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Erie County (PA) Regional Recovery Hub

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Substance Use Prevention, Outreach, Resources, and Training

S.U.P.O.R.T.

Request form for: Naloxone, Fetanyl Test Strips, Xylazine Test Strips, Medetomidine Test Strips, Overdose Kits, Medication Lock Boxes, and Training

These resources are for ERIE COUNTY (PA) residents ONLY. If you are not a resident of Erie County (PA), you can find resources for accessing naloxone here: https://nextdistro.org/

Are you requesting as:(Required)

Individual - Personal Use

Individual - Distribution

Organization

Other

Todays Date(Required)

First name(Required)

Last name(Required)

Phone

Company name (if applicable)

Requested Items (check all that apply):(Required)

Naloxone (Narcan)

Fentanyl Test Strips

Xylazine Test Strips

Medetomidine Test Strips

Overdose Kits

Medication Lock Boxes

Please note the number of each requested item in the field below:(Required)

Will you need training or technical assistance, or Layperson Narcan Training? If so, please provide detailed information in the box below.(Required)

Yes

Training needs

By checking this box, I acknowledge that the completion of this form does not guarantee any of these Prevention/Harm Reduction products will be available. Based on availability and priority, the Erie County Dept of Drug and Alcohol may or may not be able to provide materials requested.

ERIE COUNTY DRUG AND ALCOHOL STAFF WILL NOTIFY YOU WHEN YOUR REQUEST BECOMES AVAILABLE.

Once notified, you can pick up your materials at:

Erie County Office of Drug and Alcohol Abuse

240 West 11th Street, Suite B-050

Erie, PA 16501

For more information regarding Recovery, visit www.recoveriepa.org

Erie County Office of Drug and Alcohol Abuse offers 24/7/365 phone screenings. Call 814.451.6877 for assitance and more information.

A Pennsylvania DDAP Recovery Rising Initiative, Supported by the Erie County Office of Drug and Alcohol Abuse.

For more information on local screening, assessment, and referral services visit Erie County Office of Drug and Alcohol Abuse

RecovEriePA.org

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