Portsmouth City Health Department (PCHD) is located in Scioto County, Ohio, which has the second highest rate of opioid addiction in the state and is designated as a “distressed county” by the Appalachian Regional Commission, meaning that it ranks in the worst 10 percent of the nation’s counties economically. PCHD helped develop an overdose review team and a post-overdose response team in the community, implemented a reentry navigation program in strong partnership with probation and parole that helps connect individuals to treatment and services in the community, and began providing Vivitrol to individuals who have SUDs and are booked in the county jail.