Interest in Joining the National Coalition to Liberate Methadone

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Please fill out this form if you are interested in working with other organizers, researchers, and advocates to improving legislation and regulations for methadone in the United States.

What is your name?
*

What is your email address?
*

What state do you live in?
*

Do you identify with any of the following? (Check all that apply)
*

Person with lived or living experience on methadone

Health care worker (physician, nurse, pharmacist, etc)

Academic researcher (e.g., professor, postdoc, etc)

Community based organization member

Policy evaluator or drug policy expert

Student or trainee (e.g., in college, medical school, graduate school)

Other:

Required

Please name any institutes (e.g., universities) or organizations (e.g., National Survivors Union, other drug users unions or harm reduction organizations) that you may be a part of: *

Do you currently provide care for people on methadone (e.g., work in an opioid treatment program)?
*

Yes

Do you have any experience doing formal or informal methadone advocacy?

Yes

Do you have experience working as a community partner with a methadone clinic in your area (e.g. through referrals, cross-training, or integrated services) *

Yes

What types of work would you want to be involved in as a part of NCLM?
*

Social media campaigns

Writing articles for scientific publication (journal articles, perspectives, etc)

Writing articles for lay media (op eds, press releases)

Organizing a conference or other events to raise awareness for methadone advocacy

Doing outreach and creating orientation materials for new members

Meeting with partners (e.g., policymakers, community-based organizations, patient advocates)

Not sure! I'm hoping to attend meetings for now and will decide later

Other:

Required

Have you published any peer-reviewed articles on methadone treatment or written/been quoted in any media articles on the topic? If so, include any links or citations you’d like to share with us here:

Is there anything else you think our organization should know?

Submit

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