Illinois Opioid Remediation Advisory Board
Medical & Research Working Group Meeting
October 17, 2023
Virtual Meeting Held Via Zoom
Meeting Minutes
Medical and Research Working Group Members
Adrienne Adams, MD, Rosecrance (Chair)
Nicole Gastala, MD, IDHS, SUPR
Jessica Perillo, Boone County Health Department
Katie Unthank, Egyptian Health Department
Michael Dennis, PhD, Lighthouse Research Institute, Chestnut Health Systems
Tamara Olt, MD, Broken No More, Jolt Foundation
Doug Smith, PhD, University of Illinois
Dana Ray, MD, Crossings Healthcare
Katherine Austman, MD, Gibson Area Hospital and Health Services
Katharine (Kitty) Juul, Southern Illinois University (SIU)
Kathryn Bocanegra, PhD, Jane Addams College of Social Work, University of Illinois at Chicago (UIC)
Lindsay Wilson, CDC Foundation
Michael Isaacson, Kane County Health Department
Dan Lustig, PsyD, MA, Haymarket Center
Leslie Wise, PhD, Illinois Department of Public Health (IDPH)
Rachel King-Johnson, Phoenix Center
Lia Daniels, Illinois Hospital Association (IHA)
Welcome and Roll Call
Sue Pickett, PhD of Advocates for Human Potential, Inc. (AHP), facilitator, welcomed the group and roll call was taken. All members were present except for Dr. Adams, Ms. Perillo, Ms. Unthank, Dr. Smith, Dr. Ray, Dr. Bocanegra, Ms. Wilson, Dr. Lustig, and Ms. King-Johnson. Dr. Dennis arrived after the review and approval of the meeting minutes. Quorum was established after Dr. Dennis arrived. Dr. Gastala led the meeting in Dr. Adams' absence.
Review and Approval of September 19, 2023 Meeting Minutes
The working group members agreed to vote on the approval of the September meeting minutes by consensus. Dr. Gastala called for a motion to approve the September meeting minutes. Dr. Wise made a motion to approve the minutes. Dr. Isaacson seconded the motion. All members present voted in favor of approving the minutes. The motion passed.
Priority Recommendations for the IORAB
Dr. Gastala led a discussion on the recommendations that were considered at the last meeting. Two recommendations (support for peer recovery specialists and wound care) are being worked on by other groups. Support for peer recovery specialists is being explored by the Workforce Development & Infrastructure working group and wound care is being considered by the Illinois Department of Human Services/Substance Use Prevention and Recovery (IDHS/SUPR) and Illinois Department of Healthcare and Family Services (HFS). The remaining three recommendations were discussed:
- Planning and implementation for partnerships between Federally Qualified Health Centers (FQHCs)/hospitals/clinics/departments of public health and Opioid Treatment Programs (OTPs) to incorporate OTPs in existing medical locations across the state. This recommendation will prioritize entities that accept public funding in rural areas and areas with no access to OTPs. Entities that are already zoned for medical can provide access to methadone relatively quickly. The process includes obtaining State licensure and following Drug Enforcement Administration (DEA) rules and regulations, which takes about six months. The planning phase will be used to develop interagency agreements and memorandums of understanding (MOUs), and to develop the physical space.
- Planning, training, and implementation of contingency management for opioid use disorder (OUD). Contingency management is important in order to increase retention in treatment.
- Notice of Funding Opportunity (NOFO) to support Emergency Medical Services (EMS)-initiated buprenorphine via EMS paramedics/fire departments for individuals for OUD or post-opioid overdose.
Dr. Gastala asked members to consider which recommendation(s) they would like to work on first. Dr. Pickett stated that they can also develop additional recommendations.
- Working group members expressed interest in working on incorporating OTPs into existing medical locations (#1) and planning, training, and implementation of contingency management for OUD (#2).
- A working group member asked how community-based organizations conducting harm reduction work can receive funding. As harm reduction is one of the approved uses of funds within the allocation agreement, the group may develop new recommendations related to harm reduction. Dr. Gastala and Dr. Pickett discussed the three approved recommendations that include harm reduction services: funding for naloxone; mobile treatment services for medications for opioid use disorder (MOUD), treatment, recovery, and harm reduction; and the Community Outreach and Recovery Support (CORS) model. The NOFOs are expected to be released by the end of the year.
- There was discussion about patient access to buprenorphine. IDHS/SUPR has funding for patients who are uninsured and underinsured who are not Medicaid eligible. Patients can receive access to buprenorphine through MAR Now. The NOFO could require that entities dispense buprenorphine to patients who are uninsured or uninsurable and include a no co-pay option.
- There was discussion about the 340B Drug Pricing Program as a way to increase buprenorphine access. In order for patients to qualify, however, providers must be 340B Program providers. A working group member said that a patient under 340B program was prescribed buprenorphine for one month (twice a day), and it was covered, but cost $93 out-of-pocket. In addition, there must be a contract with each pharmacy.
- The group developed another recommendation to address access to MAR: 4) Buprenorphine for people with no insurance/'buprenorphine for all'/MAR for all.
- A working group member noted that there should not be limits on the amount of buprenorphine prescribed. Some patients need to take buprenorphine four times/day, and some insurance plans won't pay for the fourth dose. Insurance is regulated by state agencies. Illinois Public Health Institute (IPHI) has been the main proponent for this type of legislation. However, opioid settlement funds can't be used for policy or legislation.
The group agreed to vote to work on three recommendations: planning and implementation for partnerships between FQHCs/hospitals/clinics/departments of public health and OTPs; planning, training, and implementation of contingency management for OUD; and buprenorphine for people with no insurance/ 'buprenorphine for all'/MAR for all. Dr. Dennis made a motion to work on the three recommendations. Dr. Olt seconded the motion. All working group members who were present voted in favor of working on the three recommendations. The motion passed.
- Dr. Gastala reviewed the Opioid Settlement Funding Recommendation Form and suggested that volunteers begin drafting a form for each recommendation. Recommendation forms will be reviewed by Sue's team and IDHS/SUPR Director Garcia and then sent to the Illinois Opioid Remediation Advisory Board (IORAB) to be approved at the January meeting. Each of the three recommendations fall under Core Strategy B (Medication Assisted Treatment) and possibly Prevention Program (Core Strategy G). The two Statewide Overdose Action Plan (SOAP) priority areas are Social Equity and Treatment and Recovery. Priority populations include rural areas for the recommendation related to OTPs and for buprenorphine for all. SAMSHA Tip 63, Medications of Opioid Use Disorder (TIP 63: Medications for Opioid Use Disorder - Full Document | SAMHSA Publications and Digital Products) will provide useful data and information for the recommendation form.
- Dr. Austman agreed to draft the recommendation for planning and implementation for partnerships between FQHCs/hospitals/clinics/departments of public health and OTPs, Dr. Dennis agreed to draft the recommendation for planning, training, and implementation of contingency management for OUD, and Dr. Olt agreed to draft the recommendation related to buprenorphine for people with no insurance/ 'buprenorphine for all'/MAR for all.
- Volunteers will send the recommendation form drafts to Dr. Pickett by November 10, who will then send the forms to the group to finalize by November 13. Working group members must approve the recommendations in November and December. Working group members are able to attend the November 21 meeting. The materials are due to the IORAB in early January.
- Working group members said that they should make sure every NOFO includes harm reduction as part of the services. The only way to reach people who are actively using is through harm reduction services. In addition, associations should distribute NOFOs to provider groups.
Public Comment
A member of the public stated that he enjoyed the conversation and was especially interested in anything that can break down barriers.
Adjourn
Dr. Gastala asked for a motion to adjourn the meeting. Dr. Olt make a motion to adjourn the meeting. Dr. Dennis seconded the motion. All working group members who were present voted in favor of the motion. The motion passed. The next Medical & Research Working Group meeting with be held via Zoom on November 21, 2023, from 12:00pm-1:00pm.
