The Puerto Rico (PR) Mental Health and Anti-Addiction Services Administration (MHAASA) proposes a 3-year SOR 2024 Project in PR to implement a comprehensive strategy addressing opioid use through evidence-based prevention, harm reduction, treatment, and recovery initiatives. Goal 1 is to increase state and community capacity to reduce opioid overdose incidence in adults with SUD by implementing EB community prevention interventions. Primary prevention efforts include enrolling 3,240 high school students in the Towards No Drugs Abuse (TND) program over three years and conducting workshops for 38,250 adults aged 55 and older annually. A social marketing campaign targets 10% of college students (15,900 individuals over three years). Harm reduction strategies involve educating 2,000 opioid users and community members annually on harm reduction practices, distributing 14,000 Fentanyl Test Strips (FTS) and Xylazine Test Strips (XTS), and training 400 first responders yearly in naloxone use. The Project will increase access to antidotes to reverse opioid events by distributing 20,000 naloxone kits to trained and collaborating FRs, Correctional Officers, inmates, OTPs, and stakeholders of CBOs. An education and awareness multimedia campaign directed to all populations in PR regarding the harm reduction model will be performed. 60 SUD certifications will be provided in 3 years to enhance and expand SU and co-occurring SU and MHD treatment workforce. A population-based study across 78 municipalities will assess MH/SU needs. These initiatives collectively aim to mitigate opioid-related harm and improve treatment access and outcomes. Goal 2 is to increase and expand access to OUD/ODU treatments based on EBP interventions and FDA approved MOUD treatment for people with OUD/ODU, including inmate populations with SUDs. Treatment services aim to integrate 50 new patients annually into Opioid Treatment Programs (OTPs), provide HIV/Hepatitis screening for 200 patients annually, and offer MOUD treatment to 60 male inmates annually. Treatment with Naltrexone and Buprenorphine will be provided to 750 OUD adults from MHAASA's San Juan Specialized Unit of Medically Managed Withdrawal. Treatment for 150 male inmates with OUD/ODU or co-occurring SU/MHD in the Ponce Correctional Institution using Methadone and Buprenorphine. Treatment and recovery services for 250 youth, young adults and their families will be provided. To increase access to integrated services of MOUD treatment with Buprenorphine, psychosocial treatment services, telehealth strategies, and recovery support services centered on patient needs for 600 new OUD patients in the 3-year period through the delegation of funds to CBOs. Goal 3 is to ensure access to community recovery support services such as peer counselling, recovery coaching, and recovery housing for adults with OUD/ODUs. Recovery support efforts focus on providing peer counseling and housing support to 480 adults annually, with additional outreach to homeless populations and engagement in community-based recovery programs. At least 60 sheltered and unsheltered homeless persons will be served yearly by a Community Outreach and Support multidisciplinary team in the Southern region of PR. The Project will integrate 35 homeless participants including people discharge from hospitals through the Assertive Community Treatment (ACT) Model. An evaluation team will collect, analyze, and report process and outcome data quarterly.