Harm reduction on the front lines: pharmacist engagement with people experiencing homelessness via community-based outreach

Introduction: People experiencing homelessness face overlapping health, substance use, and material needs that are not always met in traditional care settings. Community-based organizations (CBOs) offer trusted, low-barrier access points, and embedding a clinical pharmacist practitioner (CPP) in these settings may expand harm reduction and education services. Methods: We conducted a prospective quality improvement project with a San Francisco-based CBO that hosts drop-in outreach events. CPP and team members attended seven events (May 2024-May 2025), offered free supplies (e.g. naloxone, fentanyl test strips, condoms, emergency contraception, sexually transmitted infection self-tests, wellness items), and provided item-specific education. Event attendance, number engaged with the CPP-led table, and item distribution counts were recorded and summarized descriptively. Results: Across seven events, 1,320 people attended, and 347 engaged with the CPP-led table (overall reach 26.3%). Because event size varied, we also calculated event-level reach; the median per-event reach was 66.2% (IQR 60.6-70.9%). In total, 4,380 items were distributed, most commonly fentanyl test strips (n = 1,084, 24.7%), condoms (n = 1,012, 23.1%), and sunscreen (n = 667, 15.2%). Lower counts of HIV and chlamydia/gonorrhea self-test distribution reflected limited on-hand inventory. Conclusions: A CPP-led harm reduction table embedded in CBO outreach was feasible, well-used, and added clinical counseling to an existing low-barrier service.