The following questions are also required for program enrollment
The next few questions are about drugs and drug use
As a reminder this form is secure, your information will be kept confidential.
The following questions are about opioid overdose
One of the most important things we do is look for ways to reach more people with injection supplies and naloxone-- we are looking to partner with people in the community who can help distribute naloxone to keep others safe.
Thank you for filling out this enrollment form. Text the handle you created above to 917-828-0293, email it to firstname.lastname@example.org, or message /u/nextdistro on Reddit. We'll respond about getting you supplies within 24 hours.