Telemedicine addiction treatment

Telemedicine For Addiction Treatment? Picture Remains Fuzzy

When President 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. Doctors are now allowed 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. So I called about a dozen addiction specialists in Indiana to find out how it was going. But no one had heard of doctors using telemedicine for opioid addiction treatment until I ran across Dr. Jay Joshi.

At Joshi’s practice, Prestige Clinics in Munster, Ind., a telemedicine consultation takes place in what looks like a standard exam room with a computer. On Tuesdays, his patient’s video chats with a psychologist who lives 140 miles away.

Elizabeth Hall is one of those patients. “The only issue I really had with it was [that] it would freeze, which is kind of inconvenient and a little bit awkward,” she said. “When it freezes you’re like, ‘What do I do? Just sit here and stare at the lady?’ ”

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

“I’m in a good place, you know?” she says. “I’m not doing nothing I shouldn’t be doing. I’m not lying to anybody. I’m not sneaking around. Plus, I have a baby. I’m really busy!”

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

Hall’s insurance also requires urine tests for drug use to keep covering her medication. But she failed her latest urine test — she had used drugs the previous week. Joshi asks Hall to talk to the telepsychologist about why that keeps happening.

“I know you know that I haven’t done anything since last week, and I told them I’m not doing anything anymore. I can’t screw up my life,” Hall says.

But because of the failed test, her insurance may refuse to pay for Suboxone, her addiction medication. Joshi’s staff may need to intervene with the insurer by phone to keep Hall’s treatment covered. “It’s one of those situations where she’s not taking any other controlled substance,” Joshi says. “We’re seeing her every two weeks. She’s participating in the counseling. It’s just one thing.”

Hall says, “I’ve been doing really good, it’s just you know, it’s hard.”