Harm Reduction
Sonya Collins
An estimated 57,997 people in the United States died from a fentanyl overdose between September 2023 and August 2024. Fatal opioid overdoses often happen when the individual is unaware they are using a drug laced with another substance. It’s unknown how many overdose deaths involved xylazine, a nonopioid central nervous system depressant and emerging clandestine ingredient in illicit drugs.
The 2024 death toll, while staggering, in fact reflects a sharp decline in opioid overdose death from the previous year, which has been attributed in part to increased education and public awareness of the threat of these insidious agents.
A team of researchers in North Carolina have begun to lay the groundwork for still more education and public awareness through their creation of community pharmacy training on fentanyl and xylazine test strips. Their article in the March 2025 issue of Exploratory Research in Clinical and Social Pharmacy outlined first steps for pharmacists in other states who would like to create similar programs.
“We found that the vast majority of community pharmacists we surveyed were interested, or at least slightly willing, to sell fentanyl test strips, but they were very uncomfortable counseling patients on test strips,” said Grace Trull Marley, PharmD, from the University of North Carolina Eshelman School of Pharmacy. “That’s ultimately why we decided to create this training.”
Program highlights
Prior to designing the training, Marley and colleagues found that pharmacists’ greatest perceived barrier to selling and counseling on test strips was that they did not know how to acquire the strips.
“That’s such an easy barrier to overcome,” Marley said, and it’s one of the components of the 30-minute training.
Pharmacists who complete the training will also learn where to place the strips in the pharmacy. It’s recommended to keep them out in the open where patients can easily see and look at them.
Nearly half of the pharmacists surveyed reported that they were uncomfortable starting a conversation with a patient about test strips.
“But that is similar to how many were uncomfortable starting conversations about naloxone when we first got prescribing authority,” Marley said.
She advises that pharmacists casually approach patients seen looking at the strips. They can then open with questions such as “Have you seen these before?” or “Do you mind if I explain these to you?”
Bringing in a team
The article describes the strategy that the North Carolina–based team used to design a six-module, 30-minute training to educate community pharmacists on how to sell and counsel patients on the use of fentanyl and xylazine test strips.
The researchers convened an advisory panel of eight members, which included three community pharmacists, two harm reduction experts, a website developer, the director of practice advancement for the state pharmacy association, and a communications expert. During six meetings that took place over 7 months, the panel designed the training, which was tailored to the needs of North Carolina pharmacists and the laws that govern the sale of drug-checking technologies.
While the article serves as a roadmap for pharmacists in other states to design their own programs, Marley said, “As long as it’s legal in your state, I would completely support anyone else simply utilizing our training and shifting it as needed for their state.”
She noted that selling drug-checking technology is legal in many states, but she urges pharmacists to familiarize themselves with the specific laws in their location.
No one is immune
“There is definitely a fear among some that this might attract people who use drugs to the pharmacy, so it’s not for everyone,” Marley said. “But I’d be surprised if I met someone who didn’t know someone who’d overdosed and died. This is rampant in most communities. It’s a public health emergency. We don’t want individuals using drugs that have been laced with this.”
CDC data show that opioid overdose affects people of all races and sexes in both urban and rural areas. Pharmacists in any community would likely find useful information in a test strip training program. ■