Abstract: BACKGROUND: Unregulated fentanyl use is driving overdose deaths, and fentanyl test strips (FTS) are a tool to support overdose risk reduction. This quality improvement project assessed a novel pharmacist-led model of FTS education and distribution Veterans Affairs (VA) substance use disorder (SUD) care and its association with fentanyl-related knowledge and overdose risk reduction behaviors (ORRBs). METHODS: This prospective single-arm cohort project was completed in outpatient SUD clinics at a VA Medical Center. A pharmacist delivered education (fentanyl, opioid overdose risk, FTS use) and offered Veterans FTS and intranasal naloxone. Veterans completed surveys pre-/post-education and at one-month. Pre-/post-changes in fentanyl knowledge, concerns, and planned ORRBs were analyzed using paired t-tests with Cohen's d for effect size. RESULTS: Fifty-seven Veterans (mean age 59.3 years, 100% male) participated (January-October 2020). Most (n=56, 98.2%) accepted at least one FTS kit, and 25 (43.9%) accepted naloxone. Significant pre-post improvements were observed in knowledge of carfentanil potency (p<0.001, d=1.21), fentanyl potency (p<0.001, d=0.74), and concern about fentanyl contamination (p<0.001, d=0.59). Planned ORRBs improved: keeping naloxone nearby (p<0.001, d=0.67); testing non-prescribed opioids for fentanyl (p<0.001, d=0.61). Eleven (22.2%) reported using at least one FTS; most positive results were followed by ORRBs. CONCLUSIONS: A brief, pharmacist-led FTS education and distribution model was feasible in outpatient VA SUD care and associated with improved knowledge and ORRBs among Veterans. This model may reach Veterans who do not access conventional community-based harm reduction services and supports broader integration of FTS education and distribution in Veteran-focused SUD care to reduce overdose risk.