PAWTUCKET – Everyone was attempting to channel Jim Gillen on Tuesday, Aug. 4, at the announcement of a new state task force to address drug overdoses, addiction and recovery in Rhode Island, held at the Anchor Recovery Community Center.

Gillen, the long-time recovery advocate, died in July after a long battle with cancer. His fighting spirit, his smile and his advocacy were invoked by Gov. Gina Raimondo, by Tom Joyce, associate director at the Anchor Recovery Community Center, by Dr. Nicole Alexander-Scott, the director of the R.I. Department of Health, by Maria Montanaro, the director of the R.I. Department of Behavioral Health, Developmental Disabilities and Hospitals, and by recovery coach Roxxane Newman, an overdose survivor, who closed her emotional speech recounting her own recovery journey by doing what she thought Gillen would have done, proclaiming in a shout: “Rally on.”

The new 32-member task force, dubbed the “Overdose Prevention and Intervention Task Force,” has been given 90 days by Raimondo to come up with an action plan, similar to the manner in which other working groups of stakeholders have been challenged by the governor.

“I want an action plan by November,” Raimondo said, choosing Anchor Recovery as the setting to sign the executive order creating the new task force, where the optics were superb. “I’ve learned that in government, you have to convene public meetings, and [set] a public deadline,” [though some might argue that this was a method learned from her experience in the world of venture capital equity investing, not government].

She continued: “I want to see clear goals, clear metrics: what are we trying to do, what are we going to hold ourselves accountable to getting done. It’s a crisis; we can’t have so many people losing their lives that should be alive.”

Raimondo joked with A.T. Wall, the director of the R.I. Department of Corrections, who attended the event, that, as a result of the work of the task force, her intention was to send fewer people his way, if he didn’t mind.

The task force will be setting a baseline, making improvements, and it will be outcome- focused. “We are going to fund and practice what we know will work,” Raimondo said. “Addiction is a disease; recovery is possible,” she continued, invoking the slogans developed by the R.I. Department of Health earlier this year as part of an outreach effort.

The new calculus of governing
This task force, however, has been organized quite a bit differently from others created by Raimondo.

A team of public health experts – Traci Green, Ph.D., the deputy director of the Boston Medical Center Injury Prevention Center at the Boston University School of Medicine, and associate professor of Emergency Medicine and Epidemiology at the Warren Alpert School of Medicine at Brown University, Dr. Josiah ‘Jody’ Rich, a professor of Medicine and Epidemiology at Brown University and an attending physician at the Miriam Hospital, and  Dr. Joshua Sharfstein, the associate dean for Public Health Practice and Training at the Johns Hopkins Bloomberg School of Public Health – will serve as consultants, helping to develop the policies.

“There’s something special that is happening here in Rhode Island,” Green told ConvergenceRI, in a brief interview after the event, buoyant about the opportunity to collaborate with Rich and Sharfstein on the development of the state’s public health policies around addiction, drug overdoses and recovery.

The consultants’ efforts will be funded in a public-private partnership through donations from Blue Cross and Blue Shield of Rhode Island and CVS Health. Raimondo said that she had personally picked up the phone and asked CVS Health to contribute, and they had stepped right up to the plate.

Mike DeAngelis, public relations director for CVS Health, who attended the Aug. 4 announcement, was forthright about CVS Health’s involvement.

“CVS Health has contributed $60,000 to support the Task Force,” DeAngelis told ConvergenceRI. “The contribution will be used to fund the work that experts from Brown University and Johns Hopkins University will be doing to develop recommendations for the Task Force.”

DeAngelis continued: “Our funding support of, and active participation in, the Governor's Overdose Prevention and Intervention Task Force are part of CVS Health’s overall commitment to the fight against drug abuse and addiction. We are proud that this innovative plan is launching in our home state.”

[A representative of CVS, Tom Davis, will serve on the task force.]

Reticent Blue Cross
In contrast, Stacy Paterno, communications spokeswoman at Blue Cross, declined to offer any details. The health insurer refused to confirm if they had matched the $60,000 contribution made by CVS Health, and referred any questions back to the Raimondo’s office, with Paterno saying in an email: “We did contribute to the task force and would suggest you reach out to the Governor’s office for more information.”

[A representative of Blue Cross, Dr. Matthew Collins, will serve on the task force.]

In turn, Sophie O’Connell, from the Governor’s press office, also punted, saying in an email: “The funding will be going directly to the team of public health experts at Brown and Johns Hopkins, who will serve as a resource to the Governor’s task force. As the funding is not going to the Governor’s office, I think the best person to confirm the amounts received and the specifics of how it will be used is Dr. Rich.”

If the Governor personally asked CVS Health for the money, and if the Governor also asked Blue Cross for the money, shouldn’t the Governor’s office know how much money was requested and received?

ConvergenceRI had already reached out to Rich, who thanked ConvergenceRI for the continued diligence in reporting. “I am glad that you are staying on this topic,” he said.

Rich, however, was somewhat reserved and politic in his responses to questions about the funding. “We do not have all the funds yet, and have not decided how to best use them, but the only metric we are using to help us is expenses that will most effectively address addiction and overdose deaths,” he told ConvergenceRI.

In turn, Green was much more open and direct in describing the way the donated funds would be used: “We will be hosting meetings, expert consultations and paying our research assistants to support the effort – lots of crunching of numbers, writing and interviews ahead of us,” she told ConvergenceRI, saying she was enthused about the process and the collaboration.

The tasks ahead
To clear up some confusion, the new task force will not be replacing the ongoing R.I. Drug Overdose Prevention and Rescue Coalition, convened in 2012 by the R.I. Department of Health’s Violence and Injury Prevention Program, supported by a Centers for Disease Control and Prevention grant, a coalition that Green currently chairs.

Rather, the new task force that Raimondo created through executive order on Aug. 4 – choose the most apt word choice here – dissolved, re-tasked, or re-issued the previous governor’s task force on drug overdoses that had been created a year ago by former Gov. Lincoln Chafee.  

The new task force will be co-chaired by Alexander-Scott and Montanaro, and its members are a strong cross-section of heavy hitters from government and law enforcement They include:

•   Dr. Kathleen Hittner, the R.I. Health Insurance Commissioner
•   Dr. Deidre Gifford, the director of the state Medicaid office
•   Ken Wagner, the state’s new education commissioner
•   Jamia McDonald, the chief strategist for DCYF
•   Jason Rhodes, emergency management services, R.I. Department of Health
•   Ed D’Arezzo, from the medical examiner’s office
•   A.T. Wall, director of the R.I. Department of Corrections
•   Colonel Steven O’Donnell of the Rhode Island State Police
•   Attorney General Peter Kilmartin
•   Rep. David Bennett
•   Sen. Josh Miller
•   James McDonald, the R.I. Board of Medical Licensure and Discipline
•   Peter Ragosta, the R.I. Board of Pharmacy, and
•   Brian Sullivan, the Police Chiefs Association.

The other groups represented on the task force include: the R.I. Dental Association, the R.I. Medical Association, the R.I. Nurses Association, the R.I. Health Center Association, RICares, the Substance Abuse Prevention Association, The Providence Center, the Drug and Alcohol Treatment Association, CODAC, the URI College of Pharmacy, and Thundermist, a community health center in Woonsocket.

Not on the agenda
One thing the task force will not be doing is formulating policy around new proposals regarding the re-enactment of the Good Samaritan Law, according to Montanaro, speaking with ConvergenceRI after the executive order signing ceremony. That remains a legislative matter, she said.

Montanaro said that the governor’s team had explored the possibility of issuing an executive order to reinstate the Good Samaritan Law, but it was not found to be feasible.

Serendipity
Two days before the executive order signing ceremony at Anchor Recovery Community Center, the award of $1.3 million grant was announced from the Agency for Healthcare Research and Quality to support a demonstration project of pharmacy-based naloxone rescue kits to help reduce opioid addiction and overdose deaths in Massachusetts and Rhode Island.

The grant will fund a study, to be conducted in partnership with the Boston Medical Center, Lifespan’s Rhode Island Hospital, and CVS Health.

Green, who had submitted the proposal in September of 2014, explained the purpose behind the study. “Pharmacies have enormous potential to expand the reach and impact of critical public health interventions, just as we have seen happen with pharmacy access to clean syringes and adult immunizations,” she said, in a news release. “But how do we do that with naloxone rescue kits? That’s what we intend to figure out here in Massachusetts and Rhode Island.”

The study will track and analyze data from the participating pharmacies throughout the two states to develop best practices for a national pharmacy-based naloxone rescue kit program.

The work will build upon a previous collaboration between Green, Rich, and Jeffery Bratberg at the URI College of Pharmacy to develop protocols for pharmacies to supply, order, and provide naloxone to patients. The goal is to identify relevant organizational and community factors associated with the successful implementation of the program in order to incorporate them into a national program.

The timing of the grant’s announcement and the creation of a new task force being announced days apart were totally coincidental, Green told ConvergenceRI. “We expect to find pearls of wise practice that will be translatable to any chain and pharmacy setting; that’s the goal [of the study],” she said.

In addition to CVS Health’s leadership, Green also said that it was worth mentioning that Walgreens leadership on this topic “has been outstanding from the start.”

“These are very exciting times, with good momentum locally and nationally – and even internationally – on the pharmacy naloxone efforts.