Seeing the treetops: How family physicians bring hope to SUD care

By David O’Gurek, MD, FAAFP

“I saw the tops of trees today.”

Those were Rodney’s words when I asked how he was doing just a few days after he started buprenorphine for opioid use disorder.

At first, I wasn’t sure what he meant. Then he explained.

For the first time in a long time, he felt like he could walk with his head held high. Quite literally, he could see the tops of trees.

It was one of those moments that stay with you.

Breaking the stigma around substance use disorders

As family physicians, we are privileged to walk alongside patients through difficult chapters of their lives. Though relationships are at the heart of our work, there are rare conversations that remind us why we chose this profession. Rodney’s story is one of those reminders. His experience wasn’t simply about a medication—it was about rediscovering hope, dignity and the possibility of a different future.

Even as our nation continues to grapple with an overdose crisis, stigma surrounding substance use and substance use disorders (SUDs) remains one of the greatest barriers to care. That stigma has deep roots. It is grounded in decades of policies shaped by systemic racism and bias, and reinforced by the outdated belief that SUDs are a “moral failing” or lack of willpower.

Although we increasingly recognize SUD as a chronic medical condition, we too often continue to treat a return to use as a personal failure rather than what it is: a symptom of that chronic illness that deserves compassionate, evidence-based care. Far too often, the environment and culture that those who use drugs face when they seek assistance leave them feeling hopeless and unheard. When that happens, opportunities to build trust and save lives are lost.

Why family physicians are essential to SUD care

Family physicians, caring for patients across generations and through every stage of life, building relationships that span years or even decades, are uniquely positioned to identify substance use early, provide treatment, reduce risks and offer hope when patients need it most.

The AAFP’s Addiction Treatment and Care CME for Family Physicians provides essential knowledge, skills and attitudes to prepare family physicians to answer the call of our patients with substance use and SUDs with a simple yet powerful message:

We hear you. We are here for you.

Everyone wants to be healthy. It’s critical to understand that the opposite of addiction is not abstinence; the opposite of addiction is hope. A patient once shared with me that the first time he used, “it felt like someone wrapped a warm blanket” around him. That statement has stayed with me. Who among us would not wish to feel this comfort and safety? Asking ourselves that question helps us approach substance use with empathy rather than judgement.

Meeting patients where they are

A common misconception persists that “nothing can be done until the person wants it.” But there is always something we can offer. That may include patient-centered risk reduction measures, including discussions of safer use, access to sterile equipment, overdose education, naloxone distribution and more. Sometimes the most powerful intervention is compassionate, active listening.

Recovery is rarely linear. Healing takes time. Hope often begins with a conversation.

The Academy’s Addiction Treatment and Care CME for Family Physicians includes training for AAFP chapters designed to help practices integrate substance use screening and treatment for patients with SUD into routine primary care. An updated implementation workbook guides teams through developing workflows, identifying community resources and building sustainable systems of care.

Speak with your chapter leadership and staff if you are interested in holding this training.

Stay current on SUD: A webinar for family physicians

Substance use continues to evolve, and so must we.

Though challenges remain among opioid use, with dangerous adulterants in the illicit drug supply as well as “gas station heroin,” we are also seeing increasing complications related to polysubstance use, especially involving methamphetamine. Keeping pace with these changes is essential if we are to provide effective, informed care.

That is why I am excited to be a panelist for What’s New in Substance Use: Emerging Substance Use Trends & Primary Care Considerations, a live webinar on Sept. 23 at 5:30 p.m. CT. Designed by family physicians for family physicians, the webinar will explore emerging trends in substance use and their implications for primary care practice.

Learning from patients with substance use disorders

Much of what I have learned about caring for individuals with SUD came from my patients. They have taught me about resilience. They have taught me about humanity. Most importantly, they have taught me about hope.

Rodney credited buprenorphine with changing his life, but I think his story is about something much bigger. Medication opened a door, but Rodney walked through it.

As family physicians, we may never fully appreciate the impact a single conversation, a moment of compassion or an offer to help can have on another person’s life. What we can do is continue to:

Because every patient deserves someone who believes that hope is possible.

And perhaps, together, we can help more people lift their heads, look forward, and once again see the tops of trees.

David O’Gurek, MD, FAAFP, is interim chair of the Department of Family Medicine at the Lehigh Valley Physician Group. He is a former chair of the AAFP’s Commission on Health of the Public and Science, and former board chair and president of the Pennsylvania AFP.