Paving a Path Toward Healthcare-Based Harm Reduction in the Veterans Health Administration: Key Lessons From Three VHA Facilities

Wednesday, April 12, 2023

4:15 PM – 5:30 PM

Location: A412 GWCC

Presenter(s)

Beth Dinges, PharmD

Clinical Pharmacist, VISN 12 Academic Detailing Service
Veterans Health Administration
Springfield, Illinois
Minh Q. Ho, DO

Infectious Disease Physician
Orlando VA Healthcare System
University of Central Florida, College of Medicine
Orlando, Florida
Elizabeth M. Oliva, PhD

VHA National Opioid Overdose Education and Naloxone Distribution (OEND) Coordinator
Veterans Health Administration
Belmont, California
Tessa L. Rife-Pennington, PharmD, BCGP

Pain Management, Opioid Safety, Prescription Drug Monitoring Program (PMOP) Coordinator; Clinical Pharmacist Practitioner, HUD-VASH Integrated Substance Use Care Team; Syringe Services Program (SSP) Lead
San Francisco Veterans Affairs Health Care System; University of California, San Francisco, School of Pharmacy
University of California, San Francisco, School of Pharmacy (UCSF)
San Francisco, California

Moderator(s)

Jan L. Losby, PhD, MSW

Branch Chief, Health Systems and Research
Centers for Disease Control and Prevention
Atlanta, GA

Among veterans, drug overdose mortality increased 53% between 2010 to 2019, and 12% have a substance use disorder (SUD). Harm reduction strategies, including syringe services programs (SSPs) and overdose education and naloxone distribution (OEND), are evidence-based practices that decrease negative consequences associated with drug use, such as human immunodeficiency virus, hepatitis c virus, and overdose. Harm reduction and SSPs have limited integration into healthcare systems despite ample evidence and support from the Office of National Drug Control Policy, Centers for Disease Control and Prevention, and Substance Abuse and Mental Health Services Administration. SSPs have not previously existed within the Veterans Health Administration (VHA) due to several factors, a key of which was the lack of clarity regarding legality of purchasing syringes with federal funds.

In this session, three harm reduction early adopting VHA facilities will describe their experiences integrating harm reduction into VHA. In 2017, the VHA facility in Danville, Illinois, launched the first VHA SSP and helped clarify legal considerations for SSP implementation. VHA facilities in Orlando, Florida, and San Francisco, California, both followed in 2019. The facility in San Francisco was the first to begin distributing fentanyl test strips to VHA patients, along with kits for hygiene/wound care and safer sex. These three programs have informed national VHA efforts to integrate harm reduction into clinical practice, complementing VHA’s robust OEND program, which has distributed more than 800,000 naloxone kits since its inception in 2014.

Learning Objectives:

Describe elements of healthcare-based harm reduction, including SSPs, fentanyl test strips, and naloxone
List effective strategies, tools, and resources for implementing healthcare-based harm reduction, such as standardized patient and provider education and electronic health record tools
Describe lessons learned from early adopters of healthcare-based harm reduction to inform implementation in other healthcare systems