Illinois Opioid Crisis Response Advisory Council December 19, 2022

Illinois Opioid Crisis Response Advisory Council Meeting

December 19th, 2022

Meeting Minutes

  • IDHS/SUPR Director Laura Garcia welcomed the group.

IDHS/SUPR Updates

Director Garcia gave the following updates:

  • A 47% rate increase for outpatient substance use behavioral health services has been implemented. IDHS/SUPR has made significant fiscal investments to support the rate increase and rate sustainability payments, as well as to support residential programs that did not qualify for the 47% rate increase.
  • Seven million dollars has been invested to support mobile Medication-Assisted Recovery (MAR) and basic healthcare services for people who use drugs (PWUD) who are not yet ready to pursue abstinence as the next phase of their recovery. Mobile services will address the gaps in services in areas of state that don't have access to treatment and harm reduction services.
  • The following initiatives began in Fiscal Year 2023: (1) Four providers received state funding to establish an Enhanced Recovery Home to support pregnant and post-partum people; (2) For the first time, IDHS/SUPR provided financial relief for permanent supported housing (there are six providers currently providing housing independent of treatment and recovery status), and; (3) IDHS/SUPR is adding 11 new recovery-oriented systems of care (ROSC) across the state in 13 additional counties.
  • Over the next 18 years, Illinois will receive approximately $760 million for the first opioid settlement agreement. This money will be used for overdose abatement programs and to provide equitable access to essential overdose prevention services. The Illinois Opioid Remediation Advisory Board (IORAB) makes advisory recommendations to the Governor's Opioid Overdose Prevention and Recovery Steering Committee regarding the use of the 55% of settlement proceeds that are allocated to the Illinois Opioid Remediation Trust Fund. The funds must be used for forward-looking opioid abatement core strategies to combat the overdose epidemic as established in the Illinois Opioid Allocation Agreement. These opioid core abatement strategies align with recommendations in the State Overdose Action Plan (SOAP). The Illinois Opioid Remediation Advisory Board will seek to ensure an equitable allocation of resources to all parts of the State. Information on the settlement and the IORAB can be found at IDHS: Illinois Opioid Remediation Advisory Board
    • The IORAB met for the first time on September 30, 2023. The IORAB has established two working groups, Access & Equity and Medical & Research.
    • Sherrine Peyton has been appointed as the new Statewide Opioid Settlement Administrator (SOSA). She can be contacted at Sherrine.Peyton@illinois.gov

Dr. Rafael Rivera, IDHS/SUPR Chief of Staff, gave the following update on the Illinois Helpline for Opioids & Other Substances (Helpline):

  • The Helpline connects Illinois residents to treatment and recovery services. It is a statewide program available 24/7 for anyone seeking help for substance use, including family members and friends of people who use drugs. The Helpline launched in December 2017 and as of November 2022 has received 77,000 calls. The Helpline's website launched in March 2018 and has received 490,000 visits from 433,000 unique individuals. To access the Hotline, call 833-234-6343, text "help" to 833234, or use the website's chat function at https://helplineil.org.

Illinois Prescription Monitoring Program (PMP)

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

  • The PMP continues to focus on its role in the State Overdose Action Plan (SOAP). This work aims to reduce diversion of controlled substances prescribing with the goal of adding additional datasets to the PMP, proactively notifying prescribers, and addressing high-risk prescribing through peer-to-peer academic detailing.
  • The Injury and Accident Notification System has been developed to incorporate additional datasets into the PMP, including IDPH diagnosis data and overdose data, and notify prescribers of potential risk for addiction and previous history of an overdose.
  • The PMP continues to work with its Peer Review Committee to identify high-risk prescribers. The focus was previously on the prescribing of high dose opioids, but this has now shifted to the co-prescribing of opioids and benzodiazepines. Prescribers were identified based on a threshold of co-prescribing benzodiazepines and opioids to 15 or more patients within three consecutive months. Prescribers who the Committee felt could benefit from additional education were provided toolkits on risk mitigation (specifically related to urine drug testing), utilizing the PMP in their practice, and co-prescribing naloxone. Moving forward, the PMP will be developing a cumulative reference score which incorporates several weighted metrics focused on high dose opioids and co-prescribing of an opioid and a benzodiazepine or benzodiazepine and a sleep hypnotic. The plan is to validate this information with IDPH overdose data. The next part of the plan involves teaming with University of Illinois at Chicago (UIC) to provide academic detailing to identified prescribers.
  • Between January and October 2022, the PMP Now experienced a large increase in the number of queries and established 177 new connections.
  • The PMP is in the final stages of its Opioid Treatment Program (OTP) reporting requirements and hope to distribute consent forms and provide education to patients about the benefits of allowing their information to be displayed in the PMP.

IDPH Updates

Jennifer Epstein, Assistant Deputy Director, Office of Policy, Planning and Statistics, provided the following updates:

  • A NOFO opportunity for post-overdose outreach programs specific to southern Illinois will be re-released (date is to be determined). The opportunity is open to any entity in the state serving southern Illinois with up to two organizations funded. For questions about the IDPH grant process or portal please contact Jennifer Epstein at Jennifer.Epstein@illlinois.gov .
  • IDPH continues to work with local health departments (LHDs) on enhancing overdose surveillance capacity. A protocol for addressing overdose anomalies at the county-level was established that entails engaging relevant partners and pushing out naloxone and other resources in those areas.
  • As reminder, the Opioid Data Dashboard  added SUDORS data to provide more in-depth information related to overdoses.

HFS Updates

Arvind Goyal, MD, Medical Director, discussed the following updates:

  • The Drug Utilization Review Board reduced initial opioid prescriptions from 7 to 5 days and initial benzodiazepine prescriptions to 14 days. This policy has been updated to include prior authorizations for chronic opioid and/or benzodiazepine therapy used to treat certain conditions (e.g., epilepsy) so that continuing authorization is no longer needed.
  • HFS is looking for help in developing quality outcome metrics to measure the cumulative effect of all its opioid related initiatives on reducing opioid overdoses and deaths. Please send your suggestions to Dr. Goyal (Arvind.Goyal@illinois.gov ).

Presentation: Data in Support of SOAP Implementation Plan

Leslie Wise, Ph.D., Epidemiologist Division of Emerging Health Issues, Office of Health Promotion, IDPH, gave the following presentation on the SOAP implementation report data (see attached handouts):

  • Monthly opioid fatalities continued to trend upward throughout 2021. The 12-month rolling average (which measures the general trend across the years) shows a slight decline in spring/summer 2021 with a continuing trend upwards through the end of the year.
  • The fatality rate for 2021 increased across all county groups (i.e., rural, small urban, suburban, and urban). The urban county group saw the largest increase of 49%, followed by rural (33%), suburban (25%), and small urban (18%).
  • Synthetic opioids were found to have the highest fatality across all county groups, however, the substance with the second highest fatality rate differed across county groups (psychostimulants in rural settings and cocaine in all other settings).
  • Synthetic opioids were the substance type with highest fatality rate across racial-ethnic groups, however, there was a wide racial disparity in fatality rates for any drug and any opioid, with non-Hispanic black experiencing the highest fatality rate.
  • Age-specific opioid overdose fatality rates by race/ethnicity continues to show wide racial/ethnic disparities in some ages, with non-Hispanic black experiencing the highest rate in all age groups except ages 25-34.

Presentation: State Overdose Action Plan (SOAP) Implementation Report

Sue Pickett, Ph.D., Deputy Director, Center for Research and Evaluation, Advocates for Human Potential, Inc., gave the following presentation on the SOAP Implementation Report (see attached handouts):

  • In addressing the overdose crisis, the 2022 SOAP expands the focus from opioids to include all drug-related overdoses and aims to address the social inequities that underlie the racial disparities in overdose deaths. The SOAP includes 25 high-priority recommendations compiled into five categories: social equity, prevention, treatment and recover, harm reduction, and justice-involved populations.
  • The 2022 SOAP was released by Governor Pritzker in March 2022, Implementation reports summarizing work-to-date and current overdose death data are submitted ever six months the Council and Steering Committee for review and feedback. The first implementation report, released in November 2022, summarize work completed on SOAP initiatives and metrics as of September 30, 2022. Overdose data from the first implementation report is summarized above in Dr. Wise's presentation.
  • Work has begun on all 25 priorities to varying degrees. Achievements include: (1) over 14,000 PWUD on Chicago's West Side received naloxone and linkage to MAR; (2) 700 PWUD on the West Side and 84 PWUD in central Illinois received services from mobile MAR units; (3) 365 people attended IDPH's harm reduction summit and the web platform had over 11,000 views; (4) nearly 100,000 Narcan kits have been distributed through the Access Narcan program; (5) 15 County jails are participating in the Illinois MAR in County Jails program; and (6) over 320,000 website visits and over 73,700 calls have been received by the IL Helpline.
  • Council Committees will begin meeting again in January. Committees will meet on Zoom every 4-6 weeks. If you have questions or are interested in joining a committee, please contact Dr. Sue Pickett at spickett@ahpnet.com .

Presentation: Illinois Maternal Mortality & Substance Use Disorder

Cara Jane Bergo, Ph.D., MPH, Maternal Mortality Epidemiologist, IDPH, gave the following presentation on maternal mortality & substance use disorder (Note: Results are preliminary and therefore the slides from this presentation will not be distributed). Please contact Dr. Bergo at Cara.Bergo@illinois.gov  if you have question about the data.

  • IDPH is currently finalizing 2020 data reviews. The data for this presentation is primarily from 2018 and 2019.
  • Illinois has two maternal mortality review committees. Each committee meets every other month and is multidisciplinary. The Maternal Mortality Review Committee (MMRC) was established in 2000 and reviews deaths that are medically related to pregnancy. The MMRC on Violent Deaths was established in 2015 and reviews deaths resulting from homicide, suicide, or drug-related causes.
  • The review process includes: (1) identifying pregnancy-associated deaths (i.e., any death during pregnancy or within one year of pregnancy); (2) gathering relevant records (e.g., prenatal care, hospital visits, autopsy or coroner reports, police reports, EMS reports, etc.); (3) sorting deaths and assigning to the two committees; (4) creating summaries based on available records; and (5) discussing deaths by committee and making decisions. Deaths are identified on a rolling basis, usually with 1-2 weeks of the death. There are five key questions that are asked by the review committees: (1) What was the cause of death? (2) Was the death pregnancy-related? (If it is not pregnancy-related, the review is terminated); (3) Was the death preventable? (4) What critical factors contributed to the death?; and (5) What recommendations are there to prevent future deaths?
  • Pregnancy-associated deaths are deaths that occur during or within one year of pregnancy due to any cause. Pregnancy-related deaths are deaths during or within one year of pregnancy due to a pregnancy-related complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiological effects of pregnancy (i.e., if they weren't pregnant, then they would not have died). Review committees focus more on pregnancy-related deaths. Examples of pregnancy-related deaths in relation to substance use disorder include: (1) a traumatic event during pregnancy or postpartum with a temporal relationship to increased drug use and subsequent death; (2) inability to access treatment due to a pregnancy; and (3) a worsening of an underlying pre-existing psychiatric condition during pregnancy that led to drug use and subsequent death.
  • On average, 75 women die each year while pregnant or within one year of pregnancy. One in three of these deaths are related to pregnancy, and substance use disorder (SUD) is the leading cause of pregnancy-related death in Illinois followed by cardiovascular disease.
  • SUD was the top underlying cause of death in 2018-2019. The main substance found at toxicology was fentanyl, followed by alcohol, heroin, cocaine, and methamphetamines.
  • Factors that contributed to deaths due to SUD include: (1) poor OUD care and poorly controlled pain; (2) not optimal care due to stigma related to SUD; (3) no navigation or warm handoffs for MAR; (4) little access to SUD support programs; (5) clinical team only called DCFS with no treatment for maternal risk factors and no follow-up; (6) hospital could not find inpatient care for mother; (7) rehab was unable to provide care due to chronic conditions; (8) no one was addressing SUD as a life threatening illness and were focused on the baby; (9) SUD as an afterthought (came in with an overdose released next day from ER), and; (10) no intervention after overdose. Examples of recommendations for intervention include: (1) providers should follow best practices for the identification and treatment of SUD and ensuring a warm handoff to a behavioral health care provider; (2) hospitals should train providers who see obstetrics patients on how best to link patients to outpatient recovery and treatment services; and (3) the State should expand home visiting and patient navigator programs for women with SUD regardless of income.

New Business

  • Dr. Steve Holtsford discussed the naloxone project  which began in Colorado with the goal that every hospital should be capable of dispensing naloxone to people at risk of overdose. The initiative is now expanding to ten other states and Illinois is primed to elevate care within the ED. Dr. Holtsford is looking to convene a small group to talk with the Colorado project and discuss how it might be brought to Illinois.
    • In response to Dr. Holtsford's announcement, Director Garcia made note of the Access Narcan website where hospitals, clinics, and anyone interested in obtaining naloxone can access naloxone for free. It is important to ensure that efforts are not duplicated.
    • It was suggested that the MAR Prescribing Practices Committee could discuss this project. It was also noted that challenges related to hospital polices and interdepartmental collaboration should be identified so strategies can be developed to encourage hospitals to distribute naloxone.
  • Luke Tomsha discussed a new legislative initiative aimed at reclassifying simple possession of substances from a felony to a misdemeanor.

Council Meeting

The next Council meeting will be held on March 20th, 2023 from 1:00 PM - 2:30 PM. This will be a virtual meeting. The meeting agenda and information on how to connect will be sent out to the Council closer to the meeting date.