The Muskingum, Morgan, and Coshocton counties first responder project aims to equip emergency medical service and firefighter first responders who serve the 136,824 residents of Muskingum, Morgan, and Coshocton counties, Ohio with training and ongoing technical assistance that will enable them to provide individuals experiencing substance use disorder and who are at risk of overdose OD, their families, loved ones, and peers with lifesaving naloxone, education on naloxone use, other opioid mitigation resources and connection to local harm reduction, and SUD treatment and recovery resources. The project will be led by the Muskingum Area Mental Health Recovery Services Board with support from University of Pittsburgh Program Evaluation and Research Unit and other partners at the local level. This intervention will provide training and ongoing technical assistance to 500 emergency medical service responders and 700 firefighters over the course of the four grant years. Specialized training will focus on changing EMS and FF FRs' perspectives about individuals experiencing SUD, addressing barriers and reducing stigma towards SUD, helping first responders reframe their emotions and assumptions about SUD as a disease, drawing up first responder internal motivation and empathy and developing hands on skills such as motivational interviewing principles, Screening, Brief Intervention and Referral to Treatment, and the use of validated assessments like DAST 10 and the NIDA Quick Screen. At the end of the training, participating EMS and FF FRs in Ohio will be able to effectively administer and leave behind naloxone, assess patients' readiness to change, determine the best course of action to reduce the likelihood of a future OD, connect consenting patients to local treatment and recovery resources, and provide harm reduction education and information to individuals and their social network in a culturally competent and trauma informed manner. In addition to training, participating agencies will receive technical assistance on developing leave behind policies and protocols as well as developing Health Insurance Portability and Accountability Act complaint data sharing and care coordination protocols with local SUD services. The Ohio Department of Health will provide EMS and FF FR agencies with free intranasal naloxone doses which will include in a naloxone recovery kit left with individuals experiencing an acute OD intervention by these agencies.