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Last month, the Trump administration declared the opioid crisis a public health emergency. Along with that it called for expanding use of telemedicine for addiction treatment. The administration said doctors could virtually prescribe medication. They don't have to see their patients in person. Indiana passed legislation earlier this year to do this. But as Side Effects Public Media's Emily Forman found out, many doctors there aren't interested.
EMILY FORMAN, BYLINE: I called about a dozen addiction specialists in Indiana. No one had heard of doctors here using telemedicine for opioid addiction treatment. Then I found one - Dr. Jay Joshi.
JAY JOSHI: We have our own in-house telemedicine counselors.
FORMAN: Who are they?
JOSHI: So her name is Rebecca, and she's from Kokomo, Ind.
FORMAN: At Joshi's practice, Prestige Clinics in northwest Indiana, telemedicine looks like a standard exam room with a computer. On Tuesdays, his patients come in and video chat with a psychologist who lives 140 miles away. Elizabeth Hall is one of those patients.
ELIZABETH HALL: It was just like doing therapy with anybody else, just she's on a screen. She was really nice. The only issue I really had with it was it, like, would freeze, which is kind of inconvenient and a little bit awkward when it freezes. You're like, what do I do, just sit here and stare at the lady?
FORMAN: She's a former nurse's assistant and has been going to Joshi for back pain and heroin addiction for about a year.
HALL: I'm, like, in a good place. You know, I'm not doing nothing I shouldn't be doing. I'm not lying to nobody. I'm not sneaking around. Plus, I have a baby. I'm really busy.
FORMAN: To get her insurance to cover her addiction medicine Hall has to prove she's in counseling. Local counselors are hard to find. By having a telepsychologist on staff, Joshi helps patients clear that hurdle.
JOSHI: The same problem keeps rearing its head.
FORMAN: Hall failed her urine drug test screen, which her insurance requires in order to cover her medication.
HALL: You know what? I haven't done anything since last week, and I told them I'm not doing nothing no more. I can't screw up my life.
FORMAN: Because of the failed test, her insurance may refuse to cover Suboxone, her addiction medicine. Joshi's staff may need to spend hours on the phone persuading them to.
JOSHI: You know, it's one of the situations where, you know, she's not taking any other controlled substance. We're seeing her every two weeks. She's participating in the counseling. But it's just one thing...
HALL: I've been doing really good. It's just - you know, it's hard.
FORMAN: This is why Joshi only prescribes Suboxone with an in-person visit. Seeing the patient in person is critical to their treatment.
JOSHI: You're not going to get a good system of health care for primary care in these high-risk areas unless you invest time and energy into these patients.
FORMAN: The face-to-face interaction establishes trust, allows him to pick up on body language. Plus, it's hard to do a urine drug test screen remotely and be sure that the sample actually belongs to the patient. A proper screen lets him know if his patients are taking their medication instead of selling it. He asks Hall if she mentioned her recent drug use to the counselor.
HALL: I really don't remember if I talked to her about it or not.
JOSHI: OK. Can we schedule you for counseling again and...
HALL: Yeah, absolutely. I was going to ask you about that anyway.
FORMAN: Joshi has a lot of conversations that aren't billable. That's partly why there's a shortage of addiction treatment doctors, says Dr. Emily Zarse.
EMILY ZARSE: Telemedicine has - it's a great idea in theory, but it doesn't fix the workforce shortage problem.
FORMAN: Zarse runs the addiction treatment program at Eskenazi Health in Indianapolis. She says insurance billing takes up a lot of time. So do the complexities of addiction treatment. There is one area where is Zarse thinks telemedicine would be helpful - as a tool to train providers.
ZARSE: That takes one expert's time for a couple of hours a week maybe, and you can reach 10, 15, 20 people all at one time.
FORMAN: In fact, Zarse plans to launch a telemedicine course to train doctors to treat addiction. They can walk through cases with trained psychiatrists like Zarse and hopefully reach more people. For NPR News, I'm Emily Forman in Indianapolis.
SIEGEL: That story is part of a reporting partnership of NPR, WFYI and Kaiser Health News.
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