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Opioid Response Network - TA Request Form

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Opioid Response Network - TA Request Form

Our main Opioid Response Network website is currently experiencing technical difficulties. In the meantime, if you need to submit a TA Request, you can do so using the form below.

Submit TA Request

Welcome to the Substance Abuse and Mental Health Services Administration (SAMHSA)-funded Opioid State Targeted Response (STR) Technical Assistance (TA) request page. The Opioid Response Network takes requests from STR grantees, individuals and organizations. Please submit the request by completing the form below. We will respond to all requests within one business day. Other entities (non-STR funded groups) may submit a request via the request form.

The contact information below refers to the individual who is requesting the TA and who should receive all notifications regarding the TA request. If you are completing this form on behalf of someone else, please provide contact information for the person who should receive the notifications.

If you have any problems using the form below for your TA request, please email [email protected]

For individuals seeking information about treatment please visit SAMHSA or call SAMHSA's National Helpline
1-800-662-HELP (4357)
1-800-487-4889 (TTY)

Free and confidential information in English and Spanish for individuals and family members facing substance abuse and mental health issues. 24 hours a day, 7 days a week.

If this is a medical emergency, please call 911.