Inclusion Criteria:  Is 18 years of age or older Is able to speak English sufficiently to understand study procedures Has a history of non-medical opioid use Is a potential candidate for ED-based MOUD treatment initiation and referral at the site as confirmed by clinical staff s not receiving MOUD through ongoing formal addiction treatment or pain management at the time of index ED visit Is willing to receive either standard ED care or enhanced ED care in EDOU depending on random assignment Presents to the ED during study screening hours  Exclusion Criteria:  Unwilling or unable to provide written/electronic informed consent/HIPAA Authorization for research procedures, including research visits at baseline and Day 30 and Day 90, and/or consent for the release of health records and data matching for a period of 2 years following enrollment and 1 year prior to enrollment. Currently in jail, prison or any inpatient overnight facility as required by court of law or have pending legal action or that could prevent participation in the study Presents from a medical-based extended care facility (e.g., skilled nursing facility) Previous participation in the current study Inadequate locator information (unable or unwilling to provide one unique mean of contact). Has acute, severe medical, psychiatric, or concurrent substance use problem or meets other criteria that would exclude the patient (clinically) from placement in EDOU according to EDOU placement clinical protocols.