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.