Opioids are a class of drugs used to reduce pain, ranging from prescription opioids such as oxycodone and morphine, to illegal opioids such as heroin. In the 1990s, healthcare providers began prescribing opioid pain relievers at increased rates, leading to the widespread misuse of prescription and non-prescription opioids. This resulted in a spike in addiction, amounting to 350,000 deaths between 1999 and 2016 from an overdose involving opioids. In 2017, the Health and Human Services (HHS) Acting Secretary declared a public health emergency to address this epidemic.
Because of the alarming number of overdoses, efforts to mitigate the epidemic tend to focus on supporting healthcare providers, raising awareness about opioid misuse, and encouraging safe choices among consumers. While valuable, these endeavors bypass many of the immediate challenges faced by those suffering from addiction throughout the recovery process, as well as by their close friends and family members. As legal problems often go hand-in-hand with the slew of effects stemming from opioid addiction, there is an opening for pro bono attorneys to help combat the crisis and improve people’s lives.
Some of the legal challenges confronted by people suffering from opioid addictions include:
- Establishing or maintaining guardianships and other child custody issues;
- Eviction and other housing-related problems;
- Access to benefits such as food and medical care;
- Gainful employment opportunities where employers allow patient-specific treatment plans, including methadone treatment;
- Obtaining driver’s licenses, which are often suspended for non-driving-related reasons; and
- Other post-incarceration barriers to re-entry.
People addicted to opioids and recovering from addiction are likely to encounter at least one – if not several – of these obstacles. The consequential hardships also affect friends and family, and result in accumulated burdens on the judicial system, healthcare centers, foster care system, and more. A multi-pronged approach is, therefore, needed to address the varying demands of the community.
Medical-Legal Partnerships as an Innovative Solution
Medical-legal partnerships (MLPs) offer a practical continuum of legal assistance and support throughout the recovery process. MLPs are collaborative arrangements between legal professionals and healthcare organizations where attorneys are available on-site to assist eligible patients with needs that would otherwise not be addressed within the clinical setting. Over 300 health care organizations operate MLPs, with more currently in the planning stage. Therefore they are an established model that can be leveraged to provide more holistic services.
A best practice is for patients to be screened for legal needs and referred for legal assistance as soon as they are admitted for opioid addiction treatment. Pro bono attorneys can help train medical professionals to identify common legal problems, while doctors can train attorneys and legal staff so that they better understand addiction and the recovery process. One optimal aspect of these partnerships is that pro bono attorneys reach out to patients, rather than the other way around, so attorneys assist patients with their specific needs and offer tailored solutions. This establishes a more client-centered process, one that is difficult to attain when performing discrete functions where clients contact attorneys for help with a specific matter.
Through MLPs, pro bono attorneys are meaningfully involved in patients’ lives, as they work with medical staff to understand specific treatment plans and other personal information. This allows attorneys to better advocate for patients, particularly before those who have misconceptions about treatment for addiction. Attorneys can successfully explain that treatment plans are medical decisions made by doctors, not by judges. For example, one patient was pressured by a judge to wean off her treatment program, which combined therapy with replacement opioids to prevent withdrawal, because the judge viewed it as replacing one addiction with another. An MLP attorney informed the judge that ending treatment is a medical decision to be made solely by a doctor and argued that the patient’s recovery depended on the specific treatment plan. Ultimately, the judge changed her mind and allowed treatment to continue.
Employment is also an important area where pro bono attorneys can be of help. Patients may not realize that barriers to future employment have legal solutions, or that termination from their job could be illegal. For instance, one employee tested positive for methadone, a prescribed replacement opioid, and her employer moved to terminate her. An MLP attorney informed the employer that they cannot not fire an employee for receiving legitimate medical treatment. Increasing opportunities for employment does not end with advocating for treatment plans; assisting in other areas, such as helping to seal criminal records will open doors for future opportunities as well.
Both testimonials and research studies reveal the benefits of embedding legal assistance in medical facilities, particularly in settings like treatment centers, where patients have complicated legal histories. While MLPs have been in place for several decades, they have only recently begun focusing on substance use disorders (SUDs). As of September 2017, only four MLPs (located in Cincinnati, Ohio; Indianapolis, Indiana; Portsmouth, Ohio; and Reno, Nevada) in the U.S. specifically focused on helping people with SUDs. While many partnerships with hospitals, health systems, and health centers exist across the U.S., pro bono work can continue to expand in this area with a focus on opioid addiction.
Diversion Programs as an Effective Tool for Recovery
Diversion programs, another experimental method of aiding recovery, mitigate the current mass incarceration problem in the United States and provide better resources to those battling addiction. Many different types of diversion programs exist; for example, drug courts act as alternatives to incarceration, where participants are transferred after pleading guilty to a drug-related crime. Through other diversion programs, participants are diverted at the point of arrest and enter the program instead of being charged with a crime. The average national completion rate for treatment courts is 60 percent, approximately two-thirds higher than probation.
One such experimental court, the Opiate Crisis Intervention Court, is a judicially supervised triage program in Buffalo, New York that links participants with medication and behavioral treatments within hours of their arrest. Drug court participants have biweekly appearances before a judge, and they receive medication and residential treatment if needed, as well as random drug testing and other social services. They are incentivized with rewards, including the reduction of court costs and gift cards.
These courts offer meaningful opportunities for pro bono attorneys to play a direct role in someone’s life. Drug court teams are typically comprised of a drug court judge, a prosecuting attorney, a defense attorney, a probation officer, treatment representatives, and a law enforcement representative. While the judge makes final determinations regarding a range of consequences, such as reduced supervision requirements, transfers to more intensive levels of care, or punitive sanctions, the drug court team meets in a collaborative setting to review each case and contribute information about participants’ progress. Because of individualized treatment plans and clinical needs, pro bono attorneys are able to advocate for patients by explaining specific information that may otherwise go unnoticed by the rest of the team. Whether it is through working in a drug court as part of a team, advocating for the expansion of similar programs, or helping funnel people into treatment centers early in the process, providing access to an attorney and representation is crucial in assisting recovering addicts.
Potential Pro Bono Opportunities
Attorneys have a unique ability to support people addicted to opioids – as well as their families – in substantial capacities. The range of pro bono opportunities is broad and deep, with options for both small and large-scale projects and those that would appeal to litigators and transactional lawyers. Options for meaningful pro bono work include, but are not limited to:
- Helping administer advice clinics run by legal services providers by offering guidance to those experience addiction, as well as to their families and to the community. Pro bono attorneys would help people identify common legal problems and provide resources to those who need individualized advice;
- Working with a public defender’s office, representing people recovering from addiction and advocating for their individualized needs;
- Working with a prosecutor’s office, figuring out the best program for people recently arrested due to opioid-related crimes while aiming to divert them from the criminal justice system into diversion programs;
- Filing lawsuits against pharmaceutical companies on behalf of states, cities, legal organizations, and citizens affected by the opioid crisis, or writing amicus briefs in support of these lawsuits (subject to business and other conflicts);
- Helping grandparents and children whose parents are addicted to opioids or recovering from addiction by partnering with children’s hospitals, foster homes, or schools; and
- Assisting nonprofits that provide services to people affected by the opioid crisis with a variety of transactional matters, ranging from compliance with laws and regulations to advice regarding government grants and contracts.
- Combatting fraudulent treatment and recovery centers.
Conclusion
Much of the conversation surrounding the opioid crisis focuses on overdose-reversal drugs, medication-assisted treatment, and best policies for decreasing the number of people addicted to opioids. Sometimes, the “very basic things that could go a long way to accessing treatment and maintaining recovery” are forgotten. It is difficult for low-income patients to successfully recover if they don’t have basic necessities, such as housing, education, childcare, employment, or transportation, or if they face significant legal barriers to obtaining these necessities. Fulfilling these basic needs can be daunting on one’s own, and it is an area where pro bono attorneys can make vast difference in someone’s life. There is an opportunity to suit the interests and talents of every pro bono lawyer.
Hat tip to PBI intern Arlyn Upshaw for her help with this post.