Q.1
Do you currently take any painkillers such as vicodin, oxycontin or percocet?
Yes
No
Q.2
Do you know someone who's been affected by prescription pain medication abuse or misuse?
Yes
No
Q.3
In your opinion how easy is it to get a prescription painkillers such as oxycontin, vicodin and percocet?
Very easy
Somewhat easy
Nearly impossible
Q.4
Do you know someone who uses heroin?
Yes
No
Q.5
Have you or are you currently using heroin?
Yes
No
Q.6
How concerned are you about prescription painkillers and heroin being abused in your community?
Very concerned
Concerned
Not concerned
Q.7
Care to elaborate on any of your answers?