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.