Trail of Truth - National Survey and Memorialization Form

National Trail of Truth - Poll and Memorialization Form
There are 3 sections to this form:
Section 1 - A poll to see where substance use impacted people stand on various measures to reduce overdose fatalities and the harms of substance use.

Section 2 - For memorialization of your loved one who has passed due to substance use related causes through the Trail of Truth and other endeavors. Only immediate family members may submit a loved one to be memorialized - parents, grandparents, siblings, spouse, significant other or children.

Section 3 - Is optional and is to help us collect data to gain a better understanding of the gaps in our current systems.

PICTURES: If you struggle to upload a picture through this form, you can submit the picture through the the very short and simple form at: https://truthpharm.org/memorial-map/
Your Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Which of the following measures do you think are most important in reducing overdose fatalities or the harms of substance use? (Select all you agree with or support)

Instant access to effective treatmentGreater access to medications that treat addictions (currently medications such as suboxone, methadone and vivitrol)Coerced or forced treatmentNaloxone access (Naloxone is a medication that can reverse an overdose)Less stigma and discrimination in medical settingsEnding the Drug WarMore policing at the street levelTargeting people who sell drugs for arrest and incarcerationEnding incarceration for personal possession of drugs (like Portugal)Syringe accessMore prevention programsIncreased access to mental healthReduction in prescribing of medications that have a risk for addiction or recreational useAvailability of a safe supply of substancesSafer use suppliesOverdose Prevention Centers (Safer Consumption Spaces)Drug interdiction at U.S. bordersEducation for family members who have a loved one with substance use disorderSupport for families who have a loved one who strugglesRecovery HousingSafe Housing for people while they are actively usingMeeting people's basic needsHaving the medical field better understand drug use and addictionIncreased access to drug testing such as fentanyl test strips or other testing methodsStop unscrupulous practices by pharmaceutical companiesUniversal HealthcareGood Samaritan Laws in every state (no prosecution for substances if you seek medical attention for someone overdosing)Drug induced homicide lawsCulturally sensitive addiction treatmentASL and/or other language interpreters in treatment settingsHarm Reduction based education for high school studentsNarcan training for high school studentsNarcan training for incoming freshmen at collegesNarcan prescribing with all opioid prescriptionsMandatory patient education on medications that have a risk for addiction or recreational useMandatory prescribing physician education on medications that have a risk for addiction or recreational useJust say No, DARE style education in middle and high schoolsPeer services responding with EMSPeer services responding with PoliceEducation beginning in Elementary school regarding substance use (not dare style, more supportive, caring and informative)Increased services for children impacted by a parent’s substance use disorderIncreased services for parents who suffer from Substance use DisorderIncreased services for children who have lost a parent
Are you a parent, grandparent, sibling, spouse, significant other or child of someone who died of substance use related causes who you would like to memorialize with the Trail of Truth and Truth Pharm?

YesNo

National Trail of Truth - Poll and Memorialization Form

Optional Data Collection Questions

Payment Methods