AMHC (Aroostook Mental Health Services, Inc.) currently provides Medication-Assisted Treatment (MAT) in a 12,431 square mile rural catchment area incorporating Aroostook,Hancock, and Washington Counties in Maine. Under this proposal, AMHC will expand MAT for a population of focus of adults (18+) with opioid use disorders (OUD) in this catchment area. Three hundred and fifty (350) unduplicated individuals will be served over five years. The total population in the catchment area is 153,107. About 94.4% of residents are White, 2.1% are Native American, 1.7% are Hispanic, 1% are Black, and 0.8% are Asian. Across the three counties, an average of 14.6% live at or below 100% Federal Poverty Level (versus 10.9% statewide), and 13.7% under age 65 lack health insurance (versus 10.1% statewide) (U.S. Census, 2017, 2019). Through this project, AMHC will build on its strong integrated system to expand MAT to meet critical needs. Goal 1: In accordance with the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Improvement Protocol 43 (TIP 43): Medication-Assisted Treatment (MAT) for Opioid Addiction in Opioid Treatment Programs, in order to engage, retain, and support clients with OUD, AMHC will expand trauma-informed and person-oriented MAT services in rural areas in 3 counties. Objective 1-1: By year 1, month 3, expand operations at existing MAT sites in Aroostook from 36 to 46 hours (20 clients) per week and expand medications available to include Vivitrol and Suboxone; Objective 1-2: By year 1, month 3, assume full operations of an existing MAT site in Hancock County which the current SAMHSA fiscal lead wishes to discontinue, thus assuring continuity of MAT services for 47 existing clients and add capacity to provide an additional 4 hours of MAT services per week (10 clients); Objective 1-3: During year 1, establish a new site providing comprehensive MAT services at an existing AMHC facility in Washington to provide 4 hours of weekly MAT services to minimally 35 unduplicated outpatient clients and continue 16 hours of weekly services to 20 clients annually at the county jail; Objective 1-4: Enroll 50 unduplicated clients in year 1, and 300 additional unduplicated clients in years 2, 3, 4, and 5; Objective 1-5: By year 3, 40% of MAT clients will demonstrate clinically significant stabilization in opioid and polysubstance use after 12 months of MAT enrollment as measured by retention in treatment and completing goals outlined in their individual treatment plans; Objective 1-6: By year 4, 50% of clients enrolled in MAT and integrated COD treatment will demonstrate clinically significant improvements through reduced recidivism rates, increased employment, and maintaining stable housing for 12 months or longer; Objective 1-7: By year 5, 50% of MAT clients will be compliant in taking medications for non-BH chronic health conditions with associated clinical improvements as documented by primary care providers (PCPs).