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As medetomidine rapidly displaces xylazine as a fentanyl adulterant, pharmacists must recognize its distinct toxidrome, understand why naloxone alone is insufficient, and support updated harm reduction strategies in an increasingly complex overdose landscape.

Pharmacy Times interviews Benjamin Kematick, PhD, BCACP, BCPMP, and explores the safety profile of Levorphanol compared with methadone, including potential reductions in risks such as accumulation, QT prolongation, and drug interactions, as well as its implications for clinical workflows and the pharmacist’s role in supporting safe opioid rotation, monitoring, and patient counseling.