Project Renewal’s Second Chance MAT-PDOA Program will provide compassionate engagement, peer support, nurse care management, and opioid use disorder (OUD) treatment to underserved persons experiencing/with histories of homelessness and who have OUD throughout NYC. NYC homeless/at-risk single adults are an extremely vulnerable group: substance use, alcohol use, and mental illness account for 69% of hospitalizations among this population, compared to 10% among non-homeless NYC adults. Drugs have been the leading cause of death among NYC homeless residents since FY14; opioid antagonists were administered to NYC shelter residents more than 700 times in FY20. The stressors associated with COVID have exacerbated the opioid crisis—especially among those without traditional support systems—and effective, accessible treatment is needed now more than ever. Project Renewal operates a distinctively comprehensive continuum of OUD support services and treatment options, of which we aim to increase utilization via Second Chance. Through the innovative use of certified-peer Recovery Coaches, nurse care management, telehealth, and a single point of contact for treatment planning/coordination, we will improve the accessibility and acceptability of OUD programming for at least 500 unique clients over the five-year grant period. As part of our outreach and engagement efforts, we will also educate and train 750 individuals annually about overdose prevention and naloxone use. The Second Chance Program has three primary goals as follows. Goal 1: Enroll and directly engage 100 participants annually, and directly support them in recovery from addiction via a harm reduction approach including MAT and an array of other recovery support services. Quantifiable objectives include: 90% of participants will engage in counseling and recovery sessions with certified peers at least monthly; 80% of participants will be connected to the Second Chance Nurse Care Manager and assessed for OUD-related health needs and services including MAT, HIV/HCV treatment, psychiatry, and other harm reduction activities; and participants will report a measured reduction in cravings, continued use of Buprenorphine, and improved quality of life as measured at intake to services, six months post-intake, and at discharge. Goal 2: Provide outreach and engagement to increase access to and participation in MAT and other recovery support services for 750 homeless/at-risk people annually. Quantifiable objectives include: provide outreach and naloxone training to 750 individuals in the population of focus annually. Goal 3: Engage Second Chance clients in complementary and stabilizing health, housing, and vocational services. Quantifiable objectives include: 90% of participants will undergo needs assessment to determine appropriate referrals for housing, vocational, tobacco cessation, and other health care assistance; 80% will have health insurance coverage; 90% will have a primary care provider; and 90% will undergo HIV and HCV screening, counseling, testing, and if positive, treatment.