Mairead O'Reilly, 2016-2018 Poverty Law Fellow
Can you share some of the highlights of your work so far?
Sure. I spent the first year doing a deep-dive into the world of policy and research related to Opioid Use Disorder and was able to individually represent and advise low-income Vermonters, many of whom were in recovery from substance use disorder. Prior to August 2016, what I knew about the opioid crisis could be reduced to headlines and anecdotes. During this past year, in and outside of work, most of my reading, reflection, discussion, and travel, has centered around the opioid crisis, the nature of addictions, drug policy across the nation and around the world, and the efficacy of certain policies on stemming crises like this one.
Last spring, I had the opportunity to attend the Harm Reduction International Conference in Montreal for 3 days. Harm reduction is a paradigm that prioritizes reducing harm (from drug use) and saving lives over all else: it’s a perspective that humanizes people who uses drugs, and recognizes that people who use drugs have complex pathways into drug use, and that punitive, violent or harsh reactions to that drug use often drive the use further underground, making it more dangerous and potentially deadly. I think it’s safe to say that my knowledge base looks very different from last year.
How did you put that new knowledge, and your legal training, to use?
During the spring and summer, most of my time was committed to case work—providing individual representation and advice and legal information to clients —from referrals through Safe Recovery, Chittenden Clinic, and Steps to End Domestic Violence. Substantively, most of my cases were housing-related, though several were family law, some were patients’ rights, and several were related to criminal records. I also participated in some administrative advocacy—and a small bit of legislative advocacy—during the winter and spring months. Finally, I’ve worked with one of the governor’s Opioid Coordination Council subcommittees to investigate Vermont’s housing landscape for people in recovery from opioid use disorder—and am helping to craft recommendations on housing for this population.
What were some of the things about your work that surprised you?
What’s surprising for me, retrospectively, is exactly how misinformed I was about opioids and about the crisis when I began. I believed, for example, that injecting heroin once is all it takes to create a life-long addiction. But I learned that it’s closer to one of 10 people who try a “highly-addictive” substance actually becoming dependent on it, and that it typically takes more consistent use before developing physical dependency. The data also shows that life-long addictions are very rare. And it also shows that often, folks who end up becoming dependent on a particular substance are the same individuals who struggle with underlying physical and mental health concerns that are not adequately treated. To me, this bodes well for future policy work—because it indicates that well-targeted interventions that consider these realities can make a huge difference in the lives of people with substance use disorders.
What role does community connection play in addiction?
The data shows that substance use disorder is inextricably bound up with isolation and stress, and inversely correlated with community connections, social capital, and support. Before beginning this fellowship, I had an intuition that lacking community and social supports was connected to substance use, but after just one year of this work, I am convinced that this factor is fairly decisive. Some of the most important protective factors from problematic substance use are strong social connections, a sense of purpose, and feelings of personal dignity and belonging. Doing meaningful work, having access to supportive community spaces, participating in civic life, and engaging in safe social interactions are all integral to preventing and overcoming addiction—just as they are key to sound mental health. It might sound sort of sentimental—but even just a short reflection on our family, friends and community members who we know have struggled with this issue can anecdotally support these findings.
Why are better legal and social supports needed for people who use drugs?
In short, this population is very vulnerable. I was not prepared to come face-to-face with the depth of our ingrained collective prejudices towards people who use drugs—or the unique gaps in services that they experience— especially poor people who use drugs. Most of my clients fell through gaping cracks in our system earlier in their lives, which is not difficult to do when you’re impoverished in this country. And then once they were identified as drug users, they were essentially stuck in that marginalized space where they became second-class citizens, and have carried around the “drug user” or “convict” label making them less able to access public institutions and services, unless those services were part of the criminal justice or corrections system.
In practice, it seems like these individuals are underserved by American institutions, both because of long-standing prejudices against them and because we still haven’t mastered service delivery and access for people with differing abilities. It’s important for all Americans have access to our institutions. And there is no persuasive justification to exclude segments of the population from mainstream society—through long carceral sentences and then through life-long exclusions due to criminal records— just because they have used certain substances to cope with pain and confusion and mental health problems. It doesn’t make much sense, and I think that after analyzing some of the grim statistics during this era, it’s clear that that response doesn’t actually solve the problem. It doesn’t lessen use and recidivism, it doesn’t prevent overdose deaths—it actually plays a big role in exacerbating those statistics. We have laws on the books that attempt to mitigate the biases against this population and to account for their disabilities, and it’s important that they’re able to access the remedies that our lawmakers deem necessary.
What was the biggest challenge of your work this year?
The biggest challenge so far has been mentally balancing the urgency and seriousness of this issue with the reality that I am a new lawyer, and that I am only one human with a finite amount of time each day. I’ve realized though that while I won’t solve Vermont’s opioid crisis, I can focus on serving each client to the best of my ability, on learning as much as possible about their unique lives and pathways into opioid use and recovery—about what worked for them and what could have prevented use or sped up their recovery—and I can bring that down to Montpelier, as I engage in more systemic work on this issue.
What will those systemic efforts look like?
This coming year will be dedicated to concretizing the gaps I’ve identified into policy recommendations, legislative and administrative advocacy, and potentially even legal-aid clinical programs—related to Medicaid transportation, housing for people with substance use disorders, access to treatment and confidentiality protections, and criminal records. The issues may also evolve into developing new systems around criminal and housing records.
Vermont is well-poised on the policy level to do a lot to get people back to work and to get them stably housed. After access to treatment, to me, these are the linchpins of ending a drug crisis. I have also worked with the governor’s Opioid Coordination Council Treatment and Recovery Committee—and in November we will submit recommendations to the governor. Finally, I am working with the Bennington Bar Association to organize a community symposium on the opioid crisis in the spring—where we will bring together stakeholders from across the community and the state to identify the Bennington-specific opioid problems as well as local solutions to the crisis.
There’s a lot taking shape—the work continues to evolve, and I am trying to let my daily client work inform my next steps.