Choctaw Nation FY24 Tribal Opiod Response IV - The Choctaw Nation of Oklahoma (CNO) proposes to provide prevention, treatment, and recovery support services aimed at reducing unmet treatment needs, opioid overdose-related deaths, stimulant misuse and use disorders across the Reservation. The project will achieve this by increasing access to culturally relevant, evidence-based practices to best contribute to the well-being of Tribal Members affected by opioid and stimulant use and misuse. The population focus will include Native American individuals residing within the CNO Reservation, adolescent age through elders with a focus on those referred from the criminal justice system. The CNO is a federally recognized tribe in southeastern Oklahoma, whose Reservation oversees a 10,922 square mile region that overlays thirteen counties: Atoka, Bryan, Choctaw, Coal, Haskell, Johnston, Latimer, Leflore, McCurtain, Pittsburg, Pontotoc, and approximately half of Hughes County, making it the third largest tribal Reservation in the continental United States. Public Transportation is neither free nor accessible and travel from one town to the next by car can take hours. According to the CNO's Tribal Membership Internal Report, the reservation hosts an American Indian population of 55,484, of which 53,450 identify as Choctaw. The remaining American Indian population is made up of different tribes, making this a diverse region with many languages, dialects, and cultures. Approximately 108,000 persons in the U.S. died from drug-involved overdose in 2022, including from illicit or prescription drugs. American Indian/Alaska Native Opioid Use Deaths (OUD) in Oklahoma are greater (30.1 per 100,000) than those reported for the general U.S. population (26.2 per 100,000) and significantly higher than the white population in Oklahoma (19.5 per 100,0000). According to CDC (Center for Disease Control) data from 2020, five counties within the Choctaw Nation of Oklahoma’s 13 county service area experienced higher than national rates of unintentional poisoning deaths involving at least one prescription opioid (Pittsburg [45 deaths], LeFlore [35], Bryan [26], McCurtain [22], and Hughes [10]).