Community Research Survey

Since 2017, the state of NH has seen a slight decrease in drug-related deaths. While a promising trend, local communities continue to suffer from the impact of opioid misuse. Heroin and Fentanyl are two drugs often blamed for the opioid crisis. In addition, the misuse of doctor prescribed pain relievers such as Percocet, OxyContin, Vicodin, Morphine, Codeine, and Methadone remains a concern. The emergence of the powerful Carfentanil is also of grave concern. This confidential survey is part of a larger effort to guide our communities on the path to saving lives. Thank you for sharing your thoughts on this important issue.

If you would like more information or would like to get involved in moving your community along the right path, please call or email Tara Graham, CNHCOR Program Coordinator at 603.238.3532 or tgraham@midstatehealth.org.

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* 1. Please select your age.

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* 2. Please select your educational level.

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* 3. What town do you currently reside in?

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* 4. How did you hear about this survey?

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* 5. Have you ever misused heroin, fentanyl, or another opioid? This includes taking prescription opioids in a manner in which they were not prescribed.

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* 6. Which form of opioid have you misused, if any?  (Examples:  Heroin, Fentanyl, Carfentanil, Percocet, OxyContin, Vicodin, Morphine, Codeine, Methadone, Suboxone, etc.)

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* 7. If you have misused any form(s) of opioids, were any of them in combination with another drug?  If so, which one(s)?

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* 8. Do you know someone that has misused heroin, fentanyl, or another opioid? This includes taking prescription opioid in a manner in which they were not prescribed.

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* 9. If you answered yes to the prior question, which form of opioid did they misuse?

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* 10. How do you know they have misused opioids and what is your relationship to this person?

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* 11. Due to the opioid crisis, are you raising your grandchild or other relative? (or have you in the past?)

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* 12. Do you know someone that is raising their grandchild or other relative due to the opioid crisis?

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* 13. Please select the best response, by checking one of the boxes:

  Strongly Disagree Disagree Neutral Agree Strongly Agree
There is a significant substance misuse problem in my community.
I would know where to get help (treatment/recovery services) if I or someone I knew had an opioid misuse issue.
I know where to get additional information about opioid misuse.
My doctor has discussed the risk of addiction of opioids with me.
I think there is a stigma/negative attitudes in the community around opioid misuse.
Town and/or campus police know how to handle overdoses.
Firefighters and paramedics know how to handle overdoses.
If I call the authorities about an overdose, I may get in trouble.
It is easy to get opioids in the community.
It is easy to get opioids from a medical provider.

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* 14. In your opinion, please rate how the following substances are negatively impacting your community:

  Unsure No Impact Minimal Impact Some Impact Strong Impact
Prescription Opioids (Percocet, OxyContin, Vicodin, Morphine, Codeine, Methadone)
Heroin
Synthetic Opioids (Fentanyl, Carfentanil)
Cocaine (Coke, Crack)
Methamphetamine (Crystal Meth, Speed)
Marijuana (Weed, Pot)
Alcohol (Beer or Hard Liquors)
Benzodiazepines (Ativan, Xanax, Valium, Klonopin, etc.) 

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* 15. Do you have regular access to the internet?

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* 16. If you do not have regular access to the internet, why not?

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* 17. Where do you get your health or wellness information? (Check all that apply)

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* 18. What annual community events do you attend? (Check all that apply)

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* 19. Is there another way you wish you could get your information, if it was available?

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* 20. Is there anything else you feel is important for us to know, or something you feel we should have asked on this survey, but didn’t?

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