A confluence of events has occurred in the United States that could help to save the lives of many patients as well as the lives and careers of many physicians. The solution is to apply the use of micropractices to address the current opioid addiction crisis. A micropractice is a small medical practice that is run efficiently to keep overhead low and put the patient first. The patient is given more time and attention than is traditionally given in a big box, assembly line clinic. Barriers between doctor and patient are removed. A micropractice may simply be one doctor working in a single room. The size of the patient panel is kept small so that each patient has access to the doctor and is treated like a human being, not a number. Micropractices also address the needs of doctors to have healthy, non-abusive workplaces. Micropractices also happen to be ideal settings for patients who need treatment for opioid dependence and addiction.
In 2001, CNN published an article documenting that doctors were being sued and disciplined for under-treating pain. Around the same time, certain pharmaceutical companies were heavily marketing the use of powerful opioid analgesics for treating pain. We, as physicians, were afraid of getting in trouble for ignoring patients in pain. We believed that we had an obligation to prescribe opioids to patients in pain to stop their suffering and improve their quality of life. Over the next decade, we learned that liberal prescribing of opioids for non-malignant chronic pain contributed to an increase in opioid dependence, addiction, and overdose death.
