University Health (UH) Opioid Treatment and Recovery Services (OTRS) project will expand access to medication for opioid use disorder (MOUD) for 400 adults with an opioid use disorder (OUD) or co-occurring OUD/mental health disorder (COD), across Texas Public Health District Region 8 (R-8). OTRS aims to reduce overall opioid use, dependence, and deaths by providing MOUD in combination with comprehensive services including outpatient counseling, peer recovery support services (PRSS), and Brief Strength-Strength Based Case Management (BSBCM). Population: With a focus on R-8 residents, OTRS will serve 400 racial/ethnic minority adults, ages 18 and older, who have an OUD, or COD and are living in one of 28 counties within R-8. Unduplicated clients served per year is as follows: 65 Year 1; 90 Year 2; 90 Year 3; 80 Year 4; and 75 Year 5. Evidence-based opioid use screening and referrals will be accepted from diverse community sectors, including 12 UH primary care clinics, AIDS Service Organizations (ASOs), Rivercity Rehabilitation Center (RCR), Rosetta’s Key (RK), and Bexar County Felony Drug Court (FDC). Interventions: Prospective clients, who screen positive on the Texas Christian University Drug Screener 5 (TCU-DS-5) (only those who report opioid use) or on both the TCU-DS-5 and Patient Health Questionnaire - 9 (PHQ-9) will be referred to the OTRS Program Manager, a licensed behavioral health provider, for clinical assessment and enrollment into OTRS. In partnership with RCR, uninsured/underinsured OTRS clients will receive six months of MOUD. In partnership with RK, uninsured/underinsured OTRS clients will receive either five individual or ten group outpatient-counseling sessions on average. Internally, OTRS staff will provide an average of three PRSS sessions with additional sessions available as needed. Additionally, OTRS staff will prove BSBCM to participants as needed. BSBCM will assist with reducing barriers to care including but not limited to enrollment in health insurance, employment, housing, etc. OTRS clients will receive MOUD from RCR, and rural/UH practitioners trained by the Texas Medication for Opioid Use Disorder training organized by UT Health San Antonio, who have obtained applicable DATA waiver, and comply with Texas’ Prescription Drug Monitoring Program. Outpatient counseling, BSBCM, and PRSS telehealth services will be implemented with rural and resources limited counties to improve access and retention in MOUD. Harm reduction services (e.g. HIV testing/Test-Kits, and safe-sex kits) will be coordinated through collaboration with ASOs and Texas Wears Condoms (TWC). Data on key outcome measures will be collected and analyzed to reduce disparities in access, service use, and outcomes. Clients will receive a $30 gift card for completing a six-month follow-up assessment. Goals and Objectives: The primary goal of OTRS is to increase access to and retention in MOUD treatment and related recovery support services and decrease opioid misuse among diverse residents across R-8 (Goal #1). It is expected that at 6-month follow-up participants will report increased access to MOUD treatment and PRSS compared to baseline (Obj 2.3). (Goal #2). It is expected at 6-month follow-up, participants will report decreased days of illicit opioid drug use and opioid misuse, and increased abstinence compared to baseline (Obj. 2.4).