The Hawaiʻi Opioid Initiative (HOI) was a collaboration of public health, public safety, healthcare professionals, and community partners working together to address opioid and other drug use, misuse, and overdose. The HOI started in 2017 and had eight workgroups that met regularly to implement the HOI strategic plan and promote system improvement by integrating substance use prevention, treatment, recovery, and harm reduction within Hawaiʻi’s healthcare system. The HOI paused activities in late 2023 and conducted a needs assessment by obtaining input and feedback from community leaders, providers of Substance Use Disorder (SUD) treatment programs, representatives of publicly funded programs, agency heads, and researchers. In early 2025, the Hawaiʻi Opioid Initiative was renamed and relaunched as the Hawaiʻi Overdose Initiative to reflect an expanded approach to addressing substance use in Hawaiʻi.