On Her Own Two Feet

This narrative describes the four-year journey of a woman with opioid use disorder and a lower-limb amputation as she seeks to walk again. Her recovery is repeatedly obstructed by rigid surgical preconditions first, a one-year abstinence requirement from her orthopedist, then a nicotine ban despite clinical evidence supporting nicotine-replacement therapy. Each setback leads to disengagement from care and deteriorating health, underscoring how inflexible, stigmatizing policies can compound harm. Ultimately, sustained peer support and renewed purpose lead her to residential treatment and coordinated care. With perseverance, she overcomes systemic and social hurdles to take her first steps on a prosthetic limb. The authors advocate for evidence-based surgical guidelines and flexible, patient-centered primary care models for people with substance use disorders to promote equity, engagement, and recovery.

This narrative describes the four-year journey of a woman with opioid use disorder and a lower-limb amputation as she seeks to walk again. Her recovery is repeatedly obstructed by rigid surgical preconditions first, a one-year abstinence requirement from her orthopedist, then a nicotine ban despite clinical evidence supporting nicotine-replacement therapy. Each setback leads to disengagement from care and deteriorating health, underscoring how inflexible, stigmatizing policies can compound harm. Ultimately, sustained peer support and renewed purpose lead her to residential treatment and coordinated care. With perseverance, she overcomes systemic and social hurdles to take her first steps on a prosthetic limb. The authors advocate for evidence-based surgical guidelines and flexible, patient-centered primary care models for people with substance use disorders to promote equity, engagement, and recovery.