Today Y-M-D
Is this form being completed by Overdose Prevention & Response Staff?
Yes
No
Do you need for resources for ....?
Are you looking for resources for ....?
Yourself, a friend, or family member? A workplace, agency, or community group? Yourself, a friend, or family member?
A workplace, agency, or community group?
Free Nasal Naloxone: Naloxone (also known as "Narcan") is an opioid blocker that can reverse opioid overdose within minutes. You do not need a prescription to receive naloxone.
If you HAVE health insurance, please request naloxone at your local pharmacy. Many insurance carriers cover the full cost.
If you DO NOT have insurance or have other barriers, click here to order a free kit through the mail from the Peoples Harm Reduction Alliance.
Fentanyl Test Strips Fentanyl test strips can detect the presence of fentanyl in urine or in a diluted drug sample.
You can pick-up fentanyl test strips from vending machines at the following locations:
Fentanyl test strips can also be mailed to King County addresses, though it may take up to 2 weeks for delivery.
Would you like to receive 5 fentanyl test strips via mail? (This service is only available to King County residents. Please allow up to 2 weeks for delivery.)
Yes No
Paid Research Opportunity Public Health - Seattle & King County is conducting a study about drug use behaviors to inform its overdose prevention programs. People who complete a 60-minute, confidential interview are given a $45 gift card. To learn more about the study go to KingCounty.gov/GetHeard
Training or Outreach Would you like to request training or other community education/outreach?
Training or Community Outreach Would you like to request training or other community education/outreach?
Yes No Supplies
After you select "Submit" at the bottom of the page, you will be asked additional questions about the training/outreach request.
To help route your request to the right team, please indicate the types of supplies needed:
For Workplace: Posters Nasal naloxone For Distribution: Postcards Fentanyl test strips
Nasal Naloxone Naloxone (also known as "Narcan") is an opioid blocker that can reverse opioid overdose within minutes.
If your workplace needs nasal naloxone kits to ensure that employees/volunteers are equipped to respond to overdoses that occur at worksite, go to the DCHS Naloxone Portal .
Naloxone Naloxone (also known as "Narcan") is an opioid blocker that can reverse opioid overdose within minutes.
Would you like to request naloxone for your agency?
Would you like to request naloxone for your agency?
Yes No
Thanks for your interest in naloxone! Please complete the remainder of this form and click "SUBMIT" at the bottom of the page. Then you will be prompted to enter your contact information. Within 1-2 business day, you will receive an email to set up a time to discuss your naloxone request with our team.
Fentanyl Test Strips Fentanyl test strips can detect the presence of fentanyl in urine or in a diluted drug sample.
How many fentanyl test strips would your agency like to receive in order to distribute to clients?
Print Materials Posters (11X17) - Click on image to download PDF # needed in English:
# needed in English:
# needed in Spanish:
# needed in English:
# needed in Spanish:
# needed in English:
# needed in English:
To order copies of this handout go to the ADAI Clearinghouse .
# needed in English:
To print copies of this handout go to StopOverdose.org
Stickers (approximately 3X2)
# needed in English:
# needed in Spanish:
# needed in English:
# needed in Spanish:
# needed in Eng lish:
# needed in Spanish:
Postcards (approximately 4 X 6)
# needed in English:
# needed in Spanish:
# needed (English one side, Spanish one side):
Does something need to be mailed to fulfill this request?
View equation
"Fentanyl is Killing King County Residents" Poster
Number of ""Fentanyl is Killing King County Residents" posters in English requested:
Number of "Fentanyl is Killing King County Residents" posters in Spanish requested:
! Next steps ! Click the "SUBMIT " button. If you see black space, then scroll up to the top of the page.
Fentanyl Test Strips Fentanyl test strips can detect the presence of fentanyl in urine or in a diluted drug sample.
How many fentanyl test strips would your agency like to receive in order to distribute to clients?
0 50 100 200 Other (specify # requested below)
Please request what you need for 1-2 months.
Please enter the number of strips your agency would like to order.
The amount you receive may be less than requested based on supply and community need.
Calculated field - # of fts ordered
View equation Injectable Naloxone for Distribution Naloxone (also known as "Narcan") is an opioid blocker that can reverse opioid overdose within minutes.
Agencies wishing to distribute injectable naloxone to persons at risk for overdose can order up to 50 intramuscular (IM) naloxone kits per month from the Hepatitis Education Project .
How many injectable naloxone kits would your agency like to receive in order to distribute to clients?
* must provide value
50
100
150
200
Other
Please limit to amount your agency can distribute within 1-2 months.
Please enter the number of injectable naloxone your agency would like to order. If greater than 200, please explain your distribution plans.
* must provide value
Number of "Signs of Overdose" posters in English requested:
Number of ""White Powder" posters in English requested:
Number of "Narcan Saves Lives" posters in English requested:
Number of "Narcan Saves Lives" posters in Spanish requested:
Number of "Don't be Faked Out" posters in English requested:
Number of "Don't be Faked Out" posters in Spanish requested:
Number of Xylazine posters in English requested:
Number of "The Risk is Real" posters in English requested:
Number of "Step Up Against Fentanyl" posters in English requested:
Number of "Fentanyl Informationl" posters in English requested:
Number of Fentanyl Takes Lives posters in English
Sticker 1: Number of "Never Use Alone" stickers requested
Sticker 2: Number of "Laced & Lethal" stickers requested
Sticker 3: Number of "I Carry Naloxone" stickers requested
Youth Sticker 1: Number of "Friends Don't Let Friends Use Alone" stickers requested:
Youth Sticker 2: Number of "I Carry Naloxone" stickers requested:
Youth Sticker 3: Number of "Laced & Lethal" stickers requested:
# of L&L I carry naloxone sticker - English
# of L&L I carry naloxone sticker - Spanish
# of L&L Never Use Alone - English
# of L&L Never Use Alone - Spanish
# of L&L Naloxone Saves - English
# of L&L Naloxone Saves - Spanish
Number of postcards in English requested:
Number of postcards in Spanish requested:
Number of postcards in English requested:
Number of postcards in Spanish requested:
Number of postcards in English requested (Narcan Saves Lives/Never Let Someone Sleep it Off):
Number of postcards in Spanish requested (Narcan Saves Lives/Never Let Someone Sleep it Off):
# of bup hotline postcards (English front, Spanish back)
Handout 1: Number of handouts in English requested:
Handout 2: Number of handouts in English requested: