.1: By 9/29/2024, 40 of Montana's recovery residences will be certified by the Montana Recovery Residence Alliance. Objective 3.2: By 9/29/2024, 200 unduplicated Montanans will be housed in certified recovery residences Objective 3.3: By 9/29/2024, 150 peers will be trained. We plan to serve 3,750 unduplicated individuals throughout this two-year grant cycle; 2,000 in year one and 1,750 in year two.

The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) in conjunction with local treatment providers serving the state aim to address the opioid overdose crisis by increasing access to a continuum of care from prevention, harm reduction, treatment and recovery services through the State Opioid and Stimulant Services initiative (SOS2). Increasing access to FDA-approved medications for the treatment of opioid use disorder (MOUD) and evidence-based treatment modalities for both opioid and stimulant use/misuse, and co-occurring disorders. The SOS2 initiative is designed to help reduce unmet treatment needs and opioid-related overdose deaths and stimulant use/misuse for all Oklahomans. The SOS2 initiative will serve individuals and their families across the lifespan affected by opioid and/or stimulant use disorder with a continued emphasis on Native Americans, pre and post-natal persons, Veterans and individuals who have served in the military and their families, adolescents, individuals in rural areas without access to treatment, and discharging from jail or prisons with OUDs at risk for relapse. ODMHSAS will continue to utilize state and grant funding; align and streamline to maximize dollars used without duplication of efforts and serve more individuals and their families. SOS initiative will collect GPRA on 2,000 in year 1 and 3,000 in year 2 with a total of 5,000 over a 2-year period. Those being served will be above these numbers, however, history has shown only a percentage are willing to engage in the GPRA evaluation. Goals and Objectives: Goals & Objectives: The following will be completed by the end of year one unless otherwise noted. 1) Increase community knowledge base to prevent abuse of opioids, stimulants, and increase access to services through messaging to 1000 individuals and practice facilitation; 2) Increase Community outreach by training, disseminate material, link referrals, and increase local action on opioid and stimulant misuse prevention; 3) Enhance the knowledge base for the workforce and better support individuals at risk or with an OUD, families and the community in prevention, treatment, and recovery supports through trainings, consultation, as well as the distribution of naloxone kits will reach approx. 10,900 individuals; 4) Promote social and emotional health for students to decrease disruptive behavior and increase quality instruction time to 100 classrooms; 5) Increase collaboration and sustain community referral base for individuals with OUD by mobilizing 4 regional OUD liaisons by conducting 800 contacts; 6) Increase access to an array of treatments for individuals with OUD/SUDs including those who are uninsured and underinsured, with emphasis on veterans, pregnant women, tribal, those coming out of jails and prisons through SBIRT and 23+providers serving 5,000 individuals; 7) Enhance the existing infrastructure to deliver evidence-based treatment interventions that include medication(s) FDA-approved for OUD, and stimulant misuse and use disorders, including for cocaine, methamphetamine, and/or co-occurring disorders including but not limited trauma, suicidal ideation in a continuum by using EBPs like Motivational Interviewing, telehealth, and recovery support strategies by 25% and developing Behavioral Health Center of Excellence. 8) Ensure contractors have a 100% of eligible prescribers on staff waivered to provided MAT services through TA provided waiver trainings; 9) Enhance Recovery Supports by increasing acceptance in Oxford Houses on MAT by 25%, train 100 PRRS in EBPs, provide support for 50 Certified Recovery Houses, IPS/housing services by 125% and use of CHESS app by 50%; 10) Increase College outreach by training, disseminate material, link referrals, and increase campus action on opioid and stimulants misuse prevention.

According to MDPH's most recent opioid report, there were 2,290 confirmed and estimated opioid-related overdose deaths in 2021, an estimated 185 more deaths than the prior year and above the previous peak of 2,110 deaths in 2016. While increases in drug overdose deaths in Massachusetts continue to trend lower than nationwide figures, they mirror a return to historically high rates driven in large part by public health challenges related to the COVID-19 pandemic, and an increasingly poisoned drug supply, primarily with fentanyl. With SOR funding the Massachusetts Department of Public Health (DPH), the applicant organization, will serve individuals affected by the opioid crisis including individuals who use stimulants, specifically targeting these high risk populations: Black, Indigenous, and people of color (BIPOC), LGBTQIA+, individuals who have experienced a prior nonfatal overdose, youth and families impacted by the opioid crisis, persons with history of incarceration, pregnant and parenting women, individuals experiencing homelessness, individuals at risk of contracting and/or currently living with infectious disease, people who use stimulants alone and/or with other drugs, and persons with co-occurring mental health disorders. MA DPH will ensure that funds are directed at the most marginalized populations and address systemic racial and ethnic disparities in access to SUD services. We seek to serve 14,975 (note: 8,975 are GPRA eligible) individuals annually over the two-year project period through implementing the following activities: 1) Prevention and intervention services for youth and families; 2) Overdose prevention and harm reduction services including Post Overdose Support Teams to outreach to people who have overdosed; 3) Opioid Treatment Program (OTP)/Office-Based Opioid Treatment (OBOT) enhancements to increase access for target populations; 4) Expansion of opioid and stimulant treatment access initiatives such as Hub and Spoke/Collaborative and Transitional Models of Care and Stimulant Treatment and Recovery Team programs; 5) Programming targeting pregnant and parenting women and their families that includes wrap-around supports, peer recovery coaching, and access to MAT; 6) Recovery supports including rapid rehousing, and the Access to Recovery program which facilitates client choice by providing voucher-based options and life skills training to support recovery goals; and 7) Expansion of developmentally appropriate recovery supports for youth and young adults. We also propose to: 8) Enhancements to existing state data analysis and reporting capabilities and improvements to web-based platforms to disseminate timely and accurate information to address the opioid crisis; 9) Implementation of wide-spread workforce development capacity building and training activities targeting a variety of sectors and audiences; and 10) Development and expansion of strategic communication and media campaigns targeting high-risk populations and high-need geographic regions in the Commonwealth to increase knowledge about addiction, decrease stigma, and improve awareness on how to prevent overdose and how to access treatment and recovery supports and 11) implement ongoing needs assessment and strategic planning to inform activities. We anticipate the MA SOR grant activities will improve, expand, and enhance access to opioid and/or stimulant use disorder, treatment, prevent overdose, and support sustained recovery to achieve life-saving results.

The State of Indiana seeks to apply for State Opioid Response grant funding to address the substance use crises affecting so many Hoosiers statewide. Since the first day of Governor Eric Holcomb's administration in 2017, he has called for an all hands on deck approach to the growing drug crisis in Indiana. The Holcomb administration has made addressing the drug crisis one of the pillars of his Next Level Agenda. The population of focus for the State Opioid Response 3 (SOR 3) grant includes individuals across the lifespan who are 1) At risk for developing Opioid Use Disorder (OUD) or Stimulant Use Disorder (StUD), 2) At risk of overdose injury or death due to opioid or stimulant use, and 3) In need of treatment and recovery resources for OUD and StUD. GPRA data for the SOR 1 and SOR 2 grants also counts 1,591 individuals with an Opioid-related Diagnosis and 1,319 with a Stimulant or Cocaine Use Disorder. Based on information gathered for the Needs Assessment, using the SAMHSA's National Survey on Drug Use & Health (NSDUH), 12.88%, a total of 709,681, of Indiana's population over the age of 12 are estimated to have used an illicit substance in the month prior to the survey. In 2020, the same survey estimates 13.82%, a total of 761,475, of the surveyed population have some type of substance use disorder. According to the Indiana Department of Health (IDOH), from 2020 to 2021, there were 4,249 recorded overdose deaths in the State of Indiana. During the same timeframe, 37,962 naloxone events were reported across the State by first responders, as reported by the Indiana Department of Homeland Security. In 2021, according to IDOH, there were 6,112 reported emergency department visits due to any opioid and 14,424 visits due to any drug. During the State Opioid Response 3 grant period, Indiana plans to address the ongoing opioid and stimulant crisis by 1) Increasing access to evidence based treatment and recovery resources to all people in Indiana with OUD or StUD; 2) Decreasing the total number of drug overdose deaths in State by 10%; and 3) Increasing the number of addiction professionals within the State providing treatment and recovery services for people with OUD and StUD.

RI SOR 2022 initiatives will serve 860 unduplicated individuals in year one and a total of 1,990 individuals over the two years of the grant plus several thousand more through universal strategies. The program will address opioid and stimulant misuse statewide, with particular focus in regions with the highest rates of Emergency Department admissions for overdose. The goals and objectives of RI SOR 2022 will address gaps and unmet needs in the areas of prevention, treatment, recovery support, harm reduction and rescue as identified by the Governor's Overdose Prevention and Intervention Task Force. Goal 1: Expand primary prevention interventions through media campaigns developed with a race equity lens, and evidence-based programs delivered in schools 1.1: By the end of Year 2, the public awareness campaign will reach 75% of the target audience at least 3 times 1.2: By the end of Year 2, students receiving the Project Success program will report increased parent/peer disapproval of using substances and more than students not receiving the program. Goal 2: Expand access to and retention in treatment for Stimulant Use and Opioid Use Disorders 2.1: By end of Year 1, participating Opioid Treatment Programs (OTPs) will have trained 60% of staff in Contingency Management (CM) 2.2: By end of Year 1, increase the number of OTPs providing CM from 2 to 8 locations 2.3: By end of Year 1, the number of individuals receiving treatment following mobile MAT induction will increase from 2 to 40. 2.4: By end of Year 1, the number of uninsured individuals receiving detox services will increase from 0 to 30 2.5: By end of Year 1, 95% of individuals seen at BH Link who require or are eligible, will be referred to community programs and treatment outside of the Emergency Department 2.6: By end of Year 1, have a certified Level IV Recovery House for the Safe Landings Program 2.7: By end of Year 2, participating OTPs will have trained 95% of staff in CM 2.8: By end of Year 2, the number of individuals receiving CM will increase their number of negative screens, (done twice/week), by 40% Goal 3: Expand access to Recovery Support Services to build recovery capital 3.1: By end of Year 1, establish a 6 month booster for recovery housing residents to extend their time in the house and engage 25 individuals in this expansion. 3.2: By end of Year 1, 75% of individuals will report that they are receiving the recovery supports that they were seeking when they began working with a Certified Peer Recovery Specialist (CPRS) 3.3: By end of Year 1, 75% of individuals working with a CPRS will report being helped with an average of three different recovery support services 3.4: By end of Year 1, 90% of individuals will be discharged from recovery housing to stable housing 3.5: By end of Year 2, increase the percentage of individuals in recovery housing who are socially connected: 90% will report interacting with family and/or friends that are supportive of their recovery and 50% will report being satisfied or very satisfied with their personal relationships Goal 4: Expand access to Rescue Services and Harm Reduction Tools and Supports 4.1: By end of Year 1, street outreach programs will increase distribution of Naloxone and fentanyl test strips through 3,000 outreach encounters.

The Connecticut Department of Mental Health and Addiction Services (DMHAS), in partnership with numerous State and community-based organizations, proposes to continue a series of targeted responses intended to reduce the negative impact of opioid use on Connecticut citizens and communities. These responses build on the State's evolving recovery-oriented, integrated system of care, helping to continue to shift the focus of care from responding to acute episodes to a prevention and recovery management framework. CT's strategy spans community education and grassroots prevention coalitions, to pre-recovery outreach and engagement, to recovery initiation through active treatment, harm reduction, and recovery support services, and finally, to long-term recovery maintenance. Connecticut's goals and objectives are designed to assist a broad swath of the population in cities and rural areas, who are actively using opioids, are early in recovery, and may have criminal justice involvement, as well as family members and the communities of people using opioids. These goals include: 1. Reduction of opioid overdose deaths and increase awareness of the danger of opioid use using multi-faceted prevention strategies. These strategies are designed to reach all 3,588,184 of the state's citizens. 2. Increasing and maintaining access to treatment, with a focus on medication assisted interventions, for at-risk populations, including individuals involved in the criminal justice system. 1100 individuals are anticipated to receive treatment services, with 550 per project year. 3. Harm reduction focused outreach and engagement to those individuals who are actively using opioids and not yet receiving treatment including individuals who may have been brought to the emergency department due to an opioid overdose. 5900 individuals are expected to be reached out to, or 2950 per project year. 4. Provision of recovery support for those newly in recovery, including temporary housing, utilizing peer specialists and employment support for individuals in methadone clinics, court involved, or otherwise in need of support in order to progress in their recovery. 1425 individuals are projected to be in need of recovery support services per year for a project total of 2850. Connecticut maintains considerable momentum to implement these projects. Community awareness of opioid problems has galvanized local, grass-roots groups into action. Community coalitions including local government leaders, health professionals, educators, police and behavioral health experts have formed to address this epidemic. The legislatively mandated Connecticut Alcohol and Drug Policy Council (ADPC) continues to support recommendations developed by subcommittees in the areas of Prevention, Treatment, Recovery and Criminal Justice. Numerous proposed SOR projects are a result of the Council's work. These SAMHSA resources are crucial in order to maintain the hard work of these groups.

Ohio's Opioid and Stimulant Response Grant aligns state level efforts with community partnerships engaging a focused, data driven approach shifting Ohio from battling to successfully emerging from the opioid epidemic. Targeting investments in communities leading in overdose deaths, OhioMHAS will serve 22,000 Ohioans with OUD, SUD and/or cooccurring mental health disorders. Successful management of opioid and substance use disorders requires acknowledgment that substance use disorders are complex clinical conditions involving internal and external mechanisms influenced by psychosocial, biochemical, genetic and environmental factors. Central to this global overarching goal, is Ohio's multi-level state opioid strategy and Ohio's success in developing an integrated behavioral health system of care. OhioMHAS partners with 50 local Alcohol, Drug, Addiction & Mental Health Boards (ADAMH) with statutory authority for planning services in 88 local county catchment areas. These Boards contract with local entities who provide Ohio's core behavioral health treatment, prevention and recovery supports. Ohio's core objectives in the new SOR3.0 funding opportunity will support access to MOUD treatment, harm reduction, prevention, psychosocial and recovery services that save lives and support individuals, their children, and families to better manage their long-term community recovery. To accomplish these goals Ohio will employ several strategies. Top priority is Ohio's laser focus on high risk, vulnerable, older, younger and minority populations who are leading the overdose deaths. Ohio's need assessment has identified several hot spot areas comprised of urban, rural and Appalachian communities. In these communities and throughout the state, Ohio will partner with primary health prescribers to sustain Ohio's 60% reduction1 in physician prescribed doses of opioids and pain relievers. Ohio will expand availability of mobile crisis and trained QRT and first responders to increase access to lifesaving overdose reversal medications. Ohio will continue its work with public safety to prevent overdose deaths by interdicting illicit drugs before they reach communities. The state will assure that culturally and linguistically appropriate outreach and treatment approaches address the diverse and socially complex of needs individuals in these communities. To achieve the goal of more individuals in long-term recovery, Ohio will emphasize the importance of peer support navigators, increase availability of recovery housing, and implement recovery-based employment business partnerships and practices. Ohio's future in navigating the opioid crisis will rely on a provider network trained to fidelity in SUD/OUD evidenced based treatment models and skilled in telehealth and emerging technology based recovery and engagement apps. Targeting investments in media to increase community awareness of the dangers of opioid and stimulant use, in partnership across the state, Ohio's SOS Grant is dedicated to successfully emerging from the opioid crisis.

The MHAASA of Puerto Rico will implement the PR-SOR 2022 Project to address opioid use Island wide using EBPs. Prevention will focus on experimenting High School Students through the TND EBP, teachers, first responders, corrections officers, SA peers, physicians, and pharmacists through FTS and Naloxone distribution and training. Treatment will focus on SA clients, reaching 1,550 (775 per year) opioid users through MAT, ORP and Wellness Plus, and Recovery will address OUD through ROS with Peer Support and Community Outreach. Prevention Goal 1: Increase state and community capacity to reduce opioid overdose incidence in adults with SUD: Objectives include educating 10,000 SU participants of OTPs, correctional settings and CBOs; Distributing naloxone to 1,800 first responders, correctional officers, SA inmates, pharmacists, Rx technicians, physicians, nurses, and CBO stakeholders in 2 years; Carrying out a MAT public campaign to reduce stigma; Expanding SUD workforce through certification of 140 staff; Capacitating 90,000 participants in ATOD workshops; and Linking to treatment 75% of SUD callers to the PAS Crisis Hotline. Treatment Goal 2: Increase and expand access to drug treatments with FDA approved MAT, including inmates: Objectives include access to 400 new OUD adults in MAT from ER and non-specialty settings with 75% retention; Enhancing EHR of OTPs; HIV/HEP/STD screening and referral; linking of 360 Drug Court Patients to relapse prevention; Initiating naltrexone and injectable buprenorphine treatment for 35 patients in detox; Linking 70 OUD/ODU adults to treatment in CBOs with enhanced psychosocial services; Expanding MAT in Ponce Correctional Institution and SU treatment transition services (ORP) in other settings;. Recovery Goal 3: Ensure access to community recovery support such as peer counseling, recovery coaching and recovery housing: Objectives include use of Wellness Plus EBP for 250 adults in 7 OTPs with positive outcomes in 3 of 5 domains; Integrate 2 Training Facilitators to certify 20 Peer Support Specialist for support to SA treatment; Improve by 5% retention of SU clients through peer support; Expand recover y services to 300 recovering OUD/ODU adults, using contingency management to improve retention; Increase access to telehealth SU treatment in rural and underserved areas; Implement ACT EBP through training of staff serving 150 homeless OUD/ODU adults.

The Commonwealth of the Northern Mariana Islands (CNMI) is a U.S. Commonwealth formed in 1978, formerly of the United Nations Trust Territory of the Pacific region of Micronesia within Oceania. The CNMI is composed of 14 islands with a total land area of 176.5 square miles spread out over 264,000 square miles of the Pacific Ocean, approximately 3,700 miles west of Hawaii, 1,300 miles east from Japan, and 125 miles north of Guam. The CNMI's population lives primarily on three islands; Saipan, the largest and most populated island, is 12.5 miles long and 5.5 miles wide with a population of 43,385 (92%; US Census 2020). The other two populated islands are Tinian (population 2,044) and Rota (population 1,893), which lie between Saipan and Guam. The nine far northern islands are very sparsely inhabited. The two indigenous ethnic populations are Chamorros and Carolinians, and the official languages are English, Chamorro, and Carolinian. The 2010 Census further notes that 52% of the CNMI population fall below the federal poverty level. The Commonwealth Healthcare Corporation (CHCC) Community Guidance Center (CGC), the designated Single State Agency for Substance Abuse Services in the Commonwealth of the Northern Mariana Islands (CNMI) will expand and enhance existing prevention, treatment, and recovery services to include opioid use disorder (OUD) through a data driven and informed approach. While treatment services are provided for anyone seeking assistance, the CGC Treatment and Recovery Clinic has limited clinical capacity and resources. Therefore, project resources will prioritize referrals from CGC clinics, primary & public health clinics and programs, criminal justice system, Tinian, Rota, and isolated villages in Saipan. The project will serve an estimated 2,250 individuals between Years 1 and 2 under prevention activities, 90 individuals with treatment and recovery services in Year 1, and an additional 174 individuals in Year 2, for a total project reach of 2,5141 unduplicated individuals. The CGC Treatment and Recovery Clinic, which administers substance use disorder treatment will collaborate with the CGC Prevention Program to lead project activities. The proposed project will include the following measurable objectives: (1) conduct a needs assessment; (2) develop a comprehensive state strategic plan; (3) implement service delivery models that enable the full spectrum of treatment and recovery support services that facilitate positive treatment outcomes and long-term recovery from opioid and stimulant use disorders; (4) implement recovery support services; (5) implement prevention and education services; (6) provide treatment transition and coverage for individuals reentering communities from the criminal justice settings or other rehabilitative settings.

The Louisiana State Opioid Response (LaSOR) Program will enhance existing statewide prevention, treatment, and recovery support services for individuals with or at risk for opioid use disorder (OUD) and stimulant use and misuse and use disorders (SUM). Special populations to be served by this grant are (1) racial/ethnic minorities, (2) LGBTQ+, (3) older adults, (4) reentering citizens from the criminal justice system, (5) birthing persons or people with infants experiencing neonatal opioid withdrawal symptoms (NOWS), (6) people who inject drugs, and (7) youth. While services will be delivered is statewide, the focus will be on the areas with the highest overdose rates and the highest overdose volumes, in addition to areas with limited access to medication for opioid use disorder (MOUD) based on the LaSOR needs assessment. The goals of LaSOR 3.0 include 1) reduce opioid and stimulant-related deaths and incidents by implementing high-quality, evidence-based (EB) treatment services for individuals with or at risk for OUD and other concurrent substance use disorders; 2) increase access to EB harm reduction services and mechanisms for priority populations; 3) increase access to community recovery support services for individuals with OUD and/or SUM; and 4) decrease opioid and stimulant use and misuse by supporting EB prevention and education efforts for priority populations. Funds will support treatment services for 1,400 individuals (400 in year 1 and 1,000 in year 2), recovery support services for 980 individuals (280 in year 1 and 700 in year 2), and prevention services for 4,000 individuals (2,000 in year 1 and 2,000 in year 2). LaSOR 3.0 will enhance and expand MOUD treatment availability statewide by building the capacity of the Opioid Treatment Programs (OTPs) and Office Based Opioid Treatment (OBOT) providers through the hub and spoke model. As part of this initiative, OBH will utilize funds to support the implementation of mobile medication unit to target high-need areas and priority populations. To increase workforce capacity and quality of care, providers across the state will receive education and consultation through academic detailing and Project Extension for Community Healthcare Outcomes (ECHO). Outreach for these services will focus on OBOTs and community pharmacy providers. To optimize maternal access to evidence-based treatment of OUD and promote practices that improve infant health outcomes, hospital-based improvement teams across the state will implement best practices to support and enhance the care for substance-exposed mothers and newborns. These services will address Louisiana's leading cause of pregnancy-associated death while building statewide capacity for more targeted identification and support of pregnant and postpartum persons with SUD. OBH will develop a centralized harm reduction distribution hub. This hub will allow organizations across the state to request harm reduction products, such as safe storage and disposal products, naloxone, fentanyl testing strips, naloxboxes, vending machines, and more, to distribute to the areas in need. Recovery support services for individuals with OUD and SUM will be enhanced and expanded by establishing new homes across the state. Additionally, mobile outreach and peer recovery support services will be provided throughout the state to educate communities about OUD services and address stigma. LaSOR will utilize the existing Strategic Prevention Framework-based infrastructure as a basis to implement prevention EBPs statewide. Strategies include education through the new Prescription Drug Abuse Prevention Module of Life Skills Training and Generation Rx.

The primary purpose of the proposed project is to continue addressing the opioid crisis in North Carolina, using the North Carolina Opioid Action Plan 3.0, updated March 2021 with the input of community partners, as the guide. The drug overdose rate has increased by 37% in the state since the start of the Pandemic and the infiltration of manufactured highly potent opioids in the illegal drug supply. The Action Plan aims to Prevent, Reduce Harm and Connect to Care. The plan focuses on several key areas: (1) Equity and lived experiences (behavioral health equity), (2) Preventing future opioid addiction through education (3) Reducing harm, (4) Connecting to care by increasing treatment access for adults in rural areas, high-need urban areas, as well those justice-involved (recovery-oriented), (5) Expand access to housing and employment supports and recover from the pandemic together. Efforts will be focused on activities that can realistically be accomplished within the time frame of the two-year grant. Objectives under each goal and their measures are described below. Goal: Treat opioid use disorder. Objective: (1) To increase access to MAT/MOUD and other EBPs, among uninsured and under-insured North Carolinians for Federal Drug Administration (FDA)-approved medications, through fee for service treatments billed under the Adult Substance Opioid Use Disorder target population. Objective: (2) Provide services to transitioning populations by facilitating MOUD/MAT in correctional and detention facilities for individuals with opioid use disorders. Goal: To increase community awareness, prevention, and education. Objective: (1) Provide education to school-aged children, first responders, and key community sectors on opioid misuse. Objective: (2) Increase secure storage of scheduled drugs and MOUD, through targeted media campaigns and providing medication lock boxes and chemical disposal kits. Goal: To Reduce Overdose Deaths through Access to Harm Reduction Supports. Objective: (1) Reduce overdose deaths from drug use by supporting and funding the use of naloxone and Fentanyl Test Strips through will funding three Syringe Service Program (SSPs) Equity Navigation programs. Goal: To Implement Recovery Supports and Services that aid in the initiation and maintenance of OUD treatment and recovery. Objective: (1) Reduce barriers to engagement and retention in treatment and recovery. Objective: (2) Provide linkages to recovery and support services Goal: To Conduct a Project Evaluation. Objective: (1) Contract with a consultant to evaluate SOR 3 performance. Objective: (2) Routinely review the extent to which the project is meeting its goals and objectives at implementation meetings. The proposed project plans to serve a minimum of 4,000 unduplicated participants in Year 1 and an additional 3,000 in the second year of the grant. Because it is anticipated that some participants that began treatment in Year 1 will continue in treatment into Year 2, the number of new participants in Year 2 is decreased. This will allow adequate funding in order that first year participants may continue in treatment as long as necessary for a total of 7000. Additionally, it is anticipated that an additional 500 individuals will be served through the proposed pilot initiatives each year.

In 2019, Vermont experienced its first statistically significant decline in opioid related deaths, decreasing by 15% (111deaths) from 2018 (130 deaths). This progress was stifled by the arrival od the COVID-19 infection in the United States. Preliminary 2021 opioid-related accidental and undetermined fatal overdose data show an increase in opioid-related fatal overdoses, with a 33% increase from 158 deaths in 2020 to 2010 in 2021. While these preliminary results are distressing, it demonstrates a profound need to continue our comprehensive public health approach. The State Opioid Response (SOR) grant proposed to help Vermonters access treatment and move from treatment to successful recovery through strengthened prevention, treatment, and recovery services. Populations of focus are: 1) individuals who need, but are not actively seeking, opioid use disorder (OUD) treatment; 2) individuals awaiting administration of Medications for Opioid Use Disorder (MOUD); and 3) individuals who may be at increased risk for opioid overdose, including those using both cocaine and opioids. We plan to implement a set of SOR year three activities that utilize enhanced and mutually reinforcing initiatives implemented through existing prevention, treatment, and recovery systems. The Vermont Department of Health (VDH), Division of Substance Use Programs (DSU) has prioritized the following three goals: GOAL 1: increase access to OUD and stimulant use disorder treatment, including MOUD. Supported activities: VT Helplink call center information, support, harm reduction resources, and referral services; ASAM Level 3.1 residential treatment program implementation; adolescent and family screening, engagement, and recovery services. GOAL 2: increase regional capacity to implement community-specific opioid strategies. Supported activities: education and referral services for New Americans at risk of OUD; enhanced recovery supports such as specialized recovery coaching for parents, and recovery coaches embedded in fourteen (14) regional hospital emergency departments. GOAL 3: decrease opioid related deaths. In addition to the interventions already described, activities include: expand information provided on the recent addition of a substance misuse prevention dedicated page on VT Helplink, providing resources on: prescription medications disposal; safe use of prescription opioids; community prevention programs; family dedicated resources; overdose prevention and how to obtain and administer naloxone; and additional resources on COVID-19 guidance in the event of outbreaks in residential facilities and alternative treatment and recovery services if you become infectious while seeking care.