Virtual Reality at the Point of Care to Increase Uptake of Medications for Opioid Use Disorder (MOUD) in the Emergency Department

Opioid use is an epidemic in the United States and is the leading cause of drug overdose deaths. Medications for opioid use disorder (MOUD) is an effective treatment for opioid use disorder (OUD), with both methadone and buprenorphine associated with large decreases in mortality and overdose. MOUD also leads to improved employment status, decreased criminal behaviors, and decreased risk of contracting HIV and hepatitis C. Despite evidence supporting the benefits of MOUD, few eligible people with OUD receive treatment. Initiating buprenorphine and methadone in the emergency department (ED) is a feasible and low-threshold strategy to improve access, yet it remains underutilized.

To increase uptake of initiating MOUD in the ED, researchers are developing and testing VR-Choice, an immersive virtual reality (VR) experience designed to increase patient willingness to engage in shared decision making (SDM) for MOUD in the ED. The design of the VR-Choice intervention is based on the emotion-imbued choice model, which describes five specific mechanisms by which emotion impacts decision making. The team hypothesizes that participating in an immersive VR experience will be more effective than currently available counseling approaches at increasing willingness to engage in SDM, because of the superior ability of VR to activate emotional responses compared to other media or motivational methods.

The specific aims of the research are as follows:

• Develop a deployable VR-Choice application system.
• Beta test and refine VR-Choice.
• Conduct a parallel, 2-arm, open-label, randomized controlled feasibility trial.

In the first phase of the research, VR-Choice will be developed and optimized with feedback from stakeholders to understand the needs of both patients with OUD and ED clinicians. Intervention content development for VR-Choice will be guided by an expert steering committee comprising expertise in OUD care and research, patient decision making, VR development and design, and persons with lived experience at various stages of OUD recovery. The VR team will iteratively develop and test a VR-Choice prototype. In the second phase of the study, the researchers will conduct a randomized controlled feasibility trial, where eligible participants will be randomized 1:1 to VR-Choice or treatment as usual. The team will track five process indicators: average number of eligible patients randomized per month, baseline measure completion, proportion randomized to the VR-Choice arm completing the VR program, proportion in VR-Choice arm developing VR-related symptoms, and acceptability of VR-Choice. Each of these process indicators will be evaluated by preset “Stop” and “Go” thresholds; meeting the “Go” thresholds suggest that VR can support agreement to treatment of buprenorphine in the ED and will provide the rationale for the researchers to conduct a future full-scale randomized controlled trial to study the impact of VR-Choice.