Mistler CB, Sullivan MC, Copenhaver MM, et al. - This study was carried out to define the direct and indirect impacts of COVID-19 among at-risk people with opioid use disorder (OUD) to understand how the pandemic has affected them, their public health response to COVID-19, and if there were differences by race/ethnicity. Researchers enrolled the sample from a drug treatment setting in the northeast region of the United States. Results indicated overall increases in depression, anxiety, loneliness, and frustration among the sample of people with OUD. Decreases in financial stability were also seen. Racial-ethnic minorities in this group reported more direct adverse effects of COVID-19, including being more worried about contracting COVID-19, not being able to get a COVID-19 test, and knowing someone who had died from COVID-19. Whites indicated increases in alcohol consumption and non–prescription drug use in greater proportions than did racial-ethnic minorities. Among people with opioid use disorder (OUD), treatment providers must be vigilant in managing direct and indirect outcomes of COVID-19. Data indicate the requirement to develop culturally competent, differentiated interventions in partnership with community-based organizations to meet the unique challenges that the COVID-19 pandemic presents for people in treatment for OUD.