INNOVATIONS in pharmacy

Pharmacist-led harm reduction outreach for veterans who inject drugs: A quality improvement evaluation

Michelle Tang

San Francisco Veterans Affairs Health Care System

https://orcid.org/0009-0007-4290-543X

Jennifer Armentrout-Jones

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

https://orcid.org/0000-0003-2023-9652

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

DOI: https://doi.org/10.24926/iip.v16i4.6978

Keywords: veterans, harm reduction, substance use

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Abstract

Introduction: Injection drug use (IDU) increases risk for preventable infections and drug overdose. Within the Veterans Health Administration, dedicated syringe services programs (SSP) aim to reduce these harms; however, identifying and engaging Veterans with recent IDU remains challenging. This quality improvement (QI) project evaluated a clinical pharmacist practitioner (CPP)-led outreach model designed to increase SSP engagement and harm reduction resource access among Veterans with IDU receiving care at a single Veterans Affairs (VA) Health Care System.

Methods: This was a prospective single-arm cohort QI project completed July 2024-April 2025. Veterans with past-year IDU were identified via the national VA Syringe Service Program Dashboard and verified via retrospective chart review. A CPP-led team contacted Veterans by phone and in-person outreach, offered education, and provided harm reduction resources. The primary outcome was engagement with outreach; secondary outcomes included acceptance of infection screening, antimicrobial treatment/prophylaxis, and supplies for safer injection, infection prevention, safer sex, and overdose prevention. Descriptive statistics were used to evaluate results.

Results: Veterans (n=53) were age 57.6 ± 12.3 years, primarily assigned male at birth (n=51, 96.2%), unknown gender identity (n=32, 60.4%), White/Caucasian (n=27, 50.9%), and straight/heterosexual (n=31, 58.5%). Fourteen (26.4%) engaged with the CPP-led outreach. Among those, most (n=13, 92.9%) accepted ≥ 1 resource: supplies for overdose prevention (n=11, 78.6%), infection prevention (n=10, 71.4%), safer injection (n=9, 64.3%), and safer sex (n=4, 28.6%), plus infection screening (n=6, 42.9%) and hepatitis B virus vaccine (n=1, 7.1%). None accepted HIV pre-exposure prophylaxis. Among the remaining Veterans, 21 (39.6%) were not reached, 15 (28.3%) declined, and 3 (5.7%) were deceased.

Conclusion: Approximately one in four Veterans with past-year IDU engaged with the CPP-led team. Outreach resulted in new linkages to resources that reduce infection and overdose risk. These findings highlight the potential value of low barrier, dashboard-driven harm reduction outreach, and further evaluation is warranted.

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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.