This project tests a training strategy to help rural jails start or increase their use of medications to treat opioid use disorder (MOUD - methadone, buprenorphine, naltrexone). Staff from participating jails will attend a series of training sessions, called Project ECHO, that include online learning sessions with skilled experts, case-based discussions (real-world examples), and peer-to-peer learning opportunities. Project ECHO is well-studied in healthcare settings but has rarely been used in correctional systems. Staff from 40 rural jails and local treatment programs will participate in 6 months of core sessions (all participants attend the same sessions), followed by 12 months of continuing sessions (where content is tailored to participants' needs). Staff will complete surveys about their knowledge and experience, and jails will provide data about their services. Researchers will measure changes in MOUD services offered by the jails over time, as well as the impact these changes have on staff's work environment. If Project ECHO helps expand MOUD services, it will offer a blueprint for expanding these life-saving services in other jails nationwide.

Inclusion Criteria:

• Administrative, security, or healthcare staff in participating jails
• Employed at the facility a minimum of 3 months

Exclusion Criteria:

• Ongoing or recent participation in similar organizational improvement project
• Inability to read or understand English or Spanish

Deidentified data from responses to staff surveys

Analytic files upon publication or no later than end of study (May 2030), indefinitely via public archives

Data will be shared via NIH-approved public data repository (likely ICPSR). Registered users who consent to terms of data use agreement will be able to access deidentified data from staff surveys via download or within secure data enclave.