Spotlight on Mairead O ’ Reilly
Mairead O ’ Reilly is the 2016 Vermont Poverty Law Fellow . We talked with her recently about her experiences during the first year of her fellowship .
Can you share some of the highlights of your work so far ?
Sure . I spent the first year doing a deepdive 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 a 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 addiction , 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 who actually become 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 loosely 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-toface 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 to 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 lifelong exclusions due to criminal records — just because they have used certain substances to cope with pain , 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 this reactive approach 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 www . vtbar . org THE VERMONT BAR JOURNAL • WINTER 2017 23