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Just in Case Oregon Survey

Thank you for taking the time to complete this survey. This is completely optional and anonymous. Nothing you share is connected to your name or address, and skipping this survey has no effect on future orders. Filling it out helps us understand how this program is impacting people in Oregon and helps us get more naloxone into communities that need it.

Please do not include names, addresses, or other identifying details in the optional open-text answer.

Have you ever witnessed or experienced an overdose?YesNoDon’t know or prefer not to say

Who are you getting this naloxone for? (Check all that apply.)MyselfA family memberA friendPeople in my communityOtherPrefer not to say

If other, please tell us who

Have you ordered naloxone from us before?YesNoDon’t know or prefer not to say

What happened to the last four naloxone doses we sent you? (Check all that apply.)I still have someI administered some to someone during a suspected overdoseSomeone administered some to meI gave some to someone else to carrySome expiredSome were lost, damaged, or thrown awayOtherDon’t know or prefer not to say

If other, please tell us what happened

What happened after the naloxone was administered most recently? (Select all that apply.)The person started breathing or responding911 was calledEmergency services arrivedThe person went to the hospitalThe person continued being unresponsiveOtherDon’t know or prefer not to say

If other, please tell us what happened

Anything else you’d like us to know? (Optional)

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Just in Case Oregon

Home Request naloxone FAQ & Privacy Privacy policy

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Contact: info@justincaseoregon.org

Media inquiries: Franny.L.White@oha.oregon.gov

This program is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $197,271,577.67 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.