Illinois Opioid Crisis Response Advisory Council January 2021 Meeting Minutes

Illinois Opioid Crisis Response Advisory Council January 2021 Meeting Minutes

Illinois Opioid Crisis Response Advisory Council Meeting

January 11, 2021

MEETING MINUTES

IDHS/SUPR Director David T. Jones welcomed the group.

IDHS/SUPR Updates

Director Jones gave the following updates:

  • The 11th District is hosting a revival January 21st - February 17th. Faith leaders and service providers will work together to provide hope and resources to West Side residents. See the attached flyer for more information.
  • SUPR is planning several learning collaboratives for its licensed providers that serve the South and West sides of Chicago. SUPR will be conducting a community needs assessment to help inform the learning collaboratives.
  • Dr. Nicole Gastala has accepted the Medical Director position and joins SUPR on January 19th.

IDHS/Prescription Monitoring Program (PMP) Updates

Sarah Pointer, PharmD, Clinical Director of the PMP, gave the following updates:

  • Electronic Health Record (EHR) integration rules went into effect on January 1st. There has been a large increase in the number of EHR integrations as a result, with nearly 800 health systems integrated and over 11,000 sites connected to the PMP.
  • The PMP continues to move forward with the injury and accident notification system. This system will help the PMP identify at-risk patients (e.g., individuals with an accidental injury or opioid overdose) and notify prescribers of the potential risk so that they can implement early interventions. The PMP is currently piloting this system and are in the process of identifying additional pilot sites for which there is funding available.
  • The peer review committee will be meeting in February. There have been significant advancements to the PMP platform that help better identify prescribers who may be prescribing outside of guidelines.

Illinois Helpline Update

Chelsea McCarron, Project Manager, Health Resource in Action (HRiA), gave the following update:

* The Helpline will host its second provider engagement session in Region 2 on January 27th from 9:30 - 11:30 am. These sessions bring substance use treatment and harm reduction providers together to discuss challenges and strategies in response to COVID. Contact Ms. McCarron at cmccarron@hria.org for more information.

Illinois Department of Public Health (IDPH) Updates

Jenny Epstein, Director of Strategic Health Initiatives, gave the following updates:

* Illinois' COVID-19 vaccination plan is based on the CDC Advisory Committee on Immunization Practices (ACIP) recommendations. It is the State's goal to conduct an efficient and effective distribution of the vaccine in order to suppress the spread of the virus. The State is using an equity centric approach by doing the following: (1) Lowering the minimum age from 75 to 65 in phase 1b, and (2) Ensuring priority groups at high risk of exposure and morbidity/mortality are prioritized to receive the vaccine. Illinois is currently in phase 1a to vaccinate frontline health workers and long-term residential care residents. Vaccination information can be found on the IDPH website at https://www.dph.illinois.gov/covid19/vaccine-faq and the Illinois Coronavirus government

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website at

https://coronavirus.illinois.gov/.

  • IDPH has started a COVID-19 Ambassador program to create peer-to-peer communication around COVID-19 prevention measures. The link to the application can be found at https://www.surveymonkey.com/r/VNFZQRC
  • Discussion:
    • Council members asked which phase addiction treatment centers have been assigned to in the State's vaccination plan. It was clarified that residential addiction centers are categorized as 1b.
    • Council members discussed coordinating Naloxone distribution with COVID-19 vaccination distribution. Naloxone distribution has been implemented at some testing sites. Ms. Epstein explained that the State wants to ensure that the vaccination plan is working smoothly before combining it with other services. Ms. Epstein will share this recommendation with others at IDPH.
    • It was noted that a provision in the Illinois Black Caucus Health Package establishes 1) a community health worker training certification and reimbursement program administered under IDPH and 2) the role of community health workers in vaccine distribution and overdose prevention. Ms. Epstein shared that IDPH is currently reviewing this plan.

HFS Update

Dr. Arvind Goyal, Medical Director, gave the following updates:

  • Dr. Goyal shared comments on State Opioid Action Plan (SOAP) recommendations that have been assigned to HFS to review and prioritize. These include recommendations related to telehealth. HFS will review the quality and cost-effectiveness of telehealth policies and share this information with the Steering Committee.
  • Dr. Goyal introduced Eric Foster, HFS' new Senior Policy Advisor on Mental Health and Substance Use Disorder Services.

Governor's Opioid Overdose Prevention Steering Committee Update

Sherie Arriazola Martinez, Safer Foundation, gave the following updates:

  • The Steering Committee (SC) met on December 16th to discuss the Council's recommendations for the new SOAP. The SC agreed that all 85 recommendations need to be carefully reviewed and that recommendations must include strategies to address polysubstance use. A small group from SUPR, IDPH, and AHP reviewed the recommendations and assigned each recommendation to the state agency that can best address it. Recommendations related to federal legislation, statewide initiatives, and input from multiple state agencies were assigned to the SC for review.
  • In their initial review, SUPR and IDPH determined whether recommendations were high or low priority. High priority recommendations are those have the greatest immediate impact on reducing opioid overdoses, especially in communities experiencing high rates of overdoses and populations at greatest risk for overdose.
  • The SC and state agencies will convene small workgroups to review and prioritize their recommendations. This process will be completed by the end of January. The timeline for drafting and finalizing the SOAP has been pushed to early Spring 2021 to allow for time needed to finalize the recommendations and obtain Council feedback on initial drafts of the SOAP.

Presentation: Telehealth Patient Survey: Findings on Patient Experience with SUD Services Delivered via Telehealth During COVID-19 Pandemic

Maria Bruni, PhD, Senior Vice President, Family Guidance Centers, Inc., (FGC), shared results of a patient survey examining patient experiences with SUD telehealth services during the COVID-19 (see attached handouts):

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  • In response to the COVID-19 pandemic, the State expanded telehealth policies to allow for reimbursement of medical and clinical telehealth services. In March 2020, FGC conducted a short survey to assess patient cell phone access and found that 93% of respondents had a usable cell phone and minutes available for telephone counseling and 57% had a Zoom-capable smart phone.
  • FGC administered a 40 item telehealth survey to patients from June through December 2020. A total of 1,914 responses were collected. Key findings include the following:
  • 95% of respondents had a telephone session with their counselor. Nearly all of these participants said that the phones were helpful to their recovery; 89% reported that the phone sessions were as helpful as in-person session. Privacy concerns were not an issue. Over 90% of respondents reported that they would like to continue telehealth services post-pandemic.
  • The most frequently cited benefits of telephone sessions were convenience, and not having to come into the clinic. Many patients also reported experiencing less anxiety with phone session compared to in-person sessions. The most frequently reported concerns included patients not being able to see their counselor's facial expressions, and that sessions were impersonal.
  • Only 23% of respondents participated in video groups. Most of these individuals (65%) reported that the video groups were helpful to their recovery; 47% said they found video groups as helpful as in-person groups. The most frequently cited benefits of video groups were convenience, being able to participate from home, social support, and connection. Video group dislikes included missing seeing people in-person, technical problems, and feeling less connected to other group members.
  • Dr. Bruni also presented findings on the FGC take-home methadone dose survey:
  • As a result of COVID-19 and related changes in take-home policies, take-home doses of methadone at FGC increased from 24% in February 2020 to 89% in March 2020. At the end of December 2020, 80% of patients had take-home doses. Over 90% of patients said the current take-home schedule was working for them.
  • Given survey results, FGC is seeking to increase capacity for one-one-video sessions and would like to create hybrid telehealth/in-person service model post-pandemic.

Presentation: Opioids and Overdose Suicide

David Swedler, PhD, Research Scientist, Pacific Institute for Research and Evaluation (PIRE), gave the following presentation on the incidence and lethality of opioid-related suicidal overdoses (see attached handouts):

  • The presentation is from the following study: "Incidence and Lethality of Suicidal Overdoses by Drug Class" published in the Journal of American Medical Association (JAMA). This study examined how drug classes consumed affect the lethality of intentionally self-inflicted drug overdoses. The authors estimate what portion of people who died from suicidal acts involving specific drugs would have survived their overdose if their suicidal drug mix had omitted a given drug class. The link to the article can be found at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763226
  • Dr. Swedler provided the following background information:
  • The means used during suicide attempts play a key role in whether a person lives or dies. Reducing a suicidal person's access to highly lethal methods is an important part of suicide prevention. More information can be found at the Harvard School of Public Health's "Means Matter" website at www.hsph.Harvard.edu/means-matter
  • Suicide is a leading cause of injury death in the US (47,000 suicide deaths of individuals age 5 and over occurred annually between 2016 and 2018.) Poisoning suicide is the 3rd most common mechanism for completed suicide in the US, accounting for nearly 20% of suicides. In Illinois, poisoning suicides where opioids were present nearly quadrupled between 2003 and 2018.

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  • The study found that opioids were the most common drug present in fatal overdose suicides (48% of fatal suicide poisoning involved opioids). The risk of fatality increased more than five times when opioids were present. In instances where opioids were present in overdose suicides, 80% of fatalities would not have been fatal if opioids were not present in the drug mix.
  • Reducing access to opioids has the potential to decrease overdose suicide lethality and thereby reducing suicide deaths. Interventions could target prescribing practices, package size, drug storage (e.g., lock boxes), and medication disposal.
  • Council members asked about harm reduction strategies for suicide prevention, the types of opioids involved in the analysis (i.e., prescription versus illicit), and recommendations for preventing fatal suicides involving illicit opioids.

Presentation: Current Trends in the Drug Supply

Victor Markowski, Drug Intelligence Officer, Chicago High Intensity Drug Trafficking Areas (HIDTA) gave the following presentation on trends in the drug supply and demand in Illinois (see attached handouts):

  • In Cook County and the Collar Counties, heroin seizures have declined but fentanyl and fentanyl analogues have increased. Novel opioids also continue to enter the area. Stimulant seizures and submissions continue to increase with the three main ones being methamphetamine, cocaine, and crack cocaine. Many of these submissions have also contained fentanyl.
  • In the remaining jurisdictions, methamphetamine and other stimulants are a significant threat. Most methamphetamine is being imported into the country - this is a large shift from the last 3-4 years. Opioids are problematic but not readily available.
  • There is a major shift towards synthetic drugs across Illinois. One theory is that drug cartels can produce product more quickly and cheaply than having to wait for products to arrive (such as cocaine from Columbia).
  • Nearly all prescription pills (e.g., Oxy M30s, Xanax bars) seized and submitted for analysis contain fentanyl. Most drug submissions contain fentanyl and very few are a single source drug. Most ecstasy or MDMA pills are actually methamphetamine.
  • LSD is making a large resurgence across the state. There is no evidence to support that the increase in LSD is related to the pandemic and increases in this drug have been observed for the past 18 months.
  • There is no evidence of diverted buprenorphine on the street nor have there been cases of illicit marijuana laced with fentanyl or other opioids.

February Council Meeting

The next Council meeting will be on February 8th from 1-3 pm. This will be a virtual meeting. The meeting agenda and information on how to connect to the meeting will be sent out to the Council closer to the meeting date.