MAIN SURVEY
Subsection Start - Knowledge
[OpioidConcern]
- Show to all.
M26_OpioidConcern. When taking opioids, how concerned were you about overdosing?
Select one response.
DEFAULT ORDER.
1. Not at all concerned 2. Not very concerned 3. Somewhat concerned 4. Very concerned 5. Extremely concerned [PersonalRisk]
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M54_PersonalRisk. When taking opioids, what did you think your risk was for overdosing?
Select one response.
DEFAULT ORDER.
1. High risk 2. Moderate risk 3. Slight risk 4. No risk
[SomeoneElseRisk]
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M55_SomeoneElseRisk. When taking opioids, how much of a risk did you think someone else in your household may have had for overdosing from your opioids?
Select one response.
DEFAULT ORDER.
1. High risk 2. Moderate risk 3. Slight risk 4. No risk
5. I had no other household members besides myself
[ODAware]
- Show to all.
M1_ODAware. Do you know any of the signs or symptoms of someone overdosing from an opioid?
Select one response.
DEFAULT ORDER.
1. Yes 2. No
3. Don't know / Unsure
[ODSigns]
- Show if respondent selected any codes [Yes, DontKnow] at M1_ODAware.
M2_ODSigns. Which of the following are the signs or symptoms of an opioid overdose?
Select all that apply.
RANDOMIZE LIST.
1. Unresponsiveness/loss of consciousness 2. Unusual sleepiness
3. Shortness of breath/slow breathing 4. Pinpoint/small pupils
5. Confusion
6. Blue skin color and dark-colored lips in normally light skinned people
7. Gray or ashen skin color in normally darker skinned people
8. Slow, erratic or undetectable heartbeat 9. Inability to speak
10. Choking or snore-like gurgling sounds 11. Fever
12. Sharp pain
13. Other (specify)__________ ANCHOR.
[StopOD]
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M57_StopOD. Which of the following, if any, are ways to reverse or stop an opioid overdose?
Select all that apply.
RANDOMIZE LIST.
1. Using a drug
2. Trying to get the person to vomit 3. Waking the person up
4. Performing CPR
5. Lying the person on their side
6. Other (specify)__________ ANCHOR.
7. Not sure an overdose can be stopped or reversed ANCHOR. EXCLUSIVE.
[NaloxoneUA]
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M3_NaloxoneUA. What product or drug name comes to your mind when you think of reversing the effects of an opioid overdose? (Do not worry about spelling, please just list any that you can think of.)
If you cannot think of anything please select "I am not aware of any drugs or products for reversing an opioid overdose"
Enter your response in the box.
MIN: 4. MAX: 50.
999. I am not aware of any drugs or products for reversing an opioid overdose
[NaloxoneAware]
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M4_NaloxoneAware. You may have already mentioned this, but have you ever heard of naloxone which can be used to reverse an opioid overdose?
Select one response.
DEFAULT ORDER.
1. Yes 2. No
[NaloxoneBrand]
- Show if respondent selected code [Yes] at M4_NaloxoneAware.
M5_NaloxoneBrand. Which of the following brand names or forms of naloxone are you aware of?
Select all that apply.
RANDOMIZE LIST.
1. NARCAN Nasal Spray 2. EVZIO Auto Injector 3. Naloxone Pre-filled Syringe
4. Naloxone Pre-filled Syringe with Nasal Atomizer
5. None of these ANCHOR. EXCLUSIVE.
[NoNaloxoneBrand]
- Show if respondent selected code [No] at M4_NaloxoneAware.
M59_NoNaloxoneBrand. You indicated you have not heard of naloxone. Have you heard of any of the following brand names or forms of naloxone?
Select all that apply.
RANDOMIZE LIST.
1. NARCAN Nasal Spray 2. EVZIO Auto Injector 3. Naloxone Pre-filled Syringe
4. Naloxone Pre-filled Syringe with Nasal Atomizer
5. None of these ANCHOR. EXCLUSIVE.
[DV_INS_Name]
- Hidden Question. Applies to all.
DV_INS_Name. Hidden variable used to hold text insert for DT_NaloxoneName Select one response.
DEFAULT ORDER.
1. , also known as {#NoNaloxoneBrand}. Autocode if respondent selected any codes [NarcanNasalSpray, EvzioAutoInjector, NaloxonePrefilledSyr, NaloxoneAtomizer] at M59_NoNaloxoneBrand.
2. . Autocode if respondent did NOT select codes
[NarcanNasalSpray, EvzioAutoInjector, NaloxonePrefilledSyr, NaloxoneAtomizer] at M59_NoNaloxoneBrand.
[NaloxoneName]
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DT_NaloxoneName. The following questions are about naloxone{#DV_INS_Name}
[NaloxoneKnow]
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M12_NaloxoneKnow. How knowledgeable do you consider yourself to be about naloxone?
Select one response.
DEFAULT ORDER.
1. Not at all knowledgeable 2. Not very knowledgeable 3. Somewhat knowledgeable 4. Very knowledgeable 5. Extremely knowledgeable [DocKnowledge]
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M31_DocKnowledge. How knowledgeable do you consider your healthcare provider and pharmacist to be about naloxone?
Select one response for each.
COLS: DEFAULT ORDER.
Not at all knowledge
Not very knowledge
Somewhat
knowledge Very knowl
Extremely knowledge
2. Your pharmacist 1 2 3 4 5
[NaloxoneOwn]
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M7_NaloxoneOwn. Do you currently have or ever had a dose of naloxone in case of an accidental overdose?
Select one response.
DEFAULT ORDER.
1. Yes 2. No
[NaloxoneBelief]
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M72_NaloxoneBelief. Do you believe you should regularly have naloxone with you?
Select the response that BEST reflects your opinion.
DEFAULT ORDER.
1. Yes, I should carry naloxone on my person regularly 2. Yes, I should keep naloxone in my home regularly 3. No, I do not believe I need to have naloxone available to
myself [NaloxoneKeep]
- Show if respondent selected code [Yes] at M7_NaloxoneOwn.
M11_NaloxoneKeep. Where do/did you keep your dose of naloxone in case it is/was needed?
Select all that apply.
RANDOMIZE LIST.
1. On your person (i.e. in pocket, purse, backpack) 2. In your car
3. In your medicine cabinet 4. On your counter or table 5. Your desk at work
6. Other (specify)__________ ANCHOR.
[NaloxoneGet]
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M73_NaloxoneGet. If someone asked you, or you yourself needed naloxone right now, do you know where to get it?
Select one response.
DEFAULT ORDER.
1. Yes 2. No
[NaloxoneGetOE]
- Show if respondent selected code [Yes] at M73_NaloxoneGet.
M74_NaloxoneGetOE. Where would you get naloxone if someone asked you, or you yourself, needed naloxone?
Enter your response in the box.
MIN: 3. MAX: 250.
[NaloxoneTrain]
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M68_NaloxoneTrain. Have you ever received formal training, where a person showed you how to administer naloxone?
Select one response.
DEFAULT ORDER.
1. Yes 2. No
[WhoTrained]
- Show if respondent selected code [Yes] at M68_NaloxoneTrain.
M13_WhoTrained. Where did you receive formal training on how to administer naloxone?
Select all that apply.
RANDOMIZE LIST.
1. Pharmacist 2. Healthcare provider 3. Friend or family member
4. Substance use professional or harm reduction program (e.g., needle exchange)
5. Community member or community/social program
6. Other (specify)__________ ANCHOR.
[NaloxoneLikelihood]
- Show if respondent selected code [No] at M68_NaloxoneTrain.
M18_NaloxoneLikelihood. How likely would you be to buy, fill a prescription or otherwise obtain naloxone for naloxone if you received instructions from your pharmacist, or health care provider about when and how to administer naloxone?
Select one response.
DEFAULT ORDER.
1. Not at all likely 2. Not very likely 3. Somewhat likely 4. Very likely 5. Extremely likely [NaloxoneInfo]
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M69_NaloxoneInfo. Other than formal training, where have you obtained or received general information about naloxone?
Select all that apply.
RANDOMIZE LIST.
1. Pharmacist 2. Healthcare provider
3. Someone at a treatment center or harm reduction program
4. Someone from the community or community/social program
5. Friend or family member
6. Personal experience with an opioid addict 7. Social media
8. Internet, online sites (e.g., news sites, forum, your own research)
9. Brochures/take home info
10. I have not obtained or received any general information about naloxone
ANCHOR. EXCLUSIVE.
[NaloxoneForms]
- Show to all.
M70_NaloxoneForms. In what ways can naloxone be taken?
Select all that apply.
RANDOMIZE LIST.
1. Swallowing a pill 2. Swallowing a liquid 3. Nasally through a spray
4. As a standard injection with a syringe 5. With an autoinjector
6. Don't know ANCHOR. EXCLUSIVE.
[NaloxoneEffect]
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M71_NaloxoneEffect. How does naloxone stop/reverse an opioid overdose?
Select one response.
RANDOMIZE LIST.
1. Naloxone flushes the opioids out of the body 2. Naloxone stimulates the lungs to improve breathing 3. Naloxone reinvigorates the heart and circulatory system 4. Naloxone blocks opioids from reaching receptors in the
brain
5. I don't know ANCHOR.
Subsection End - Knowledge Subsection Start - Access
[NaloxoneHP]
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M75_NaloxoneHP. Have you ever asked a healthcare provider how to get naloxone and they did not know or were unable to answer the question?
Select one response.
DEFAULT ORDER.
1. Yes 2. No [NaloxoneUnable]
- Show to all.
M77_NaloxoneUnable. Have you ever tried to buy, fill a prescription or otherwise obtain naloxone, but were unsuccessful or unable to do so?
Select one response.
DEFAULT ORDER.
1. Yes 2. No [NaloxoneUnableOE]
- Show if respondent selected code [Yes] at M77_NaloxoneUnable.
M78_NaloxoneUnableOE. Why were you unsuccessful or unable to get naloxone?
Enter your response in the box.
MIN: 3. MAX: 250.
[NaloxoneAmount]
- Show to all.
M79_NaloxoneAmount. How many times have you obtained or been given naloxone?
Select one response.
DEFAULT ORDER.
1. Zero 2. Once 3. 2-5 times 4. 6-10 times 5. 10-20 times 6. Over 20 times [NaloxoneObtained]
- Show if respondent selected any codes [Once, _25Times, _610Times, _1020Times, Over20Times] at M79_NaloxoneAmount.
M80_NaloxoneObtained. Where have you obtained or been given naloxone?
Select all that apply.
RANDOMIZE LIST.
1. Pharmacist 2. Healthcare provider
3. Substance use professional/treatment center 4. Needle exchange/harm reduction program 5. Community member or community/social program 6. Friend or family member
7. A dealer or on the street
8. Other (specify)__________ ANCHOR.
[NaloxoneReqInfo]
- Show if respondent selected any codes [Once, _25Times, _610Times, _1020Times, Over20Times] at M79_NaloxoneAmount.
M81_NaloxoneReqInfo. When you tried to obtain naloxone, what information did you have to provide?
Select all that apply.
RANDOMIZE LIST.
1. Personal identification (e.g., driver’s license, government issued ID)
2. Proof of insurance coverage 3. Name of healthcare provider
4. Medical history or current medications 5. Reason for needing naloxone
6. Whether the naloxone was for you or someone else 7. Your substance use history or whether you had a history
of addiction
8. Other (specify)__________ ANCHOR.
9. I did not have to provide any information ANCHOR. EXCLUSIVE.
[NaloxoneEncourage]
- Show to all.
M83_NaloxoneEncourage. Which of the following, if any, have encouraged or recommended you to obtain naloxone?
Select all that apply.
RANDOMIZE LIST.
1. Pharmacist 2. Healthcare provider 3. Friend or family member
4. Substance use professional or harm reduction program (e.g., needle exchange)
5. Community member or community/social program
6. Other (specify)__________ ANCHOR.
7. None of the above ANCHOR. EXCLUSIVE.
[ObtainLikelihood]
- Show to all.
M39_ObtainLikelihood. How likely would you be to obtain naloxone if the following people recommended you do so?
Select one response for each.
COLS: DEFAULT ORDER.
ROWS: RANDOMIZE LIST.
Very unlikely
Somewhat unlikely
Neither likely nor
unlikely
Somewhat
likely Very likely
1. Pharmacist 1 2 3 4 5
2. Healthcare provider 1 2 3 4 5
3. Friend or family
member 1 2 3 4 5
4. Substance use professional or harm reduction program (e.g., needle exchange)
1 2 3 4 5
5. Community member or
community/social program 1 2 3 4 5