How Can Virtual Reality Interventions Help Reduce
Prescription Opioid Drug Misuse?
Brenda K. Wiederhold, PhD, MBA, BCB, BCN,
Giuseppe Riva, PhD,
and Mark D. Wiederhold, MD, PhD, FACP
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
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 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.
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
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
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-
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.’’
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.’’
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 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
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
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.’’
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
Virtual Reality Medical Institute, Brussels, Belgium.
Interactive Media Institute, San Diego, California.
Department of Psychology, Catholic University of Milan, Italy.
Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy.
The Virtual Reality Medical Center (VRMC), San Diego, California.
CYBERPSYCHOLOGY,BEHAVIOR,AND SOCIAL NETWORKING
Volume 17, Number 6, 2014
ªMary Ann Liebert, Inc.
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.’’
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Profs. Brenda K. Wiederhold, Giuseppe Riva,
and Mark D. Wiederhold