What time was the overdose?
What drug(s) were used?
Did the drug look, taste, smell, or feel different than usual? Can you tell us what the drug/flap/baggie looked like?
What happened to the person?
How was the drug used?
What city or town was the drug bought in?
What neighbourhood was the drug bought in?
If naloxone (Narcan) was given, how many doses were used?
Was 9-1-1 called?
Did the person get medical help?
Did the person go to a hospital?
You can add a photo of the drug, flap, or baggie here.

Allowed file type(s):
Any other comments?
Contact information (optional):
If you are staff from an organization, please leave the name of your organization, phone number, or email for follow up.
Are you reporting bad dope or just testing this form?