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

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.