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Fentanyl test strips (FTS) are increasingly used to address fentanyl contamination of the illicit drug supply by testing a drug for the presence of fentanyl, allowing people who use drugs to engage in overdose prevention. While emergency departments (EDs) have implemented various harm reduction strategies for people who use drugs, to date distribution of FTS in EDs is limited and not evaluated. Thus, we sought to explore ED staff experiences distributing FTS.Twenty-one staff serving different roles (e.g., physician, nurse, technician, social worker, certified recovery specialist) within two urban EDs in a major metropolitan area were enrolled in a pilot study to distribute FTS to patients who use drugs. Participants were interviewed about their experience at three weeks and again at three months. Interviews were recorded, transcribed verbatim, and coded using a conventional content analysis approach.All participants endorsed the utility of FTS distribution in the ED. Across forty-two interviews, participants discussed evolving strategies to approach patients about FTS, primarily favorable patient reactions to FTS, improved dynamics between participants and patients, mixed intervention support from other staff, and named challenges of FTS distribution and recommendations to make FTS distribution in the ED widespread. Recommendations included medical records prompts to offer FTS, offering via different types of staff, and offering FTS during triage.Implementing FTS distribution may improve patient rapport while providing patients with tools to avoid a fentanyl overdose. Participants generally reported positive experiences distributing FTS within the ED but the barriers they identified limited opportunities to make distribution more integrated into their workflow. EDs considering this intervention should train staff on FTS, how to identify and train patients, and explore mechanisms to routinize distribution in the ED environment.