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* 1. At what age should we start talking to people about drug and alcohol use?

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* 2. Are you aware of a drug take-back program in your community?

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* 3. If I have leftover medication, but no longer need it, I am inclined to:

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* 4. If your doctor or dentist has prescribed opioid pain medication to you or a family member, were you provided any warning about the dangers of opioids by that doctor or dentist?

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* 5. If your doctor or dentist has prescribed opioid pain medication to you or a family member, were you provided any warning about the dangers of opioids by the pharmacist who filled your prescription?

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* 6. Do you know of a local family who has been negatively impacted by opioid use?

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* 7. Do you think your community has an opioid problem?

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* 8. Illicit opioids, including illicit prescription medication and drugs like heroin, are readily available in my community.

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* 9. Other drugs, such as cocaine and methamphetamines, are readily available in my community.

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* 10. Use of other drugs, such as alcohol, marijuana, and benzodiazepines, can lead to misuse of opioids, cocaine, or methamphetamines.

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* 11. Addiction is:

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* 12. I believe that law enforcement in my community has enough capacity and that its efforts are effective in limiting substance abuse.

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* 13. I have an addiction treatment program in my community.

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* 14. I would know where to turn to for addiction help for myself, a family member or friend.

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* 15. My community has effective programs in place, such as counseling and transition living services, to support people in recovery for substance use disorder.

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* 16. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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