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Pharmacists who had practiced for many years (P= 0.002) and pharmacists who discussed safe opioid disposal and storage regularly (P= 0.002) reported a higher likelihood of using the handout. Pharmacists were much more likely to counsel patients on opioid risks and safety using this handout for a long-term opioid prescription than for a short-term opioid prescription. A participatory research design successfully refined a handout for opioid risks and safety counseling, which the majority of pharmacists evaluated as feasible and useful for