Report Naloxone Use – York Opioid

Report Naloxone Use

Submit A Report

If you’ve responded to an opioid overdose utilizing naloxone provided to you through the OPAL program or an affiliate organization, please fill out this naloxone administration form. This is not required, however your responses will help illustrate the importance of naloxone availability and distribution to the community and overall need. At the end of this report, you will have the option to request another OPAL kit.
Name is not required to complete the reporting form.
If you responded to more than one overdose (more than one person), please fill out one form for each occurrence.

Naloxone Report Form