How VR can be used to combat America’s opioid crisis
How VR can be used to combat America’s opioid crisis
The opioid crisis is another epidemic currently affecting America. In 2015 America experienced a fall in life expectancy for the first time in 100 years, which is very likely due to a huge increase in overdoses and suicide as a result of opioid addiction [1]. However, a drug called naloxone can be used as a treatment for opioid overdoses and it can be administered by both health professionals and the general public [2]. By increasing accessibility and training of naloxone administration, including by VR experiences, many opioid overdose deaths could be avoided.
Opioids are widely prescribed in America as pain medication, including hydrocodone (e.g. Vicodin®), oxycodone (e.g. OxyContin®, Percocet®), oxymorphone, morphine, codeine and fentanyl [3]. In fact, although America makes up less than 5% of the world’s population it consumes over 80% of the world’s opioids [4]. Opioids work by binding to opioid receptors on nerve cells, resulting in pain relief (analgesia) [5]. The endogenous agonists of opioid receptors are endorphins, which dull pain, increase feelings of pleasure and boost overall mood. Therefore, as opioids are agonists at the same receptors, they produce similar responses [6]. When a person stops taking opioids, they may miss these nice feelings, and so continue taking them when they are no longer needed, initiating an addiction. Opioid addiction is common among the American population and it has been estimated that around 10% of patients prescribed opioids for chronic pain develop an opioid use disorder [7]. It has also been shown that continual use of opioids causes tolerance to the drugs, so more opioid is needed to elicit the same response [8]. Once tolerance has been developed, drug dependence may follow, and the patient will usually experience withdrawal symptoms if they stop taking opioids [8].
It has been estimated that about 80% of people who use heroin had previously misused prescription opioids [7]. Heroin is a powerful opioid that is easy to overdose with, and it causes more deaths than any other illegal drug [9,10]. However, it is also possible to overdose on prescription opioids, especially if the patient has developed dependence. Opioid overdose-induced deaths occur when the opioid binds to receptors in the brain stem, desensitizing it to the carbon dioxide levels in the blood so that breathing mechanisms are not triggered, leading to respiratory failure [11,12]. In the US, the death rate from opioid overdoses increased almost six-fold between 1999 and 2017, and in 2018 in the US, 128 people were dying every day due to opioid overdoses [1,7].
Naloxone is an effective opioid overdose drug treatment as it is a high affinity opioid receptor inverse agonist [2,13]. This means that naloxone has a strong ability to bind to opioid receptors, and when it does, it will cause the opposite effect to opioids at this receptor. The naloxone will therefore compete with opioids to bind to the opioid receptors, reducing their impact on the body, including opioid-induced respiratory depression.
In the US, most states have introduced Naloxone Access Laws that increase access to the drug and there is evidence that this has saved lives [14]. Both a hand-held auto-injector and a nasal spray have been made available to the public to give to those experiencing an opioid overdose [15]. It has been shown that up to 86% of heroin-related overdoses occur when the drug-taker is in the company of others [12], and so a majority of overdoses could be preventable if the person witnessing the overdose had access to, and training in, naloxone administration.
VR immersive experiences are being trialled and offered to teach communities how to administer naloxone [16]. A study carried out by the University of Pennsylvania and the Philadelphia Department of Public Health has shown that VR naloxone training is an effective and low-cost alternative to in-person training and is just as effective [16]. In their short training video, participants are immersed in 360o, real-world settings where passers-by view an opioid-induced overdose. The participant will then witness the bystanders responding appropriately, by calling for emergency services, checking for signs and symptoms of an overdose, explaining how they administer naloxone, and also how to comfort the individual after they regain consciousness [17].
This is yet another example of how important VR technology is, providing immersive experience to better prepare people for real life situations and train them in saving lives. This may not be a solution to end this epidemic in America, but while there continues to be a high rate of opioid addiction, it provides a much-needed approach to reduce opioid-induced deaths.