Naloxone Initiatives and Syringe Service Programs in the Veterans Health Administration: Critical Lessons During the Fourth Wave

The Veterans Health Administration (VHA) is the largest integrated healthcare system in the United States and has a track record of supporting harm reduction efforts. For instance, VHA’s Rapid Naloxone Initiative was launched to prevent opioid overdose deaths among veterans through: (1) opioid overdose education and naloxone distribution (OEND) to VHA patients at risk for opioid overdose, (2) VA Police naloxone, and (3) select automated external defibrillator cabinet naloxone (https://www.jointcommissionjournal.com/article/S1553-7250(21)00156-2/pdf). VHA received the 2020 John M. Eisenberg National Level Innovation in Patient Safety and Quality Award from The Joint Commission and National Quality Forum for this work, which has also been highlighted in VHA’s Quality Enhancement Research Initiative (QUERI) Roadmap for Implementation and Quality Improvement.

With the fourth wave of the opioid crisis involving dramatic increases in stimulant overdoses deaths, the majority of which involve opioids, VHA is also expanding OEND and emphasizing evidence-based treatments (e.g., contingency management) for patients with stimulant use disorders. Recently, upon confirmation that VHA could purchase syringes and operate syringe services programs (SSPs) in areas where legally allowed, VHA released a policy memorandum recommending that VHA Medical Centers develop SSPs or otherwise ensure enrolled veterans have access to SSPs where such programs are not prohibited under state, county, or local law. VHA is applying effective strategies used to support naloxone implementation to support national SSP implementation. To date, there are six VHA SSPs — Danville and Hines (Chicago), IL; Orlando, FL; Cincinnati, OH; San Francisco, CA; and Puget Sound (Seattle and Tacoma), WA — and at least 24 VHA facilities working towards implementation. The first VHA SSP (Danville) was selected as a 2021 VHA Shark Tank winner and is assisting with SSP implementation across VHA facilities in the Northeast (https://blogs.va.gov/VAntage/96799/2021-vha-shark-tank-competition-winners-revealed-at-iex/; https://marketplace.va.gov/innovations/implementation-of-syringe-services-programs-within-the-va).

This session will describe: (1) VHA’s Rapid Naloxone Initiative, including efforts to increase naloxone distribution to patients with opioid use disorder (66% increase between December 31, 2020, and January 31, 2022) and patients with stimulant use disorder, and (2) how VHA will increase the availability of SSPs nationwide with an emphasis on elements that can be adopted by other healthcare systems (e.g., policy, standardizing SSP kits and note templates, patient and provider education, program models). A focus will be sharing toolkits and resources to support naloxone and SSP implementation (e.g., https://www.pbm.va.gov/PBM/academicdetailingservice/Opioid_Overdose_Education_and_Naloxone_Distribution.asp; https://www.hiv.va.gov/patient/ssp.asp) and highlighting the importance of integrating substance use disorder treatment into these efforts.