Legal Aid as Harm Reduction: Supporting Recovery from Opioid Use Disorder

a graphic image that says "harm reduction is about rights and respect for all people"

What is “harm reduction? A set of principles that gives rights, and respect, to people who use drugs. These public health principles seek to minimize the harmful consequences of drug use instead of condemning those under its influence. Philadelphia has a well-developed and growing network of agencies designed to help people reduce drug-related harm by ensuring access to sterile syringes, assistance with social services, and linkages to substance abuse treatment programs, such as Medicine Assisted Treatment (MAT) programs which combine behavioral therapy with a careful use of milder opiates to prevent withdrawal symptoms.

While these are important steps forward in a city where the rate of deaths due to opiate overdose has been on the incline, no such program can be effective if patients experience or are concerned about eviction, their utilities being shut off, and loss of public benefits like SNAP, Medicaid, and Supplemental Security Income.

That is where legal aid comes in.

Integrating legal aid resources within neighborhoods that are most affected by opioid use is an essential component to addressing the opioid epidemic in Philadelphia. The Medical-Legal-Community Partnership (MLCP) at Philadelphia Legal Assistance (PLA) does this by providing on-site legal advice at community health centers, including four Medicine Assisted Treatment (MAT) programs. The opioid epidemic has created a civil legal aid crisis for people with substance use disorders (SUDs), their families, and the wider community related to issues such as child support and custody, health benefits, domestic violence, elder and child abuse, housing, and employment. These issues act as a barrier to being able to fully utilize recovery resources in more ways than one. Through community-based partnerships such as PLA’s MLCP, legal advocates have the unique opportunity to act as harm reductionists by addressing previously unmet legal needs. In celebration of Recovery Month, here are some of the many ways in which legal aid can support recovery from opioid use disorders:         

1) Fighting Stigma

When someone is stigmatized, other people view the person as the problem rather than viewing the condition as the problem. Opioid use disorders (OUDs) are some of the most stigmatized chronic conditions in the world. Stigma surrounding OUDs can bring up feelings of shame and isolation, making it harder for people to ask for help. This stigma persists despite substance use disorders - including OUDs - being considered  a disability under the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). The prevalence of this stigma prevents people with OUDs from accessing social services and legal representation. By advocating on behalf of people with OUDs, attorneys help reinforce the notion that addiction is not a moral failing; is it a chronic behavioral disease that 2.1 million Americans struggle with.

Patients participating in Medicine Assisted Treatment (MAT) programs also face additional, considerable stigma. MAT is a recovery program that combines behavioral therapy with the careful use of milder opiates to prevent withdrawal symptoms. Unfortunately, there is an inaccurate perception that frames MAT as simply replacing one drug with another. This misperception often leads to MAT patients being discriminated against during their search for housing or employment.  Individuals in recovery from an OUD and engaged in MAT are protected under the ADA and Fair Housing Act, but many patients, as well as SUD treatment and housing professionals, are unaware of these legal protections. By providing legal aid at MAT programs, legal and medical professionals can work together to ensure that MAT patients are protected under these provisions. Legal and medical professionals are also able to support a patients’ long term recovery goals by helping them establish routines and independence.

2) Decreasing the Risk of Relapse and Overdose         

People who struggle with mental illness are also vulnerable to substance use disorders and vice versa. MLCP clients at the MAT clinics often have a mental illness and personal history of trauma that is compounded with their OUD. As a result, these clients are at a high risk of overdose death. By providing free legal aid, attorneys are able to lessen some of the external factors that increase a patient’s risk of relapse. For instance, MLCP attorneys frequently advise patients on landlord-tenant or eviction issues. Ensuring that patients participating in MAT programs have safe and consistent housing, mitigates the risk of patients experiencing homelessness or chronic housing instability and thus, lessens the risk of relapse.

3) Connecting Clients to Social Services

Civil Legal Aid attorneys who work with people with SUDs and OUDs are joining the call for judgment-free and at-will resources for people who use drugs. By acting as a recovery resource and giving clients access to their wider network, legal aid attorneys are increasing the likelihood that clients will seek out additional help. For instance, advocates at the MLCP consistently connect clients with relevant community resources and refer them to other legal aid providers in our network

4)  Increasing Quality of Life

Dealing with complex legal problems can be all-consuming and dispiriting. This prevents people from being able to focus on their recovery and they may feel so demoralized that they give up on their ongoing legal battles. The sense of hopelessness that can result from ongoing legal battles may also cause people to feel pessimistic about reducing the health risks associated with drug use or ending drug use altogether. By addressing legal problems faced by people with substance use disorder, advocates make the recovery journey more accessible.

Interested in promoting Legal Aid as Harm Reduction?

During September 2019, PLA is celebrating National Recovery Month and the work of the MLCP in MAT programs. In addition to continuing their direct work with MAT patients, the MLCP advocates will be working with their medical partners to amplify stories of recovery and how legal advocates can act as harm reductionists to address opioid epidemic. These stories will be shared on our social media accounts and we encourage you to follow along. Additionally, you can support the continued work of the MLCP at the following link: Donate