Opioid Steering Committee Minutes 12.14.2023

Governor's Opioid Overdose Prevention and Recovery Steering Committee Meeting Minutes

Juliana Stratton - Lieutenant Governor

Dr. Sameer Vohra - Director, Department of Public Health Dulce Quintero - Secretary, Department of Human Services

• 4th Quarterly Meeting Pursuant to Executive Order 2020-02

• Date and Time
• December 14, 2023
• 10:00 AM to 11:30 AM
• Meeting Location
• Teleconference
• Meeting ID: 835 3713 7415
• Passcode: 74550583

1. Call to Order and Welcome
   1. Lieutenant Governor Juliana Stratton called the meeting to order at 10:06 AM.
2. Roll call
   1. Director Laura Garcia conducted roll call.
      1. Present:
         1. Lt. Governor Juliana Stratton (chair)
         2. Secretary Dulce Quintero (co-chair)
         3. Director Dr. Sameer Vohra (co-chair)
         4. Director Brendan Kelly
         5. Dr. Arvind Goyal (representing Director Eagleson)
         6. Luke Tomsha
         7. Sherie Arriazola-Martinez
         8. Director Laura Garcia
         9. Director Mueller
         10. Jennifer Parrack (Representing Acting Director Latoya Hughes)
   2. A quorum was established.
3. Approve Agenda and Meeting Minutes
   1. Agenda for 12/14/23
      1. Motioned by Director Sameer Vohra
      2. Seconded by Sherie Arriazola-Martinez
      3. All in favor
      4. No opposition
      5. No abstention
   2. Minutes for 09/27/23
      1. Motioned by Dr. Arvind Goyal
      2. Seconded by Luke Tomsha
      3. All in favor
      4. No opposition
      5. No abstention
4. Chairs' Remarks
   1. Lt. Governor Juliana Stratton
      1. Lieutenant Governor Stratton provided updates and highlighted the distribution of 106,488 fentanyl test strips in state fiscal year 2023 (SFY23) by state-funded providers; distribution of 339,156 2-dose boxes of Narcan in 12 months; the county jail-based learning collaborative, in which 25 counties are participating and 614 incarcerated individuals received medication-assisted recovery (MAR); and the objectives of the State Health Improvement Plan (SHIP).
   2. Director Dr. Sameer Vohra
      1. Director Sameer Vohra discussed the SHIP, a five-year plan which outlines goals, objectives, and strategies to improve the health of Illinois residents in priority areas. One of the plan priorities is Mental Health and Substance Use Disorders. The four main objectives of the Mental Health and Substance Use priority area are to:
         1. Improve the mental health and substance use disorder (SUD) system's infrastructure to support and strengthen prevention and treatment.
         2. Reduce mortality due to mental health conditions and substance use disorders through harm reduction and preventative care strategies.
         3. Increase access to age-appropriate community-based care to reduce institutionalized treatment and incarceration.
         4. Improve the resilience and recovery capital of communities experiencing violence.
      2. Director Sameer Vohra discussed the connections between Mental Health and Substance Use Disorders and two other plan priorities, Maternal and Infant Health, and Racism as a Public Health Crisis. He said the plan will address priorities in a comprehensive way. c. Secretary Dulce Quintero i. Secretary Dulce Quintero discussed MAR Now and the Illinois Helpline and noted that MAR Now is now serving persons with alcohol use disorder. Secretary Quintero announced that the county jail learning collaborative will be hosting a statewide conference in Peoria at the end of January to focus on MAR for persons involved in the justice system.
   3. Secretary Dulce Quintero
      1. Secretary Dulce Quintero discussed MAR Now and the Illinois Helpline and noted that MAR Now is now serving persons with alcohol use disorder. Secretary Quintero announced that the county jail learning collaborative will be hosting a statewide conference in Peoria at the end of January to focus on MAR for persons involved in the justice system.
5. New Business
   1. Maternal Morbidity and Mortality Report: Cara Bergo, PhD, MPH, Department of Public Health Illinois, Office of Women's Health, and Family Services, Illinois Department of Public Health Illinois
      1. Dr. Bergo gave a presentation on the Illinois Maternal Morbidity and Mortality report released in October 2023.
      2. The Maternal Mortality Review Committee (MMRC) reviews deaths suspected to be medically related to pregnancy. The Maternal Mortality Review Committee on Violent Deaths reviews deaths resulting from homicide, suicide, drug overdose, or other drug-related causes. Both committees serve as advisory bodies to the state Perinatal Advisory Committee and to IDPH.
      3. The MMRC process includes identifying pregnancy-associated deaths, gathering relevant records, sorting deaths and assigning them to the two committees, creating summaries based on the records, and discussing deaths and making decisions. The purpose of the MMRC is to determine contributing factors to maternal mortality and identify potential interventions to prevent future maternal deaths. The vision is to eliminate preventable pregnancy-related deaths in Illinois.
      4.  Key questions asked are whether the death was pregnancy related, the cause of death, whether the death was preventable, the contributing factors to the death, recommendations to address contributing factors, and the anticipated impact of those actions if implemented. v. An average of 88 pregnancy-associated deaths occurred each year during 2018- 2020. Pregnancy-related mortality in Illinois was higher in 2018-2020 than in 2015-2017.
      5. Black women continue to have the highest rate of pregnancy-related deaths. Pregnancy-related deaths have increased in all geographic areas. Black women have a higher rate of medical pregnancy-related deaths compared to other groups. Substance use disorder continues to be the leading cause of pregnancy-related death. Most pregnancy-related deaths due to substance use disorder involved opioids, specifically fentanyl, and were due to two or more substances.
      6. The categories of contributing factors to preventable pregnancy-related deaths are clinical skill/quality of care, continuity of care/care coordination, mental health conditions, discrimination, access/financial, and substance use. viii. The Illinois Maternal Morbidity and Mortality Report can be found at: Maternal Morbidity Mortality Report Dr. Bergo may be contacted to discuss the report and/or present (cara.bergo@illinois.gov).
      7. Lieutenant Governor Stratton stated that she chairs the Illinois Council on Women and Girls and would like the Council to have the report so they can consider how to support the work..
      8. Dr. Arvind Goyal commented that he hopes that doctors are telling pregnant and postpartum individuals to get evidence-based treatment. He said that postpartum persons often don't realize that if they use the same dose of opioids they were using before a pregnancy, they may suffer respiratory depression; there needs to be education around this. He said that providers caring for pregnant people should be aware of Illinois DocAssist.
      9. Lieutenant Governor Stratton discussed the importance of coaching patients during transition points. She discussed health care system bias and said that sometimes medical professionals don't take persons seriously, and sometimes patients don't trust providers. She indicated that her team may reach out to discuss how to make sure providers are aware of DocAssist.
      10. Sherrie Arrizola-Martinez commented that partnering with workforce development or Illinois Department of Finance & Professional Regulation (IDFPR) to increase the pipeline of students of color into the field could help with this issue. xiii. Director Vohra shared that IDPH is implementing the Equity and Representation in Health Care Act. They are working in partnership with the Illinois Primary Health Care Association to create scholarship programs with the goal of increasing numbers of persons of color in the health care workforce.
      11.  Lieutenant Governor Juliana Stratton read comments in the chat regarding a concern that persons with an overdose are assumed to have SUD. Dr. Bergo clarified that they use records and history to identify SUD. Another meeting attendee commented that a peer workforce of people with lived experience would be helpful in working with pregnant mothers with opioid use disorder (OUD).
6. Statewide Semiannual Overdose Report: Leslie Wise, Ph.D. Epidemiologist, Department of Public Health Illinois, Division of Emerging Health Issues, Office of Health Promotion
   1. Dr. Leslie Wise gave a presentation on 2022 Illinois drug fatalities as summarized in the October 2023 Statewide Semiannual Overdose Report
   2.  In 2022, there were 3,261 opioid overdose fatalities and 3,908 total drug overdose fatalities. The number of all drug overdoses has increased, but opioids continue to account for 80% of the deaths.
   3. In 2021-2022, there was a 5.1% increase in drug overdose fatalities in Illinois. i
   4. In 2022, synthetic opioids accounted for the highest fatality rates in each geographic region. v. The highest rates of opioid fatalities are in Non-Hispanic Black individuals, men, ages 35-64.
   5. The rise in the number of opioid fatalities in the past decade nationwide is attributed to the influx of synthetic opioids (fentanyl and its analogs) into the drug supply and to an increase in polysubstance use. In 2022, toxicology testing found 2,994 (92%) of the opioid fatalities involved a synthetic opioid; 2,111 (65%) of the opioid fatalities involved at least one additional substance.
   6. Opioid overdose fatalities are occurring across the state and are not limited to urban and suburban areas.
   7. Non-Hispanic Black individuals of any age are 3.5 times more likely to die from an opioid overdose than non-Hispanic White individuals of any age; the fatality rate of non-Hispanic Black individuals 55-64 years of age is 10.2 times higher than non-Hispanic White individuals of the same age; and the fatality rate of non- Hispanic Black individuals aged 45-54 and 65+ is 4.1 and 6.2 times higher than non-Hispanic White individuals of the same age, respectively.
   8. Synix. thetic opioid fatalities in adolescents aged 13-17 years have increased dramatically. In 2013, there was 1 synthetic opioid overdose fatality among adolescents aged 13-17; in 2022, there were 11 synthetic opioid overdose fatalities. x. In the chat, Luke Tomsha said that advanced drug checking is a great tool to understand what is in the drug supply pre-mortem instead of post-mortem toxicology reports.
7. Illinois Opioid Settlement Funding Update: Laura Garcia, Director, Department of Human Services, Division of Substance Use Prevention and Recovery
   1. Director Laura Garcia stated that Statewide Opioid Settlement Administrator (SOSA) Sherrine Peyton is no longer with SUPR and wished her well.
   2. She encouraged those seeking information on settlements to review the Illinois Opioid Allocation Agreement  and the National Opioid Settlement websites.
   3. The Illinois Opioid Remediation Advisory Board (IORAB) website is at IDHS: Illinois Opioid Remediation Advisory Board (state.il.us). There were no new recommendations approved at the October IORAB meeting.
   4. The Illinois Regional Care Coordination Agency (RCCA) is coordinating Notice of Funding Opportunities (NOFOs) and some NOFOs will be released soon. The new Illinois Opioid Settlements Initiative website will host the NOFOs. SUPR will share a Smart Alert with all partners when NOFOs are released.
   5. In the chat, a harm reduction provider who uses the MAR Now program said that there are significant waiting lists to get into the local MAR program, and even when people are connected, often the MAR Now program cannot provide enough Suboxone to cover the time it takes to enroll in a program. Director Laura Garcia said she will look into this issue.
8. Member Updates
   1. Luke Tomsha asked two questions. He said he sees the barriers people with distrust of systems face on a day-to-day-basis, and asked how harmful state-level policies can be addressed. He noted that policies must be changed in order to impact issues in the long term. Second, he asked if anyone is studying the economic effect of harm reduction outreach and street outreach with persons at highest risk of overdose. What is the economic impact of their work versus the burden on emergency medical services and emergency departments?
      1. Director Vohra acknowledged that injustice needs to be addressed. He said Racism as a Public Health Crisis had to be called out in Healthy Illinois 2028 in order to face the challenges around this issue. He noted that we need to work on how to create processes in our systems to create equity and to broaden all human and public health services to make an impact. Although the public comment period for the SHIP is over, he invited everyone to provide feedback on this issue in order to better develop action plans. Jennifer Epstein, Deputy Director, Office of Policy, Planning, and Statistics, IDPH, provided a link to the Healthy Illinois 2028 documents in the chat Healthy Illinois 2028
      2. Director Vohra said there are continuing conversations in public health and with government partners around the levers in our health care system that are causing economic and workforce challenges. HFS is putting forward in an 1115 waiver to determine how Medicaid systems, in partnership with the federal government, can get more reimbursement around health-related social needs. He said he is happy to follow up, in partnership with HFS, DHS and others, regarding how the 1115 waiver is progressing.
      3. Lieutenant Governor Stratton asked if any entities are studying the economic impact of not doing anything, and what would happen if we invested on the front end to help people live productive lives. The economic questions are important, and it would be helpful to know who has this data. In the chat, an attendee stated that OnPoint NYC may have done some calculations on the economic impact.
9. Public Comment
   1. There were no public comments.
10. Adjournment
    1. Lieutenant Governor Stratton thanked everyone for attending the meeting. She stated that progress has been made, but there is still work to be done and we are up for the challenge. Together we can get to the root of the issues that continue to touch the lives of so many individuals, families and communities. All 2024 Steering Committee dates will be provided at the beginning of the year. She thanked the Steering Committee for their leadership and wished them happy holidays.
    2. Lieutenant Governor Stratton adjourned the meeting at 11:30 AM.
       1. Motioned by Luke Tomsha
       2. Seconded by Dr. Arvind Goyal
       3. All in favor
       4. No opposition
       5. No abstention