Meeting Minutes
Juliana Stratton - Lieutenant Governor
Dr. Sameer Vohra - Director, Department of Public Health
Grace Hou - Secretary, Department of Human Services
1st Quarterly Meeting Pursuant to Executive Order 2020-02
Date and Time
Monday, February 27th, 2023
10:00 AM to 11:30 AM
Name Organization
Lt. Governor Juliana Stratton (co chair) Lt. Governor
Secretary Grace Hou (co chair) Illinois Department of Human
Services
Director Dr. Sameer Vohra (co chair) Illinois Department of Public Health
Director Laura Garcia Illinois Department of Human
Services, Division of Substance Use
Prevention Recovery
Dr. Leslie Wise Illinois Department of Public Health
Director Br e nd a n Kelly Illinois State Police
Anthony Kestner ( Dir. Kelly) Illinois State Police
Director Heidi Mueller Illinois Department of Juvenile
Justice
Director Marc Smith Illinois Department of Children and
Family Services
Arvind Goyal Illinois Department of Children and
Family Services
Jessica Reichert Illinois Criminal Justice Information
Authority
Director Rob Jeffries Illinois Department of Corrections
Shalandra Barnes (rep. Director Jeffries) Illinois Department of Corrections
Luke Tomsha Public Member, The Perfectly
Flawed Foundation
Sherie Arriazola-Martinez Public Member
Agenda
I. Call to Order and Roll Call
a. Secretary Grace Hou called the meeting to order at 9:05 AM.
b. Dr. Ogwal and Dr. Sue Pickett conducted roll call.
c. A quorum was established.
II. Approval of Agenda for 5/10/23 and Minutes for 10/06/22
a. Agenda for 2/27/23
i. Motioned by Lt. Governor Juliana Stratton
ii. Seconded by Dr. Arvin Goyal
iii. All in favor
iv. No opposition
v. No abstention
b. Minutes for 2/27/22
i. Motioned by Luke Tomsha
ii. Seconded by Dr. Leslie Wise
iii. No opposition
iv. No abstention
III. Chairs' Remarks
a. Secretary Hou
i. She invited Lt. Governor Juliana Stratton and Dr. Vohra to share remarks.
b. Lt. Governor Juliana Stratton
i. Lt. Governor Juliana Stratton wanted to thank everyone for the work we are doing. She noted the updates and the previous recommendations that were voted on. She encouraged all to take pause to reflect on the ongoing work that is happening. She said we are making progress and express her appreciation to all. She passed it back to Secretary Hou.
c. Director Dr. Sameer Vohra
i. Director Vohra thank everyone and committee members. It is a critical time with public health. This week marks shared that though this week is 0 the end of the Covid-19 Public Health Emergency declaration, public health will continue to stay abreast of Covid-19 and it's impacts. It is not an end to public health issues, including what we are discussing today. It5's important to write new chapters. We are 3new hurdles we are facing with opioid. We want to continue highlighting opioid overdoes prevention and recovery is critical in this. We appreciate all contributions to this work. Every single overdoes. You're going to hear about Xyalzine later. It has become increasingly prevalent in the Illinois drug supply and the drug supply has been linked to opioids across the country..
ii. He said. the White house office of Drug Control and Policy, and their leader, Dr. Gupta. Really spoke to the need and understanding on this. The number of the number of positive overdoses in 2022, had increased 42% from 2021. It causes detrimental effects around kind of soft tissue, wounds, extreme withdrawal symptoms and increased risk of overdose. He said Dr. Wise will describe this in detail.
iii. Narcan has been approved for over the counter sale. We have an standing order in the state, signed by Dr. Vohra and will continue to keep that standing order in effect. There are multiple formulations that are available for purchase at any pharmacy. Wanted to make sure it will remain in effect to cover those not available over the counter.
iv. Dr. Vohra also informed all that Department of Public Health has applied for a grant renewal for CDC's overdose to action grant. we requested federal funding to support some of the initiatives outlined in the statewide over those action plan. Those things are the things that we, uh, know, uh, are incredibly effective harm reduction services, overdose, surveillance, efforts, collaborations with clinicians, health care systems, public safety. we really wanted to emphasize our work and the CDC was heavily emphasizing the importance of patient navigators and peer support in recovery knowing how critical those things are to the recovery of those facing opioid challenges.
v. Dr. Vohra then emphasized his departments commitment to harm reduction and improving the quality of people's lives. Afterwards, he thanks Secretary Houe and passed it back to Secretary Hou.
d. Secretary Hou
Secretary thanked him on his remarks, acknowledged the end of the public
health emergency. She In May of 2020, we 1st met virtually to comply
with the governor stay at home order in response to the Covid 19
epidemic. And during that 1st, virtual meeting, while implementing
Covid-19 harm reduction strategies that saved many lives, we heard an
update on the States progress on access to care.
i. She said we together have been shifting from a punishment-based approach to substance-use disorder treatment to a more harm reduction approach. Data in 2021 shows that there were over 3700 overdose fatalities in Illinois 3700, which is a loss of more than 10 people every day. It is the leading cause of accidental death for Illinois residents aged 18 to 49 years old. She said, harm reduction is an approach that emphasizes direct respectful, compassionate engagement with people who use drugs to reduce the risk of harm, including an overdose. There's data associated with other harm reduction strategies that have proven effective improving mortality outcome, such as nicotine gum to reduce the risk of lung cancer, to reduce the risk of homicides and accidental shooting. Blood alcohol limits to reduce the risk of the related accidents and sunscreen to reduce the risk of skin cancer. She said we need to apply those same principles to the work that we're doing here. Harm reduction provides a comprehensive approach to addressing substance use disorders where.
ii. She said, the relationship with the person who uses drugs is paramount. That individuals are treated with respect and dignity and individuals set their own goals. They receive overdose education, counseling, and referral to treatment for infectious diseases and substance use disorders. And individual's at risk of overdose, or those who might respond to an overdose receive overdose reversing naloxone. Individuals receive a message of hope. And healing from people with lived experiences and lived expertise. She said harm reduction also reduces the stigma associated with substance use and current disorders as the model helps us recognize
that substance use disorders are medical conditions.
iii. She said research has confirmed that addiction is a medical disorder that affects the brain and changes behavior. Scientists have identified many of the biological and environmental risk factors and are beginning to search for the genetic variations that contribute to the development and progression of the disorder. Therefore, substance use disorder, intervention, intervention and treatment services for people with opioid disorders that do not integrate harm reduction strategies, such as lack of access and lock down do not reduce the risk of an overdose. She invited all to continue to strengthen our system, to provide us with good ideas, to be our partners, be our implementers to expand overdose, harm reduction strategies across our system. She said, I think we have an amazing opportunity in the state of Illinois, with strong leadership from our governor and lieutenant governor, and our agency directors who are committed, committed to the harm reduction strategies. And, we have the benefit of an attorney general who is fighting for more resources to be brought to our state so that we could put them to use. I greatly appreciate all the work.
IV. New Business
a. Xylazine update by Dr. Leslie Wise
i. Dr. Wise began by saying Xylazine is a non-opioid. That thi urinary tranquilizers currently not approved for human use. It's used in large animals as well as, smaller pet animals. That right now it is being added to illicit heroine signal and benzodiazepines. And the reason is being added to those substances is Dilithium. Dilithium causes a long deep sedation and is able to extend the incentive effect of those substances is also known as "tranq."And what we're seeing in our in our fatality information is that xylose being positive in overdose fatalities in 2022. 98% of them were also included as synthetic opioid, Sentinel. She said it seems to be mostly mixed with Sentinel. So, concern about is that it is associated with soft tissue wounds that they do become severe very quickly, and they do require medical attention for healing. To show( while presenting slides to all), this is showing our increase in and positive fatalities in Illinois, starting in 2018 through 2022 fatality data are provisional at this point in time. Hopefully that will be those will be finalized in the next month or so. She said, holiday time usage have increased dramatically in the past several years. They have increased 43% from 2021, but also 413% from 2020. So it has really made its way into Illinois pretty quickly over the past couple of years. She said we're seeing, at this point in time, that 66% of those overdose fatalities occurred in an urban county. We're also seeing 15% in suburban and 100% in small, urban and 7% rural. So, we are seeing it throughout the state. It's not just a county issue. We are seeing it. across all regions. Here is a brief breakdown of who we are seeing. So these are percents of the fatalities in 2022 the highest percentages of fatalities for age group. It's almost equal between the 25 to 34 year age group.,35 to 44, and the 55 to 64 years age groups. She said are also seeing the highest percentages of fatalities of positive overdose fatalities in the non Hispanic black communities followed by non Hispanic, white and Hispanic and Latin X.
She said, a couple of recommendations I know. 1) Since is commonly mixed with an opioid, we still recommend delivery of naloxone when an overdose is suspected because as we. So far 98% of the time in 2022. it was mixed with that opioid. I also said the incentive effects are strong and so that person may not become fully alert with the delivery of naloxone. 2) She said, we're trying to recommend that we really shift to a, if the person is breathing, they do not need more naloxone instead of continuing to give him the lockdown and tell the person. Strips are now available. However, there are inpatient treatment options that can help manage use withdrawal symptoms. One suggestion that was given is the opioid help line or and the substance use hotline and the 98 sites, suicide in crisis lifeline. That is going to be my update for today. Thank you all
ii. Secretary asked the question, given the percentages of Black residents, does it also reflect the percentages of those suffer fatalities? Dr. Wise responded by saying If we were looking at if we're looking at percentage of total opioid overdoses that's actually generally a non-Hispanic white. She said, generally, the older age groups are what we're seeing with the higher fatalities and opioids.
iii. Lt. Governor asked the question, about what to look for during those critical moments, do you look for breathing or not breathing? How to know to keep going with Naloxone. Dr. Wise responded is that yes, it's a difficult and you may not get their with Naloxone as the drug effects cause deep sedation. She said, you may deliver and they are at a point where they're breathing. However, naloxone can wear off before the Opioid wears off in which case they could go back into a state of non, breathing and respiratory distress. In which case they would need another they may need more in a locked. So it's important that somebody is with them at all throughout the, throughout the entire duration. And if not, then to call 901, if they cannot stay. Lt. Govenor responded by acknowledging in recognizing the different affects of naloxone usage and saying she often reflects how we educate the public on this. She passed it on to Luke Tomsha.
iv. Luke Tomsha said, I really think we need to take a strong look at why we're seeing all these other analogues come into the system. He recommended looking at policies.
v. Karen Birk asked the question, Are those trips able to tell the, uh, tell the user about the potency of drug that they are about to use, or it just says whether it's in there or not. Dr. Wise responded saying yes, it to see if the presence is there or not.
vi. Laura Fry commented, that's what we really need out in the field for people like us that are on the street being able to check people's drugs in real time and educate people. She said that's what we really need out in the field for people like us that are on the street being able to check people's drugs in real time and educate people Small nonprofits like us do not have the 25,000 dollars sitting around to purchase one but I am telling you that we would be out on the streets 7 days. Luke responded in saying, it allows a conversation to occur. Don't use behind closed doors. That there's some dangerous substances out there, go low and go slow. I mean, our goal is to reduce over those death period.It is just that connection and that trust that you can build with the community.
vii. Dr. Goyl asked, Are you seeing any isolated related deaths? Dr. Wise responded saying, For 2022 as the 231 that we have now, that have been solidly positive there. We're 4 did not have any other substances present. He thanked her and also commented, In sync with what you just said about putting the policy and the future agenda of these meetings. I think that's a great idea. We need to look at the possibility. Secretary Hou thanked him and started to pass it to next presenter.
viii. Lt. Gover also gave a quick comment that as a restorative justice practitioner, we have to not only create policies that repair harm, but to make sure that it does not do further harm. She asked Luke Tomsha to take up some leadership in furthering this conversation.
b. Harm Reduction: Overview and Ongoing Initiatives: Dr. Nicole Gastala,
i. Dr. Gastala opened by acknowledge the historical way we use to address substance abuse from a punitive perspective and how we need to continue to change to harm reduction. She said, judgmental language and stigma, and then really poor outcomes for patients, then we have the addition of criminalization of drugs, which then exacerbated that punitive treatment of individuals with addiction, where incarceration as the primary consequence, rather than treatment of substance use disorder. Criminalization has really led to this historic all or nothing approach to treatment and then there's corresponding punitive policies and practices, which then are sort of not effective. So, if a patient is not on the road to abstinence, this does not mean that they're not on the road to recovery
ii. She said, our goal is to help save lives. That when we think about recovery, it can include abstinence, but it can also include a myriad of other things. Right? It can include reduction in use improving of an individual's quality of life. Harm reduction really focuses on being proactive as well as evidence based. And community level again, meeting the individual where they're at, based on their goals with the goal of reducing death overdose and infections and it's for everyone who's using substances, not just those who are working towards sobriety and recovery. She said, for those who are homeless who are moving through that sort of drug induced altered state to reduce harms for them supervised consumption sites are also another evidence based approach that has been used in New York and internationally to prevent infection transmission as well as overdose death medication. there are several evidence based ways, we can do this decreasing use, not using alone, using test doses, utilizing clean materials, using the quality of life scale, addressing Social determinants of health, employment, status, housing, relationship, building, addressing the individual's full health. For example, we had this clinician who was not really interested in treating substance use as part of their, you know, what they do in primary care. And then we had a Practitioner who was integrating it within their family medicine practice and there was a patient that went from that doc, to the nurse practitioner who had severe opioid use disorder who had uncontrolled diabetes and uncontrolled hypertension. Well, once that nurse practitioner supported that individual and their treatment, that patient then was also able to focus on their other chronic diseases as well. So it's sort of impacts. The person's whole health.
iii. Another area is also meeting familiar partner responsibilities. So, being a caregiver, we have a lot of patients and individuals who do care for their families and helping support them to engage with them is important. So, and this is exactly who we're missing in treatment, right? About 40% of people who need treatment are not ready to stop using and they're afraid to ask for treatment or ask for any sort of treatment because they're afraid of being stigmatized for not wanting.to participate in an abstinence only model and so this is, if we really want to impact overdose death, right we really have to open the way that we offer treatment. We also have to expand the way that we look at substance use disorder as really a chronic health condition and really meet Individuals where they're at again to reduce that morbidity and mortality. So naloxone doesn't increase drug use that actually increases drug treatment. It's cost effective. It's been shown to reduce overdose desk and really should be centered around people who use drugs. The formulation should really be chosen by that individual or community, and there's a lot of different feedback from different communities, they're individuals about the type of naloxone that they want to use, whether it's injectable versus international and as well as the dosing structure of that. And then a 2nd, route is through access where hospitals and clinics can actually order narcan direct.
iv. Another important area that you've heard about, and functional test trips, so over 90% of opioid related overdose and county involve fentanyl, t allows individuals to check for presence of substance in their drugs and it does show that it impacts outcome. Data shown that it's increased overdose safety by 77%, change any behavior related to use by 50% and results in using less drug than usual at 32%. Empowering individuals on how to approach uncertainty and potential unknown substances, and their drug supply gives them the control to be able to decide how much. able to decide how much or how little they should use, so they can then really have an impact on their overdose risk. Then Centers, these are safe, welcoming and trauma, informed spaces, especially for those who are experiencing homeless news to move through that drug and use altered state and reduce harm and it's really an opportunity for low threshold engagement.
v. Another evidence base tool that we have that just started in the United States is overdose prevention sites or supervised consumption sites. These are harm reduction programs that allow individuals to bring Pre, obtain drugs, have staff on site who are ready to administer. Of those EMS transports, any sort of criminalization. any sort of criminalization that's involved end all of that. So it really has helped support a lot of those communities. And what does the data show worldwide as well as in the U. S. well, it decreases overdose death it decreases substances. It decreases public disorder and public injecting it decreases HIV and hep C risk and decreases cost from many different areas. It increases entry into treatment increases entry into medical treatment and increases entry into social services as well as healthcare value.
vi. Next medication assisted recovery so this is most commonly known as now buprenorphine and methadone compared to sort of behavioral therapy alone. It was in Baltimore, and when they introduced, um, medication buprenorphine into the community in area, they saw a significant reduction in overdose staffs. We were able to do this because of the covid 19 pandemic, and the relaxation on telehealth rules. We're able to actually start a hotline. For individuals to access treatment services and so an individual can call 24/7 through our Illinois help line and just say I have, I use opioids. I'm really interested in treatment or I'm experiencing withdraw. And then the Illinois help line will directly transfer that call To a care manager that care manager then provides 24 access to a provider. So you can either can prescribe buprenorphine through a home induction do same day or next day with methadone or buprenorphine, and then connection to other care. Since May 2022, since May.
we've had 300 patients who have called 106, methadone, 163 buprenorphine, 21 in withdraw management and 11. we're seeking residential treatment in 99% of those. I'm also investing in mobile services in Chicago as well, as in our rural areas. Chicago successfully reached nearly 600 patients, and traditionally medically underserved on neighborhoods with the highest rate of overdose in the West side of Chicago. Dr. Gastala went on to encourage all of these harm reduction strategies and working together and meeting people where they are.
vii. Director Garcia commented saying she invited us to reflect on what we heard and to think about what opioid use means to the individuals who use and that relationships are important to this work and recovery. The recovery partners can include those who have similar life experiences, or who are specific recovery coaches. To also recognize recovery centers like we see warming centers.
viii. Dr. Goyl also commented on pairing the counseling and the use of these drugs. Lt. Governor also expressed that importance of seeing communities get this important information. She also pointed out that there may still be discrepancies in racial dynamics of who gets jailed and who gets treatment. She thanked Dr. Gastala for the extensive detail on harm reduction. Secretary Hou acknowledged this as well and passed it to Dr. Vohra. Dr. Vohra emphasized the next steps to be continuing of expanding services and access to services. Luke Tomshar also agreed and reiterated education. Jennifer Epstein also agreed with the need for wider education, marketing and outreach to various communities. Secretary Hou thanks all and passes it to Driector Garcia to go over updates for the IORAB.
c. Director Garcia gives update on I O. R. A. B. which is the Illinois opioid remediation advisory board
i. She informed the body that there is still ongoing development with the opioid settlement funds. That they are waiting on additional strategies and will be sharing at a later date for that. She said review is ongoing on the recommendations to vote on regarding the strategies. 21 recommendations were submitted to the board but no voting has occurred yet. Which means nothing has been submitted to the steering committee yet. She passed it back to Secretary Hou.
V. Public Comment
i. Secretary Hou then noted we had a few minutes left and opened for public comments. Seeing none, she wished everyone well, a Happy Mother's Day weekend.
VI. Adjournment
a. Secretary Hou adjourned with assistance from Lt. Governor by saying all in favor. Meeting ended at 11:24 AM.
i. No opposition
ii. No abstention
