The Illinois Department of Human Services Division of Substance Use Prevention and recovery (IDHS/SUPR) has been awarded multiple grants to address the opioid crisis, from the Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the U.S. Department of Health and Human Services (HHS). This report focuses on the State Opioid Response (SOR) grant funding, and reports on total number of persons served. Future reports will be in a different format, and will report on services beginning July 1, 2022.
State Opioid Response (SOR) Grant
SOR II- IDHS/SUPR received an award from SAMHSA for SOR-II funding of $36.7 million. The project period is 9/30/2020 through 9/29/2022, for a total of $73.5 million over two years. SUPR continues to fund the work of programs in this report and has initiated some new projects as well. These include MAR Integration for Justice-Involved Populations; Leadership Centers; and Access Narcan. Descriptions of these projects are included in this report. Additionally, this grant expands the pool of those who can be served to now include persons with stimulant use disorder.
The grants include initiatives that align with the State Overdose Action Plan (SOAP). The SOAP forms the strategic framework for addressing the overdose epidemic in Illinois, setting a statewide goal of reducing the number of overdose deaths, and formulating a set of evidence-based strategies to achieve this goal.
The SOAP focuses on efforts in five categories:
- 1) Social Equity
- 2) Prevention
- 3) Treatment and Recovery
- 4) Harm Reduction
- 5) Justice-Involved Populations and Public Safety
Each priority includes a set of metrics that will be used to document our progress. The programs supported through these grants are designed to address the range of serious overdose-related problems and issues that are being experienced among residents across Illinois. These programs primarily aim to address the overdose crisis by expanding the availability of medication assisted treatment (MAR), improving the quality of the MAR provided, enhancing access to treatment, reducing overdose related deaths, increasing public awareness of overdose-related problems and expanding access to the resources that are available to address these problems.
Through June 30, 2022, 5,224 persons were served through the outreach, treatment, and recovery support services supported through the SOR grant. *
*Population-based activities, such as public awareness campaigns, the Helpline, and Naloxone distribution, are not included in this number but are summarized below
2022 Update and Summary
In 2020, SUPR began using the term Medication Assisted Recovery (MAR) to replace the term Medication Assisted Treatment (MAT). Medication Assisted Recovery (MAR) includes the use of evidence- based FDA approved medications (e.g., methadone, buprenorphine, naltrexone, disulfiram, acamprosate) for individuals with a substance use disorder (SUD) who are in recovery. The term MAR recognizes that individuals who take medications to manage their SUD who identify in recovery are in recovery since often these medications are prescribed long term and are used outside of treatment. Older documents might still use the term MAT.
Illinois Opioid Crisis Helpline SOR funds support a statewide 24-hour, 7-day/week, 365 day/year helpline for persons with OUD-related issues. https://helplineil.org The Helpline was launched on December 5, 2017 and received 73,934 calls as of June 30, 2022. Of these calls, 49,099 ended in a referral, with 7,266 of those being a warm transfer. The Helpline's website was launched in March 2018 and has received 444,685 visits by 348,712 unique individuals. During 2020, texting was added to the Helpline telephone technology, and a chat function was added to the Helpline website, opening more opportunities for people to seek and receive help. As of June 30, 2022 2,632 chat interactions resulted in 445 referrals and 901 text interactions resulted in 303 referrals. New marketing campaigns were implemented statewide, including television ads in the Chicago market to focus on the West Side heroin epidemic. The Recovery Housing registry is now managed by the Helpline. Additionally, Helpline partnered with the Illinois Department of Public Health (IDPH) to design a harm reduction campaign, leading people to resources for syringe services, fentanyl test strips, and other harm reduction supports.
Improved Medical Provider Electronic Health Record (EHR) The Illinois Prescription Monitoring Program (PMP) receives Controlled Substance prescription data from retail pharmacies which enables prescribers and dispensers to view the historical data for current and prospective patients. Prescribers are required to review the PMP when considering opioids for individual patients, but this manual process is burdensome for medical practitioners in a busy practice. IDHS/SUPR is supporting a portion of the PMP's PMPnow campaign, an effort to support improved opioid prescriber reporting in commonly used EHR systems among Illinois medical provider systems. These "automated connections" make it more convenient for prescribers to check the PMP through their EHR, rather than logging into an external system. Senate Bill 722 (SB722), which took effect on January 1, 2018, mandates that all prescribers possessing an Illinois Control Substance license must register with the PMP. The PMP attributes the new law, along with the increase in automated connections, to a massive influx of PMP registrations. As of June 30, 2022, there were 1,304 PMP/EHR connectivity implementations (PMPnow), and 79,633 registered PMP users. Additionally, 55,459,195 searches were conducted through PMP now requests.
OUD Public Awareness Activities - Public awareness approaches are underway to deliver messaging and education to various audiences regarding the impacts of the opioid crisis in Illinois and the availability of programs and activities that have been developed in response. Primary campaigns that ran their course include Guard and Discard and Ending Opioid Misuse in Illinois. In June 2019, IDSH/SUPR added an important component to the overall statewide public awareness campaign by launching the A Dose of Truth campaign. The A Dose of Truth campaign started with a focus on creating a baseline of knowledge in the general population about what are opioids, specifically those found in medicine cabinets, and has evolved overtime to focus on the current drivers of overdose and overdose death in Illinois. This includes the need to address the ever-increasing crisis of opioid overdose and racial disparities. The initial Dose of Truth campaign included social media Facebook posts reaching an estimated 18,049,187 individuals, engaged (likes, comments, and shares and more) 75,849 individuals, and had 3,008,400 video views (video played for at least 3 seconds and excludes replaying the video during a single instance). In June 2019, IDHS/SUPR added another public awareness campaign, Naloxone Now. The Naloxone Now campaign addressed issues of stigma and acceptance of this life-saving medication within the general population, equating it to other life-saving medications and devices. The Naloxone Now campaign ended June 2020 and components were integrated into the current ADOT campaign. As of October 31, 2020, messaging for the Naloxone Now campaign through interior rail and bus cards displayed on Chicago's trains and buses, achieved an estimated 543.2 million impressions. An additional 12.75 million impressions were achieved through PACE interior bus cards and bus shelters. Final numbers for displays through gas stations and convenience stores statewide include an estimated 131.4 million views and 37,675,400 million views for bar restrooms signage.
An increasing need was identified to demystify Medication Assisted Recovery (MAR) and encourage both prescribers and patients to discuss its effectiveness in treating OUDs, what using medications to treat a SUD signifies in the context of recovery, and ultimately its effectiveness in decreasing overdose deaths. This led to the development and implementation of the Rethink Recovery campaign. Rethink Recovery is a statewide public awareness campaign that seeks to increase an openness and interest in MAR) among those at high risk of overdose. This campaign provides education and resources directly to those in-need and their support systems including medical providers and loved ones, to facilitate the first steps towards recovery.
New reach numbers are being reported to reflect the change in the ADOT campaign. As of June 30, 2022, the ADOT campaign has 14,282,598 Social Media Impressions (Social Media Impressions are the number of times that paid or unpaid content was displayed/seen by someone), 4,074,624 Social Media Engagements (Social Media Engagements are the number of actions a person took on campaign content, including post likes/reactions, photo views, link clicks, post saves, video/gif completions, shares/retweets, comments/replies, and page likes/follows), and 67,882 Website Sessions (Website Sessions are a single visit to a campaign website. As of June 30, 2022, for the Rethink Recovery campaign, there have been 32,691 Website Sessions, 5,008,668 Social Media Impressions, 729,677 Social Media Engagements, and 178 pdf downloads.
Student Athlete OUD Primary Prevention Services IDHS/SUPR supports a regional program that focuses on the risk of increased access to opioid pain medications for student-athletes. The Student Athlete Opioid Use Prevention Project conducts educational and awareness activities that target high school coaches, athletic directors, parents, and student-athletes regarding the misuse and risk of misuse of prescribed opiate pain medications by youth athletes. These activities include training on the Rx Playbook and dissemination of awareness promoting key messages, partnering with key organizations who focus on High School athletes, collaborating with existing prevention resources to promote key messages, promoting the Rx Playbook to targeted High Schools, and establishing social media connections with targeted schools and athletes attending those schools. As of June 30, 2022, the Rx Playbook has been shared at 42 county, statewide, and national events and conferences, reaching 3,394 school staff, parents, and/or community members. Comprehensive opioid education and awareness materials have been distributed to over 203 prevention providers and grantees (CSUPS, CDC-DFC, SUPS). Social media activities include a total of 131,653 reaches on Twitter, 347,752 reaches on Facebook, and 71,404 engagements on Instagram page. The project website received in total over 49,972 page views with 5,426 visits to the Rx Playbook pages.
The ilhpp.org website has a membership of 259 individuals. In addition, the project has launched 4 self-paced online training courses, The Athletic Trainer's Role in Opioid Education, Adolescent's and Opioids, Opioids 101 , and Be Your Own Best Advocate.
Other accomplishments include the addition of two new courses Stimulants 101: Introduction to Stimulants and Stimulants 102: Types of Stimulants.
Treatment and Recovery Initiatives
Access to Medication Assisted Recovery (A-MAR) Networks. One of IDHS/SUPR's approaches to increase access to MAR is via the AMAR Project. The AMAR Project utilizes a "Hub and Spoke" model, the goal of which is to have a substantial population center working with the surrounding areas with low access to MAR. Illinois has implemented five AMAR Networks, across Illinois. All five networks were identified via the NOFO process. As of June 30, 2022, 1,357 clients have been admitted to MAR through these service networks.
Residential Stabilization Centers for Patients with Opioid Use Disorder - These resources are targeted to the current gap in the service continuum for persons with OUD who lack housing and other supports to effectively engage in MAR during the early stage of their recovery process. Residential/inpatient care is expensive and unnecessarily restrictive for many persons with MAR, but many individuals still need safe, stable, temporary housing and supports like clothing, meals, and access to mental health services and primary health care. As of June 30, 2022, 810 clients have been admitted to the Residential Stabilization Centers.
Recovery Homes- Recovery Homes are alcohol and drug free homes whose rules, peer-led groups, staff activities and/or other structured operations are meant to help with maintaining sobriety. ORF grants have allowed IDHS/SUPR to expand Recovery Home services for persons with OUD who have unstable living arrangements and are active in some form of MAR. As of June 30, 2022, 1,012 clients have been admitted to a recovery home.
Correctional Facility-Based MAR Services Injectable naltrexone is the form of medication assistance for OUD that is most often preferred by correctional facility administrators because it has no risk of diversion. Federal ORF grant funds support six organizations providing injectable Naltrexone services for persons with OUD in county jails and at the Sheridan Correctional Center, one of Illinois' prisons.
These services consist of screening, assessment, initial injections, and post-release treatment referrals before discharge. Through June 30, 2022, 426 persons have been served. About 95% of these offenders were admitted by the community-based treatment providers to which they were referred.
Learning Collaborative to Support MAR Implementation for the Justice-Involved Population in Illinois Counties This program offers expert technical assistance (TA) for county teams starting or expanding medication assisted recovery (MAR) programs in their jail with continued recovery support in the community post-release. It expands upon the injectable naltrexone project by moving counties towards offering all three forms of federally approved medications for opioid use disorder. Currently fifteen jails (Kane, Kendall, Grundy, Will, Lake, DuPage, Iroquois, LaSalle, Boone, Kankakee, Lee, Ford, Sangamon, Richland, Bureau) are participating in the program with their county team that includes custody officers, SUD and BH healthcare providers, probation, health departments, and others.
Leadership Centers Five organizations were chosen to support the development of a comprehensive statewide network to assess and move persons with SUD through treatment and recovery, helping to bring together the numerous programs created in IL in response to the overdose crisis. Centers plan, develop and manage relationships and connections between traditional SUD services and the medical system, integrating prevention, treatment, and recovery. Each Center has an area of expertise that helps SUPR meet the goals of the SOR program. Centers expand the use of recovery support services through their provider networks, including interventions for co-occurring medical/mental illness.
Co-Located Hospital Warm Hand-off Services Patients who arrive at a hospital emergency department (ED) after an overdose reversal are at high risk of subsequent overdose. Additionally, patients in other hospital departments June have undiagnosed OUD. Hospitals don't typically screen for substance use disorders routinely, so patients with OUD are not often discharged with a referral to address their opioid use. Hospital Warm Hand-off Services involve robust, evidence-based screening and referral to treatment. Peer recovery support specialists "warm up" the referral to MAR services by going beyond providing a written referral or scheduling an appointment. It involves establishing a collaborative relationship with the patient, providing practical, personalized support for entering and adhering to treatment, and, in coordination with treatment providers, delivering ongoing recovery support services based upon patient needs. The Co- located Hospital Warm Hand-off Services have been initiated at 15 hospitals and multiple Cook County Health (CCH) locations, with 9,110 patients served through June 30, 2022. Over 70% of these patients were admitted by the community- based treatment providers to which they were referred following discharge.
Hospital Screening and Warm Handoff Services This is an expansion of the Co-Located Hospital Warm Hand-off Services, whereby hospitals provide grant-supported services directly rather than through sub agreements with external organizations. These services build upon the co-located hospital warm hand- off ORF grant awards in that services will be available throughout the hospital, and at more extended period time. Service delivery is consistent with the evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) model that has been the focus of multiple SAMHSA-funded cooperative agreements and discretionary grants. The number of patients screened positive for OUD and referred to treatment post discharge is 4,305 through June 30, 2022
Rush University Hospital Multi-Disciplinary Programs IDHS/SUPR funds support multiple programs within Rush University Hospital, which is located on the west side of Chicago. As of July 2022, Rush provided Screening, Brief Intervention, and Referral to Treatment (SBIRT) services to 25,813 patients, of whom 6,149 screened positive for any SUD, with 2,600 of these patients screening positive for OUD. Buprenorphine services were initiated for 559 patients, 345 patients were referred to other MAR services, and 661 non-OUD patients were referred to external SUD providers.
Community-based Outreach/Linkage/Referral Services Specialized and specific community-based outreach, referral, and linkage services are offered for persons with OUD in high-need areas. As a means of identifying individuals who are currently using heroin or other illicit opioids, peer outreach workers canvass multiple locations that are frequented by high-risk individuals, such as parks, street corners, public transportation stations, mini-marts, and liquor stores. Through the end of June 2022: 8,294 persons were provided outreach services; 5,503 of these persons screened positive for opioid and other illegal substance use and expressed an interest in treatment; 3,253 of these completed a meeting with a linkage manager; and 2,572 presented for the treatment intake.
Service Enhancement for Pregnant and Postpartum Women with OUD Enhanced services are made available to pregnant and postpartum women with OUD by staff who are certified in the following evidenced-based practices: Community Reinforcement and Family Training (CRAFT), Motivational Interviewing, Seeking Safety, Real Life Parenting, Individual Placement and Support (IPS) Employment. The staffing pattern for the supported enhancement will include Doula Certified Recovery Coaches. A Doula Certified Recovery Coach is a person in active recovery who obtains dual certification as both a birth and a postpartum doula to assist the recovering mother through prenatal and postpartum phases, and with recovery from her addiction. Services have been initiated by the five providers which were selected through the NOFO process. As of June ).
30, 2022, 1,258 women have been admitted to these enhanced services.
Opioid Use Disorder (OUD) MAR in Federally Qualified Health Centers (FQHC) The intent of this initiative is to increase the number of persons who are receiving MAR at FQHCs in Illinois. FQHCs can bill Medicaid for the medications and supportive services that make up MAR, so this grant will support services for patients that are not Medicaid-eligible, and services that are not Medicaid-billable. Such services include case management and recovery support services. Through the NOFO process five providers were identified and services began in November 2019. As of June 30, 2022, 203 clients have been admitted to these services.
Digital Toolkit Recovery Support Services In order to retain patients in MAR and offer additional supports, Illinois Recovery Community Organizations (RCOs) and SUPR-licensed providers have been awarded funds and technical assistance to develop digital recovery support toolkits including secure messaging, web resources, and recovery support mobile applications (apps) for persons with OUD who are active in some form of MAR. Through the NOFO process five providers were identified and began services in December 2019. As of June 30, 2022, 596 clients have been admitted to these services.
Technical Assistance for MAR Providers Rush Fellowship has developed a comprehensive weekend program for training and supporting medical staff to prescribe and treat individuals with the medication buprenorphine. Patients with OUD can be medically complex and sometimes medical staff are hesitant to treat these patients. The purpose of the program is to provide technical assistance to office-based buprenorphine prescribers in Illinois, especially within counties with limited or no current access to MAR. Physicians who have successfully begun prescribing buprenorphine share their challenges, successes and words of wisdom to assist their colleagues in breaking down the challenges to providing MAR. There have been six cohorts participate in an immersion weekend, held by Rush, since November 2018. A total of 62 providers participated. Training of a 7th Cohort began in January 2022. A total of 38 prescribers are participating. Ongoing technical assistance, including coaching and additional training, is being provided to these cohorts. Several rural counties are represented by prescribers who have thus far enrolled, and senior fellows who have been through the training are now assisting to gain experience for mentoring in their own communities.
Expanded Naloxone Purchase/Training/Distribution Services Naloxone is a medication that reverses an overdose by blocking opioids, including prescription opioids, heroin, and fentanyl. Federal funds are used for naloxone purchase, training, and distribution to traditional first responders like law enforcement officers and fire departments as well as non-traditional first responders like people who use drugs, friends and family members of people who use drugs, and other bystanders or community members who may witness an opioid overdose. As June 30, 2022, there have been 91,792 naloxone kits distributed and 114,806 people trained in overdose recognition and response. SUPR has recently initiated a program "Access Narcan" for organizations that enroll in our Drug Overdose Prevention Program. Information on Access Narcan can be found here: IDHS: IDHS/SUPR Drug Overdose Prevention Program (state.il.us)
Community Reinforcement Approach (CRA)
CRA is an evidence-based treatment for substance use disorders and has been shown to be effective for both stimulant and opioid use disorders, especially in combination with contingency management. CRA training is for clinicians and clinical supervisors. SUPR funds this training for any of our treatment providers where appropriate. As of the end of 2021, 115 SOR and SUPR-funded staff persons have been trained in CRA; 20 have earned CRA certification, and many are currently enrolled in the ongoing trainings. For more information about the CRA model, training, and certification, visit https://www.chestnut.org/ebtx
Data and Outcomes
IDHS/SUPR has taken multiple steps to comply with SAMHSA expectations regarding administration of the CSAT GPRA tool to each person who participates in the treatment and recovery services supported by this grant. The Illinois SOR grant has a two-year cumulative target of 4,500 unduplicated clients for the 10 service programs that contribute to this target.
For the SOR-II project, for the period September 2020 through March, 2022, Illinois SOR-II has recruited and provided 3,419 clients with SOR-funded services. Among the clients with both a baseline and 6-month follow up:
- There were statistically significant reductions from the month before intake to the month before follow up in 15+ days using heroin/opioids (41% to 11%), as well as decreases in 15+ days use of other substances including cocaine/crack/methamphetamines (29% to 5%).
- Participants also experienced significant decreases in mental health symptoms, including reductions in 15+ days of anxiety (33% to 25%), and in physical health problems (51% to 39% reporting poor/fair health).
- Conversely, there were significant increases in 15+ times utilizing substance use treatment including MAT (25% to 38%).
- Improvements in these domains were generally seen within each SOR-II service type. There was some variability in outcomes across service types, reflecting the differences in baseline levels of severity among participants in the different service types.