Project Summary Illicit drug use is pervasive, yet treatment rates remain disproportionately low. Individuals with substance use disorder (SUD) encounter numerous obstacles to engagement in treatment. Addressing the specific needs of groups least likely to receive treatment requires integrating their perspectives into user-centered design. Between 2015 and 2020, the rate of fatal opioid overdoses in Virginia increased from 10.8 to 25.1 deaths per 100,000, with significantly greater increased mortality for African Americans. There are racial disparities in rates of prescriptions for medications for opioid use disorder and completion of office-based treatment programs. To better understand the needs and barriers faced by adults with SUD in underserved, high-poverty communities in Richmond, VA. In the initial phase of our project, the Virginia Patient Engagement Resource Center (PERC) is set to establish and sustain a patient advisory panel. Comprising approximately 15 members from Richmond and the surrounding region, this panel will include people in recovery as well as peer recovery navigators. Employing diverse engagement strategies, we aim to create an inclusive, accessible, and productive structure, drawing lessons from existing literature and fostering authentic engagement. Collaborating with the panel, our focus will be on building their capacity as consultants to researchers striving to enhance SUD treatment and research. We will implement a consultation process co-developed with the panel to facilitate discussions with researchers regarding their grant proposals, ongoing research projects, and/or emerging research outcomes. The impact of the panel on both its members and participating researchers will be systematically evaluated. Moving into the second phase, the PERC will adopt a community- based participatory (CBPR) approach to investigate patient experiences. The CBPR approach recognizes the importance of engaging stakeholders equitably across all facets of research and is particularly important in addressing the needs of vulnerable and hard-to-reach populations often excluded from health research. Research on patient experiences will include a survey of individuals not yet in recovery as well as qualitative, participatory, arts-based research that aims to empower participants to explore and articulate their experiences. Data and insights gleaned from the research and collaboration with stakeholders will inform the design of responsive interventions or tailoring of existing evidence-based strategies. In the third phase, we will plan and conduct two pilot research projects focused on increasing treatment initiation and retention. Testing strategies proposed by stakeholders, our goal is to establish a proof of concept regarding the impact of patient panels on SUD intervention efforts. Our broader objective is to gather multiple perspectives on the feasibility and accessibility of SUD service delivery to inform program modifications tailore...