Project Summary/Abstract New York State (NYS) has been heavily impacted by the nation?s increasing opioid crisis, experiencing a nearly 40 percent increase in opioid overdose deaths from 2,166 in 2015 to 3,009 deaths in 2016. To address this issue, NYS created community-based Drug User Health Hubs to increase access to appropriate health, mental health, and medication-assisted treatment services for persons who use drugs. Hubs are located at Syringe Exchange Programs and expand and enhance their services, a change that is expected to reduce opioid overdoses and improve the overall health and well-being of people who use drugs. The objectives of the proposed project are to: 1) construct a complete and rich description of the service elements offered at established Hubs to support assessment of their efficacy and guide replication efforts; 2) assess and compare the effectiveness of a sample of SEPs to the Hubs in a) reducing fatal and non- fatal opioid overdoses and b) improving various health and social indicators for clients; and 3) examine service utilization and costs to estimate the potential overdose reduction and economic impact of implementing the Hub model at SEPs in NYS. Project objectives will be achieved through three specific aims. Aim 1: Construct a complete and rich description of the service elements offered at established Hubs to support assessment of their efficacy and guide replication efforts. Service offerings are unique to the communities the Hubs and SEPs serve. We will employ quantitative and qualitative measures (surveys, state records review, and interviews with site service coordinators) to construct a full description of service elements and mechanisms of operation for three Hubs and three comparison SEPs in NYS, excluding New York City (NYC). We will explore Hub/SEP organization and administrative capacity, community referral network structure and function, and resources required to deliver services. Aim 2: Compare effectiveness of Hubs and SEPs in reducing overdose incidence and improving other client health and social indicators. We will assess the effectiveness of the expanded service elements of Hubs over and above those offered by SEPs in reducing fatal/non-fatal overdose (primary aim) and changing substance use-related behaviors; improving physical health, psychosocial functioning, and social determinants of health, and decreasing involvement in the justice system. We will administer client surveys at four time points over one year (enrollment; 4 months, 8 months; and 12 months) to measure client overdose risk level at entry, engagement with services during the subsequent 12 months, and change/success on outcome indicators after 12 months. Aim 3: Examine service utilization and costs at Hubs to estimate the potential overdose and economic impact of implementing the Hub model at SEPs in NYS. Using site records, participant survey results, site visit interviews, and records from state and local health department registries and databases, we will determine on-site service utilization and costs associated with operating the Hubs; estimate the additional costs and cost savings to the healthcare system in the Hub models compared to SEPs; and forecast the potential impact on opioid overdoses and healthcare system costs if Hubs were expanded statewide (excluding NYC).