The abuse of opiates is a harrowing problem in parts of rural America. So is addiction treatment. In a letter to the professional journal Psychiatric Services, a doctor in Golden, Colorado, describes how he has been working with rural patients through telepsychiatry. "Over the past two years, I have treated approximately 40 opioid-dependent patients from communities throughout Colorado, all of whom were seen exclusively via telepsychiatry from their own homes or offices," writes Dr. Douglas M. Ikelheimer.

Ikelheimer is among the "relatively small number "of physicians certified to prescribe buprenorphine, a drug recently approved to manage dependence on opiates. Using fairly inexpensive video-conferencing software (like iChat and Skype), he is able to diagnose patients and monitor their conditions, working in conjunction with local doctors, laboratories, and pharmacists. Patients with home computers, Webcams, and the high-speed Internet access they require, can take advantage of this treatment.

"As this process becomes more widely accepted by physicians, patients, and the insurance industry," he writes, "it may well represent the long-sought realization of the potential for telepsychiatry as an efficacious and cost-saving modality with far-reaching implications."