Thank you for completing this survey.  All responses are confidential and will be seen only by the evaluator.  Please answer as honestly as you can.  Your answers will help to develop a plan for addressing opioid use disorder in Cherokee County!  Contact the evaluator at dsscott@sageways.com with any questions.

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* 1. What town in Cherokee County, Oklahoma do you live in?

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* 2. How long have you lived in your community?

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* 3. How satisfied are you with living in your community?

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* 4. What do you like least about living in your community?

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* 5. What do you like most about living in your community?

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* 6. What would you say is the most critical issue facing your community?

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* 7. In your opinion, do you think your community has a problem with opioid use disorder?

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* 8. If yes, please say why you think this is so.

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* 9. If yes, what conditions in your community do you think contribute to opioid use disorder?

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* 10. If no, what are the conditions in your community that may protect against opioid use disorder?

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* 11. Do you have family members or friends who are struggling with opioid use disorder?

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* 12. Do you have family members or friends who have tried to get treatment for opioid use disorder but could not get the care they needed?

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* 13. If yes, how many friends/relatives have tried to get treatment for opioid use disorder.

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* 14. What kept them from getting the help they needed?

Please say what your experiences have been with opioids or similar drugs.

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* 15. How old were you the first time you took a prescription for pain medication that was not your own for the feeling it caused? (Suchas Oxycodon, Hydrocordon, Darvocet, Darvon, Tylenol with Codeine, Percoset, Percodan, Tylex, Vicodin, Lortab, Lorcet or any other pain reliever).  If you never did this please say "Never".

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* 16. How many times during the past 30 days have you taken medications that were not prescribe for you in order to get high?

What do you think is the level of risk for the following behaviors?

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* 17. How much do people risk harming themselves physically and in other ways when they smoke heroin once or twice?

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* 18. How risky or harmful do you think it is to take pain medicine that is not prescribed for you?

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* 19. How risky is it to keep unused pain medicine in the household just in case someone man need a pain medicine?

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* 20. Do you have a supply of pain medication in your house right now "just in case"?

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* 21. When a doctor writes you a prescription for pain medication, do you typically ask if it contains opioids?

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* 22. Have you ever heard of Syboxone?

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* 23. Have you ever heard of Narcan?

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* 24. If yes, do you know how to administer Narcan?

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* 25. Do you know how long it takes for someone to get addicted to opioids?

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* 26. Do you know that it is illegal and a felony to share your prescription narcotic pain medicine with anyone else?

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* 27. How difficult or easy would it be for you to get heroin if you wanted it?

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* 28. How difficult or easy would it be for you to get pain medicine if you wanted to?

Just a few more questions about you.

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* 29. What is the best way to notify your community about public meetings?

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* 30. What is your gender?

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* 31. What is your age?

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* 32. Does your household struggle to meet the expenses of daily living?

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* 33. Has anyone in your family been treated for any of the following?  Check all that apply.

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* 34. Use this space to let us know any other thoughts or comments about opioid use disorder.

Thank you for completing this survey!

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