Naloxone (Narcan) Kit Request Form
Naloxone (Narcan, Kloxxado) is a life-saving medication that can reverse an overdose from opioids including heroin, fentanyl, and prescription opioid medications. If you or someone you know is at an increased risk for opioid overdose, you should carry naloxone and keep it at home. Naloxone has no effect on someone not using opioid drugs. Naloxone kits are available to all Mississippi residents with no out of pocket cost.
Please complete the following survey to receive your free naloxone kit. This survey will take approximately 14 minutes to complete. You will be required to watch a short training video that is provided at the end of this survey. Kits will be mailed to the address you provide.
All information will be kept confidential. Answers will not be shared with any personal identifying information. Your responses will only be used to identify areas of need and to help us to improve services offered by our program.
If you have questions or need assistance with the survey, please contact the Mississippi State Department of Health at 601-713-3457 or email email@example.com. For more information about the opioid epidemic in Mississippi visit ODFree.org.
*Due to high demand and limited product availability, the time to process requests may be longer than usual. Requests will be filled in the order that they were received.*
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