Rural Opioid Response Community Needs Assessment

Question Title

* 1. What is your age?

Under 18

18-29

30-39

40-49

50-59

60-69

70 or older

Question Title

* 2. What is your gender?

Female

Male

Other (please specify)

Question Title

* 3. What race and/or ethnicity best describes you? (Check all that apply.)

Native American

Asian

Native Hawaiian/Pacific Islander

Black/ African American

Hispanic/ Latino

White/ Caucasian

Question Title

* 4. What is your highest level of education?

Less than high school

Some high school

High school diploma/GED

Some college

Associate's Degree

Bachelor's Degree

Master's Degree

Doctorate Degree

Question Title

* 5. What community do you live in?

Timber Cove/Cazadero

Stewarts Point

Sea Ranch

Gualala

Point Arena

Manchester

Irish Beach

Question Title

* 6. What is your family size?

2-3

4-6

Question Title

* 7. What is your family's annual income?

$24,000 or less

$24,001 - $45,000

$45,001 - $65,000

$65,001 - $85,000

$85,001 - $100,000

$100,001 or more

Question Title

* 8. Do you think substance use is a serious problem in your community (this includes alcohol, various street drugs and prescription drugs)?

Yes

Question Title

* 9. What substances do you feel are the most worrisome in your community? Check your top two answers.

Alcohol

Cocaine

Marijuana

Methamphetamines

Prescription Opioids (Oxycontin, Vicodin, Norco, ect.)

Heroin

Tobacco

Vaping

Question Title

* 10. What barriers do you believe people face in trying to get help with opioid or substance use? Choose your top two answers.

Availability of Addiction treatment services

Availability of Mental Health Services

Childcare

Cost of treatment

No health insurance

Location of services/distance from home

Transportation to services

Stigma (too embarrassed or ashamed to ask for help)

Fear

Not ready to receive help

Availability of support services for achieving sobriety and getting life back on track (housing, care coordination, support groups, etc.)

Question Title

* 11. Which of the following services do you feel would be useful in your community? Check your top three choices.

Easily accessible prescription and drug disposal sites/ locked boxes throughout the community

Needle or sharps disposal sites/locked boxes throughout the community

Medicated Assisted Treatment for opioid addiction

Addiction treatment for substance use disorder

Free health screenings for infectious diseases (for example, HIV, Hepatitis)

Narcan distribution (life-saving overdose reversal medication for all forms of opioids

Free prescription lock bags

Kits to dissolve and deactivate unused medications at home

Treatment for infectious diseases (e.g. HIV, Hepatitis)

Free education forums/workshops (prevention information, healthy lifestyle changes, affects of substance use, infectious diseases, etc.)

Question Title

* 12. Are you currently dependent on opioids or other substances?

Yes (If yes, continue to Question #13)

No (If no, skip to Question #15)