Required fields are marked with asterisks (*)

Drug Reporting Tool

Have you or someone you know had an overdose or an unexpected drug reaction?

Our online Drug Reporting Tool is for you, or someone who supports you, to anonymously share about a bad or unexpected reaction to street drugs. The information you give us will help Durham Region Health Department look at local trends and send drug alerts to community agencies, who then share alerts with people who use drugs.

All questions in this form are confidential and anonymous. Please do not use names or include any information that could identify you or others in your answers.

Reporting information

Which best describes you?

I am a member of the public

I am a service or health care provider.

Who had the bad reaction or overdose from the drug?

Someone else

Approximately when did the drug reaction occur?

This week

Last week

Last month

More than one month ago

Other

When did you get the drug?

This week

Last week

Last month

More than one month ago

Other

Where did you get the drug? Please do not include any names.

Please describe the drug as much as possible (e.g., colour, texture, smell, taste). Was it different than usual?

Additional information

Please do not include any identifying information or details, including names.

Is there anything else you would like to share?

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Drug Reporting Tool

Have you or someone you know had an overdose or an unexpected drug reaction?

Reporting information

Additional information