INNOVATIONS in pharmacy

Harm reduction services for veterans in supportive housing: A pharmacist-led, interdisciplinary, street medicine approach

Tessa Lynne Rife-Pennington

San Francisco Veterans Affairs Health Care System; University of California, San Francisco, School of Pharmacy

https://orcid.org/0000-0002-5397-3012

Thao Thanh Vu

San Francisco Veterans Affairs Health Care System; VA Palo Alto Health Care System

https://orcid.org/0009-0002-9438-1408

DOI: https://doi.org/10.24926/iip.v16i3.6753

Keywords: harm reduction, veterans, naloxone, pharmacists, housing

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Abstract

Background: United States Veterans are disproportionately impacted by homelessness. Substance use, mental health conditions, and trauma increase the risk for homelessness and contribute to challenges in maintaining housing. Street Medicine utilizes a trauma-informed approach to provide low-barrier health and social services for those at risk for and experiencing homelessness. Limited evidence exists describing pharmacist roles on Street Medicine teams, including provision of harm reduction services.

Objective: To implement a pharmacist-led Harm Reduction Program Street Medicine intervention at a supportive housing building in San Francisco, California, evaluating overall Veteran acceptance of harm reduction resources and the total number of Veterans who accepted 1) referral for infection screening, immunizations, and follow-up care, 2) referral for mental health and substance use disorder (SUD) care, and 3) pharmacist-provided harm reduction resources.

Methods: During phase 1 (August–September 2022), Harm Reduction Program informational materials were mailed to Veteran residents. During phase 2 (October–December 2022), pharmacists called Veteran residents to offer harm reduction resources. During phase 3 (December 2022–June 2023), an interdisciplinary team (pharmacists, physicians, nurses, and a social worker) completed 6 HUD-VASH housing building visits to offer harm reduction resources. Data were prospectively collected, and descriptive statistics were used to evaluate results.

Results: During Phase 2, most Veterans (49/72, 68.1%) were unable to be reached by telephone. Of those remaining, 16 (22.2%) declined and 7 (9.7%) accepted ≥1 resource. During Phase 3, team members met with 29/73 (39.7%) Veterans a range of 1–6 times. Twenty-three (31.5%) accepted ≥1 resource, and 6 (8.2%) declined. Through combined telephone and on-site outreach, a total of 26/73 (35.6%) Veterans accepted ≥1 resource, including referral for infection screening, immunizations, and follow-up care (n=6, 8.2%); referral for mental health and SUD care (n=6, 8.2%); and pharmacist-provided harm reduction resources (n=24, 32.9%). The harm reduction supplies most frequently accepted included naloxone (n=20, 27.4%), antibiotic ointment (n=11, 15%), alcohol pads (n=10, 13.7%), and bandages (n=10, 13.7%).

Conclusions: Telephone-based outreach to Veterans in supportive housing was challenging, as many did not have a working phone. In-person visits increased Veteran acceptance of harm reduction services from 10% to 36%, demonstrating the value of a Street Medicine approach. Many Veterans reported mistrust of the healthcare system and were not engaged in care. Ultimately, the focus of outreach visits shifted from offering resources to building rapport, tailoring discussions to individual needs, and linking individuals to services, including a new on-site primary care/infectious disease provider. Future research should evaluate impacts on health and patient-reported outcomes and cost-effectiveness.

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Author Biography

Tessa Lynne Rife-Pennington, San Francisco Veterans Affairs Health Care System; University of California, San Francisco, School of Pharmacy

Tessa Rife-Pennington, PharmD, BCGP, pronouns she/her, is a clinical pharmacist practitioner at the San Francisco Veterans Affairs Health Care System and Volunteer Clinical Assistant Professor at the University of California, San Francisco, School of Pharmacy. Since graduating from the West Virginia University School of Pharmacy in 2010, she has worked in a variety of roles within the Veterans Health Administration, including medication therapy management, academic detailing, pain and opioid stewardship, and substance use disorder care. She currently serves as Harm Reduction Coordinator, manages 15 harm reduction vending machines, and is completing a 1-year HIV prevention fellowship with the American Academy of HIV Medicine. Dr. Rife-Pennington’s research and quality improvement work centers on implementation and evaluation of harm reduction interventions among people who use substances, experience related infections and overdoses, and housing insecurity.