Share Your Story

Please share how you prevented an overdose using Naloxone provided by Naloxone Texas:

We want to hear from you! Naloxone saves lives, and your experiences help us understand how it's used in real-world situations and how we can improve access, training, and support across Texas.

Your responses are completely confidential. No personal information is collected unless you choose to share it, and all data is used in aggregate for research, education, and public health.

Together, we can strengthen our response to overdoses and save more lives.

Need more naloxone? You can order free naloxone for yourself, your organization, or your community through NaloxoneTexas.com

Which statement best describes your role or experience related to this naloxone use?

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I used naloxone on someone

Naloxone was used on me

I was a bystander or was told about the use of naloxone

I represent an organization and want to report multiple instances where naloxone was used

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Organization name:

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Organization address:

What is the estimated age of the person the naloxone was used on?

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Gender of the person naloxone was used on:

Year the naloxone was used:

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Month the naloxone was used (if known):

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Zip code where the naloxone was used:

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Where did the naloxone come from?

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Which hub?

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If other, please explain:

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What type of naloxone was used?

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What brand of naloxone was used?

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If other, please describe:

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Did the person survive the overdose event?

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Please share any additional details about the overdose event or circumstances surrounding it. Your responses are confidential:

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To the best of your abilities please provide information on the use of naloxone and outcomes for your organization:

Reporting Month

Reporting Year

Age of individual who received naloxone	Under 18	18-25	26-34	35-44	45-54	55-64	65+	Unknown
Total #:

Gender	Male	Female	Other	Prefer not to say
Total #:

Type	Intermuscular Injection	Nasal Spray	Unknown
Total #:

Event Survival	Yes	No	Unknown
Total #:

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