Louisville–Jefferson County Metro is the largest county in the state, spanning 365 square miles and home to 760,000 residents within its consolidated city/county boundaries. It also has the highest number of opioid-related deaths of any county in Kentucky. In 2018, Louisville Metro experienced 177 opiate-related overdose fatalities and 2,359 nonfatal overdoses. Data reported in 2017 indicates a total of 426 overdose fatalities, up from 364 in 2016. In 2018, the Louisville Metro Department of Corrections (LMDC) placed 7,400 individuals on a detox protocol upon entering the jail after self-reporting the use of substances or exhibiting signs of substance use. Of the total number of individuals placed on a detox protocol, 63 percent (4,697 bookings) self-reported opiate use including prescription opioids and heroin. While MAT is currently initiated in-custody for select populations, Louisville–Jefferson County would like to improve service provision, expand the MAT program to additional inmates outside of pregnancy, increase linkage to care services, and expand naloxone provision.