Background: In the United States, there has been a 150% increase in heroin use every year since 2007 and a 14% increase in opioid overdoses. Medication-assisted treatment (MAT) increases the likelihood of recovery and improved health outcomes and is the leading treatment modality for opioid addiction. Unfortunately, only 30% of persons who might benefit ever enroll in MATs with high dropout rates in early recovery undermining effective treatment. This study describes and tests whether an early recovery specialist (ERS), providing tailored, intensive early care, increases 90-day retention rates at a California Opioid Treatment Program (OTP). Methods: The ERS program was introduced and tested at one OTP within a statewide network. Pearson's Chi-Square and Fisher's Exact Test assessed differences in retention rates for five pre-pilot months, five months during ERS program implementation, and three months after the program (preliminary data). Results: The majority of patients (73%) were MediCal funded and male (68%). Sixty-nine percent were non-Hispanic White and 31% Hispanic, with analyses indicating demographic distribution did not vary over the 13-months study period (p > .05). There was a statistically significant increase (p < .01) in 90-day retention during the piloted months (63.2% to 88.0%) as compared to pre-pilot, with preliminary post-pilot (3-months) data suggesting a return to pre-pilot retention rates (71.9%) (p < .05) after program conclusion. Conclusions: This pilot program, delivering intensive, tailored care, improved early recovery patient retention, a key factor in optimal patient outcomes. Higher retention rates are associated with greater patient investment in recovery, time in treatment, program compliance and clinical outcomes. Early recovery specialist programs also offer important professional development opportunities for providers. These preliminary results provide compelling evidence that treatment strategies focused on early care can improve retention rates during a critical period of recovery from opioid addiction. Implications for future research are discussed.