Beginning in 2015, the Wisconsin Department of Corrections (DOC) began a coordinated response to the opioid epidemic that continues to have a devastating national impact. Through the implementation of many initiatives that focused on medication-assisted treatment service delivery to those under the Wisconsin DOC’s care and control, harm reduction, and evidence-based practices, the overdose fatality review (OFR) committee continued to see fatalities from this disease. In 2020, leaders across the Wisconsin DOC embraced a concept to review the fatalities at a state level to better understand the processes and policies that the OFR team could improve upon to lessen overdose fatalities in its correctional population. The Wisconsin DOC’s OFR team is modeled after other national teams, but its uniqueness stems from statewide membership and coordination that reflects the diversity of Wisconsin. Wisconsin is home to 72 counties, which vary greatly from urban to rural and in race, age, income, and service level for responding to the opioid epidemic. The Wisconsin DOC supervises clients in all 72 counties (and a Native American territory), and as a result, its fatality review team reviews cases from all 72 counties. The team reviews two fatalities per month, with overall leadership offered by the Medical College of Wisconsin. Cases are selected with consideration for age, race, gender, geographic location, toxicology reports, and other factors suspected to contribute to the fatality. The Wisconsin DOC is eager to share its experience, project data, policy improvements, and lessons learned for other states to replicate.