Centering Veteran expertise: advancing peer-led harm reduction in the Veterans health administration

Abstract The principle “Nothing about us without us” underscores the ethical imperative to involve people with lived and living expertise in shaping harm reduction praxis. While the United States Veterans Health Administration (VHA) has expanded harm reduction initiatives, such as syringe services and naloxone distribution, over the past four years, Veterans with lived and living expertise (VWLLE) have not been meaningfully integrated into policy and program design. In response, VHA clinicians and advocates established the Harm Reduction Veteran Engagement Board (HR-VEB), a peer-supported initiative that positions VWLLE as partners in harm-reduction reforms. This perspective emphasizes structural barriers faced by Veterans who use drugs, highlights the leadership and work of HR-VEB members, and outlines policy and practice recommendations for designing more equitable care. Through the voices and work of Veterans, we argue that peer-led harm reduction is both evidence-based and a matter of social justice.