A Virtual Reality Intervention to Promote Uptake of Medications for Opioid Use Disorder in the Emergency Department Following Opioid-Involved Overdose Based on Input From People With Lived Experience: Development Study

Background: Opioid use disorder (OUD), which leads to thousands of deaths per year, continues to pose a tremendous challenge to health care systems. While medications for opioid use disorder (MOUDs), such as buprenorphine and methadone, are the most effective treatments for OUD, the initial patient conversation and decision to engage in MOUDs remain major barriers. Decision-making is strongly influenced by the patients' current emotional state. While the emergency department (ED) is a promising access point for initiating MOUDs, patients' readiness to engage in treatment can be limited, in part, by the negative emotions and experiences associated with the ED visit. Objective: We co-designed and developed a novel emotion-based virtual reality (VR) intervention to increase patient readiness to engage in shared decision-making for treatment with MOUDs following an ED admission for an opioid-related overdose. Methods: This paper describes a 3-stage, iterative process involving 59 stakeholders, including people with lived experience (LE), to design and develop an intervention that resulted in a VR app and preliminary assessments of user experience. Results: Our process incorporated the perspectives of LE stakeholders across all aspects of the design and refinement of the VR platform VR-Choice. VR-Choice consists of a VR journey up a mountain ("Mountain Journey"), culminating in the presentation of nine 180-degree videos showing different positive aspects of life during recovery ("Possible Worlds"). Of the 20 participants who experienced the final platform version, none reported more than slight motion sickness symptoms. Nineteen of the 20 participants stated they liked the videos shown in the final version, considered it to be potentially helpful for patients in the emergency room after an opioid-involved overdose, and thought the experience should be offered to those patients. All participants agreed that the program was easy to use, and only 1 participant described it as confusing. Conclusions: To our knowledge, this is the first effort to use feedback from participants with LE to design an engaging VR experience for people in the ED who may be candidates for MOUDs. Participants' feedback was positive, and we will move forward with development.