The Providence Overdose Prevention Project - The Providence Overdose Prevention Project will support first responders, with a focus on Emergency Medical Services, citywide overdose prevention efforts among adults 18 years of age and older in the urban catchment area of Providence, Rhode Island. The Overdose Crisis continues to affect the City of Providence disproportionately. While Providence accounts for less than a fifth of the State population, over a quarter of overdose fatalities occurred there in 2022, totaling 110 lives lost. Providence is also disproportionately affected by non-fatal overdose, with a rate that is consistently 1.5 to 2 times higher than Rhode Island. The Providence Overdose Prevention Project will use an evidence-based integrated public health approach, based on Substance Abuse & Mental Health Service Administration's Connecting Communities to Substance Use Services: Practical Approaches for First Responders guide to support Emergency Medical Services’ efforts to increase the capacity of first responders to implement approaches that reduce the rate of fatal and non-fatal overdoses among adults in Providence. The project proposes to serve 1500 unique individuals in Year 1 and 7250 total by the end of Year 4. With over 189,000 residents, 80.3% over 18 years of age, Providence is the capital of Rhode Island and accounts for 17% of the state population. The population of Providence is the most diverse in Rhode Island, with only 45.6% of Providence’s residents identifying as White, alone compared to 82.8% statewide. In addition, 42.6% identify as Hispanic compared to 17.6% statewide. There are more than double the statewide percentage of foreign-born residents and households speaking a language other than English, over 35 different languages, in Providence at 31.6% and 48.4%, respectively. Of the 39 census tracts in Providence, almost 59% have a Social Vulnerability Index between 0.75 and 1, meaning more than half the City’s residents are considered the most vulnerable. The City of Providence is located in Providence County, Rhode Island, and has an overall Social Vulnerability Index of 1. The Providence Overdose Prevention Projects goals are (1) increasing the capacity of Providence Emergency Medical Services (EMS) to implement evidence-based practices that effectively engage People Who Use Drugs (PWUD) and connect them to substance use services (2) Decreasing the rate of fatal overdose in Providence by implementing Overdose Education and Naloxone Distribution (OEND) with first responders and members of other community sectors to aid in the administration of Naloxone during suspected overdose (3) Decrease the rate of nonfatal overdose to a rate similar to the statewide rate through connections to appropriate treatment, recovery, harm reduction, and other psychosocial support services. This will be achieved through partnerships with Providences’ Housing & Human Services Department, Emergency Medical Services, service providers, and community anchors implementing a range of public health strategies, including Overdose Education and Naloxone Distribution, Referral, Active Outreach, Post Overdose Outreach, and Community Paramedicine, and Diversion programs.