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Harm Reduction Integration in an Interprofessional Primary Care Training Clinic
Background
Among people who use drugs (PWUD), harm reduction (HR) is an evidence-based low barrier approach to mitigating ongoing substance use risks and is considered a key pillar of the Department of Health and Human Service’s Overdose Prevention Strategy.1 Given the accessibility and continuity, primary care (PC) clinics are optimal sites for education about and provision of HR services.2,3
Aim
- Determining the impact of active and passive methods for HR supply.
- Recognizing the importance of clinician addiction education in the provision of HR services.
Methods
In January 2024, physician and nurse practitioner trainees in the West Haven Veterans Affairs (VA) Center of Education (CoE) in Interprofessional Primary Care received addiction care and HR strategy education. Initially, all patients presenting to the CoE completed a single-item substance use screening. Patients screening positive were offered HR supplies, including fentanyl and xylazine test strips (FTS, XTS), during the encounter (active distribution). Starting October 2024, HR kiosks were implemented in the clinic lobby, offering patients self-serve access to HR supplies (passive distribution). Test strip uptake was tracked through clinical encounter documentation and weekly kiosk inventory.
Results
Between January 2024 and June 2024, 92 FTS and 84 XTS were actively distributed. Upon implementation of the harm reduction kiosk, 253 FTS and 164 XTS were distributed between October 2024 and February 2025. In the CoE, FTS and XTS distribution increased by 275% and 195%, respectively, through passive kiosk distribution relative to active distribution during clinical encounters.
Conclusions
HR kiosk implementation resulted in significantly increased test strip uptake in the CoE, proving passive distribution to be an effective low barrier method of increasing access to HR and substance use disorder (SUD) resources. Although this model may reduce stigma and logistical barriers when presenting for a healthcare encounter, it limits the ability to track and engage patients for more intensive services. While each approach has unique advantages and disadvantages, test strip demand via both methods highlights the significant need for HR resources in PC settings. Continuing education for PC clinicians on low barrier SUD care and HR is critical to optimizing care for this population.
- Haffajee, RL, Sherry, TB, Dubenitz, JM, et al. Overdose prevention strategy. US Department of Health and Human Services (Issue Brief). Published October 27, 2021. Accessed December 11, 2025. https://aspe.hhs.gov/sites/default/files/documents/101936da95b69acb8446a4bad9179cc0/overdose-prevention-strategy.pdf
- Substance Abuse and Mental Health Services Administration. Advisory: low barrier models of care for substance use disorders. SAMHSA Publication No. PEP23-02-00-005. Published December 2023. Accessed December 11, 2025. https://library.samhsa.gov/sites/default/files/advisory-low-barrier-models-of-care-pep23-02-00-005.pdf
- Substance Abuse and Mental Health Services Administration: Harm Reduction Framework. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, 2023.
Background
Among people who use drugs (PWUD), harm reduction (HR) is an evidence-based low barrier approach to mitigating ongoing substance use risks and is considered a key pillar of the Department of Health and Human Service’s Overdose Prevention Strategy.1 Given the accessibility and continuity, primary care (PC) clinics are optimal sites for education about and provision of HR services.2,3
Aim
- Determining the impact of active and passive methods for HR supply.
- Recognizing the importance of clinician addiction education in the provision of HR services.
Methods
In January 2024, physician and nurse practitioner trainees in the West Haven Veterans Affairs (VA) Center of Education (CoE) in Interprofessional Primary Care received addiction care and HR strategy education. Initially, all patients presenting to the CoE completed a single-item substance use screening. Patients screening positive were offered HR supplies, including fentanyl and xylazine test strips (FTS, XTS), during the encounter (active distribution). Starting October 2024, HR kiosks were implemented in the clinic lobby, offering patients self-serve access to HR supplies (passive distribution). Test strip uptake was tracked through clinical encounter documentation and weekly kiosk inventory.
Results
Between January 2024 and June 2024, 92 FTS and 84 XTS were actively distributed. Upon implementation of the harm reduction kiosk, 253 FTS and 164 XTS were distributed between October 2024 and February 2025. In the CoE, FTS and XTS distribution increased by 275% and 195%, respectively, through passive kiosk distribution relative to active distribution during clinical encounters.
Conclusions
HR kiosk implementation resulted in significantly increased test strip uptake in the CoE, proving passive distribution to be an effective low barrier method of increasing access to HR and substance use disorder (SUD) resources. Although this model may reduce stigma and logistical barriers when presenting for a healthcare encounter, it limits the ability to track and engage patients for more intensive services. While each approach has unique advantages and disadvantages, test strip demand via both methods highlights the significant need for HR resources in PC settings. Continuing education for PC clinicians on low barrier SUD care and HR is critical to optimizing care for this population.
Background
Among people who use drugs (PWUD), harm reduction (HR) is an evidence-based low barrier approach to mitigating ongoing substance use risks and is considered a key pillar of the Department of Health and Human Service’s Overdose Prevention Strategy.1 Given the accessibility and continuity, primary care (PC) clinics are optimal sites for education about and provision of HR services.2,3
Aim
- Determining the impact of active and passive methods for HR supply.
- Recognizing the importance of clinician addiction education in the provision of HR services.
Methods
In January 2024, physician and nurse practitioner trainees in the West Haven Veterans Affairs (VA) Center of Education (CoE) in Interprofessional Primary Care received addiction care and HR strategy education. Initially, all patients presenting to the CoE completed a single-item substance use screening. Patients screening positive were offered HR supplies, including fentanyl and xylazine test strips (FTS, XTS), during the encounter (active distribution). Starting October 2024, HR kiosks were implemented in the clinic lobby, offering patients self-serve access to HR supplies (passive distribution). Test strip uptake was tracked through clinical encounter documentation and weekly kiosk inventory.
Results
Between January 2024 and June 2024, 92 FTS and 84 XTS were actively distributed. Upon implementation of the harm reduction kiosk, 253 FTS and 164 XTS were distributed between October 2024 and February 2025. In the CoE, FTS and XTS distribution increased by 275% and 195%, respectively, through passive kiosk distribution relative to active distribution during clinical encounters.
Conclusions
HR kiosk implementation resulted in significantly increased test strip uptake in the CoE, proving passive distribution to be an effective low barrier method of increasing access to HR and substance use disorder (SUD) resources. Although this model may reduce stigma and logistical barriers when presenting for a healthcare encounter, it limits the ability to track and engage patients for more intensive services. While each approach has unique advantages and disadvantages, test strip demand via both methods highlights the significant need for HR resources in PC settings. Continuing education for PC clinicians on low barrier SUD care and HR is critical to optimizing care for this population.
- Haffajee, RL, Sherry, TB, Dubenitz, JM, et al. Overdose prevention strategy. US Department of Health and Human Services (Issue Brief). Published October 27, 2021. Accessed December 11, 2025. https://aspe.hhs.gov/sites/default/files/documents/101936da95b69acb8446a4bad9179cc0/overdose-prevention-strategy.pdf
- Substance Abuse and Mental Health Services Administration. Advisory: low barrier models of care for substance use disorders. SAMHSA Publication No. PEP23-02-00-005. Published December 2023. Accessed December 11, 2025. https://library.samhsa.gov/sites/default/files/advisory-low-barrier-models-of-care-pep23-02-00-005.pdf
- Substance Abuse and Mental Health Services Administration: Harm Reduction Framework. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, 2023.
- Haffajee, RL, Sherry, TB, Dubenitz, JM, et al. Overdose prevention strategy. US Department of Health and Human Services (Issue Brief). Published October 27, 2021. Accessed December 11, 2025. https://aspe.hhs.gov/sites/default/files/documents/101936da95b69acb8446a4bad9179cc0/overdose-prevention-strategy.pdf
- Substance Abuse and Mental Health Services Administration. Advisory: low barrier models of care for substance use disorders. SAMHSA Publication No. PEP23-02-00-005. Published December 2023. Accessed December 11, 2025. https://library.samhsa.gov/sites/default/files/advisory-low-barrier-models-of-care-pep23-02-00-005.pdf
- Substance Abuse and Mental Health Services Administration: Harm Reduction Framework. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, 2023.