Expanding Harm Reduction Services and Implementation of Syringe Services Programs (SSP) within Veterans Health Administration (VHA)
Last updated
Share PrintSyringe services programs are community-based prevention programs which provide evidence-based, life-saving services for people who use illicit drugs, including access to syringes, naloxone, fentanyl test strips, infection screening and linkage to treatment. Historically, syringe services programs did not exist within the Veterans Health Administration due to many factors, including lack of clarity regarding legality for federal agency-purchased syringes. Three champions at Veterans Affairs facilities in Danville, Illinois, Orlando, Florida, and San Francisco, California, worked to clarify legal considerations, address barriers, and implement syringe services programs that are integrated in the healthcare systems.
Origin:
November 2017, Danville VA Medical Center (Danville, Illinois), Orlando VA Medical Center, San Francisco VA Medical Center
Adoptions:
10 successful, 12 in-progress
Awards and Recognition:
VHA Shark Tank Winner, Diffusion of Excellence Promising Practice, iNet Spark Award Investee
Partners:
HIV, Hepatitis, and Related Conditions, Mental Health and Suicide Prevention
Recent Updates
Overview
The problem
Images
Above:
Mental Illness and Substance Use Disorders in America among Veterans
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Illicit Drug Use among Veterans
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Peer Specialist and Beth handing out naloxone at Stand down in Peoria, IL
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Poster presentation at AMERSA 2023
Files
- 2019 National Survey on Drug Use and Health: Veteran Adults 2019 National Survey on Drug Use and Health: Veteran Adults
The solution
Images
Above:
Kits across Danville, SF, Orlando
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Harm reduction outreach to Veterans at Edwin M. Lee Apartments in San Francisco, CA. Free harm reduction kits, naloxone, and fentanyl test strips provided. Pictured left to right: Ariga Allehyari, PharmD Candidate, UCSF School of Pharmacy; Cedric Thurman, PMHNP; Tessa Rife-Pennington, PharmD, BCGP; Mary Sanders, LCSW
Above:
Harm reduction kit assembly. Pictured left to right: Ariga Allehyari, PharmD Candidate, UCSF School of Pharmacy; Tessa Rife-Pennington, PharmD, BCGP; Alec Barajas, PharmD Candidate, UCSF School of Pharmacy
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Orlando VAHCS Outreach to provide Harm Reduction Services at Annual 25th Annual Central Brevard Stand Down to Stand Up
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UCSF Addiction Research Program for eligible Veterans on harm reduction services including providing free fentanyl test strips
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Virtual education session on harm reduction services provided to Veterans staying at Domiciliary during their substance use recovery
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Harm reduction vending machine installation in process at the San Francisco Downtown Clinic, which will allow enrolled veterans to access the machine via barcode and dispensed free harm reduction supplies, such as sterile syringes, fentanyl test strips, and condoms
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SSP lead at Danville, Beth, packaging up fentanyl test strips into baggies w/ instructions
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San Francisco VAHCS Harm Reduction Program Outreach at Stand Down on the Delta in Antioch, CA, September 2023
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San Francisco VAHCS Harm Reduction Program Outreach at North Coast Stand Down in Ferndale, CA, October 2023
Files
- VHA SSP memo - Apr 2021 VHA SSP memo - Apr 2021
- PIs: Justeen Hyde, PhD; Westyn Branch-Elliman, MD, MPH. Co-designed by team of Vets, Clinicians, Community Harm Reduction Specialists, and Researchers Your Health Matters: Let's Talk about how to keep you safe
Links
- Local IL NPR interview Local IL NPR interview
- Danville Facebook story Danville Facebook story
- Danville homepage - external facing Danville homepage - external facing
- NPR story on Orlando NPR story on Orlando
- Utilizing alternative funding option to save Veteran lives 2019 Koda-Kimble Seed Award supports School of Pharmacy’s boldest ideas
- Legislative analysis and public policy association summary of syringe service programs and their legality as it varies across the United States Understand State Laws on Syringe Service Program
- Article regarding the legality of drug checking equipment in the United States Understanding legality of drug checking equipment within the United States
- The article discusses about federal restrictions and how these restrictions may not be applicable to other federal departments beyond VHA Understanding federal restrictions on funding for syringe service program
The results
Files
- 2022 IDWeek Conference presentation on successful model for increasing harm reduction services and linking veterans into care Successful Model for Pharmacy Driven Harm Reduction Services to Link Veterans Who Inject Drugs Into Care
- 2021 IDWeek Conference presentation on development and Implementation of Innovative Syringe Service Programs for Veterans in Rural and Urban Settings Development and Implementation of Innovative Syringe Service Programs for Veterans in Rural and Urban Settings
- Drs. Dinges & Rife-Pennington discusses solutions for education and implementation of harm reduction services at AMERSA 46th Annual Conference Harm Reduction Education for Clinicians in the Veterans Health Administration slides
- 2023 Rx Summit Presentation on Local Experiences - high level audience 2023 Rx Summit Presentation
- Incorporating Lived/Living Experience into VA Harm Reduction amersa 2023 poster
Links
- Implementing syringe services programs within the Veterans Health Administration: facility experiences and next steps Implementing syringe services programs within the Veterans Health Administration: facility experiences and next steps
- Dr. Rife-Pennington receiving an award at the 39th Federal Employees of the Year for her work in harm reduction services serving Veterans at San Francisco VA 39th Federal Employees of the Year Award Virtual Ceremony
- Dr. Dinges utilizes VHA Innovation platform to discuss solution for improving veterans access to harm reduction services within VHA Innovation Revolutionary: Keeping Veterans safe with sterile syringes
- Successful UCSF-San Francisco VA pilot paved the way for nationwide testing initiative. Successful UCSF-San Francisco VA pilot paved the way for nationwide testing initiative.
Metrics
- Three champions at Veterans Affairs facilities in Danville, Illinois, Orlando, Florida, and San Francisco, California, worked to clarify legal considerations, address barriers, and implement syringe services programs that are integrated in the healthcare systems. Since 2017, these three programs have engaged approximately 400 Veterans and distributed nearly 10,000 syringes, 2,500 fentanyl test strips, 50 wound care kits, and 45 safer sex kits.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
6 months for our program to be established
It will not take this long for other facilities because we have tackled most of the major obstacles, including securing VA ethics approval, VA Office of General Counsel (legal for VAs to purchase syringes for people who inject drugs), and a National memo (and soon directive) in support of VA SSPs
Departments
- Adaptive sports
- Homeless Veteran care
- Pharmacy
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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PROCESSES |
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TOOLS |
|
Files
- Patient education guide regarding injection drug use Injection Drug Use Brochure
- Danville HR business card Danville HR business card
- Dr. Beth Dinges educating other VHA pharmacists on Harm Reduction during the monthly national meeting Harm Reduction Monthly Teleconference slideset
- SSP Implementation Guide for Shark Tank SSP Implementation Guide for Shark Tank
Links
- Harm Reduction Talk for VHA Opiod Safety and Risk Mitigation monthly meeting with Dr. Elizabeth Oliva as moderator Harm Reduction Initiatives in the Veterans Health Administration
- Pharmacy Resident Deanna Cordero Da Silva explains the Syringe Service Program and how you can learn more Introduction to Orlando VAHCS Syringe Service Program
- Pharmacy Resident Riley O'Donnell Turner explains about PrEP, daily pill to prevent HIV, as part of harm reduction services at Orlando VAHCS Introduction to PrEP, a daily pill to prevent HIV, part of harm reduction services provided at Orlando VAHCS
Optional Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
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Links
- Internal SharePoint with national and local resources. SSP SharePoint
Support Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
|
Files
- Patient handout on safe injection practices Safe injection practice brochure
- SSP checklist SSP checklist
- Implementation Guide for Shark Tank SSP Implementation Guide
- Education material on safer booty bumping utilized at San Francisco VA Education Material on Safer Booty Bumping
- Education material on safer smoking utilized at San Francisco VA Education Material on Safer Smoking
- Intro to Harm Reduction & SSPs for VA Clincians Harm Reduction & SSPs Provider Guide
Risks and mitigations
| Risk | Mitigation |
|---|---|
| Stigma towards people who use drugs | Ongoing education provided by Subject Matters Experts, including those working at community programs AND veterans with lived experience (past or present). Culture change within the VA, a piece of that comes with making basic syringe access available A bigger commitment would be ongoing staff discussions, education regarding stigma and harm reduction. |
| Engaging veterans who use drugs to use VA services, including syringe services is a challenge. Veterans, especially those who use drugs have reluctance to trust and engage in VA services. Many use community resources instead which are more anonymous and less stigmatizing. | Building pathways between the VA and community programs is key. Community programs do directly provide medical services, but rather linkage to care. For example, medical treatment for Hepatitis C or HIV or SUD is not directly provided by most community programs. |
| State and local laws | At this time, VA does not have federal supremacy over state/local laws limiting syringe access. There are 12 or more states where this applies and at this time, those VAs would not be able to participate. |
| Existing VA policies | Current Social Work practice does not allow social workers to carry or administer naloxone (or carry/distribute syringes). Many people who use SSPs have unstable housing and Homeless SW and Peer Specialists are often doing outreach to these individuals in the community. Although we can mail syringes and naloxone, it'd be an obvious plus for outreach workers to have this capability. |
Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
Email elizabeth.dinges2@va.gov with questions about this innovation.
About
Origin story
Original team
Elizabeth Dinges
VISN 12 Academic Detailing, VA Illiana SSP lead
Minh Q Ho
Orlando VA ID physician, co-lead for Orlando SSP
Tessa Rife-Pennington, PharmD, BCGP
VA San Francisco, Harm Reduction Coordinator. Pilot lead for Fentanyl Test Strips, co-development for VA national education on stigma, harm reduction, SSPs
Great work. I would love to see this at the Los Angeles VA.
aww. thank you! emily defraites at GLA is getting this off ground there! LMK if you want me to put you in contact w/ her.