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Expanding Harm Reduction Services and Implementation of Syringe Services Programs (SSP) within Veterans Health Administration (VHA)

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Syringe 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.

This innovation is scaling widely with the support of national stakeholders. See more scaling innovations.

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

composite image of a syringe

Tags:

Access to Care Health Equity Mental Health Outpatient Care Pharmacy Specialty Care
Contact Team

Overview

Problem

Mental illness and illicit substance use afflict million of veterans. Syringe 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 ... See more

Images

Peer Specialist and Beth handing out naloxone at Stand down in Peoria, IL

Peer Specialist and Beth handing out naloxone at Stand down in Peoria, IL

Poster at Amersa 2023

Poster presentation at AMERSA 2023

Solution

Danville VAHCS SSP developed (2017), Orlando VAHCS developed SSP (2019), using donated syringes because we were under the misimpression that VAs were barred from purchasing syringes for people who use drugs. This misinterpretation has been long promulgated. In the meanwhile, San Francisco VAHCS developed SSP (2019) utilizing pilot award funding to provide ... See more

Images

Kits across Danville, SF, Orlando

Kits across Danville, SF, Orlando

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

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

Orlando VAHCS Outreach to provide Harm Reduction Services at Annual 25th Annual Central Brevard Stand Down to Stand Up

UCSF Addiction Research Program for eligible Veterans on harm reduction services including providing free fentanyl test strips

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

San Francisco VAHCS Harm Reduction Team members Tessa Rife-Pennington and Renée Dembo attended the Stand Down on the Delta at the Contra Costa County Fairgrounds in Antioch, CA, September 2023. This was a four-day event wherein Veteran’s received services in Medical, Dental, Veterans Treatment Court, Housing, Job Placement, Mental Health and Drug and Alcohol Counseling. More information is available at: https://deltaveteransgroup.org/stand-down-on-the-delta Tessa and Renée offered Veterans overdose education, naloxone, safer injection kits, and other harm reduction education and supplies. Pictured upper left and clockwise: 1) Veteran and Tessa sitting at the harm reduction table discussing naloxone; 2) Tessa at the harm reduction table; 3) Veteran with dog and Tessa sitting at the harm reduction table after discussing the available resources; 4) Renée at the harm reduction table.

San Francisco VAHCS Harm Reduction Program Outreach at Stand Down on the Delta in Antioch, CA, September 2023

San Francisco VAHCS Harm Reduction Team members Tessa Rife-Pennington and Thao Vu attended the North Coast Stand Down at the Humboldt County Fairgrounds in Ferndale, CA, October 2023. This was a three-day event wherein Veteran’s received services in Medical, Dental, Veterans Treatment Court, Housing, Job Placement, Mental Health and Drug and Alcohol Counseling. More information is available at: https://northcoaststanddown.org/ Tessa and Thao offered Veterans overdose education, naloxone, safer injection kits, and other harm reduction education and supplies. Pictured upper left and clockwise: 1) Tessa and Thao sitting at the harm reduction table; 2) Tessa and Veteran standing at the harm reduction table discussion naloxone; 3) Veteran and Thao standing by the harm reduction program banner; 4) Thao and Veteran standing at the harm reduction table; 5) Veteran and Thao at the harm reduction table discussing naloxone.

San Francisco VAHCS Harm Reduction Program Outreach at North Coast Stand Down in Ferndale, CA, October 2023

Results

The impact is that we have brought a service to our VA which was, up until that point, a service not available at any VAs. We spreading to VISN 12 facilities (12+ at other VAs across the country). Academic Detailing helping support spread, networking with community SSPs. HIV and Hepatitis Related Conditions (HHRC) national workgroup to standardize practice ... See more

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)

Statuses

CA: San Francisco VA Medical Center (San Francisco) FL: James A. Haley Veterans' Hospital (Tampa, Florida) FL: Orlando VA Medical Center (Orlando)
  • Started adoption on 08/2020.
IL: Captain James A. Lovell Federal Health Care Center (North Chicago) IL: Edward Hines Junior Hospital (Hines) IL: Jesse Brown Department of Veterans Affairs Medical Center (Chicago, Illinois) MI: Oscar G. Johnson Department of Veterans Affairs Medical Facility (Iron Mountain) OH: Cincinnati VA Medical Center (Cincinnati, Ohio) UT: George E. Wahlen Department of Veterans Affairs Medical Center (Salt Lake City) WI: Tomah VA Medical Center (Tomah)

AZ: Bob Stump Department of Veterans Affairs Medical Center (Prescott) CO: Denver VA Medical Center (Denver) CT: West Haven VA Medical Center (West Haven) FL: Bruce W. Carter Department of Veterans Affairs Medical Center (Miami) KY: Troy Bowling Campus (Lexington Cooper) MD: Baltimore VA Medical Center (Baltimore) MN: Minneapolis VA Medical Center (Minneapolis, Minnesota) TN: Nashville VA Medical Center (Nashville) WI: Clement J. Zablocki Veterans' Administration Medical Center (Milwaukee, Wisconsin) WV: Beckley VA Medical Center (Beckley) WV: Hershel "Woody" Williams VA Medical Center (Huntington, West Virginia) WV: Martinsburg VA Medical Center (Martinsburg)

There are no unsuccessful adoptions for this innovation.

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

  • Pharmacy
  • Homeless Veteran care

Core Resources

Resource type Resource description
PEOPLE
  • Clinical Application Coordinator required for 2-4 hours/week for 1-2 weeks
  • SSP lead for 5-10 hours/week, ongoing. Most logically, the lead would be a clinical pharmacist or a social worker, but the role could be filled by different professions
PROCESSES
  • Ongoing staff education and trainings. There are tons of existing, free resources available for facilities to use, including VA developed ones I've helped create.
  • A process for evaluating impact and outcomes, possibly through local quality management.
TOOLS
  • Syringes and other supplies are orderable through Pharmacy and Logistics. It will vary site to site, but the essentials (i.e. syringes, alcohol swabs, naloxone, etc) are all readily accessible at all facilities through a prescription

Files

Links

Optional Resources

Resource type Resource description
PEOPLE
  • Our biggest local partnership is between Pharmacy and Homeless Social Work (patient outreach). Project can potentially touch upon multiple services: Social Work, ID, GI, MH/SUD, Cardiology. It's important to note that this was rolled out a rural, level 3 complexity facility. While nice to have additional services, the most central component is sterile syringes (readily accessible) and a identified SSP lead.
PROCESSES
  • Process for compensating veterans with lived experience and community harm reductionists for their feedback into policy and rollout
TOOLS
  • Designated laptop for employees to use

Links

Support Resources

Resource type Resource description
PEOPLE
  • Supportive assistance is available through HIV, Hepatitis, Related Conditions (HHRC) Syringe Service Program Affinity Group, of which both Danville SSP leads are members, along with leads from Orlando and other developing programs. One on one consultations are available.
PROCESSES
  • For V12, we have worked out a process with Accounting and Fiscal Services to provide some compensation to Veterans and Community Activists who have assisted in our development
TOOLS
  • We have developed numerous handouts (both locally, regionally, and nationally (HHRC workgroup) which are vetted and ready to share and reproduce at other sites

Files

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

VA User (Pathology Assistant) posted

Great work. I would love to see this at the Los Angeles VA.

1

Email

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About

Origin story

The Danville VA piloted the VA’s first SSP in 2017, prompted by a veteran who was HCV positive, injecting drugs and requesting sterile syringes. Due to a misunderstanding of the law, the veterans request for syringes was declined. A VA employee then coordinated for a community organization who provided sterile syringes while patient’s HCV was treated by the ... The Danville VA piloted the VA’s first SSP in 2017, prompted by a veteran who was HCV positive, injecting drugs and requesting sterile syringes. Due to a misunderstanding of the law, the veterans request for syringes was declined. A VA employee then coordinated for a community organization who provided sterile syringes while patient’s HCV was treated by the VA. We’ve also since clarified that the VA is legally and ethically justified in providing syringes to veterans who inject drugs. By having a pre-established pathway between the VA and the community, we could’ve more effectively treated and even prevented his infection.

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

Andi M. Phillips, LCSW

HUD-VASH Supervisor

Search tags

Access to Care Health Equity Mental Health Outpatient Care Pharmacy Specialty Care