In addressing the opioid crisis, a team at Penn is piloting a new solution: virtual reality.

The FDA-approved nasal spray, Narcan, can reverse the effects of an opioid overdose—real or suspected—in fewer than five minutes. It’s available without a prescription, carried by most major pharmacy chains, and covered by many different types of insurance. In theory, it’s available to just about anyone. The problem, however, is that most people don’t know about it or, if they do, they’re unfamiliar with how to use it or what to do after it’s administered.

Researchers from Penn’s School of Nursing and Annenberg School for Communication want to change that with a seven-minute virtual reality Narcan training session they created. A recent pilot study showed it’s as effective as in-person simulation training for health care providers. And in the future, a shorter version geared toward a more general audience could become accessible using only a cell phone and an inexpensive viewer like Google Cardboard.

“This all started with the idea of offering a robust and realistic training exercise in how and when to administer Narcan and what happens after,” says Nicholas Giordano, who earned his doctoral degree in 2018 from Penn Nursing, and who has since been working on similar trainings with Ann Marie Hoyt-Brennan, director of the School’s Helene Fuld Pavilion for Innovative Learning and Simulation.

Though the School of Nursing had recently incorporated Narcan simulation training into its curriculum, Hoyt-Brennan knew from the get-go such an approach with the larger Penn community would require intensive resources, not only people to run the center but also actors to participate in the simulations. More importantly, it would only cater to those who sought out this type of information, not everyone who might need it.

“We wanted to offer the training and disseminate it via the web, but we still wanted it to be as immersive as possible,” Hoyt-Brennan says. “We also wanted something that would be easily accessible to the larger community.” A colleague and member of the three-year-old Penn Working Group on Virtual Reality suggested to Hoyt-Brennan that virtual reality might be just the innovative approach they were seeking.

Kyle Cassidy, the Working Group’s founder and a digital-design specialist at Annenberg, made the pitch to Hoyt-Brennan’s team, which included Giordano and doctoral students Clare Whitney and Sydney Axson. “They had been doing high-fidelity simulations to train on Narcan. It’s the most effective way to train people in using this particular drug,” Cassidy explains. “I thought that was a perfect opportunity to try an immersive video experience, where you could then send the video to the trainee, rather than having the trainee come to the experience.”

Cassidy’s passion for virtual reality is contagious. He sees its potential in wide-ranging fields, from virtual conference attendance to health care trainings. When he first began the Working Group, he says, “we were a bunch of IT professionals who would rove door to door trying to push this emerging technology.” But Hoyt-Brennan and her colleagues saw its potential immediately.

Using funding awarded to Whitney and Axson from the Alex & Rita Hillman Foundation, they decided to conduct a pilot study in Hoyt-Brennan’s senior-level course, Nursing in the Community. A randomly selected three-quarters of the 79 students would receive training as usual through the Helene Fuld Pavilion at the School of Nursing; the other quarter would use the new virtual-reality immersive experience that Cassidy created, accompanied by in-person conversations with Hoyt-Brennan. Before-and-after questionnaires measured participants’ attitudes toward and knowledge about intervening in the face of an opioid overdose.

Preliminary results confirmed what the researchers had hypothesized.

“This is hot off the presses: Our virtual-reality students performed just as well as their peers who participated in an in-person simulation,” Giordano says. “That’s exciting, and it gives us a lot of energy to think about what’s next,” something in which Natalie Herbert, a doctoral candidate at Annenberg, will play a role.

Herbert specializes in health communication. She joined the project as the team was collecting data from the pilot, so she didn’t help with the initial script geared toward nursing students. But she is helping shape a new, broader script and to expand the overall campaign.

From her perspective, virtual reality can remove some of the barriers—physical, mental, or otherwise—that might prevent someone from getting trained on using a tool like Narcan. “People have different attitudes toward opioid overdose. A lot of us are fatalistic in the face of an overdose,” she says. “I’m thinking about how we can we tailor these messages based on individual differences, how we can make the training in plain language, and make sure the virtual environment can really complement the environment in which individuals are learning.”

It’s a tricky balance, and one that the team is still working out. In the near-term, now that the researchers have data proving the effectiveness of the virtual-reality methodology, they are beginning to think about partnership opportunities such as with Penn’s School of Dental Medicine, which recently mandated Narcan training for its students, and other health schools at the University.

That’s because the reality of the situation, in the eyes of Hoyt-Brennan, Cassidy, and the others, is that everyone should be educated and trained on this life-saving drug.

Narcan, or naloxone, the generic version of the drug, “is being placed in people’s hands without a lot of context in how to use it and what to do after you revive somebody,” Giordano says. “One simulation center alone isn’t going to crack this issue. All health disciplines working together, talking through this with innovative ideas, is the only way to address this public-health priority.”