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Outside of the Salt Lake City metro area, Carbon and Emery counties have the highest overdose (OD) rates in Utah. Emergency departments (ED) often are at the front lines of care for those with Opioid Use Disorder (OUD) or who experienced OD. Previous research has documented ED buprenorphine initiation can promote greater treatment engagement following discharge. Additionally, ED naloxone distribution can reduce associated harm and a warm handoff referral is an evidence-based method connecting individuals with OUD to treatment. Castleview Hospital is the only acute care hospital that serves Carbon and Emery counties and is the only location in these two counties with an ED. Through a collaboration between Castleview Hospital and the University of Utah (U of U), this project will implement an ED-led low-threshold buprenorphine induction and naloxone distribution program—combined with warm hand-off referral to continued treatment (BINDeR-Tx). The BINDeR-Tx project aims to support treatment for patients presenting to Castleview ED with OUD. To incorporate this model into ED workflow, the project provides OUD screening, buprenorphine introduction, and naloxone distribution training to hospital staff. The project also supports an ED-embedded support worker to provide warm-handoffs. Program assessment includes monitoring the number of patients served and implementation quality. BINDeR-Tx may provide a service model for rural implementation of ED based opioid-related harm reduction services for further statewide or national dissemination.