American Family Physician, the journal of the American Academy of Family Physicians, is celebrating its 75th anniversary with a commemorative video series highlighting key topics in family medicine and honoring experts in the field. Dr. Elizabeth Salisbury-Afshar, a leading voice in addiction medicine and public health, was featured in October. Her contribution serves as a call to action for family physicians to embrace harm reduction as a cornerstone of compassionate, patient-centered care.
Elizabeth Salisbury-Afshar, MD, MPH
Redefining Harm Reduction in Primary Care
For Salisbury-Afshar, harm reduction is the essence of primary care. “When we recommend seat belts, vaccines, or safer sex practices, we’re practicing harm reduction,” she explains. Yet, when it comes to substance use, stigma often clouds clinical judgment. “The ‘just say no’ approach hasn’t worked. Harm reduction means meeting patients where they are, understanding their experiences, and helping them reduce risk—even if abstinence isn’t their goal.”
This philosophy transforms clinical encounters. Instead of enforcing abstinence, Salisbury-Afshar listens deeply, explores the role substances play in her patients’ lives, and collaborates on realistic, incremental goals. “Progress isn’t linear,” she says. “But every step forward builds trust and capacity for change.”
Her journey into harm reduction reshaped her clinical approach. “I used to think my job was to get people to do what I thought was best,” she admits. “But I realized that perfection is rarely achievable. Real progress comes from small, steady steps.”
By embracing harm reduction, she became an ally rather than an enforcer. Patients stayed engaged, even when their goals didn’t align with traditional models. “It’s not about encouraging drug use—it’s about acknowledging complexity and focusing on health, safety, and dignity.”
Training the Next Generation
Salisbury-Afshar is also a passionate educator. Through collaborations with the American Academy of Family Physicians and advocates like Brandon George and Stephen Murray, she brings voices of lived experience into training sessions. “Data alone isn’t enough. Hearing directly from people impacted by substance use makes harm reduction real.”
She emphasizes that harm reduction is an evolving practice. “Every time I teach, I learn something new. The more we center lived experience, the better we become at delivering care that truly meets patients where they are.”
The Compass Program: A Model for Integrated Care
In 2024, Salisbury-Afshar helped launch the Compass Program—a blueprint for integrated, low-barrier care. Patients can walk in and receive same-day services: addiction treatment, STI and hepatitis C care, wound care, contraception, and more. The program also distributes essential supplies like naloxone, test strips, hygiene kits, and cold weather gear.
Her ultimate vision for the future extends beyond clinical care. “Imagine a living room model—a welcoming space with showers, laundry, art therapy, and yoga. A place where people who use substances feel safe and supported.” It’s a holistic approach that addresses physical, emotional, and social health.
Breaking Barriers and Building Infrastructure
Despite growing interest in addiction care, systemic barriers persist. “Stigma is real, but the bigger issue is infrastructure,” she says. “Clinicians are willing, but they’re stretched thin. Panel sizes are too large, and visits are too infrequent for high-acuity patients.”
She advocates for scalable solutions: embedding addiction education in all health professions training, expanding diverse workforce pipelines, ensuring pay equity, and investing in wellness for providers. “Burnout is high. We need systems that support the people doing this vital work.”
Salisbury-Afshar’s passion for advocacy stems from witnessing systemic failures firsthand. “I love patient care, but I’m frustrated by how hard it is for people to access what they need. Advocacy lets me turn that frustration into action.”
Whether she’s teaching, treating, or testifying, her mission is clear: to make health care more accessible, humane, and effective. “The most rewarding part is doing all of it—caring for individuals while helping shape systems that support them. That balance keeps me inspired.”
Published: November 2025