Today M-D-Y
What type of naloxone distribution was conducted?
* must provide value
Individual
Business/Organization
NaloxBox/Vending Machine
Individual
Business/Organization
NaloxBox/Vending Machine
If you don't think your activity fits into any of these categories, please contact Anita Jacobson at anitaj@uri.edu
Agency
* must provide value
ADCARE Rhode Island Addiction Recovery Institute AdvanceBox Agape Church Alert Healthcare Allies in Recovery Amos House Anchor of Hope Foundation Anchor Outreach (MORE) APRI Behavioral Health Group BHDDH BHLink Blackstone Valley Community Health Care Blackstone valley Prevention Coalition Block Island Health Services Bridgemark Addiction Recovery Services Bristol Police Department Brown School of Public Health Building Futures RI Burrillville Prevention Action Coalition Center for Health and Justice Transformation Central Falls City Hall Central Falls Office on Health Charlestown Ambulance-Rescue Service Child & Family Clinic Esperanza CODAC CODAC ACI CODAC Health Home Nursing CODAC Pawtucket Community Care Alliance: Harbour Youth Ctr. Community Care Alliance Shelter Community Care Alliance: Safe Haven Community Care Alliance: Serenity Center Community Care Alliance: Wilson House Community Health Care Continuum Community Support Program Comprehensive Community Action Program (CCAP) COYOTE RI Crossroads Department of Children Youth and Family Services (DCYF) Department of Corrections East Bay Community Action Program East Bay Recovery Center East Bay Regional Coalition Executive Office of Health and Human Services Faith and Hope Ministry Family Service of RI Full Send to Recovery Galilee Mission Gateway Healthcare: Eastman House Gateway Healthcare: Johnston Gateway Healthcare: Pawtucket Gateway Healthcare: South County Health and Wellbeing HOPE Initiative House of Hope CDC John Brown Mutual Aid Justice Assistance Kent County Prevention Coalition Lake Mishnock Fire Lifespan Recovery Center/ RI Hospital LISC Marigold Health NAMI Block Island Narragansett Fire Narragansett Indian Health Services Needle Exchange- ENCORE Newport County Prevention Coalition Newport Mental Health Newport Mental Health/ RIO NK School Dept. Office of Family Learning OneCranston HEZ Open Doors Open Door Health Pawtucket Police Department Pawtucket Housing Authority Pawtucket Prevention Coalition Phoenix House New England PONI Prime Healthcare, Landmark Project Weber/RENEW Providence College Friars Providence Gay Flag Football League Providence Regional Coalition Providence CTC PSNRI Ray of Hope RAPHA.RI Recovery Friendly Workplace REST Rhode Island Free Clinic Rhode Island Hospital Inpatient RICARES RI College RIDOH Drug Overdose Prevention Program RIDOH First Responder Leave Behind RI DLT Worker's Compensation Unit- Arrigan Rehabilitation Center RI User's Union Scituate Health Alliance Smithfield Fire Department Sojourner House South County Health Equity Zone South County Prevention Coalition South Kingstown Community Resource South Providence Library Southern Providence County Regional Coalition Strategic Prevention Partnerships SUMHLC, Leadership Council Systems Change Strategies The Inner You Counseling Center The Journey to Hope, Health & Healing The Milagros Project The Providence Center: General The Providence Center: MRTR The Providence Center: WRTR Thrive Behavioral Health Thrive Housing First Thundermist Health Center of South County Thundermist Health Center of West Warwick Thundermist Health Center of Woonsocket Transitions/Recovery Clinic Trash City Medic Collective University of Rhode Island URI Emergency Medical Services U.S. Attorney's Office/ LE Vibco VICTA Vida Church WellOne Primary Medical & Dental Care Westerly Prevention and Wellness Partnership West Warwick Health Equity Zone Wide Awake Collectives Wood River Health Woonsocket CTC Woonsocket Prevention Coalition Woonsocket Health Equity Zone
If your organization is not listed, please contact Catherine Ahern at Catherine.Ahern@uri.edu
Business or Organization Name
Nalox Box/Vending Machine Street Address
City or Town of Distribution
* must provide value
Barrington Bristol Burrillville Central Falls Charlestown Coventry Cranston Cumberland East Greenwich East Providence Exeter Foster Glocester Hopkinton Jamestown Johnston Lincoln Little Compton Middletown Narragansett New Shoreham Newport North Kingstown North Providence North Smithfield Pawtucket Portsmouth Providence Richmond Scituate Smithfield South Kingstown Tiverton Warren Warwick West Greenwich West Warwick Westerly Woonsocket Massachusetts Connecticut Unknown Other, outside RI, MA, & CT
Distribution Zip Code- Barrington
* must provide value
02806 02915
Distribution Zip Code- Bristol
* must provide value
02809
Distribution Zip Code- Burrillville
* must provide value
02826 02830 02839 02858 02859
Distribution Zip Code- Central Falls
* must provide value
02863
Distribution Zip Code- Charlestown
* must provide value
02812 02836 02875 02813
Distribution Zip Code - Coventry
* must provide value
02816 02827
Distribution Zip Code- Cranston
* must provide value
02831 02888 02905 02907 02910 02920 02921 02823
Distribution Zip Code- Cumberland
* must provide value
02864
Distribution Zip Code- East Greenwich
* must provide value
02816 02818 02893
Distribution Zip Code- East Providence
* must provide value
02861 02903 02905 02906 02914 02915 02916
Distribution Zip Code- Exeter
* must provide value
02817 02818 02822 02852 02874 02892
Distribution Zip Code- Foster
* must provide value
02814 02815 02825 02827 02857
Distribution Zip Code- Glocester
* must provide value
02814 02829 02839 02857 02859
Distribution Zip Code- Hopkinton
* must provide value
02804 02808 02813 02822 02832 02833 02873 02891 02894 02898
Distribution Zip Code- Jamestown
* must provide value
02835
Distribution Zip Code- Johnston
* must provide value
02828 02857 02909 02911 02919 02920 02921
Distribution Zip Code- Lincoln
* must provide value
02802 02837 02838 02860 02863 02864 02865 02896 02904 02917
Distribution Zip Code- Little Compton
* must provide value
02801 02837 02878
Distribution Zip Code- Middletown
* must provide value
02842 02871
Distribution Zip Code- Narragansett
* must provide value
02882
Distribution Zip Code- New Shoreham
* must provide value
02807
Distribution Zip Code- Newport
* must provide value
02840 02841 02842
Distribution Zip Code- North Kingstown
* must provide value
02852 02854 02874 02877
Distribution Zip Code- North Providence
* must provide value
02904 02908 02911
Distribution Zip Code- North Smithfield
* must provide value
02824 02876 02896
Distribution Zip Code- Pawtucket
* must provide value
02860 02861 02862
Distribution Zip Code- Portsmouth
* must provide value
02871 02872
Distribution Zip Code- Providence
* must provide value
02901 02902 02903 02904 02905 02906 02907 02908 02909 02910 02912 02918
Distribution Zip Code- Richmond
* must provide value
02812 02822 02836 02875 02892 02894 02898
Distribution Zip Code- Scituate
* must provide value
02815 02823 02831 02857
Distribution Zip Code- Smithfield
* must provide value
02828 02830 02917
Distribution Zip Code- South Kingstown
* must provide value
02874 02879 02880 02881 02882 02883 02892
Distribution Zip Code- Tiverton
* must provide value
02878
Distribution Zip Code- Warren
* must provide value
02809 02885
Distribution Zip Code- Warwick
* must provide value
02886 02887 02888 02889
Distribution Zip Code- West Greenwich
* must provide value
02808 02817
Distribution Zip Code- West Warwick
* must provide value
02886 02893
Distribution Zip Code- Westerly
* must provide value
02808 02891
Distribution Zip Code- Woonsocket
* must provide value
02895
Distribution Zip Code- OOS/Unknown/Other
* must provide value
Note: If unknown zip, enter 99999
Recipient City or Town
* must provide value
Barrington Bristol Burrillville Central Falls Charlestown Coventry Cranston Cumberland East Greenwich East Providence Exeter Foster Glocester Hopkinton Jamestown Johnston Lincoln Little Compton Middletown Narragansett New Shoreham Newport North Kingstown North Providence North Smithfield Pawtucket Portsmouth Providence Richmond Scituate Smithfield South Kingstown Tiverton Warren Warwick West Greenwich West Warwick Westerly Woonsocket Massachusetts Connecticut Unknown Other, outside RI, MA, & CT Unhoused/ Transient
Recipient Zip Code- Barrington
* must provide value
02806 02915
Recipient Zip Code- Bristol
* must provide value
02809
Recipient Zip Code- Burrillville
* must provide value
02826 02830 02839 02858 02859
Recipient Zip Code- Central Falls
* must provide value
02863
Recipient Zip Code- Charlestown
* must provide value
02812 02836 02875 02813
Recipient Zip Code - Coventry
* must provide value
02816 02827
Recipient Zip Code- Cranston
* must provide value
02831 02888 02905 02907 02910 02920 02921 02823
Recipient Zip Code- Cumberland
* must provide value
02864
Recipient Zip Code- East Greenwich
* must provide value
02816 02818 02893
Recipient Zip Code- East Providence
* must provide value
02861 02903 02905 02906 02914 02915 02916
Recipient Zip Code- Exeter
* must provide value
02817 02818 02822 02852 02874 02892
Recipient Zip Code- Foster
* must provide value
02814 02815 02825 02827 02857
Recipient Zip Code- Glocester
* must provide value
02814 02829 02839 02857 02859
Recipient Zip Code- Hopkinton
* must provide value
02804 02808 02813 02822 02832 02833 02873 02891 02894 02898
Recipient Zip Code- Johnston
* must provide value
02828 02857 02909 02911 02919 02920 02921
Recipient Zip Code- Jamestown
* must provide value
02835
Recipient Zip Code- Lincoln
* must provide value
02802 02837 02838 02860 02863 02864 02865 02896 02904 02917
Recipient Zip Code- Little Compton
* must provide value
02801 02837 02878
Recipient Zip Code- Middletown
* must provide value
02842 02871
Recipient Zip Code- Narragansett
* must provide value
02882
Recipient Zip Code- Newport
* must provide value
02840 02841 02842
Recipient Zip Code- New Shoreham
* must provide value
02807
Recipient Zip Code- North Kingstown
* must provide value
02852 02854 02874 02877
Recipient Zip Code- North Providence
* must provide value
02904 02908 02911
Recipient Zip Code- North Smithfield
* must provide value
02824 02876 02896
Recipient Zip Code- Pawtucket
* must provide value
02860 02861 02862
Recipient Zip Code- Portsmouth
* must provide value
02871 02872
Recipient Zip Code- Providence
* must provide value
02901 02902 02903 02904 02905 02906 02907 02908 02909 02910 02912 02918
Recipient Zip Code- Richmond
* must provide value
02812 02822 02836 02875 02892 02894 02898
Recipient Zip Code- Scituate
* must provide value
02815 02823 02831 02857
Recipient Zip Code- Smithfield
* must provide value
02828 02830 02917
Recipient Zip Code- South Kingstown
* must provide value
02874 02879 02880 02881 02882 02883 02892
Recipient Zip Code- Tiverton
* must provide value
02878
Recipient Zip Code- Warren
* must provide value
02809 02885
Recipient Zip Code- Warwick
* must provide value
02886 02887 02888 02889
Recipient Zip Code- West Greenwich
* must provide value
02808 02817
Recipient Zip Code- West Warwick
* must provide value
02886 02893
Recipient Zip Code- Westerly
* must provide value
02808 02891
Recipient Zip Code- Woonsocket
* must provide value
02895
Recipient Zip Code- Unhoused/Transient
* must provide value
99999
Recipient Zip Code- OOS/Unknown/Other
* must provide value
Note: If unknown zip, enter 99999
Recipient Ethnicity
* must provide value
Hispanic Non-Hispanic Unknown
Recipient Race
* must provide value
Select all that apply
Recipient Race
* must provide value
Select all that apply
If Other, Please Specify
* must provide value
If Other, Please Specify
* must provide value
Recipient Age
* must provide value
Under 18 18-24 25-34 35-44 45-54 55-64 65 or Above Unknown
Recipient Gender
* must provide value
Select all that apply
Month Naloxone Was Distributed
* must provide value
1-12
Year Naloxone Was Distributed
* must provide value
Type of Naloxone Distributed
* must provide value
(Ex: IN00000)
(Ex: IM00000)
Number of Doses Distributed
2-99 (One Narcan nasal spray kit equals two doses)
Number of IN Kits Distributed
* must provide value
1-24 kits
Number of IN Doses Distributed
2-48 (One Narcan nasal spray kit equals two doses)
Number of IM Kits Distributed
* must provide value
1-99
Number of IM Doses Distributed
1-99
Number of Other Doses Distributed
1-99
Number of Other Kits Distributed
* must provide value
1-99
Total Number Doses Distributed
View equation
Total Number Kits Distributed
View equation
What Type of Activity Was This Distribution Related To?
* must provide value
Community Training Fixed site (clinic, hospital, drop-in site) International Overdose Awareness Day Mail order URI Phone Order NaloxBox/Vending Machines Outreach (mobile, street, home)
If other activity, please specify
From What Agency Did You Receive The Naloxone For Distribution?
* must provide value
(i.e. what agency funded your naloxone?)
If Other, Please Specify:
* must provide value
Did The Individual Use Their Last Kit To Respond To An Overdose?
* must provide value
Yes No/Not applicable Unknown
What Type of Naloxone Was Used In The Overdose Situation?
Intramuscular (Naloxone)
Narcan Nasal Spray (pre-assembled, single use)
Other
Unknown
Intramuscular (Naloxone)
Narcan Nasal Spray (pre-assembled, single use)
Other
Unknown
Today M-D-Y If unknown, leave blank
How Many Doses Were Administered?
1 Dose
2 Doses
3 or More Doses
Unknown
1 Dose
2 Doses
3 or More Doses
Unknown
Yes
No
Unknown
Yes
No
Unknown
If 911 was not called, why not?
If you have any questions related to completing this survey, would like to submit changes to this or a previous survey, or have a data request, please fill out this short form . For urgent data-related questions, please contact Kristen St. John at Kristen.Stjohn@health.ri.gov . If you would like more information about obtaining and distributing naloxone, please contact Catherine Ahern at Catherine.Ahern@uri.edu.
Clicking "Submit" will submit your form and redirect you to a new distribution form.