PROJECT SUMMARY/ABSTRACT There has been more than a 30% increase in opioid overdose deaths in the last year. Bystander access to naloxone medication effectively reverses opioid overdose deaths with limited adverse events. However, current naloxone distribution strategies are missing individuals at high risk of opioid overdose. Vending machines are an innovative strategy shown to increase reach of harm reduction services in Europe. Young adults who witnessed or experienced an opioid overdose expressed a desire for naloxone vending machines but identified features of the built environment (including safety and location) as perceived factors contributing to use. There is widespread interest in naloxone vending machines in the U.S. Yet, implementation challenges have slowed down or limited adoption including navigating stakeholder approvals and identifying appropriate locations for placement. The aim of this proposal is to study a community-initiated, stakeholder engaged adaptation of naloxone distribution, VEnding machine Naloxone Distribution for Your community (VENDY), to increase the reach of naloxone in underserved populations at-risk of opioid overdose. Study Aims include: Aim 1: To refine the VENDY program in 3 underserved communities (2 urban and 1 rural) using an iterative user centered design (UCD) implementation strategy and stakeholder engagement to increase reach, implementation, and sustainability. We will use iterative usability and message testing to refine the program with community members who misuse opioids. We will conduct surveys and qualitative interviews with stakeholder to refine the UCD implementation strategy for future use. Aim 2: Conduct a 6 month pilot assessment of the VENDY program in 2 urban and 1 rural community. The pilot includes a midcourse adaptation and evaluation of reach, effectiveness, adoption, implementation and maintenance (RE-AIM) outcomes. Aim 3: Identify factors in the social and built environment contributing to reach and implementation of the VENDY program using photovoice qualitative evaluations with organization implementers and community members currently using opioids. Photovoice evaluations will occur in potential locations in Aim 1 to inform VENDY placement and in the VENDY location in Aim 2 to inform stakeholder adaptations. Community-based approaches such as VENDY are particularly important to reach opioid users not currently engaged with health systems. To accomplish these aims, Dr. Wagner will pursue training in 1) user centered design, an innovative implementation strategy, 2) conduct of pragmatic trials in diverse settings, and 3) assessment of the built and social environment and its effect on reach and implementation. This mentored research project and career development plan are designed to prepare Dr. Wagner to become a leader in the adaptation of effective interventions addressing substance use to better reach underserved populations and to produce sustainable implementatio...