Civil Legal Aid is a Recovery Resource: An Interview with James Tiderington

When did you start working for Philadelphia Legal Assistance and the Medical-Legal Community Partnership?  

I joined PLA in 2016 representing survivors of sexual abuse in domestic violence matters. In December of 2018, PLA’s Medical-Legal Community Partnership (MLCP) expanded to two separate Federally Qualified Health Centers (FQHC) to serve the legal needs of Philadelphians with opioid use disorder by fully integrating within the Medication-Assisted Treatment (MAT) programs. In 2018, I was asked to join the MLCP in order to lead the expansion and develop our partnerships within the MAT programs. 


What is Medication-Assisted Treatment?  

Medication-Assisted Treatment is an evidence-based response to treating individuals with opioid use disorder. MAT combines behavioral therapy with careful use of medication to help the individual cope and manage their opioid dependency by preventing withdrawal symptoms. It is a harm reduction approach and an important step towards sustainable recovery. 


What is a Medical-Legal Partnership? 

Medical-Legal Partnerships embed legal advocates in health care settings to prevent and resolve health-harming legal needs.  

The Medical-Legal Partnership model is being increasingly adopted across the country as a way to address the “social determinants of health.” There are many barriers to effective medical treatment: social, economic, and legal, and others.  Health care providers cannot address these barriers directly, but they can partner with social workers and lawyers and together help patients overcome those barriers.  Legal advocates and social workers, working in concert with healthcare providers, can address the issues that make patients’ lives chaotic: domestic violence, unsafe living conditions, child custody, debt, evictions, mortgage foreclosure, and loss of benefits. 


How does legal aid address the opioid crisis? 

There are many ways that legal aid can address the opioid crisis. To begin, legal aid advocates can connect folks who use drugs or who are in recovery to essential social services. We can also fight stigma in the courts, decrease the risk of relapse by providing stabilizing legal care, and help folks navigate burdensome legal or administrative processes.  

At PLA, we’ve had a Medical-Legal Partnership serving general primary care patients since 2013. In 2017, at the peak of the opioid epidemic, we decided that it was time to tailor our program to specifically serve folks who were struggling with substance use. Our city has a well-developed and growing network of agencies designed to help people reduce drug-related harm. However, no such program can be effective if patients experience or are concerned about eviction, their utilities being shut off, employment, or loss of public benefits like SNAP or Medicaid. Considering that, our goal is to offer a wrap-around service that prevents and resolves the very issues that cause and exasperate substance use.  


Are all of your clients in recovery? 

No. Most of my clients are in recovery. I also work with general patients from the local Health Centers. 


Can you share a bit about one of your cases? 

One of my clients, Brian, appeared in Criminal Court around the same time I was working with him on a number of housing issues. I don't practice criminal law, but I supported Brian by going to court with him on that day and testified on his behalf regarding his participation in his MAT treatment. At the beginning of the proceeding, the Judge had an expectation and told my client that he had to "wean off" his suboxone, the medication he was receiving for his addiction, in order to be considered to have fully recovered from Opioid Use Disorder. 

There is a common misconception that a patient will only be considered fully recovered only when the patient stops taking their medication. Brian and others with opioid use disorder face a unique challenge that leads to an inaccurate, stigmatized perception that frames MAT as simply replacing one drug with another. This biased stigma can affect people's employment, their search for housing, and even their success in certain court settings. However, this discrimination is illegal, and people participating in MAT are protected under the Americans with Disabilities Act (ADA) and the Rehabilitation Act.  

Unfortunately, patients, treatment professionals, other lawyers, and judges are unaware of these legal protections. The courts are getting better, but education around the opioid crisis is lacking and a dearth of legal aid resources means that lots of patients like Brian will be given a court-appointed lawyer who isn’t familiar with their treatment.  

By supporting Brian at court on that day, I was able to educate the judge about MAT programs in that these programs exist with an expectation that patients may need to utilize MAT for years if not the rest of their lives. Opioid Use Disorder is a lifelong disorder just as Alcoholism is a lifelong disease. Brian’s success is not measured by his “weaning” off of his MAT medication but is rather measured by Brian not actively using illegal drugs. An alcoholic’s success is not measured by whether or not they are going to AA meetings or other supports but is rather measured by not actively drinking alcohol.  


What is one thing you wish people knew about your work?  

That every single person deserves respect regardless if they are actively using illegal drugs. Every person has their own struggles and only through mutual respect will you be able to connect with somebody.  


What is the best part of your job? 

Being able to help the most vulnerable of our community.  


What does recovery mean to you?  

It is an everyday process. Every single day there will be challenges and barriers to recovery. However, strength in recovery is built up day by day and, eventually, recovery becomes normalcy. It is at that point when I believe that true recovery is achieved.