Self-Report Naloxone Use

If you have responded to an opioid overdose using take-home naloxone, filling out this Opioid Overdose Incident Form is critical.


Your responses will help us ensure the continued supply of online and mail-based naloxone distribution, and provide vital data that can lead to increased recovery and rehabilitation services.

When filling out the form below, keep in mind:


  • Your name is not required. 

  • If you responded to more than one overdose, please fill out one form for each occurrence.

Project Opioid Headquarters

255 S. Orange Avenue

Suite 104

Orlando, Florida 32801






Project Opioid, Inc. is a registered 501(c)3 nonprofit organization.