IORAB Minutes April 19, 2023

  • Illinois Opioid Remediation Advisory Board April 19, 2023

  • 2:00 - 3:30 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
  • Karen Ayala, 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 Ms. Lechowicz and Mr. Ewing were present. Quorum was established. The ex officio roll call was taken. All members except Representative Windhorst and Senator Turner were present. Adam Braun and Susan Ellis attended on behalf of Attorney General Raoul. Dr. Kenneth Osborne attended on behalf of IDOC Chief of Programs Parrack and Jennifer Epstein attended on behalf of IDPH Chief of Staff Vaught.

Approve Agenda and the January Meeting Minutes

Chief Jones called for a motion to approve the agenda and the January 12, 2023 meeting minutes. Mr. Johnson made a motion to approve the agenda and the minutes. Ms. Ayala seconded the motion. All IORAB members who were present voted to approve the agenda and minutes. The motion passed.

IDPH Semi-Annual Opioid Data Update

Dr. Wise, IDPH Opioid Epidemiologist, reviewed the February 2023 Statewide Semi-Annual Opioid Report (Statewide Semi-Annual Opioid Report - February 2023). Dr. Wise noted that 2022 data are still provisional. Fatalities have been steady since a May 2020 spike but continue to be elevated above pre- 2020 levels. Non-fatal overdoses were highest in July and August 2022 and then decreased. Synthetic opioid fatalities for adolescents increased in 2021 to 367% increase over 2020. However, the actual number of fatalities was low: there were three fatalities in 2020 and 14 fatalities in 2021.

An ex officio member asked if there was a way to track opioid overdose reversals. Dr. Wise stated that data on naloxone provided by emergency management services are available; however, data quality and completeness are a concern as this reporting is voluntary.

An IORAB member asked if settlement funds could be used for non-opioid concerns in the community. Chief Jones said that block grant funds, general funds, cannabis funds, and other strategies are considered when addressing non-opioid concerns.

Working Group Updates

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

Dr. Adams shared the Medical & Research Working Group's summary statement and recommendations for best practices related to State Overdose Action Plan (SOAP) Priority #23: Equitable access to all forms of Medication Assisted Recovery (MAR), overdose treatment and prevention, harm reduction, and recovery support services for any individual within the justice system.

  • Solutions to allow implementation of better access to medications for opioid use disorder (MOUD) within the Illinois justice system:
    • Mandate/incentivize all county jails and IDOC to join the learning collaborative project funded by IDHS/Division of Substance Use Prevention and Recovery (SUPR) and become active members.
    • Standardize the services for MOUD to include: common formularies among all facilities and appropriate staff to inmate ratio to maintain competent standard of care which should include: screening for all, referral of positive screens to providers for opioid use disorder (OUD). diagnosis and treatment, case management for connection to outpatient resources upon discharge (MAR), and funding for transportation for warm handoffs.
    • Develop local community partnerships to allow for MAR including methadone and buprenorphine.
    • Support/fund/expand peer support/peer re-entry support training and services.

Joel K. Johnson, Treatment Alternatives for Safe Communities (TASC), Chair, Access & Equity Working Group

Mr. Johnson shared the Access & Equity Working Group's recommendation related to Community Outreach and Recovery Support (CORS) model pilot funding:

Recommendation that CORS pilot funding with consideration of impact of OUD (per capita rates of death); geographic distribution and leveraging existing infrastructure support with the expectation that sustainable funding will be available if outcomes have been met. The intent of this recommendation is to provide input into how communities will be selected for the COR pilot funds and ensure ongoing funding if pilots are successful.

Office of Opioid Settlement Administration (OOSA) Updates Recommendations Process Review

Sherrine Peyton, Statewide Opioid Settlement Administrator (SOSA), IDHS/SUPR reviewed the recommendations process.

The IORAB's role is to review and consider recommendations regarding the administration and distribution of the Illinois Remediation Fund. Recommendations that align with the Core Abatement Strategy (CAS) approved by the IORAB are submitted to the Governor's Opioid Overdose Prevention and Recovery Steering Committee (Steering Committee). Recommendations approved by the Steering Committee are sent to the Attorney General's office for certification. OOSA is responsible for implementation of approved recommendations following state procurement protocols established under the Grant Accountability and Transparency Act (GATA). The Executive Order outlining these requirements can be found at: Executive Order 2022-19.

Recommendations may be submitted by the Working Groups, as well as associations and larger trade groups. Individual organizations may not be able to make requests that benefit their own organization due to conflicts of interest. Ms. Peyton will create a Frequently Asked Questions (FAQ) document that addresses conflict of interest and post it on the IORAB website.

OOSA has developed an Opioid Settlement Funding (OSF) Core Abatement Strategy Recommendation Form. Proposed recommendations must be submitted via this form. Completed forms should be sent to Ms. Peyton (sherrine.peyton@illinois.gov) with the subject line "IORAB OSF Recommendation". Data or research related to the proposed recommendation, if available, should be attached. Ms. Peyton will notify submitters within seven business days that the form has been received. In adherence with OMA and GATA, do not include IORAB members, the Attorney General (AG), the AG office, SUPR staff, Chief Jones, consultants, or others on the email. Ms. Peyton will work with submitters to ensure the recommendations align with the core abatement strategies and the SOAP.

Equitable Distribution Metrics

Ms. Peyton reminded the group that remediation resources must be distributed equitably across the seven IDPH regions of the state. Average opioid use disorder rate, average age-adjusted overdose death rate, morphine milligram equivalents (MMEs) shipped to the region, and Illinois Census population in each region are examples of the metrics that may be used to determine equitable distribution.

Update on Approved Strategies

Ms. Peyton provided an update on the recommendations that have been approved to date. Agencies have received funding totaling $3 million (M) for the expansion of licensed Opioid Treatment Program (OTP) services for warm handoffs and recovery services. The Notice of Funding Opportunity (NOFO) for the $5M allocated for the CORS pilot has not yet been released. The distribution of naloxone under Access Narcan ($4.5M allocated) is going well and will extend into the next fiscal year. The Illinois Prescription Monitoring Program (ILPMP) has used $750,000 of the allocated $3.75M to update information technology to increase the number of providers registered and utilizing the PMP.

An IORAB member asked about how remediation funding for state-funded programs works, as the state receives its own opioid settlement allocation. Ms. Peyton stated the state's opioid settlement allocation is for administrative services. Remediation funds used for opioid abatement strategies are not replacing state funds (e.g., general revenue funding) but are expanding or adding services to existing programs.

IORAB members requested a breakdown of current funding. Chief Jones clarified that $750M is projected over an 18-year period; this year's allocation is $88M and the majority of these funds are available. IDHS/SUPR Director Garcia clarified that some of the remaining funds will be allocated to approved strategies. A detailed breakdown of the settlement funding will be presented at the next IORAB meeting.

Board Recommendations and Discussion

Chief Jones led a discussion on the 21 proposed recommendations that have been submitted for consideration. These recommendations have been condensed into ten categories:

Increase or improve:

  1. Prevention Services
  2. Equitable Access to Harm Reduction Strategies (Services that prevent drug-related deaths and offer access to healthcare, social services, and treatment)
  3. Access to Treatment (including treatment for adolescents and justice-involved individuals)
  4. Services for Pregnant and Postpartum People
  5. Mobile Units
  6. Crisis Response Services
  7. Reentry Services
  8. Comprehensive Drug Testing
  9. Capital Improvement Gap (brick & mortar)
  10. Workforce Challenges in Behavioral Health and Peer Services

Ms. Peyton discussed considerations for equitable distribution of funding:

Current efforts/resources

  • Areas with low access to treatment
  • Areas with high poverty rates, high unemployment, and/or extreme stigma against people who use drugs
  • Areas with high Emergency Room overdose rates, OUD, overdose deaths increasing above the state or national rate, overdose rates disproportionately experienced by a marginalized group, and/or
  • A loss in funding for a strategy will lead to a loss in life saving services

Discussion

An IORAB member noted that there is a limitation for dispersing capital improvement funding. It was requested that Ms. Peyton, IDHS, and SUPR identify a mechanism and process by which those funds could be dispersed for capital improvement under the qualifying factors set forth in the SOAP and the settlement agreement.

An IORAB member asked for clarification about the types of recovery support, crisis response services and workforce issues that would qualify for funding consideration. Director Garcia stated that recovery support services should be supported throughout the continuum of care. Regarding crisis response services, models will vary by community, and IORAB members can help to inform the types of services that could be considered based on communities' needs. It was requested that IORAB members suggest strategies to address workforce challenges.

Public Comments

A member of the public asked Dr. Wise about a study that showed that overdose deaths are undercounted in Cook County due of stigma. Dr. Wise is aware of the study and reported that IDPH is exploring ways to address stigma and obtain accurate, high-quality data.

Adjournment

Chief Jones requested a motion to adjourn the meeting. Mr. DeLoss made a motion to adjourn the meeting. Ms. Campos seconded the motion. The motion passed and the meeting was adjourned.