Illinois Opioid Remediation Advisory Board
Medical & Research Working Group Meeting
January 16, 2024
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, Health Management Associates
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)
Lia Daniels, Illinois Hospital Association (IHA)
Brent Van Ham, Southern Illinois University School of Medicine
Welcome and Roll Call
Sue Pickett, PhD of Advocates for Human Potential, Inc. (AHP), facilitator, welcomed the group and conducted roll call. All members were present except for Nicole Gastala, Tamara Olt, Doug Smith, Dana Ray, Kathryn Bocanegra, Katharine Juul, Michael Isaacson, and Brent Van Ham. Quorum was established. Adrienne Adams and Michael Dennis arrived after roll call.
Review and Approval of December 19, 2023 Meeting Minutes
Dr. Pickett called for a motion to approve the meeting minutes. Dr. Wise made a motion to approve the December meeting minutes. Dr. Austman seconded the motion. All members present voted in favor of approving the minutes. The motion passed.
2024 Meeting Schedule
The working group will meet every other month in 2024. Dr. Pickett will send a new meeting invitation. The next meeting will be in March.
Priority Recommendations for the IORAB
Two recommendations discussed at the December meeting have been sent to the Office of Opioid Settlement Administration (OOSA): 1) Implement and support partnerships between opioid treatment programs (OTPs) and Federally Qualified Health Centers (FQHCs), hospitals, clinics, and public departments of health to expand access to methadone and 2) Fund sites to
IORAB Medical and Research Working Group January 16, 2024 Meeting Minutes 2
pilot a contingency management program. The interim Statewide Opioid Settlement Administrator (SOSA) Jim Wilkerson, MS, LCPC, Illinois Department of Human Services Division of Substance Use Prevention and Recovery (IDHS/SUPR), reported that the recommendations are being reviewed.
- A working group member asked if all recommendations must go through the working groups. Mr. Wilkerson said the recommendations do not have to go through the working groups; recommendations have been submitted by the general public and other entities. At times, the OOSA may ask the working group to provide feedback on recommendations that were submitted by others.
Working group members discussed how to revise the recommendation to improve access to buprenorphine:
- In addition to those who are uninsured and underinsured, the recommendation should clearly include a third group, those with geographic barriers to a clinic.
- Some people may not be able to access buprenorphine because they don't have money to see a provider in order to get a prescription. This should be added to the recommendation.
- At the December meeting, the group discussed pharmacies, substance use treatment providers, or Opioid Treatment Providers (OTPs) providing buprenorphine and applying for funding to cover it. There was also discussion about doing something similar to the 340B program and rolling it out to more pharmacists and providers.
- The Illinois Pharmacist Association (IPhA) and Garth Reynolds may be interested in supporting this recommendation because pharmacists are trying to gain a status similar to providers. There may be an opportunity to work with them.
- There was discussion in a prior meeting about local health departments increasing access to Medication-Assisted Recovery (MAR) through telehealth, especially in rural communities. Health departments could offer telehealth appointments with providers.
- The recommendation should address both financial barriers and geographic or other barriers to getting an appointment with a provider. The recommendation will aim to promote access to buprenorphine after individuals receive a prescription and buprenorphine initiation.
- Mr. Wilkerson said that while providing more detail about how this recommendation could be operationalized is helpful to IDHS/SUPR, the working group does not have to develop that plan. The organizations that respond to a Notice of Funding Opportunity (NOFO) will also address this.
- Providers could give cards to individuals to cover the cost of medication. For example, when providers give patients discount cards from drug companies, patients take them to the pharmacy. The pharmacy runs their insurance, and the drug maker picks up the remainder. Insurance should still be used to pay for buprenorphine.
- Consider removing financial support for underinsured from the proposal. If individuals are covered by Medicare and the medication is only partially covered and then it further covered by a separate state entity, it may be prohibited by federal law. If the recommendation is limited to the uninsured, it may improve the chances the proposal is approved.
- There was discussion about whether Emergency Management Services (EMS) providing buprenorphine would fall under this recommendation or if it should be explored separately. Dr. Pickett suggested the group explore it separately, in part because it is a State of Illinois Overdose Action Plan (SOAP) priority. A working group member said they are not sure if the group determined whether or not Illinois allows EMS to provide buprenorphine.
- The group discussed how to support access to clinics when a patient is uninsured and doesn't have access to a Federally Qualified Health Center (FQHC). More mobile vans can help provide access and this is sustainable through the use of telehealth. There are no restrictions to initiating or providing buprenorphine via telehealth. However, FQHCs have to have a certain percentage of clients coming from the geographic area they target. It could be an issue if an FQHC covers a rural area but doesn't prescribe buprenorphine.
- The recommendation should explicitly include adolescents as a special population. Sometimes prior authorization for a prescription is needed, which deters some providers. Providers may not know that adolescents require treatment, not just detoxing. If a media campaign was funded, this information should be included.
- AHP will revise the recommendation based on today's discussion. Drs. Wise, Austman, Lustig, and Adams will then review the recommendation.
A working group member noted that at the last Steering Committee meeting, there was a question about the economic impact of overdose in Illinois, such as the cost of Emergency Medical Services (EMS) and Emergency Department (ED) visits, and also the economic impact of harm reduction services. The group could consider a recommendation to fund research on the economic impacts of overdose and how harm reduction programs are affecting economic impacts. Dr. Wise will conduct a literature review on the topic, and the working group could make a recommendation to fund research to fill the gaps in the literature.
- A working group member said that the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH) is funded by National Institute on Drug Abuse (NIDA) to conduct this type of work. They may know if research has been done. Dr. Dennis can connect them to Dr. Wise.
- Dr. Pickett said this type of recommendation may fall under L., Research in the Illinois Opioid Allocation Agreement.
- The following resource was provided in the chat: The Economic Burden of Opioid Use Disorder and Fatal Opioid Overdose in the United States, 2017 - PMC (nih.gov)
Public Participation
A member of the public said that a medication assistance program for buprenorphine, such as there was for Hepatitis C Virus (HCV) in New York City (NYC) for those who were uninsured and wanted treatment, may be considered to increase access to buprenorphine. In NYC, individuals would receive a script that was covered and reimbursed once they were helped to get assistance through insurance. This could be set up through pharmacies, clinics, or drug companies.
Adjourn
Dr. Pickett called for a motion to adjourn the meeting. Dr. Dennis made a motion to adjourn. Dr. Wise seconded the motion. Dr. Pickett adjourned the meeting. The next meeting of the Medical & Research Working Group will be held on March 19, 2024 from 12:00pm-1:00pm.
