Report a substance

Required fields are marked with an asterisk (*).
Who is this form about? You do not have to answer this question if you don't want to
e.g. valium, cocaine, heroin
Source of supply
This is to help us identify any potential clusters to make sure services can provide additional support where needed.
Please tell us as much about the appearance of this substance as you can
What form did it come in *
e.g. were there any markings on pills/capsules, what was the packaging like, distinctive smell or taste
Has a sample been tested (e.g. sent to WEDINOS, drug testing kits)?
When was it taken? *
Where was it taken
Did the person use alone or with others?
How was it taken? Select all that apply
Was this more, less or about the same amount they would usually use?
In a typical month, how often would the person/people use this substance?
Were there any unwanted or unexpected effects after they took it? (please tick all that apply)
Were there other substances taken at the same time? *
What help was needed or given?
Please tick all that apply Knowing what to do in the event of an overdose can save lives, see our 'Keeping Safe' page for more info