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When President Donald Trump declared the opioid epidemic a public health emergency, it came with a regulatory change intended to make it easier for people to get care. The declaration allows for doctors to prescribe addiction medicine virtually, without ever seeing the patient in person.

In Indiana, this kind of virtual visit has been legal since early 2017. But among a dozen addiction specialists in Indiana contacted by a reporter, just one had heard of doctors using telemedicine for opioid addiction treatment: Dr. Jay Joshi.

At Joshi鈥檚 practice,聽聽in Munster, Ind., a telemedicine consultation takes place in what looks like a standard exam room with a computer. On Tuesdays, Joshi鈥檚聽 patients have video chats with a psychologist who lives 140 miles away.

Elizabeth Hall is one of those patients. 鈥淭he only issue I really had with it was [that] it would freeze, which is kind of inconvenient and a little bit awkward,鈥� she said. 鈥淲hen it freezes you鈥檙e like, 鈥榃hat do I do? Just sit here and stare at the lady?鈥欌��

But she said she appreciates the counseling. She鈥檚 a former nurse鈥檚 assistant and has been going to Joshi for back pain and to treat a heroin addiction for about a year.

鈥淚鈥檓 in a good place, you know?鈥� she said. 鈥淚鈥檓 not doing nothing I shouldn鈥檛 be doing. I鈥檓 not lying to nobody. I鈥檓 not sneaking around. Plus, I have a baby. I鈥檓 really busy!鈥�

To get her insurer to cover her addiction medicine, Hall has to prove she鈥檚 engaged in counseling. Local counselors are hard to find. By having a telepsychologist available, Joshi helps patients clear that hurdle.

Hall鈥檚 insurance also requires urine tests for drug use to keep covering her medication. But she failed her latest urine test 鈥� she had used drugs the previous week. Joshi asked Hall to talk to the telepsychologist about the relapse.

鈥淚 know you know that I haven鈥檛 done anything since last week, and I told them I鈥檓 not doing nothing no more. I can鈥檛 screw up my life,鈥� Hall said.

Because of the failed test, her insurance may refuse to pay for Suboxone, her addiction medication. Joshi鈥檚 staff may need to intervene with the insurer by phone to keep Hall鈥檚 treatment covered. 鈥淚t鈥檚 one of those situations where she鈥檚 not taking any other controlled substance,鈥� Joshi said. 鈥淲e鈥檙e seeing her every two weeks. She鈥檚 participating in the counseling. It鈥檚 just one thing.鈥�

Hall said, 鈥淚鈥檝e been doing really good, it鈥檚 just, you know, it鈥檚 hard.鈥�

This is why Joshi requires in-person visits 鈥� to begin and maintain his patients鈥� Suboxone prescriptions. He prefers to see these patients every two weeks and will even arrange transportation before going too long without seeing them.

Occasionally he鈥檒l prescribe Suboxone remotely, but typically only for a refill once or twice during a patient鈥檚 treatment. Seeing the patient in person is critical to their treatment, he said.

鈥淵ou鈥檙e 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,鈥� he said.

The face-to-face interaction establishes trust, allows him to pick up on body language. Plus, it鈥檚 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 asked Hall if she mentioned her recent drug use to the counselor.

鈥淚 really don鈥檛 remember if I talked to her about it or not,鈥� she said. Joshi said to make sure she comes in for her next counseling session.

Joshi said he has a lot of conversations that aren鈥檛 billable.

That鈥檚 partly why there is a shortage of addiction treatment doctors, said Dr. Emily Zarse. She runs the addiction treatment program at Eskenazi Health in Indianapolis.

鈥淭elemedicine is a great idea in theory, but it doesn鈥檛 fix the workforce shortage problem,鈥� she said.

Insurance billing takes up a lot of time and so do the complexities of addiction treatment, she said.

There is one area where Zarse thinks telemedicine would be helpful 鈥� as a tool to train providers. 鈥淭hat takes one expert鈥檚 time for a couple of hours a week, maybe, and you can reach 10, 15, 20 people all at one time,鈥� she said.

In fact, Zarse plans to launch a course to train Indiana doctors to treat addiction. In January, she鈥檒l learn more about how to do it, from聽, a resource for clinicians seeking virtual training tools. Zarse envisions a place where doctors from around the state can call in to video chat and walk through cases with trained psychiatrists like herself.

This story is part of a partnership that includes ,, and Kaiser Health News.