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For more than two decades, New York State’s county governments have stood resolute on the frontlines of an opioid crisis that has ravaged families and communities, strained the criminal justice system, and claimed the lives of hundreds of thousands of Americans. Fueled by the opioid lawsuit settlements and recent legislative actions, counties are now channeling new resources into reversing the harm inflicted by the opioid scourge and fortifying local treatment, recovery, and prevention initiatives. This report aims to highlight the strategies counties are employing in their relentless battle against opioid abuse and underscore the need for continued investment in county initiatives.