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EDITORIAL
How Can Virtual Reality Interventions Help Reduce
Prescription Opioid Drug Misuse?
Brenda K. Wiederhold, PhD, MBA, BCB, BCN,
1,2
Giuseppe Riva, PhD,
3,4
and Mark D. Wiederhold, MD, PhD, FACP
5
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).
1
Prescription drug overdose rates have more
than tripled since 1990, paralleling a 300% increase in sales
of strong prescription opioids.
2
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 in-
clude 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 Sche-
dule 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.
3
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.
4
Consistent with other studies on the subject, one
study using Medicaid data found that about 3% of individ-
uals will graduate to abuse or dependence, with the popu-
lation most vulnerable to addiction being those younger than
40.
5
Studies suggest similar rates of prescription opioid misuse
in the EU, although direct United States–Europe comparisons
are difficult because of different physician prescribing pat-
terns.
6
Another study found that ‘‘Native Americans had
significantly greater rates of nonmedical prescription drug use
and drug use disorders, highlighting the need for culturally-
sensitive prevention and intervention programs.’’
7
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.’’
8
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.’’
9
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.
10
The European Federation of Inter-
national 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.’’
11
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.’’
12
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.
12
The editor and others involved in VR research have made
strides in showing the effectiveness of ‘‘various psycholog-
ical techniques, including distraction by virtual reality en-
vironments and the playing of video games, [which] are
being employed to treat pain.’’
13
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
1
Virtual Reality Medical Institute, Brussels, Belgium.
2
Interactive Media Institute, San Diego, California.
3
Department of Psychology, Catholic University of Milan, Italy.
4
Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy.
5
The Virtual Reality Medical Center (VRMC), San Diego, California.
CYBERPSYCHOLOGY,BEHAVIOR,AND SOCIAL NETWORKING
Volume 17, Number 6, 2014
ªMary Ann Liebert, Inc.
DOI: 10.1089/cyber.2014.1512
331
the need for opioid prescriptions and the deadly conse-
quences of their abuse. As recently suggested by Herta Flor,
‘‘The analysis of neurophysiological mechanisms may also
lead to the development of new psychological interventions
that can target these changes in a much more specific manner
than pharmacological interventions.’’
14
References
1. Achenbach J. Philip Seymour Hoffman’s death points to
broader opioid drug epidemic. The Washington Post, Feb.
7, 2014.
2. Christensen J. DEA turns to texting to fight prescription
drug abuse. CNN.com, Feb. 21, 2014.
3. CNN Staff. FDA aims to tighten control of hydrocodone.
CNN.com, Oct. 25, 2013.
4. Fishbain DA, Cole B, Lewis J, et al. What percentage of
chronic nonmalignant pain patients exposed to chronic opi-
oid analgesic therapy develop abuse/addiction and/or aber-
rant drug-related behaviors? A structured evidence-based
review. Pain Medicine 2008; 9:444–459.
5. Edlund MJ, Martin BC, Fan M-Y, et al. Risks for opioid
abuse and dependence among recipients of chronic opioid
therapy: results from the TROUP study. Drug & Alcohol
Dependence 2010; 112:90–98.
6. Denisco RA, Chandler RK, Compton WM. Addressing the
intersecting problems of opioid misuse and chronic pain
treatment. Experimental & Clinical Psychopharmacology
2008; 16:417–428.
7. Huang B, Dawson DA, Stinson FS, et al. Prevalence, corre-
lates, and comorbidity of nonmedical prescription drug use and
drug use disorders in the United States: results of the National
Epidemiologic Survey on Alcohol and Related Conditions.
Journal of Clinical Psychiatry 2006; 67:1062–1073.
8. White AG, Birnbaum HG, Mareva MN, et al. Direct costs of
opioid abuse in an insured population in the United States.
Journal of Managed Care Pharmacy 2005; 11:469–479.
9. Strassels SA. Economic burden of prescription opioid
misuse and abuse. Journal of Managed Care Pharmacy
2009; 15:556–562.
10. Institute of Medicine. (2011) Relieving pain in America: a
blueprint for transforming prevention, care, education, and
research. Washington, DC: National Academies Press.
11. European Pain Federation. Costs of chronic pain. www.efic
.org/index.asp?sub =B47GFCF5J4H43I (accessed Feb. 24,
2014).
12. Jensen MP, Turk DC. Contributions of psychology to the
understanding and treatment of people with chronic pain:
why it matters to ALL psychologists. American Psycholo-
gist 2014; 69:105–111.
13. Wiederhold MD, Wiederhold BK. Virtual reality and in-
teractive simulation for pain distraction. Pain Medicine
2007; 8:S182–S188.
14. Flor H. Psychological pain interventions and neurophysi-
ology. American Psychologist 2014; 69:188–196.
Profs. Brenda K. Wiederhold, Giuseppe Riva,
and Mark D. Wiederhold
332 EDITORIAL
