From Clinic to Community: Deploying Harm Reduction Vending Machines Across a Veterans Affairs System.

Harm reduction vending machines (HRVMs) can expand low-barrier access to overdose prevention, sexual health, safer-use, and basic self-care supplies; however, practical guidance for implementing HRVMs in health system and supportive housing settings is limited. This practice report describes a clinical pharmacist practitioner (CPP)-led deployment of 15 HRVMs across a Veterans Affairs (VA) system and Veterans supportive housing in California. Beginning in December 2021, the CPP conducted site engagement, market research, and funding applications; convened cross-departmental stakeholders (logistics, engineering, biomedical, environmental management, information security/technology); and completed contracting. Contracts were awarded to VendNovation, LLC, for HRVMs which were placed in 7 community-based outpatient clinics, 6 supportive-housing sites, and 2 hospital locations. The CPP designed the HRVM wrap and interior layout; curated product assortments (eg, fentanyl/xylazine test strips, syringes, safer-sex supplies, wound-care, and hygiene items; naloxone added after launch) based on prior quality improvement interventions and Veteran feedback surveys; and established barcode-based user access and software-enabled inventory management. Implementation challenges included staff concerns (eg, stigma, not in my backyard attitudes), connectivity barriers (eg, Wi-Fi requirements), and added costs for deliveries to non-VA locations. HRVMs within VA clinics were accessible during business hours; supportive-housing HRVMs operate 24/7. Planning and installation required nearly 2 years, underscoring the need for dedicated staffing (CPP plus logistics technician), braided funding for start-up and recurring costs, and standardized purchasing and installation pathways. HRVMs seem feasible and acceptable in VA clinical and housing settings and may increase anonymous, low-barrier access to harm-reduction supplies. Implications for scale-up include development of centralized or prevetted procurement pathways, clearer implementation guidance, and operational supports to reduce site-level contracting burden.