The Standing Rock Sioux Tribe (SRST) through treatment program proposes the "Tribal Opioid Treatment and Prevention project to address the opioid crisis in Standing Rock by increasing access to culturally appropriate and evidence-based treatment, including medication-assisted treatment (MAT) using Food and Drug Administration (FDA) -approved medications for the treatment of opioid use disorder (OUD); decrease illicit opioid use and prescription opioid misuse; and reduce unmet treatment need and opioid overdose-related deaths through the provisions of prevention, treatment, and recovery support services for OUD. The goals of the opioid treatment and prevention project include: Strengthen program services capacity by hiring staff; strengthen the capacity of SRST treatment program, and tribal systems to increase utilization of culturally relevant evidence-based and evidence-informed programs for providing clinical services, including MAT and supports for opioid, prescription drug and other drug misuse; facilitate education of the Tribal labor force & Community members to increase knowledge of strategies for prevention, treatment & recovery from opioid and prescription drug misuse; strengthen the capacity of SRST tribal health and tribal systems to improve & implement systematic referral mechanisms for Tribal members needing opioid misuse treatment; prevent the initiation and progression of youth substance misuse (including tobacco use) in the community by implementing promotion and prevention strategies with school age youth; increase awareness of available resources, supports written and electronic materials for community members on substance (including opioids and prescriptions) misuse, prevention, treatment and recovery; and promote family and community support. To achieve these goals the project team will increase staff members; plan and organize culturally relevant and cross-cultural opioids, prescription drugs and other drug misuse training; improve patient tracking system among providers both on and outside the reservation; utilize IHS behavioral health to provide MAT services; utilize telehealth services to reach, engage and retain patients in treatment; provide harm reduction services, including opioid misuse education, naloxone distribution, syringe services, and other services across the Tribe's 8 districts; compile existing/or revise/or develop policies and procedures for behavioral health for service coordination among partnering organizations; utilize social media, social marketing and awareness campaigns to provide electronic information and access to substance misuse resources; promote healthy lifestyle choices, positive communication, personal success and cultural involvement; and regularly assess and monitor collaboration among participating organizations. The project is slated to serve twenty-five unduplicated individuals in each year for a total of 125 over the 5-year project period. Additionally, we hope to reach the reservation population of 8,612 through community education and media messages.