Illinois Opioid Remediation Advisory Board
Medical & Research Working Group Meeting
November 21, 2023
Virtual Meeting Held Via Zoom
Meeting Minutes
Medical and Research Working Group Members
Adrienne Adams, MD, Rosecrance (Chair)
Nicole Gastala, MD, IDHS, SUPR
Jessica Perillo, Boone County Health Department
Katie Unthank, Egyptian Health Department
Michael Dennis, PhD, Lighthouse Research Institute, Chestnut Health Systems
Tamara Olt, MD, Broken No More, Jolt Foundation
Doug Smith, PhD, University of Illinois
Dana Ray, MD, Crossings Healthcare
Katherine Austman, MD, Gibson Area Hospital and Health Services
Katharine (Kitty) Juul, Southern Illinois University (SIU)
Kathryn Bocanegra, PhD, Jane Addams College of Social Work, University of Illinois at Chicago (UIC)
Lindsay Wilson, CDC Foundation
Michael Isaacson, Kane County Health Department
Dan Lustig, PsyD, MA, Haymarket Center
Leslie Wise, PhD, Illinois Department of Public Health (IDPH)
Lia Daniels, Illinois Hospital Association (IHA)
Welcome and Roll Call
Sue Pickett, PhD of Advocates for Human Potential, Inc. (AHP), facilitator, welcomed the group and conducted roll call. All members were present except for Adrienne Adams, Jessica Perillo, Tamara Olt, Katie Unthank, Doug Smith, Dana Ray, Kathryn Bocanegra, Lindsay Wilson, and Dan Lustig. Quorum was not established. Dr. Gastala chaired in the meeting in Dr. Adams' absence. The group agreed to vote by consensus.
Review and Approval of October 17, 2023 Meeting Minutes
Michael Isaacson motioned to approve the October meeting minutes. Dr. Dennis seconded the motion. All members present voted in favor of approving the minutes. The motion passed.
Office of Opioid Settlement Administration (OOSA) Updates
Dr. Pickett reviewed the opioid settlement overview document that SUPR created and discussed with the IORAB working group chairs. The document summarizes the governance structure of the Opioid Settlement Funds (OSF), role of the working groups, the process for making recommendations, and includes a slightly updated recommendation submission form (appendix A) and approved list of abatement strategies (appendix B). Recommendations cannot include activities or efforts that are already funded and/or supplant an existing effort, including those funded by Medicaid/Medicare. Certified recommendations are subject to the procurement process either through a competitive funding opportunity (i.e., NOFO), expansion of services already funded by the State (e.g., expanding Access Narcan), or an interagency agreement. Settlement funds will be disbursed annually through 2038. Ideally, recommendations should be sustainable after settlement funds expire.
- If there is a strategy that is currently funded but is not available in a certain part of the state, then the recommendation would be to expand the service, so it is more readily available statewide.
- There was some confusion as to what "available to adults and adolescents" refers to in the table of abatement strategies currently implemented in Illinois. Dr. Pickett will reach out to Chief of Staff Rivera for clarification.
- Please send any corrections or comments regarding the settlement overview document to Dr. Pickett.
Priority Recommendations for the IORAB
Dr. Gastala led the review of the recommendations discussed at the October working group meeting. Drafts of these recommendations were sent to the working group prior to today's meeting.
(1) Planning, training, and implementation of contingency management (CM) for opioid use disorder (OUD).
- Dr. Dennis prepared the draft recommendation on CM. CM is an evidence-based strategy to improve retention in treatment and medication compliance. The recommendation could possibly fall under the following core abatement strategies: medication assisted treatment or warm hand-off programs and recovery services (e.g., CM can improve initiation and engagement in warm hand-offs to MAR services). Dr. Pickett's team will help identify the most appropriate strategy and approved uses for this recommendation.
- A member of the public commented that the focus of CM should not be on abstinence of illicit drug use but rather continuation of MAR, even if there is co-occurring illicit drug use (e.g., stimulants, benzodiazepines) because the risk of fatal overdose is greater for people who are taken off MAR than when their using additional substances while on MAR (medications like buprenorphine can serve as a harm reduction strategy by blocking the effects of fentanyl often found in illicit drugs). Dr. Gastala agreed that it is not indicated to take patients off medication unless there is a medical contraindication or if the patient chooses to do so. She clarified that CM is not to be used to punitively to take PWUD off their medication but to support the positive reinforcement process in their brain that they may not be getting from substances. Positive reinforcement via CM might come in the form of bus passes, monetary rewards, or control over one's dosing.
(2) Planning and implementation for partnerships between Federally Qualified Health Centers (FQHCs)/hospitals/clinics/departments of public health and Opioid Treatment Programs (OTPs) to incorporate OTPs in existing medical locations across the state.
- Dr. Austman reviewed the recommendation she drafted. The group discussed that the recommendation could fit under the following core abatement strategies: medication assisted treatment, pregnant & postpartum people, or treatment for incarcerated populations. Dr. Gastala added that the recommendation could fall under treatment for incarcerated populations because it could potentially ensure that a high priority population is served when returning to the community.
- The group discussed the disparities and social determinants of health that the recommendation addresses, including transportation barriers, access to appropriate medical care, and employment stability (expanded access to methadone means that people will not have to take as much time off work to dose).
- The group discussed what services they would like to see implemented via this recommendation: expanding access to methadone either through (1) the expansion of existing OTPs or (2) supporting new OTPs serving priority populations and in areas of the state that don't have any OTPs or lack OTPs that are publicly funded (i.e., serving underinsured and uninsured populations). Dr. Gastala will reach out to SUPR to identify which OTPs are publicly funded.
- Dr. Pickett's team will work with Drs. Dennis, Austman and Olt to further refine the recommendations and complete the submission form. Revisions will be shared with working group and discussed at the December meeting.
Public Participation
A member of the public asked why OTP requirements focus on methadone when many patients in MAR deserts have adjusted to the lack of methadone access and seem to prefer Suboxone (buprenorphine) over methadone. Dr. Gastala responded that while regulations for methadone make it more difficult to implement OTPs, it is important that patients have equitable access to all three FDA approved MOUD because patients deserve to have options and access to the medication that works best for them. Data shows that methadone has a slightly higher reduction in mortality than buprenorphine and there are situations when methadone would be the best option (for example, patients with co-occurring pain or cancer). The state has made significant strides to increase access to buprenorphine, and hopefully this recommendation will do the same for methadone. Hopefully, FDA regulations for methadone will become more lenient over time. There is some preliminary work at the federal level regarding dispensing methadone in pharmacies rather than OTPs. A working group member noted that methadone is also important because it is easier for patients who use high potency opioids like fentanyl to get stabilized on methadone versus buprenorphine.
Adjourn
Dr. Pickett adjourned the meeting. The next meeting of the Medical & Research Working Group will be held on December 19, 2023 from 12-1 PM.
