Addressing health-harming legal needs in opioid treatment programs: Staff perspectives on implementing a medical-legal partnership.

INTRODUCTION: Opioid treatment programs (OTPs) serve highly marginalized populations who frequently experience civil legal challenges related to housing instability, employment discrimination, transportation barriers, public benefits denial, and child welfare involvement. Medical-legal partnerships (MLPs) embed attorneys within healthcare settings to address health-harming legal needs, yet no studies have assessed their implementation in OTPs. Therefore, we solicited OTP staff perspectives on the idea of implementing an MLP in their facility. METHODS: We conducted virtual semi-structured interviews with 17 OTP staff across three metropolitan OTPs in Massachusetts and Florida. Interviews explored OTP staff perspectives on patients' health-harming legal needs, current OTP approaches to addressing legal issues, and anticipated feasibility, acceptability, and implementation considerations for integrating an MLP into the OTP setting. Transcripts were analyzed using Rapid Qualitative Analysis. RESULTS: We identified the following themes: (A) a variety of civil legal issues negatively affect OTP patients' recovery by taking time away from treatment, creating stress, inducing feelings of hopelessness, and increasing the likelihood that patients will remain in "triggering" living situations; (B) OTP staff currently struggle to address civil legal issues and desire help; (C) staff believe MLP integration into the OTP would be feasible; (D) Staff believe patients will be interested in and benefit from an MLP; and (E) flexibility in MLP service provision could facilitate service adoption. CONCLUSIONS: OTP staff perceive substantial unmet civil legal needs among patients, negative effects of civil legal needs on patients' treatment engagement, feasibility of integrating an MLP into their OTP, and anticipated positive effects of the MLP on patient engagement and recovery.