The opioid crisis in America has devastated urban, suburban and rural communities in almost every state. According to studies, 115 people die every day in the United States from opioid overdose. More than 2 million people are currently living with an opioid-related substance use disorder.
Opioid-related disorders physically cripple individuals and can destroy family connections. Civil legal issues are frequently associated with such disorders, including issues related to child support and custody, health benefits, domestic violence, housing, employment, and child abuse and neglect.
Policymakers in both the criminal justice system and the public health sector have begun to understand that the best responses require a comprehensive approach to help people recover from opioid-related disorders and to prevent additional individuals from becoming addicted in the future.
A focus has recently been placed on how legal services and other social services can serve as critical recovery resources alongside medical treatment.
Dozens of Legal Services Corporation grantees participate in such medical-legal partnerships, which are flexible, collaborative arrangements in which legal professionals are embedded in a health care organization to address the unmet civil legal needs of patients that directly impact health outcomes.
This connection between LSC and the opioid crisis was the topic of an LSC Access to Justice event on Aug. 9 at the American Bar Association Annual Meeting in San Francisco.
Access to justice still problematic
Judicial leaders conducted the first of two panels, “A Conversation About Access to Justice and the Judiciary,” at the event. Associate Justice Goodwin H. Liu of the California Supreme Court, Chief Justice Paul L. Reiber of the Vermont Supreme Court and Chief Justice Cheri Beasley of the North Carolina Supreme Court led the distinguished panel moderated by LSC President James J. Sandman.
The panel discussed barriers to justice and the impact large numbers of unrepresented litigants have on the justice system.
Liu pointed out that the “courts mirror society. Since our society has become more unequal, hiring a lawyer can take a backseat to more pressing economic needs.” He said that the scale of the problem was difficult to fathom pointing out that in California alone, four million litigants go unrepresented.
Beasley echoed those sentiments, saying that 86 percent of civil legal needs go unmet in North Carolina and that the impact is great. “These people are making serious decisions about their lives without legal representation,” she said.
Beasley said those numbers have grown drastically and that the substance abuse epidemic is fueling the rise. Reiber agreed and pointed out the emerging stress it is putting on the court system. “There has been a substantial increase,” Reiber said. “The child protection docket is being driven by problems with addiction.”
Sometimes, legal help can be as simple as assisting in filling out complicated government forms. Beasley pointed to the pro bono aid that the ABA and other lawyers have provided in the wake of hurricanes and other natural disasters.
ABA President-elect Judy Perry Martinez echoed those sentiments in her remarks to the gathering, praising LSC and all lawyers for their work. She said that living in New Orleans where hurricanes have become too common makes her appreciate that work even more.
Liu advocated for a better system of access to justice for people with needs and pointed out that California courts have developed self-help centers. This can provide a triage system that can inform people of the level of help they may need. Sandman agreed but cautioned that “technology as a tool of assistance works best with human assistance.”
The panel concluded that the judiciary does have an important role in solving the opioid crisis in America by keeping the issue visible, by not operating on false assumptions and by knowing they are empowered to do something.
A second panel at the event explored legal aid’s important role in combating the opioid crisis.
The panel, moderated by LSC Vice President and General Counsel Ronald S. Flagg, included Jia Min Cheng, medical-legal partnership project coordinator and senior staff attorney of Bay Area Legal Aid; Tarra Simmons, LSC Opioid Task Force member and a Skadden Fellow with the Public Defender Association; Dr. Ori Tzvieli, medical director, Public Health Clinical Services in Contra Costa County; and Steven Weiss, regional managing attorney, Bay Area Legal Aid.
Families affected by the opioid epidemic face a variety of civil legal issues, such as caring for relatives, custody disputes, domestic violence, access to health care, evictions and difficulty accessing insurance and employment benefits. Individuals with an opioid use disorder often encounter legal barriers to obtaining or maintaining access to medication-assisted treatment.
Tzvieli stressed the importance of education. “Explaining and educating judges about the science of the treatment can help overcome the stigma,” he said. He pointed to examples where judges have ordered defendants to stop medication or be sent to jail when that medication is, in fact, critical to the person’s recovery.
Simmons recounted her powerful personal story of overcoming addiction. She was a registered nurse who got addicted to opioids after they were prescribed to her following a car accident. The addiction escalated to heroin, and her habit led to robbery and selling drugs. She went to prison for two years, lost her children, her husband, her house and her nursing license.
But Simmons got help from lawyers who encouraged her to go to law school. Now she is an attorney who helps others trying to rebuild their lives. She illustrated the very real problems with collateral consequences and how the help of a lawyer can make all the difference.
The event also highlighted the recently released report titled “Strengthening the Role of Civil Legal Aid in Responding to the Opioid Epidemic: Report of the LSC Opioid Task Force,” which includes 13 recommendations that emphasize collaborating and creating better partnerships with the courts, healthcare providers and youth and faith-based organizations.
The report stresses the importance of education on the issues. There is a need to educate public health officials and treatment providers about the legal obstacles patients face in obtaining and remaining in treatment. Judges, law enforcement officials, child welfare workers and employers need to learn about the civil legal issues connected to medication-assisted treatment for opioid-related disorders. Public health officials and treatment providers need to promote a comprehensive model of recovery that includes legal aid attorneys as resources for individuals and families affected by the opioid epidemic.
Finding a solution to the crisis will not be easy and will require a comprehensive effort. LSC will play a role but is woefully underfunded. Our country requires focus and more resources to fully address this problem.