IORAB Minutes July 13, 2023

  • Illinois Opioid Remediation Advisory Board July 13, 2023

  • 2:00 - 4:00 PM
  • Virtual Meeting Held Via Zoom

MEETING MINUTES

  • Illinois Opioid Remediation Advisory Board Members

  • Dr. Adrienne Adams, Rosecrance
  • Dr. Allison Arwady, Chicago Department of Public Health
  • Christopher Hoff, DuPage County Health Department Eddy Borrayo, Rincon Family Services
  • Ryan Brauns, Rockford Consulting & Brokerage
  • Blanca Campos, Community Behavioral Healthcare Association of Illinois
  • Jud DeLoss, Illinois Association of Behavioral Health
  • Jeffrey Carl Ewing, Monmouth-Roseville CUSD #238
  • Dr. Bernice Gordon-Young, SMART Recovery Intervention Program
  • Angie Hampton, Egyptian Health Department
  • Joel K. Johnson, Treatment Alternatives for Safe Communities, Inc.
  • Chelsea Laliberte Barnes, Live4Lali
  • Laura Lechowicz, Office of the Cook County President Dana Rosenweig, St. Clair County Mental Health Board
  • Dr. Kathy Yoder, McLean County
  • Kevin Zeigler, Thresholds

  • Illinois Opioid Remediation Advisory Board

  • Ex Officio Members
  • David T. Jones, Chief Behavioral Health Officer (CBHO)
  • Secretary Grace Hou, Illinois Department of Human Services (IDHS)
  • Laura Vaught, Chief of Staff, Illinois Department of Public Health (IDPH) Director Brendan Kelly, Illinois State Police (ISP)
  • Dr. Arvind Goyal, Medical Director, Illinois Department of Healthcare and Family Services (HFS)
  • Jennifer Parrack, Chief of Programs and Support Services, Illinois Department of Corrections (IDOC)
  • Kwame Raoul, Attorney General
  • State Representative Patrick Windhorst
  • State Representative LaShawn Ford
  • State Senator Sally Turner

Welcome and Roll Call

Roll call of the Illinois Opioid Remediation Advisory Board (IORAB) was taken. All members except Mr. Ewing, Dr. Gordon-Young, Mr. Johnson, and Ms. Rosenweig were present. It was noted that Ms.

Rosenweig retired. Quorum was established. The ex officio roll call was taken. All members except Secretary Hou, Laura Vaught, Director Kelly, Ms. Parrack, and Senator Turner were present. Adam Braun and Andrea Law attended on behalf of Attorney General Raoul.

Approve Agenda and the April Meeting Minutes

IORAB members voted on the approval of the agenda and the meeting minutes. All members who were present voted to approve the agenda. All members who were present voted to approve the meeting minutes, except for Mr. Hoff and Ms. Lechowicz, who abstained. The motion passed.

Understanding the Opioid Settlement Fund

Andrea Law, Attorney, Office of Attorney General Kwame Raoul

Andrea Law, Attorney, Office of Attorney General, provided a refresher and update on the status of the opioid settlements and their allocation. The finalized national opioid settlements include AmerisourceBergen, Cardinal, and McKesson; Johnson & Johnson; Allergan; Teva; CVS; Walgreens; Mallinckrodt; and Walmart. The Illinois Opioid Allocation Agreement governs how funds from any National Multistate Opioid Settlement coming to Illinois will be allocated. A total of 55% goes to Illinois Remediation Fund for which the IORAB makes recommendations; 25% is allocated directly to local subdivisions; 20% is allocated to the State; for the State's 20% allocated share, 12% goes directly to the State and 8% goes to City of Chicago. Additional national settlements are expected. A total of $760 million is expected to come into Illinois under the first two settlements over an 18-year period. A total of $770 million is expected to go into the Illinois Remediation Fund. This includes funds that have already been dispersed, and those expected to be dispersed, for all of the finalized national settlements.

  • An IORAB member asked how the 20% appropriated to the State is allocated, and if it goes to the General Revenue Fund (GRF). Adam Braun, Attorney, Office of Attorney General, stated that the money that comes to the State comes to the Attorney General's office and then goes to a separate fund, but not to GRF.
  • An IORAB member asked if the expected settlements from Purdue and Endo were included in the totals, and the size of these settlements. Ms. Law stated that only the finalized settlements were included in the projections, not Purdue and Endo. She stated that while she didn't think they would be insignificant, they would not be of the magnitude of larger settlements.
  • An ex officio member asked about allocation of the City of Chicago monies. Ms. Law stated that monies for eligible subdivisions are dispersed directly to the subdivisions. The member also stated that he hoped that the IORAB would be able to provide input on approval for Notice of Funding Opportunities (NOFOs) and hoped the harm reduction community could provide input on the NOFOs.
  • An ex officio member asked if the funds for states and municipalities were required to be spent on opioid prevention and treatment, and how the allocation for counties and municipalities is determined. Ms. Law said all monies are intended to be used for opioid abatement. There are different reporting requirements, and monies should be tracked. Allocation percentages amongst Illinois counties and eligible municipalities are based on an agreed upon formula based on various factors, including harm metrics and population size.

Working Group Updates

Adrienne Adams, MD, Rosecrance, Chair, Medical & Research Working Group

Dr. Adams provided an update on the Medical & Research Working Group:

  • The Medical & Research Working Group finalized the group's recommendation for evidence-based Medication-Assisted Recovery/Medications for Opioid Use Disorder (MAR/MOUD) services for incarcerated and justice-involved individuals, including youth. This recommendation is being discussed and voted on today.
  • At the June meeting, they also discussed the recommendation for pregnant and postpartum people and would be happy to collaborate with the Access & Equity Working Group on any additional efforts related to this recommendation.
Blanca Campos, Community Behavioral Healthcare Association of Illinois, Access & Equity Working Group

Ms. Campos provided an update on the Access & Equity Working Group in Joel Johnson's absence:

  • The Access & Equity Working Group worked to refine the recommendations they developed earlier this year and shared at the January IORAB meeting.
  • Three of the Access & Equity Working Group's recommendations will be discussed and voted on today. These include:
    • Funding for services for pregnant and postpartum people with opioid use disorder (OUD)
    • Funding infrastructure support for small and emerging organizations
    • Providing sustainable funding for services that increase access to OUD treatment and recovery, including assertive outreach, peer-led team services, harm reduction, and practical assistance related to social determinants of health. This is happening through recommended changes to the Community Outreach and Recovery Support (CORS) model.
  • The working group also is discussing how they can address challenges Black, Indigenous, People of Color (BIPOC) and rural organizations may experience during the NOFO process. They want to put strategies in place that will encourage these organizations to apply for NOFOs.

Chief Jones stated that Ms. Campos agreed to chair the new Workforce Development & Infrastructure Working Group. The first meeting will take place in August or September and once determined, the date will be posted on the State's website IDHS: Illinois Opioid Remediation Advisory Board (state.il.us).

Persons interested in participating can contact Dr. Pickett (spickett@ahpnet.com) or Ms. Peyton (sherrine.peyton@illinois.gov).

Office of Opioid Settlement Administration (OOSA) Updates

Sherrine Peyton, Statewide Opioid Settlement Administrator (SOSA), provided updates on the Regional Care Coordination Agency, settlement funds, and the recommendations process.

Regional Care Coordination Agency

The Regional Care Coordination Agency (RCCA) put out a competitive bid to identify up to seven organizations that would help with NOFOs and training, technical assistance and management of organizations awarded. Through a merit-based process, Advocates for Human Potential (AHP) was selected to be the RCCA. They are responsible for subrecipient selection, contracting and technical assistance; opioid settlement funds dashboard; and regional advisory group coordination. Currently, information on all settlement decisions to date can be found at IDHS: Illinois Opioid Remediation Advisory Board (state.il.us). The AHP RCCA Team includes Ellen Radis, Interim Project Director; Chantel Laperle, Interim Deputy Project Director; Tina Willson, Training/TA Director; and Alan Marzilli, Senior Writer. They are currently hiring for open positions.

  • An IORAB member asked if the RCCA was establishing the regional groups. Ms. Petyon stated that the RCCA is not establishing regional groups. The RCCA will work with local organizations to establish groups in each of the seven regions. There is additional information about this in the NOFO. The link to this additional information was requested.

Settlement Funds Update

As of the date the presentation was developed, Expand Community Intervention Services (CIS) had awarded $2.3 million (M) to existing opioid treatment programs. Access Narcan has spent $1M so far and has expanded Naloxone distribution through hospitals. The Illinois Prescription Monitoring Program (IL PMP) has spent $750K so far, and since funding was approved, has seen successes including an increase in the number of people using the program. To date, a total of $16.25M has been approved, and there is a total of $71,543,171 left in cash to spend.

Recommendations Process

Ms. Peyton discussed the recommendations process. Recommendations should be sent to Ms. Peyton (sherrine.peyton@illinois.gov), who makes sure the recommendation is one of the Core Abatement Strategies. Recommendations that relate to the same Core Abatement Strategy have been combined. Recommendations then go to the IORAB, and after approval by the IORAB, recommendations are putforward to the Steering Committee. If approved by the Steering Committee, they then must be approved by the Attorney General. They are subject to the procurement process and then distributed. Funding routes are NOFOs, expansion of services, and intergovernmental/interagency agreements. She shared slides displaying local data that organizations can use to demonstrate need.

An IORAB member asked for clarification on how a group of providers can submit a recommendation. Chief Jones said that they will share the document that includes this information at a later time.

Official Board Members Call for Motion, Discussion, and Vote

The IORAB voted on nine recommendations:

  1. Core Strategy A. Naloxone and Other FDA-Approved Drug to reverse overdose Recommendation: $3M ($1M a year for 3 years) to establish a system for intramuscular naloxone acquisition, supplies, and distribution for all seven regions. Ms. Laliberte Barnes made a motion to approve the recommendation. Mr. Borrayo seconded the motion.
    1. An ex officio member stated that the funding should be tied to an annual report to ensure accountability. Ms. Peyton stated that all Core Abatement Strategies will include a quarterly process evaluation and a report due annually.
    2. An IORAB member asked why intramuscular naloxone was called out in the proposal. Ms. Peyton stated that Access Narcan uses nasal Narcan, which has a separate manufacturer. A separate proposal was needed for intramuscular naloxone recommendations.
    3. All IORAB members who were present voted in favor of the motion. The motion passed.
  2. Core Strategy B. Mobile Medication Opioid Use Disorder (MOUD)
    1. Recommendation: $15M ($5M a year/ for 3 years) with a rolling application to increase access to mobile services that provide medication assisted recovery, treatment, healthcare and recovery support services in areas with highest overdose rates and gaps in service. Medication-assisted recovery (MAR) must be the primary service. Dr. Arwady made a motion to approve the recommendation. Ms. Hampton seconded the motion.
    2. All IORAB members present voted in favor of the motion. The motion passed.
    3. It was noted that the funding amount was incorrect in the presentation slide, which was subsequently corrected.
  3. Core Strategy C. Pregnant and Post-partum People and their family (wrap-around services) Recommendation: $6M ($2M/year for 3 years) to pilot comprehensive wrap-around services to pregnant and post-partum people with opioid use disorder (OUD), and their families based on regional needs (IDPH 7 Regions). Mr. Borrayo made a motion to approve the recommendation. Mr. Hoff seconded the motion.
    1. An ex officio member requested that the words 'families' be replaced by 'newborns'. Ms. Peyton stated that it is important to think about services needed for older children, such as services for developmental delays. Chief Jones clarified that the purpose of the word 'families' is to be more inclusive. It includes wraparound services for newborns as well as support for parents and caregivers.
    2. All IORAB members present voted in favor of the motion. The motion passed.
  4. Core Strategy E. Expansion of Warm Handoff programs and Recovery Services Recommendation: $6M ($2M/year for 3 years) to expand recovery services in high impact areas and procure new services where there is no provider, but services are needed based on data.
    1. Mr. DeLoss made a motion to approve the recommendation. Mr. Borrayo seconded the motion.
    2. There was discussion about the potential to increase the funding amount, as members stated that the amount should be higher. An IORAB member asked how the amount of funding was determined. Director Garcia stated the funding was based on the spending across the peer-run programs. Because there is a workforce shortage, they didn't want to tie up too much money. Ms. Peyton added that other historical spending was also considered, and they wanted to make sure funds will not be returned. In addition, Ms. Peyton stated a lot of these services will also be offered through the CORS model.
    3. An IORAB member asked if the funding amount could be raised and tied to something empirical.
    4. An IORAB member asked if the funding had to be used as new funding, expanded funding, or if it could supplant existing funds. Ms. Peyton stated that the funds could not supplant other funds.
    5. Chief Jones proposed that they put the recommendation to a vote and consider the issue later, perhaps adding additional funding. He noted that members stated that there are innovative programs that could be funded under this program. Dr. Pickett clarified that the vote was with the caveat that the IORAB would come back later to propose additional innovative programs and potentially increase the funding amount.
    6. All IORAB members present voted in favor of the motion (Dr. Arwady was not present). The motion passed.
  5. Core Strategy F. Treatment for Incarcerated Population
    1. Recommendation: $6M ($2M /year for 3 years) to provide evidence-based MOUD services for those incarcerated or transitioning out of incarceration as well as training for the criminal justice system.
    2. Dr. Adams made a motion to approve the recommendation. Ms. Hampton seconded the motion.
    3. An IORAB member requested clarification on the distinction between state programs funded through remediation funds versus funds that are coming directly to the state. Ms. Peyton stated that the direct funding to the state is for administration and not for services.
    4. All IORAB members who were present voted in favor of the motion (Dr. Arwady was not present). The motion passed.
  6. Core Strategy G. Prevention Services (selected, indicated, and harm reduction)
    1. Recommendation: $15M ($5M/year for 3 years to fund regional and local coalitions and/or organizations to coordinate and/or implement prevention programs, strategies, and efforts that focus on any of the following affected by the opioid crises: youth (pre-school+), individuals and families affected by the opioid crises, and disparately impacted schools, communities, or groups. Mr. DeLoss made a motion to approve the recommendation. Ms. Laliberte Barnes seconded the motion. All IORAB members who were present voted in favor of the motion (Dr. Arwady was not present). The motion passed.
    2. It was noted that a million-dollar symbol (M) was missing from the presentation slide, which was subsequently corrected.
  7. Core Strategy I. Data and Evaluation
    1. Proposal: $1.5M ($500K/year for 3 years). Up to $50K per sub-grantee/per year to conduct community- based participatory evaluation and/or to evaluate the effectiveness of innovative strategies funded by settlement dollars. Ms. Campos made a motion to approve the recommendation. Mr. Zeigler seconded the motion. All IORAB members who were present voted in favor of the motion (Dr. Arwady was not present). The motion passed.
  8. CORS Model Recommended Change
    1. SUPR/OOSA Updated Recommendation: Open the CORs Model qualifications to recovery, peer organizations and harm reduction programs (certification not required), and treatment organizations; adjust the funding amounts per award to allow for more grantees and make the program a 3-year cycle ($5M/year) by adding $10M to make it a 3-year grant. Ms. Hampton made a motion to approve the recommendation. Ms. Campos seconded the motion. All IORAB members present voted in favor of the motion (Dr. Arwady was not present). The motion passed.
  9. Capital Improvement Recommendation
    1. Recommendation: Use of Opioid Settlement Funds for capital projects that support the Core Abatement Mr. DeLoss made a motion to approve the recommendation. Ms. Laliberte Barnes seconded the motion.
    2. An IORAB member asked for clarification regarding the ability of government to participate in the program, and asked what funds would be used. Director Garcia stated that she is unable to answer the question fully at this time. She noted that local government can apply for funding through NOFOs.
    3. An IORAB member asked if harm reduction and low threshold housing providers could be added to the list of qualified providers. Director Garcia stated they will consider this with the aim of making sure they are specific and broad enough.
    4. An IORAB member clarified whether a dollar amount would come back to the group for a recommendation. Chief Jones stated that the IORAB would vote on a dollar amount later.
    5. All IORAB members who were present voted in favor of the motion (Dr. Arwady was not present). The motion passed.

Ms. Peyton stated that of the $770M that is anticipated over 18 years, if evenly divided, spending totals to $42.77M per year. With everything approved today, spending totals $20.8M/year.

Public Comments

Fanya Burford-Berry of the West Side Heroin/Opioid Task Force stated that women of color who have substance use disorder have a tendency to have their children taken away. She suggested that persons who work with people of color who are pregnant may need additional training. Chief Jones stated that Dr. Gastala has also raised this issue. They want to ensure that women aren't afraid to access treatment.

Dr. Pickett noted that attendees were asking about next steps in the chat. Chief Jones stated that the recommendations would move to the Steering Committee for approval. Director Garcia stated that after that, their Division would work with the RCCA to ensure the NOFO process goes smoothly. She stated that everyone would receive notification of NOFOs, and NOFOs would also be posted on the website.

John Greenwood, co-founder of Goldfinch Health in Iowa City, discussed the billion pill pledge, through which providers have reduced the opioids they are prescribing. He would like to discuss this further.

Chief Jones suggested that he review the (State of Illinois Opioid Overdose Action Plan) SOAP and follow up with Ms. Peyton (sherrine.peyton@illinois.gov).

Aaron Henry of Carolon Behavioral Health stated he already received the answer to his question.

Adjournment

Chief Jones requested a motion to adjourn the meeting. Dr. Adams made a motion to adjourn the meeting. Mr. Borrayo seconded the motion. The meeting was adjourned. The next meeting will take place on October 5, 2023 from 2:00-4:00pm.