How Can Virtual Reality Interventions Help Reduce Prescription Opioid Drug Misuse?

The recent death from a heroin overdose of actor Philip Seymour Hoffman at the age of 46 highlights the danger of opioid addiction. However, according to the U.S. Centers for Disease Control, prescription opioids such as OxyContin, Percocet, and Vicodin may be gateway drugs for heroin addiction and are responsible for five times as many deaths. ‘‘The main driver of overdoses right now in our country is from opioid medications, more than from heroin,’’ said Nora Volkow, director of the National Institute on Drug Abuse (NIDA). Prescription drug overdose rates have more than tripled since 1990, paralleling a 300% increase in sales of strong prescription opioids. What is being done about this growing problem, and how can virtual reality (VR)-assisted behavioral interventions help? In addition to NIDA, other U.S. agencies involved in the fight against prescription opioid abuse and misuse include the Drug Enforcement Administration and the Food and Drug Administration. In February, the DEA launched a new texting initiative, TIP411, which helps the public report suspicious activity such as seeing a pharmacy tech drive off in an expensive car. Tipsters can use the keyword PILLTIP to report anomalies that may indicate illegal prescription drug activity, and the message will be forwarded to a DEA agent for investigation. The FDA is proposing to reclassify hydrocodone combination pills such as Vicodin from Schedule III to Schedule II. Adoption of the proposal would mean that prescriptions for this type of drug couldn’t be called in over the phone and would require reauthorization from the physician before being refilled. Studies have concluded that only a small percentage of people who are prescribed opioids for medical reasons will go on to develop addictions to these drugs, and that one of the ways to prevent addiction is to preselect for no previous history of or current problems with drug or alcohol abuse or addiction. Consistent with other studies on the subject, one study using Medicaid data found that about 3% of individuals will graduate to abuse or dependence, with the population most vulnerable to addiction being those younger than 40. Studies suggest similar rates of prescription opioid misuse in the EU, although direct United States–Europe comparisons are difficult because of different physician prescribing patterns. Another study found that ‘‘Native Americans had significantly greater rates of nonmedical prescription drug use and drug use disorders, highlighting the need for culturallysensitive prevention and intervention programs.’’ In addition to humanitarian reasons, there are significant financial incentives to find ways to reduce the incidence of prescription opioid misuse. One study found that ‘‘mean annual direct health care costs for opioid abusers were more than eight times higher than for nonabusers.’’ Another study noted, ‘‘The total cost of prescription opioid abuse in 2001 was estimated at $8.6 billion, including workplace, health care, and criminal justice expenditures.’’ Of course, this amount is a drop in the bucket compared to the total cost to the U.S. economy of chronic pain, recently estimated by the Institute of Medicine at between $560 and $630 billion annually. The European Federation of International Association for the Study of Pain (IASP) Chapters notes that to date, ‘‘there is no comprehensive pan-European epidemiological survey laying out the scope of the pain problem.’’ However, a 2010 report noted that ‘‘chronic pain costs Europe billions of euros every year, with national costs ranging from 1.1 billion to nearly 50 billion Euros.’’ Combinations of prescription opioids with other drugs have a modest additive effect on pain relief, while combinations of prescription opioids with behavioral interventions have been shown to be effective, for example, in reducing headache pain. As we researchers in the field of VR-assisted therapy have been saying for many years, it would be most helpful if we could identify predictors of who will be likely treatment responders. The editor and others involved in VR research have made strides in showing the effectiveness of ‘‘various psychological techniques, including distraction by virtual reality environments and the playing of video games, [which] are being employed to treat pain.’’ Perhaps if additional dollars were directed to support evidence-based research on both the psychological and neurophysiological mechanisms related to pain, and the effectiveness of these nondrug modalities, we would be able to make a significant contribution to reducing