Cuyahoga County OD2A LOCAL Initiative (CCOD2A LOCAL) - Background: Cuyahoga County continues to have a high rate of unintentional overdose deaths with 586 reported in 2021 (CDC Wonder, 2021). The Cuyahoga County Board of Health, together with new and established community partners seek OD2A LOCAL funding to enhance and improve the effectiveness of the County’s system of care, which includes multi-level, long-established and well-integrated surveillance, prevention, linkage to treatment, retention in care and evaluation strategies to ameliorate the effects of the opioid epidemic in the County. Approach and Purpose: The Cuyahoga County Local Initiative will further the work of the OD2A 2019-2023 funding by advancing established initiatives and developing new efforts in the system of care surveillance, prevention, linkages to treatment, retention in care and the evaluation of these activities using the new funding proposed as well as in-kind support of the Regional Opioid Collaborative. Our target population includes children, transition age youth and adults at risk of initiating drug use or at risk for experiencing an unintentional non-fatal or fatal drug overdose. Emphasis will be directed to persons with lived experience of opioid use who are disproportionately affected and underserved and/or experiencing homelessness or incarceration. Partner agencies will provide social and medical services and resources that address patients’ SDoH barriers (e.g., cultural/linguistic, physical/mental health, trauma, etc.) at individual, interpersonal, community and societal levels. Activities are tailored to reduce health and substance use disparities and improve equity and access to substance use services. Extensive activities are planned in Prevention Strategy 1A (Linkage to and Retention in Care), 2A (Harm Reduction), and 3A (Stigma Reduction) across community, public safety and healthcare settings as well as Prevention Strategy 4A (Clinician and Health Systems Best Practices) and Surveillance Strategy 6A (Overdose Surveillance Infrastructure). Established and new partners include treatment agencies, public health, health-care settings, nonprofit harm reduction, peer support agencies, and others. Outcomes: The overarching goal of the effort outlined is to acquire and share high-quality, complete, and timely data on (a) fatal and non-fatal overdose incidence, and (b) individuals’ linkage to treatment and retention in care to inform partners’ actions to reduce overdose morbidity and mortality, while aiming to improve health equity for disproportionately affected and underserved populations. Additional Components: An application for Component B is included to provide data via toxicologic testing of paraphernalia to improve services and awareness of people who are using illicit drugs and persons at high-risk for overdose. Long-term outcomes include enhancing the ability of programs to respond to overdose trends for groups disproportionately affected by overdose, increasing use of standardized indicators on toxicologic findings and linkage to care to support local and national surveillance, and expanding and improving use of surveillance, program evaluation and community data to drive prevention actions that are community/population appropriate. An application to Component C is included to better understand the cascade of care through surveillance data on individuals’ linkage to treatment and retention in care to inform partners’ actions to reduce overdose morbidity and mortality, while aiming to improve health equity for disproportionately affected and underserved populations. Outcomes will be: (1) enhanced ability of programs to respond to overdose trends for groups disproportionately affected by overdose; (2) collect and use of data on linkage to and retention in care among people at high-risk of OD to improve care and (3) increased expanded and improved use of surveillance, program evaluation, and community data to drive prevention action that are community/population appropriate.