Thank you for your willingness to complete this brief survey. Your responses are collected anonymously. We appreciate your assistance in helping us to better understand our community and work to improve its health. 

Let's begin...

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* 1. Some commonly prescribed pain medications are: Dilaudid; Vicodin; Tramadol; Percocet; Lortab, Oxycontin, Fentanyl, Oxycodone, Codeine, Hydrocodone, and Methadone. How many of these drugs did you know were a narcotic, or considered an opioid?

Good to know: Opiates, also called narcotics, are medicines sometimes prescribed to relieve pain. They are extremely addictive and should be used cautiously under prescriber care.

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* 2. Have you, a family member, or a close friend ever felt the need to take a pain medication daily to function? 

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* 3. The term “opioid dependence” refers to physical dependence on opioids. When someone becomes physically dependent on a substance, their body relies on it to function. Often, it is only after their prescription ends that many people realize they’ve become dependent on the effects of opioids to function “normally.” Has this ever happened to you or someone who is a family member or close friend?

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* 4. As a patient, you have the right to ask the prescribing doctor if there is a non-opioid pain relief alternative which he/she can suggest. Have you ever had this conversation with a doctor?  

Good to know: There are many methods to relieve pain besides opioids. Medication alternatives include Tylenol or anti-inflammatory medications, nerve pain medications, gels/creams/ointments, or intervention. Non medication alternatives include physical therapy, massage therapy, acupuncture, chiropractic, or behavioral/mental health therapies.

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* 5. How often have you shared, given unused, or left-over prescription medications of any kind with friends or family?

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* 6. Please expand on reasons for you have shared a prescription medication with someone else

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* 7. How many bottles containing left over or unused prescription medications of any kind do you have in your home right now?  

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* 8. The main reason for keeping left over medications in your home is:

Good to know: The main source of illicit prescription drug use is through a family or friend (i.e. medicine cabinet often without their knowledge.) You can help avoid this by dropping off unused medications at a collection site.

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* 9. Did you know that you can drop off unused medications for disposal at The Englewood Sheriff’s Office, the Port Charlotte Sheriff’s Office, the Punta Gorda Safety Complex, and the Englewood Walgreens?  

Good to know: Charlotte County has local community-based coalitions whose shared vision is a healthy, safe, and drug free community. There is one in your area:

Drug Free Charlotte County (941) 255-0808 x3205

Drug Free Punta Gorda (941) 979-7471

Englewood Community Coalition, Inc. (941) 681-0091

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* 10. Were you aware of the coalition in your community?  

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* 11. Do you have children under 18 who frequently visit your home?  

Please help us understand the demographics of our survey-takers. Thank you!

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* 12. Your zip code:

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* 13. Education level:

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* 14. Your age:   

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* 15. Hosehold Income: 

Thank you for your time and interest. Stay Safe and Healthy

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