Illinois Opioid Remediation Advisory Board
Medical & Research Working Group Meeting
December 19, 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, Health Management Associates
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)
Brent Van Ham, Southern Illinois University School of Medicine
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 Tamara Olt, Doug Smith, Dana Ray, Kathryn Bocanegra, Lia Daniels, and Dan Lustig. Quorum was established.
Review and Approval of November 21, 2023 Meeting Minutes
Dr. Adams called for a motion to approve the meeting minutes. Michael Isaacson made a motion to approve the November meeting minutes. Dr. Wise seconded the motion. All members present voted in favor of approving the minutes. The motion passed.
Priority Recommendations for the IORAB
The group discussed three recommendations that were drafted for submission. Dr. Pickett noted that, given the recommendation review process, the recommendations will most likely be considered at the April IORAB meeting.
(1) The opioid treatment provider (OTP) recommendation would expand access to methadone by having OTPs work with other entities to increase access to priority populations and in MAR deserts. There are many locations where high priority populations can't access an OTP.
- Language was added to ensure that OTPs and medical entities would respond to Notice of Funding Opportunities (NOFOs) as partners.
- A question was asked about sustainability. The funding will be used to develop partnerships, workflows, hiring, and other first-year start-up costs. By year three, the recommendation would hopefully be sustained by billing Medicaid and insurance. Sustainability will be considered as part of the NOFO process. Entities that are awarded funding must accept Medicaid, Medicare, and the uninsured.
- The recommendation was revised, as follows: Implement and support partnerships between opioid treatment programs (OTPs) and Federally Qualified Health Centers (FQHCs), hospitals, clinics, and public departments of health. Enable (fund) partnerships to be created between existing OTPs and medical entities to start new satellite OTP locations within medical sites. Funded partnerships must accept people who have Medicaid, Medicare, and/or are uninsured to ensure that all have access to these services. These partnerships will enable OTPs to increase access to methadone to priority populations as well as in "MAR desert" regions of the state.
- Dr. Adams called for a motion to approve the recommendation. Dr. Dennis made a motion. Lindsay Wilson seconded the motion. A roll call vote was conducted. All present voted in favor of approving the recommendation. The motion passed.
(2) The continency management recommendation would fund sites to pilot a contingency management program. Funding will support program set up, staffing, implementation tools and resources, incentives, and evaluation, which should include an evaluation of cost-effectiveness. Because contingency management is new for providers, funding would support a training and technical assistance program to help sites learn to set up a model program. The training and technical assistance program would assist providers in adapting the program to their local resources and needs, provide tools to help implement it in a cost-effective way, and monitor implementation and evaluation effectiveness and cost-effectiveness. The evaluation is important in order to justify long-term sustainability.
- There are Medicaid waivers in some states to pilot test contingency management programs. While contingency management is well-studied, it is largely not in use because of regulatory barriers. It is important to show that contingency management is as effective in practice as research suggests.
- A question was asked about the need for Institutional Review Board (IRB) approval for this research. As SAMHSA and National Institutes of Health (NIH) are both under the United States Department of Health and Human Services (HHS), the research should follow HHS human subjects guidelines. Any entity that applies to conduct the technical assistance, training and evaluation should have an IRB that can cover the entities providing contingency management.
- Dr. Adams called for a motion to approve the recommendation. Dr. Austman made a motion. Dr. Wise seconded the motion. A roll call vote was taken. All working group members who were present voted in favor of the motion. The motion was approved.
(3) The Buprenorphine for All recommendation states: By removing cost and geographic barriers, provide access to buprenorphine for all Illinoisans with OUD who are prescribed the medication. In particular, the recommendation will ensure access to buprenorphine for two groups: 1) persons who are underinsured and unable to pay the copay, and 2) persons who are uninsured who don't have access to a clinic that provides buprenorphine at no cost.
- Dr. Pickett asked about the need to provide more information about how the strategy would be operationalized. A working group member said there are different ways the recommendation could be operationalized. A substance use treatment provider could potentially apply for funding to purchase buprenorphine and then dispense it to patients or could work with a pharmacy to provide copay assistance. SUPR would not be dispensing the medication. A pharmacist, substance use treatment provider, or OTP would provide the medication, and would apply for funding to cover it.
- The recommendation will be discussed in detail at the January meeting.
Public Participation
A member of the public said it is important to note that contingency management shouldn't only be for abstinence-based programs. The group discussed the need to add this to the recommendation form.
- The recommendation could provide examples of what contingency management would reward, such as taking medication or attendance, talking to a sponsor, or going to a dry social event. Dr. Dennis will make changes to the recommendation.
A member of the public asked how a partnership between an OTP and a street outreach team could work. It was noted that a recommendation was previously approved for mobile units. A street outreach team could partner with a mobile unit that dispensed medication. The OTP must own the DEA license, and the DEA has to certify the mobile unit. If the team wants to dispense at a particular physical location, the entity could still apply, but they would have to take additional steps in order to be zoned as medical.
Adjourn
Dr. Adams called for a motion to adjourn the meeting. Brent Van Ham made a motion to adjourn. Dr. Wise seconded the motion. Dr. Adams adjourned the meeting. The next meeting of the Medical & Research Working Group will be held on January 16, 2024 from 12-1 PM.
