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.