Accepted for/Published in: JMIR XR and Spatial Computing (JMXR)
Date Submitted: Dec 12, 2025
Date Accepted: May 12, 2026
A Virtual Reality Intervention to Promote Uptake of Medications for Opioid Use Disorder in the Emergency Department Following Opioid-Involved Overdose: Development with Input from People with Lived Experience
ABSTRACT
Background:
Opioid use disorder (OUD), which leads to thousands of deaths per year, continues to pose a tremendous challenge to healthcare systems. While opioid agonist medication treatments (OATs), such as buprenorphine and methadone, are the most effective treatments for OUD, the initial patient conversation and decision to engage in OAT remains a major barrier. Decision-making is strongly influenced by the patients’ current emotional state. While the emergency department (ED) is a promising access point for initiating OAT, 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 OAT following an ED visit for an opioid-related complaint.
Methods:
In this paper, we describe the different stages of working with stakeholders to design and develop the intervention, the resulting VR application, and preliminary assessments of user experience.
Results:
The current paper describes a three-stage, iterative process that drew heavily on incorporating the experiences and perspectives of people with lived experience in 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 360-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 20 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 overdose, and thought the experience should be offered to those patients. All participants agreed that the program was easy to use, and only one participant described it as confusing.
Conclusions:
While the efficacy of this environment has not yet been tested, initial feedback from participants with lived experience points to the feasibility of VR as a way to engage patients undergoing an extremely difficult experience in a challenging environment
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