BACKGROUND: Opioid overdose is an ongoing public health issue in the rural United States and can be countered by increasing access to the opioid antagonist naloxone. Community pharmacists are well-positioned to offer and dispense naloxone to patients at risk of opioid overdose, but still experience a range of communication barriers. Understanding rural patient communication preferences is essential to prepare pharmacists to discuss naloxone in a patient-centered manner. OBJECTIVE: To explore rural community pharmacists' and patients' naloxone communication preferences employing the Linguistic Model of Patient Participation in Care (LM). METHODS: In-depth qualitative interviews were conducted with 40 community pharmacists and 40 patients from rural areas in Alabama, Iowa, North Carolina, and Wisconsin. After a thematic analysis of the interview transcripts, three code reports were selected for a secondary qualitative analysis informed by the LM. RESULTS: All elements described in the LM (Predisposing Factors, Enabling Factors, And Provider's Communication Style) were associated with patient-pharmacist naloxone communication. The analysis revealed four additional factors not accounted for in the model: Stigma, Privacy, Insurance Coverage and Price, and Collaboration with Physician. CONCLUSION: Patient-pharmacist naloxone conversations are impacted by the factors described in the LM, as well as several pharmacy-specific factors which were included in an adapted conceptual model. Future studies should consider these findings when developing interventions to improve patient-pharmacist communication and pharmacists can utilize the practical tips provided to actively address the opioid epidemic.