Illinois Opioid Remediation Advisory Board
Medical & Research Working Group Meeting
March 19, 2024
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
Katherine Austman, MD, Gibson Area Hospital and Health Services
Katharine (Kitty) Juul, Southern Illinois University (SIU)
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
Geoff Bathje, PhD, Sana Healing Collective, Chicago Recovery Alliance
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 Jessica Perillo, Michael Dennis, Tamara Olt, Doug Smith, Katharine Juul, Michael Isaacson, and Dan Lustig. Michael Wahl represented Lia Daniels in her absence. Quorum was established.
Review and Approval of January 16, 2024 Meeting Minutes
Dr. Pickett called for a motion to approve the meeting minutes. Dr. Austman made a motion to approve the December meeting minutes. Ms. Unthank seconded the motion. All members present voted in favor of approving the minutes. The motion passed.
Chairs Meeting Update
Dr. Adams and Dr. Pickett gave an update on a recent meeting of the IORAB Working Group Chairs. At the January 18, 2024 IORAB meeting, there was discussion about working groups' role in the recommendation review process. In response, the Chairs, Dr. Pickett and the Interim Statewide Opioid Settlement Administrator (SOSA) Jim Wilkerson met and discussed strategies to increase working groups' involvement in the recommendation review process. Going forward, the Chairs and SOSA will meet as needed to review recommendations that have been sent to the Office of Opioid Settlement Administration (OOSA). Chairs will decide which recommendations are relevant to their working group; these recommendations will be sent to the respective working group(s) for review before they are presented to the IORAB. All working groups should continue to develop new and innovative recommendations.
Priority Recommendations for the IORAB
The working group discussed the following updates:
* 8 mg naloxone recommendation: The IORAB did not approve this recommendation at the January 18, 2024 meeting. The IORAB requested that the Medical & Research Working Group review research on 8 mg naloxone to help inform the IORAB's discussion of this recommendation. Mr. Wilkerson reported that the Office of the Attorney General expects to finalize a settlement agreement that will impact this recommendation. The OOSA also anticipates receiving results of new research on 8 mg naloxone. This recommendation is on hold pending the new settlement agreement and research.
* Contingency management recommendation: The working group had developed a recommendation to 1) fund sites to pilot a contingency management program and 2) provide training and technical assistance related to contingency management. The IORAB and Steering Committee approved the recommendation for an Opioid Training and Technical Assistance Center (OTTAC). The OTTAC will provide training and technical assistance on contingency management. Thus, the recommendation was revised as follows: 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.
- A working group member asked if the recommendation was only abstinence-focused. Dr. Gastala said the focus should be patient-centered and include goals related to a reduction in use, safety, and harm reduction. The working group added to the recommendation, indicating that contingency management may be used to reduce opioid use, co-occurring stimulant/other drug use, and to address any patient-centered goals, which may include harm reduction.
* Buprenorphine for all recommendation: The OOSA reviewed the recommendation and determined that it that buprenorphine is already covered by insurance and/or Medicaid. Recommendations cannot supplant other funding sources, including Medicaid; therefore this recommendation will not be brought forward to the IORAB.
- A working group member asked for clarification regarding what supplanting Medicaid means. Mr. Wilkerson explained that a recommendation cannot duplicate existing services or substitute (supplant) existing funding for a proposed activity. If a proposed strategy or activity is funding by Medicaid or Medicare, settlement funds cannot be used to fund it and the recommendation cannot move forward. recommendation, it is supplanting funding.
* Opioid Treatment Program (OTP) recommendation: The OTP recommendation will be for start-up funding only as service are covered by other sources and we want to avoid supplanting funding. The recommendation will be voted on at the April IORAB meeting.
* Illinois Prescription Monitoring Program (ILPMP) recommendation: A request for FY2025 funding for the ILPMP was brought to the working group for review and discussion. Mr. Wilkerson explained that IORAB and Steering Committee previously approved use of settlement funds to expand ILPMP services. The ILPMP is requesting an additional year of funding million to hire a staff person to assist with enhancement connections and training entities on the use of PMPnow.
- A working group member has been collecting research on the impact of PMPs and can share a list of studies for the working group to review. The research has shown that people with the least severe pain are more likely to get opiates than those with the most severe pain. This seems to indicate that there is bias toward persons who have already been prescribed controlled substances. Dr. Pickett will share the studies with working group members. She noted that the PMP is mandated by the State legislature and will continue to operate regardless of this recommendation.
- A working group member asked if funding is being used to integrate PMPnow into electronic medical records (EHRs). Some rural hospitals can't afford to integrate it. Mr. Wilkerson said that if the group decides to get more information before moving the ILPMP recommendation forward, it would also be an opportunity to also get more information on the exact uses of the funding.
- A working group member discussed issues with the one-click system. With the oneclick system, there is no way to determine if hospital providers are using the ILPMP before prescribing. Mr. Wilkerson will bring this issue to the ILPMP's attention.
- A working group member suggested that pharmacists should receive education related to the ILPMP and noted that buprenorphine that is prescribed by providers should never be denied. There was discussion about whether this education should be a separate recommendation, or part of the OTTAC recommendation. Mr. Wilkerson suggested that it should be added to the OTTAC's role. It was noted that the ILPMP could discuss this topic in their quarterly newsletter.
- Dr. Austman made a motion to move the recommendation forward. Dr. Adams seconded the motion. Dr. Pickett conducted a roll call vote. Dr. Adams, Dr. Austman, Dr. Wahl (in Lia Daniels' absence), Dr. Gastala, Ms. Unthank, Mr. Van Ham, Ms. Wilson, and Dr. Wise voted in favor of the motion. Dr. Bathje voted against the motion. The motion passed. The ILPMP recommendation will move forward to the Board at the April IORAB meeting.
- Mr. Wilkerson noted that if the group is still interested in reviewing research on the impact of the PMP, they may still do so. Dr. Pickett will send Mr. Wilkerson the questions about the one-click system and noted that the group is interested in reviewing research related to PMPs at a later date.
* Dr. Adams received a letter from the Illinois Health and Hospital Association (IHA) with recommendations submitted by individual hospital and health systems.
Recommendations were organized by Core Abatement Strategy. This included recommendations for Warm Handoff Programs and Recovery Services (Contingency Management, Family Support Services, Recovery Groups), Prevention Programs (Opioid Use Prevention and Harm Reduction Programs for Youth, Parents, Educators, and Staff), Expanding Syringe Service Programs (SSPs) (Comprehensive SSPs), and Evidence-Based Data Collection and Research Analyzing the Effectiveness of Abatement Strategies Statewide (Youth Opioid Abatement Research).
- Dr. Pickett noted that IHA's recommendations could be discussed at the May meeting. She noted that two laws went into effect in January that address Prevention Programs; a recommendation was recently passed by the Steering Committee for SSPs; a Contingency Management recommendation is being put forward and could be modified to include youth; and the Notice of Funding Opportunity (NOFO) related to research could be modified to address Youth Opioid Abatement Research.
- Mr. Wilkerson had a conversation with IHA to get clarity on some of the recommendations. He will follow-up with IHA, and if there is an opportunity to develop a new recommendation, he will bring it back to the working group.
- A working group member said that there are limited resources for adolescents, and that family services for substance use disorder (SUD) are lacking. More research on adolescent treatment is needed.
Public Participation
Dr. Adams welcomed public participants. Public participants did not make any comments.
Adjourn
Dr. Adams called for a motion to adjourn the meeting. Dr. Wise made a motion to adjourn. Dr. Wahl seconded the motion. Dr. Pickett adjourned the meeting. The next meeting of the Medical & Research Working Group will be held on May 21, 2024 from 12:00pm-1:00pm.
