Prescription Painkiller Survey Please note that this is a confidential survey. Please answer honestly as we are trying to get a real idea of how prescription painkillers are possibly affecting the lives of our readers. We will NOT share ANY information with outside sources. Question Title * 1. Have you ever tried a painkiller not prescribed to you? Yes No Question Title * 2. If yes, why? I was under a lot of stress Peer pressure I had low self-esteem / a desire to fit in I was curious what it would be like Other (please specify) Question Title * 3. Do you feel prescription painkiller abuse is common among girls your age? Yes No I’m not really sure Question Title * 4. If you’ve ever taken a painkiller not prescribed to you, how old were you when you first tried it? Never taken a painkiller? Please jump to question 21. 9 or younger 10 11 12 13 14 15 16 17 18 19 or older Question Title * 5. What painkillers have you tried? Check all that may apply. Vicodin OxyContin Percocet Other (please specify) Question Title * 6. How often do you take painkillers not prescribed to you? Daily Almost daily A couple times a week Only once in a while Other (please specify) Question Title * 7. How do you usually get these painkillers? Check all that may apply. I take them from the medicine cabinet at home I grab them from another family member’s medicine cabinet I get them from someone at school I usually find them at a party I get them from my friends Other (please specify) Question Title * 8. What kind of environment do you usually take painkillers not prescribed to you? Check all that may apply. At a party At a gathering with a group of friends When I’m with one or two friends Alone Other (please specify) Question Title * 9. Why do you take painkillers in this type of setting? Please explain. Question Title * 10. Please describe how prescription painkillers make you feel. Question Title * 11. Do you have any health concerns about taking painkillers not prescribed to you? Please explain what they are and why. Question Title * 12. Have you ever been caught with painkillers not prescribed to you? Yes No Question Title * 13. If yes, who caught you? Check all that may apply. Parents Sibling Friend who didn’t know you were taking them Teacher Coach Law enforcement officer Other (please specify) Question Title * 14. How did you feel when you got caught? Please explain. Question Title * 15. Have you ever been in rehab for prescription painkiller abuse? Yes No Question Title * 16. Have you tried any other drugs besides prescription painkillers? Check all that may apply. Heroine Cocaine Marijuana LSD Ecstasy Other prescription medication I’ve only tried prescription painkillers Other (please specify) Question Title * 17. Have you ever mixed prescription painkillers with other drugs or alcohol? Yes No Question Title * 18. If yes, what kind of drugs or alcohol did you mix it with? Please explain. Question Title * 19. Have you ever stolen anything because of painkillers? Yes No Question Title * 20. If yes, what? Please explain. Question Title * 21. Do you think it’s easy for someone to become addicted to prescription painkillers? Yes No Question Title * 22. Why / why not? Question Title * 23. Do you think taking a painkiller not prescribed to you is dangerous? Yes No Question Title * 24. Why / why not? Question Title * 25. Do you think it’s easier to get painkillers than other sorts of drugs? Yes No I'm not really sure Question Title * 26. If yes, why? Question Title * 27. Do you think it’s safer to take painkillers than other types of drugs? Yes No I'm not really sure Question Title * 28. Why / why not? Question Title * 29. Have you ever been prescribed a painkiller by a doctor for a medical reason (ie a broken bone, tooth extraction)? Yes No Question Title * 30. If yes, what did you do with any leftover painkillers? I threw them out I flushed them down the toilet I gave them to a friend My parents took them and locked them away I still have them Other (please specify) Question Title * 31. Has anyone ever approached you about selling your prescription painkillers to them? Yes No Question Title * 32. Has anyone ever approached you about buying painkillers from them? Yes No Question Title * 33. If yes, where were you? Question Title * 34. Do you know someone who is abusing prescription painkillers? Yes, I know for a fact No, definitely not I think so, but I’m not sure I don’t personally know someone, but have heard of people abusing them Question Title * 35. If yes, who? Please select all that may apply. My friend A sibling My boyfriend A classmate Other (please specify) Question Title * 36. If you do know someone who might be abusing prescription painkillers, how does that make you feel? Please explain. Question Title * 37. Has a friendship or relationship of yours ever been affected by someone who might be abusing prescription painkillers? Yes No Question Title * 38. If yes, please explain how it affected you. Question Title * 39. Have you ever hung out with someone when they were high off painkillers? Yes No I'm not really sure Question Title * 40. If yes, what was that experience like? Please explain. Question Title * 41. Please tell us why you choose to NOT take painkillers that aren’t prescribed to you. Check all that may apply. It’s illegal, I don’t want to risk my future I heard there are really bad side effects. I don’t want to risk my life It’s not my thing, I don’t need drugs in my life It scares me, I know people or have heard of people who have gotten really messed up because of them I just never had the opportunity Other (please specify) Question Title * 42. How can girls out there help a friend whom they think might be abusing prescription painkillers? Question Title * 43. What’s your first name and last initial? Note: We are changing all names for this story, so your answers will remain anonymous. Question Title * 44. What's your age? 9 or younger 10 11 12 13 14 15 16 17 18 19 or older Done