PROVIDENCE – A new task force on addiction, drug overdoses and recovery is being organized by Gov. Gina Raimondo and her team. It is scheduled to be announced on Tuesday, Aug. 4, according to numerous sources.

Like many of Raimondo’s recent policy initiatives, it will be organized through an executive order, and the task force itself will consist of a number of stakeholders.

Participants who may have been invited to serve on the task force have been reticent to speak on the record to confirm their invitation to serve.

The actual mission of the new task force has apparently not yet been discussed with potential participants.

What, if any, will be the continuing role of the current R.I. Drug Overdose Prevention and Rescue Coalition, convened in 2012, remains uncertain.The broad-based coalition had been meeting as recently as June.

Some of the task force’s work plan, no doubt, will be focused on resolving the current impasse around the Good Samaritan Law, which sunset on July 1, after the R.I. General Assembly ended its session without resolving the differences between the Senate and House versions.

The differences in the law can best be summarized by the question: is an overdose a medical emergency or a crime scene?

Re-enactment of the law would have provided immunity to those who called 911 at the scene of an overdose, in order to potentially save lives, through the dispensing of Narcan by emergency responders.

The opportunity for Raimondo to issue an executive order to re-instate the provisions of the existing Good Samaritan Law remains an option, at least to cover the next few months until the R.I. General Assembly reconvenes, either this fall or in January, and it is able to resolve its differences.

Cause and effect
Since an event held on June 22, when Raimondo and Sen. Jack Reed convened what was billed as a “roundtable” to discuss Rhode Island’s drug overdose crisis, the landscape has appeared to shift dramatically. [See link to ConvergenceRI story below.]

That event, held at the headquarters of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, amounted mostly to an hour-long dog-and-pony show for the news media, ostensibly to champion a new national “Overdose Prevention Act” being sponsored by Reed.

It featured Raimondo, Reed, Maria Montanaro, director of BHDDH, Dr. Nicole Alexander-Scott, director of the R.I. Department of Health, and Colonel Steven O’Donnell of the R.I. State Police. R.I. Attorney General Peter Kilmartin, who criticized the re-enactment of the Good Samaritan Law, did not attend.

Surprisingly, no one active in Rhode Island’s recovery community – either health practitioners or peer recovery leaders – had been invited to attend or to participate at the roundtable.

The timing of the hastily called “roundtable” seemed to coincide with the release of a report by an 18-member taskforce in Massachusetts, detailing 65 actionable steps to curb the epidemic of drug overdoses.

“We are not going to arrest or incarcerate our way out of this,” said Mass. Attorney General Maura Healey, who co-chaired the working group. “Addiction must be treated like any other chronic illness.” Healey pledged that she would enforce the state law requiring health insurers to cover behavioral health in the same way that they cover physical health.

At that June 22 event, Raimondo, when asked what her position was about competing versions of the Good Samaritan Law then pending before the R.I. General Assembly, ducked the question, saying only that it was her position that it was a priority to re-enact law.

Issues around data, autopsies and reporting
Since then, management of the role of the state’s medical examiner in conducting autopsies has come under increased scrutiny.

•    The state’s chief medical examiner, Christina Stanley, was placed on administrative leave by Alexander-Scott on July 22.

•    The action followed the revelation that on June 1, the National Association of Medical Examiners said that it would not renew the office’s full accreditation, citing a lack of sufficient staff that was hindering its work.

•    The staff shortage that resulted in delays in completing autopsy reports was cited as a primary reason why the office was being downgraded from full to provisional accreditation.

•    Further, Dr. Carolyn H. Revercomb, a forensic pathologist and the assistant state medical examiner, resigned from her job on June 1, according to a story by Lynn Arditi published July 31 in The Providence Journal.

•    In contrast to her predecessor, Dr. Michael Fine, Alexander-Scott had changed the reporting requirements for how accidental overdose deaths would be reported, changing it from suspected overdoses to only confirmed overdoses. The move eliminated a more time-conscious immediacy in reporting overdoses.

In an interview with ConvergenceRI in June, Alexander-Scott explained the reason why the reporting had been changed. “What we learned in the process [of looking at] all of what’s being collected, in reporting apparent deaths, we were taking additional time to develop a different database for in-house information,” she said. “It was one step further to determine where we have confirmed deaths that were in a packaged database, and that was a little more efficient in the way we could share that regulatory data.”

Alexander-Scott continued: “We took the step [to eliminate the use of the apparent deaths database] and said: that’s one less additional database that’s being kept separately and taking time away from our medical examiners being able to get the work done that they need to get done.”

Critics of the changing database on overdose deaths in the recovery community had told ConvergenceRI that they believe the changes have made it more difficult to know what is happening in a timely basis, because the current data of confirmed deaths is often two months old.

In the name of change
The new task force on addiction and substance use is being created at a time when there are also major policy changes underway within the state’s public health infrastructure and policies. These include: the working group to reinvent Medicaid, the new working group on health care innovation, focused on controlling costs; the new working group to reinvent the criminal justice system; the reorganization of the R.I. Department of Children, Youth and Families; the reformation of the Children’s Cabinet, and the restructuring of Slater Hospital.

In addition, a new memorandum of understanding has been signed with the Centers for Medicare and Medicaid Services, moving forward with integration of Medicare services under the Integrated Care Initiative, which had been managed with just Medicaid funds under what’s known as Rhody Health Options by Neighborhood Health Plan of Rhode Island for the past two years.

Also now underway – but not yet made public – is a major restructuring at the R.I. Department of Health. The impetus for those changes is not clear.

In the Governor’s budget proposal for FY 2016, it appeared that many of the functions now under the auspices of the Department of Health related to health facility policies around certificate of need would be shifted to the R.I. Executive Office of Health and Human Services, under the direction of Secretary Elizabeth Roberts.

How exactly the new task force on addiction, overdoses and recovery will fit into the policy framework being established remains to be seen.