(82) Augmented Reality Technology Engages Opioid Use Disorder Patients in Their Treatment

Background & Introduction: In the past two decades, the United States (U.S.) age-adjusted mortality rate for opioid overdose among American Indian and Alaska Native (AI/AN) people increased six-fold. In 2023, the rate among AI/AN residents of Alaska was four times the U.S. national average (1, 2). Federal Drug Administration-approved Medications for Addiction Treatment (MAT) has been shown to reduce return to use and overdose death, but 6-month treatment retention rates on MAT are as low as 39%. Early engagement in treatment has been shown to increase the odds of 6-month retention by almost 21 times (3).

New ways of engaging individuals in their treatment are needed to inform decisions and prevent drop-out and return to illicit substance use. Utilization of extended reality technology, such as the Microsoft Hololens2 headset, has been shown to increase engagement, learning, and information retention in other fields (4), but to our knowledge, has never been utilized within Substance Use Disorder (SUD) treatment. This pilot trialed the acceptability and effectiveness of an informational, augmented reality (AR) application (app) for Hololens2 among AI/AN individuals diagnosed with Opioid Use Disorder (OUD) seeking treatment within an outpatient Tribal Health Organization (THO)-run MAT program in Alaska.

Methods: The Hololens2 AR Opioids and the Brain app addresses how opioid use affects the brain using holographic models of the brain and various scenarios to teach these concepts. The graphic user interface was developed by the Alaska Native Epidemiology Center and the Behavioral Health team of the Alaska Native Tribal Health Consortium (ANTHC), who specifically included AI/AN cultural elements to further engage the individual with the content utilizing familiar contexts. This included utilizing both common indigenous environmental aspects (fire, wind, animals such as bear and salmon) and cultural aspects (Native families doing traditional activities, content also offered in the Yupik language).

During a two-year time period from 5/5/22-5/5/24, all AI/AN OUD patients presenting to our outpatient MAT program were included in this pilot project and viewed the roughly 15-minute Hololens2 AR Opioids and the Brain app content. A total of 73 individuals participated in the pilot and subsequently completed a customized 7-question survey immediately afterward. After the two-year pilot period ended, the de-identified surveys were provided to the ANTHC Behavioral Health team for analysis, with the results approved to be released by the participating THO.

Results: All 73 participants completed the post-use survey. Individual questions that were left blank were not included in the total. With regard to the acceptability of the technology, 89% of participants ranked the Hololens2 AR tool as either neutral, easy, or very easy to use, as opposed to 10% that felt that the technology was hard, and 1% that felt that it was very hard. 75% of participants preferred the Hololens2 AR tool as their way of learning the information, as compared to the information being verbally explained (0%), in written form (1%), via video (14%), or “don’t know” (10%). With regard to the effectiveness of the Hololens2 AR technology, roughly 92% of participants felt that their understanding of their addiction improved either a little (35%) or a lot (57%) whereas only 4% felt that their level of understanding was unchanged, with another 4% responding as “don’t know.” Around 92% of participants responded as “yes” to the question of “Do you feel it was worth your time to view the presentations?” with another 4% answering “no,” and 4% answering “don’t know.” 81% of participants were interested in viewing other addiction-related subjects in the Hololens2 AR format, with another 19% stating they had no future interest or didn’t know. Open-ended questions about what participants liked the most about the Hololens2 AR tool included the graphics, learning about how opioids affect the brain, and the interactive nature of the tool. Dislikes mostly centered on various challenges with initially utilizing the technology.

Conclusion & Discussion: Our pilot project found that the Hololens2 AR device, with its Opioids and the Brain app content, was generally well-accepted, enhanced understanding of addiction, perceived to be worthwhile by the participants, and was the preferred method of learning for most individuals, with four out of five participants voicing interest in viewing other addiction modules with the same technology. Utilizing innovative extended reality technologies to better engage OUD patients in their treatment may be one strategy for retaining individuals in treatment and combatting the rising opioid epidemic in our country. Including cultural elements in programming for the highest risk AI/AN population may also help to make the content feel more familiar and welcoming. Limitations of this pilot project include a lack of control for individual variances that may have affected response to the technology and that participation was limited to the AI/AN population being served at our Alaska-based treatment facility. Next steps for future studies may include evaluating treatment retention rates with varying degrees of extended reality technology utilization.

References: 1) Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 1999-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at https://wonder.cdc.gov/mcd-icd10.html on Sep 19, 2024.

2) Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Provisional Mortality on CDC WONDER Online Database. Data are from the final Multiple Cause of Death Files, 2018-2022, and from provisional data for years 2023-2024, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at https://wonder.cdc.gov/mcd-icd10-provisional.html on Sep 19, 2024.

3) Williams AR, Mauro CM, Feng T, Wilson A, Cruz A, Olfson M, Crystal S, Samples H, Chiodo L. Performance Measurement for Opioid Use Disorder Medication Treatment and Care Retention. Am J Psychiatry. 2023 Jun 1;180(6):454-457. doi: 10.1176/appi.ajp.20220456. Epub 2022 Oct 26. PMID: 36285405; PMCID: PMC10130230.

4) Curran VR, Xu X, Aydin MY, Meruvia-Pastor O. (2022). Use of Extended Reality in Medical Education: An Integrative Review. Med Sci Educ. Dec 19;33(1):275-286. doi: 10.1007/s40670-022-01698-4. PMID: 36569366; PMCID: PMC9761044.