Beyond Opioids - New program to assist with unseen effects of addiction

October 12-18, 2020

By Dwain Hebda


A generation is defined by many things – fashion, popular media, technology. Drugs of choice also run in cycles according to generational tastes.


Booze ruled the 1950s, followed by pot and LSD in the 1960s. That, in turn, gave way to heroin and cocaine in the 1970s and those to crack in the 1980s followed by various 1990s party drugs such as ecstasy and methamphetamine. Each of these substances brought with them, uniquely and in common, societal problems of era and circumstance. 


But it is fair to say that few of the above-named substances hit the public more quickly, or with as much deadly force, as the opioid epidemic that has ruled the streets for the past 20 years.


Beyond the death and destroyed lives opioids have wrought (in 2017, 188 confirmed opioid overdose deaths in Arkansas, per the National Institute of Drug Abuse’s Arkansas Opioid Summary) there are far more issues facing those in addiction than society generally understands. Among these are various civil legal entanglements on everything from custody and visitation to barriers to employment and housing. 


Into this maelstrom, steps the Center for Arkansas Legal Services in Little Rock and Legal Aid of Arkansas based in Rogers, offering a new program of free, non-criminal legal services specifically for low-income individuals and their families dealing with the ancillary fallout of opioid addiction. 


“Drug addiction is a disease that takes over an individual and shatters an entire family and their community,” said Helen Gratil, CALS project director. “A lot of the things that we have heard of and are basically looking at for parents in active addiction, for example, include children being neglected and sometimes, sadly, grandparents having to step into that space.


“You’re going to find [the grandparents] can’t make decisions when it comes to the children’s education and health care without legal guardianship,” said Gratil. “That’s a barrier to grandparents helping the children through this phase as their parents go through addiction and hopefully, recovery.”


The new program, Beyond Opioids – Breaking Legal Barriers for Families in Recovery, is a three-year initiative funded through a combined $2 million in grant awards from the Health Resources and Services Administration. The program connects individuals dealing with substance use disorder (SUD), specifically opioid use disorder (OUD), with resources and help across a wide range of needs, including legal representation. 


Julie Norman, managing attorney of CALS’ Little Rock branch office, said formation of the first-of-its kind Beyond Opioids program fills a hole in the legal organizations’ range of services to low-income Arkansans.


“Back in 2017 or 2018, there were a lot of publications about the opioid epidemic, so we had an internal discussion of how to address it. At that point it was not part of our case acceptance priorities,” she said. “That basically means, we didn’t have funding to respond.”


“Through a planning grant, we were able to interview health care practitioners and try to find out what civil issues they were seeing with their patients. Eighty-five percent of those practitioners talked about how their patients needed advice on custody and visitation issues to unite their families. 


“There’s also a really high rate, about 83%, that talked about protecting children against neglect and abuse through a guardianship process. So, the biggest area is stabilizing that family core.”


Another very common legal issue is removing barriers to employment and housing via the sealing of criminal records and the list goes on, right down to seemingly ubiquitous tasks the general population does without a second thought. But, to a person with a record or history of addiction, these tasks often represent major roadblocks to continuing their sobriety. 


“Some people, they’ve been in recovery, they need a job, but they don’t have a driver’s license,” Norman said. “That’s one of the first things that your employer is going to say is, ‘I need a copy of your driver’s license.’ 


“Helping clients reinstate driver’s licenses may sound like a small thing, but on a much larger scale it’s going to open a lot of doors. It opens the door to that job that provides stabile housing for that family, that can then put food on the table, that can help pay monthly bills,” she said.


Beyond Opioids follows the legal organizations’ current operational model of assessing a client’s needs and referring them to appropriate legal resources, typically a local pro bono attorney. But the new program also ups the ante considerably in the variety and number of community partners statewide that have signed on to provide various services. 


“Our primary business is to provide legal services,” Gratil said. “But, if someone comes to us and asks, ‘What if my child wants to get treatment?’ we are in partnership with some of these groups that get opioid-specific funding to provide treatment on a sliding scale or for free. At that point, it’s just a matter of us saying, ‘Where do you live?’”


National Institute on Drug Abuse statistics show how pervasive the problem of OUD is in Arkansas. In addition to the 188 opioid overdose deaths, in 2017 a staggering 105.4 prescriptions were written for every 100 people in the state, roughly twice the national average. In 2018, the number of prescriptions were down sharply, but the number of opioid overdose deaths spiked to 208, representing almost half of all overdose deaths statewide. Nationally, 20 million people reported a SUD related to alcohol or narcotics in 2018, two million due to opioids.


Arkansas’s recent numbers are the highest in more than a decade and, experts predict, are likely to get worse from here. As the COVID-19 pandemic has cloaked the nation in fear over health, job stability and isolation, trending numbers on addiction behaviors are concerning. 


The Association of American Medical Colleges reported in July that while the full effect of the pandemic on addiction won’t be realized for some time, alcohol sales are up 25% in 2020, and urine test data from just one national laboratory service, Millennium Health, shows spikes in drug use, too. Among them, a 32 percent increase for nonprescribed fentanyl, 20% bump in methamphetamine and 10% rise in cocaine, just for the period of mid-March through May. Saddest, if not particularly unexpected, is University of Baltimore data showing suspected overdoses for that same time window up 18% nationwide.


While no one at CALS or Legal Aid of Arkansas could have predicted the new program would roll out in such an environment, Gratil said it reinforces the vital importance of the initiative itself.


“We are the first in the nation with this,” Gratil said. “There are other legal aid programs that have attempted to serve the OUD SUD population, but those programs are not statewide. In Vermont there’s one legal aid program to that effect, but it’s never been a holistic approach addressing OUD SUD where we plug into the overall state to respond. We are in fact doing that.”


“One of the key things of this project is that the two [legal aid] programs came together and worked collaboratively and pursued the same grant to make sure we have statewide coverage. The grant that we have does only address rural counties, but it’s a good start for us. It covers 90 percent of Arkansas. And we are moving forward to make sure that we are in partnership with practitioners on the ground to cover the entire state.”