IORAB Minutes 01.18.24

Illinois Opioid Remediation Advisory Board

January 18, 2024

2:00 - 4:00 PM

Virtual Meeting Held Via Zoom

MEETING MINUTES

Illinois Opioid Remediation Advisory Board Members

Dr. Adrienne Adams, Rosecrance
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
Christopher Hoff, DuPage County Health Department
Joel K. Johnson, Treatment Alternatives for Safe Communities, Inc.
Chelsea Laliberte Barnes, Live4Lali
Laura Lechowicz, Office of the Cook County President
Donna Nahlik, Chestnut Health Systems
Matthew Richards, Chicago Department of Public Health
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 Dulce Quintero, 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

Call to Order/Welcome

Chief Jones called the meeting to order and welcomed the group.

Roll Call and Approve Agenda and 10.5.23 Meeting Minutes

Dr. Sue Pickett, facilitator, of Advocates for Human Potential, Inc. (AHP) conducted the roll call of the Illinois Opioid Remediation Advisory Board (IORAB) and a roll call vote for approval of the meeting agenda and the October IORAB meeting minutes. All members except Angie Hampton, Kathy Yoder, and Laura Lechowicz were present. Quorum was established. All IORAB members who were present voted to approve the agenda and the meeting minutes. The ex officio roll call was taken. All ex officio members were present except Secretary Dulce Quintero. Andrea Law and Adam Braun attended on behalf of Attorney General Kwame Raoul. Jennifer Epstein attended on behalf of Chief of Staff Laura Vaught

Chairperson's Welcome Remarks: David T. Jones, Chief Behavioral Health Officer (CBHO)/Chair

Chief Jones welcomed the group. He reminded the IORAB that recommendations must align with the State of Illinois Overdose Action Plan (SOAP pdf). A key goal of all recommendations is to support all people in their recovery journey, having multiple pathways available to assist individuals in reaching long-term sustained recovery.

Office of Attorney General Kwame Raoul, National Opioid Settlements Update: Andrea Law, Deputy Bureau Chief, Health Care Bureau

Ms. Law provided an update on projected payments from the national opioid settlements.

  • To date, more than $109.8 million has been dispersed to the Illinois Opioid Remediation Trust Fund (Fund). The grand total of disbursed and estimated disbursement payments from 2024 to 2038 is $762 million. A large proportion of the estimated $117.1 million that is expected to be dispersed this year will be coming in to the Fund in the early months of 2024.
  • An IORAB member asked about expected payments from outstanding settlement agreements, and how many settlements are ongoing. Ms. Law explained that the amount of funding is expected to increase, but it is difficult to predict the amount as she cannot comment on ongoing investigations.

Working Group Updates

Medical & Research: Adrienne Adams, MD, Chair

The Medical & Research Working Group have developed three recommendations. These recommendations aim to expand access to methadone, contingency management, and buprenorphine.

The recommendations should be ready for review at the April IORAB meeting.

Access & Equity: Joel K. Johnson, Chair

The Access & Equity Working Group endorsed the Workforce Development & Infrastructure Working Group's recommendation to support and expand the behavioral health workforce. The Access & Equity Working Group is discussing a potential recommendation related to telehealth.

Workforce Development & Infrastructure: Blanca Campos, Chair

The Workforce Development & Infrastructure Working has focused on strategies to support and expand the harm reduction, peer-run organization, and traditional behavioral health workforce. This Working Group submitted a recommendation to support supervision, field training, and scholarships that they hope will be reviewed at the April IORAB meeting.

Illinois Settlement Funds Website: Regional Care Coordination Agency, Dr. Randi Moberly, Senior Program Director, Advocates for Human Potential, Inc.

In April 2023, Illinois Department of Human Services Division of Substance Use Prevention & Recovery (IDHS/SUPR) awarded AHP to serve as the Regional Care Coordination Agency (RCCA). The RCCA supports the Office of Opioid Settlement Administration (OOSA) through three main activities: the administration of sub-awards, the development and management of the opioid settlement funds (OSF) website, and the coordination and management of seven regional coalitions. The Illinois Opioid Settlements Initiative website provides information on the disbursement of settlement funds and helps to make the process transparent. Notice of Funding Opportunities (NOFOs), application materials and resources can be found on the website.

Regional Coalition Plan

Chantel Laperle, RCCA Deputy Director, said RCCA team advisors are assigned to each of the seven Illinois Department of Public Health (IDPH) regions to help manage sub-recipients in their regions.

  • The RCCA is recruiting people to serve on regional coalitions. The RCCA will develop and maintain one coalition per region, complete one annual workplan per region, and develop and offer training and technical assistance. The first meeting will be in March. Individuals interested in serving on a coalition can contact the RCCA at ilrcca@ahpnet.com.
  • An IORAB member asked if funding for regional care coalitions came from the 55% of the settlement proceeds that are allocated to the Fund. Director Garcia said that neither the RCCA funding nor the regional care coalitions are funded through the 55%.
  • An IORAB member asked how information about coalitions and NOFOs is getting out grantees. They said the deadline for the CORS NOFO may not provide enough time for organizations to apply. Director Garcia said that the date is established by Grant Accountability and Transparency Act (GATA) requirements and can't be changed. The regional coalitions are separate from the NOFOs.
  • Chief Jones said that IORAB members have an opportunity to serve as liaisons to share information about the regional coalitions and the NOFOs, and to encourage even small organizations to apply to NOFOs. Suggestions about people who should be part of the process should be sent to interim State Opioid Settlement Administrator (SOSA) Jim Wilkerson (Jim.Wilkerson@Illinois.gov).

Office of Opioid Settlement Administration Updates: Laura Garcia, Director, IDHS/SUPR

Director Garcia introduced interim SOSA Jim Wilkerson, the Administrator of Gambling Initiative Programs at IDHS/SUPR.

  • Mr. Wilkerson reviewed the recommendations process. SUPR reviews pending recommendations to determine if they are an existing recommendation, duplicate existing efforts, or can be funded by existing resources.
  • After the IORAB votes to approve a recommendation, the recommendation moves to the Steering Committee and the Attorney General's (AG) Office for certification of the recommendations.
  • Once SUPR receives the certification from the AG's Office, the GATA and procurement rules determine how to implement the strategy, which could be a NOFO, intergovernmental agreement or funding expansion.
  • SUPR experts develop the statement of work (SOW) that describes grant requirements. The RCCA then develops NOFO language that includes the SOW and advertises and releases the NOFO. According to GATA rules, NOFOs must be out for a minimum of 30 days.The RCCA chooses grantees based on the merit-based review process and GATA rules.

Approved Recommendations Update

  • Director Garcia said the estimated average annual funding amount available is $42 million. The Board has recommended an estimated $28 million per year until Fiscal Year (FY) 2026. Unspent money allocated to each strategy will remain in the Fund.
  • SUPR received questions regarding the FY2023 Community Intervention (CI) recommendation that expanded CI services. Director Garcia explained that the recommendation resulted in the approval of $3 million for opioid treatment programs (OTPs) to expand or implement CI services, and a little over $1.8 was spent. OTP grants were adjusted to reflect projected spending in existing, non-OSF programs. To reduce the administrative burden on the OTPs, separately but simultaneously, SUPR added OSF to implement the OTP-CI strategy. SUPR added a different funding code for this strategy to keep separate accounting for the funding. SUPR will confirm the use of this funding in future post payment audits. Updates on strategy implementation will be included on the opioid settlements initiative and State websites.
  • An IORAB member asked if all providers received a simultaneous reduction in their contracts and an increase in OSF in the same amount. Director Garcia said she was uncertain if the reduction /*was for all providers and will check.
  • IORAB members said the 30-day window to respond to NOFOs is an administrative burden, particularly for smaller organizations, and suggested that the process be extended to 45-60 days. Members also recommended NOFO forecasting to allow time for organizations to prepare. Mr. Wilkerson said the CORS NOFO was extended to 45 days. In addition, RCCA is offering technical assistance for applicants.

New Funding Recommendations

There are three recommendations for the Board to consider. Each aligns with the approved abatement strategies in the allocation agreement as well as the SOAP.

  1. Recommendation A. Harm Reduction
    • Opioid settlement funds shall be dedicated to low-barrier syringe service programs, harm reduction, and peer support services.
    • The funding request is for $15 million over three years ($5 million per year)
  2. Recommendation B. Naloxone
    • Funding will be used to support a pilot project to distribute higher dose (8 mg) naloxone nasal spray across the state to reduce and prevent overdoses.
    • Expanding access to 8 mg naloxone nasal spray will increase options in the naloxone formulations available statewide.
    • The funding request is for $1.5 million over three years ($500,000 per year).
  3. Recommendation C. Training and Technical Assistance
    • It is recommended that opioid settlement funds be used to create an Opioid Training and Technical Assistance Center (OTTAC) to address 1) training and technical assistance needs identified in several recommendations submitted to the OOSA and 2) the needs of people who have an opioid use disorder (OUD) who are served by a variety of programs.
    • The OTTACr will support a statewide web-based and interpersonal infrastructure, toolkits, subject matter experts, and innovative approaches to address training, technical assistance, and collaborative cross-system coordination to prevent opioid misuse, overdose. In addition, the OTTAC can provide training for organizations that need assistance to apply to NOFOs.
    • The funding request is for $9 million over three years ($3 million per year).

Board Recommendations and Discussion: David T. Jones, CBHO/Chair

The IORAB discussed and voted on the three recommendations.

  1. Recommendation A: Harm Reduction
    • Chief Jones called for a motion to approve the recommendation. Mr. Ziegler made a motion to approve the recommendation. Mr. Borrayo seconded the motion.
    • An IORAB member recommended a higher recommended funding amount.
    • An IORAB member asked if the opportunity was for one organization providing statewide services. Director Garcia said that this would be an intergovernmental agreement because SUPR does not have jurisdiction over harm reduction services. SUPR will work with grantees to understand how to implement it. A NOFO will be released, which will be open to all organizations that meet the minimum requirements.
    • An IORAB member asked how decisions are made about the number of awardees. Mr. Wilkerson said the decision is driven by the proposal and the statement of work, which are then passed to the RCCA. Director Garcia added that the number of organizations that are funded is also determined by the amount of funding, as well as the need to prioritize areas in the state that have high levels of overdose.
    • All members present voted in favor of the recommendation (Mr. Johnson was not present). The motion passed.
  2. Recommendation B: Naloxone
    • Chief Jones called for a motion to approve the recommendation. Mr. Hoff made a motion to approve the recommendation. Dr. Gordon-Young seconded the motion.
    • An IORAB member expressed concern that higher dose naloxone may cause precipitated withdrawal, which may last 12-15 hours; individuals aren't willing to wait that long to get inducted to buprenorphine. The member proposed spending more time considering different types of naloxone.
    • An IORAB member said they have concerns about 8 mg naloxone and requested that the group have more time to consider the recommendation. They suggested one of the working groups review research before the IORAB votes.
    • An IORAB member said a distinction should be made between individuals in an overdose situation that are experienced with opioids and individuals who are not actively using opioids. If an individual isn't actively using opioids and uses drugs laced with fentanyl, they will go into an overdose that requires an immediate response, which is what 8 mg naloxone is intended to address. Eight mgnaloxone is preferred by those who aren't medically trained and aren't harm reduction specialists to provide a quick and effective response to an overdose. There are no studies that indicate that there are more or worse withdrawal symptoms by using 8 mg vs 4 mg. The member said the group should find opportunities to address the overdose crisis in every way possible.
    • An IORAB member said the group needs to be comfortable making this decision, and asked to defer the vote until more information could be provided on 8 mg naloxone.
    • Dr. Adams, Mr. Borrayo, and Mr. DeLoss voted in favor of the recommendation. Mr. Brauns, Ms. Campos, Mr. Ewing, Dr. Gordon-Young, Mr. Hoff, Ms. Laliberte Barnes, Ms. Nahlik, Mr. Richards, and Mr. Ziegler voted against the motion, stating that they prefer to defer the vote until additional information is available. Mr. Hoff, Ms. Laliberte Barnes, Ms. Nahlik, and Mr. Richards also asked for the Medical & Research Working Group to review research on 8 mg naloxone and report their findings to the IORAB. Mr. Richards additionally requested that the Medical & Research Working Group consider how different formulations of naloxone might serve different types of patients. Mr. Johnson was not present. The motion did not pass. The Medical & Research Working Group will review the naloxone research and report their findings to the IORAB. The IORAB will reconsider the recommendation after their review of the Medical & Research Working Group's report.
  3. Recommendation C: Training and Technical Assistance
    • Chief Jones called for a motion to approve the recommendation. Ms. Nahlik made a motion to approve the recommendation. Ms. Gordon-Young seconded the motion.
    • An IORAB member said their workplace has a behavioral health workforce center and asked if this could be leveraged, rather than creating a new center. Director Garcia said there has not been discussion with any technical assistance centers because they will have to compete for the NOFO. The workforce center is eligible to apply for this funding. Director Garcia and Chief Jones suggested the member consider abstaining from the vote because of a potential conflict of interest.
    • Dr. Adams, Mr. Borrayo, Mr. Brauns, Mr. Ewing, Mr. Hoff, and Mr. Ziegler voted in favor of the motion. Ms. Campos, Dr. Gordon-Young, Ms. Laliberte Barnes, Ms. Nahlik, and Mr. Richards abstained. Mr. DeLoss voted against the motion. Mr. Johnson was not present. The motion passed.

Public Comments

  • A member of the public thanked the IORAB for voting on the harm reduction recommendation. They asked for more clarification about the purpose of the IORAB Working Groups. They thought the Working Groups reviewed all recommendations. The Access & Equity Working Group had discussions about whether or not there were proposals submitted on harm reduction and did not receive information on the recommendation. They asked for more transparency and clarity. Chief Jones said the function of the working groups is discussed on the website. He also reminded the group that recommendations can be submitted through the Working Groups as well as to the SOSA. The OOSA will work to make sure information is shared more inclusively with the Working Groups.
  • An IORAB member suggested that the group be given an opportunity to meet separately to have an informed discussion about proposals prior to the vote.

Chair Closing Remarks and Adjournment

Chief Jones said he appreciated the thoughtful discussions and the well-thought-out recommendations. He requested a motion to adjourn the meeting. Ms. Campos made a motion to adjourn the meeting. Mr. Ewing seconded the motion. The motion passed and the meeting was adjourned. The next meeting will take place on April 18, 2024 from 2:00pm-4:00pm