Acceptability and Perceived Utility of Virtual Reality Among People Who Are Incarcerated Who Use Drugs.

People who are incarcerated are at heightened risk of overdose upon community reentry. Virtual reality (VR) may provide an innovative tool for overdose prevention intervention in corrections facilities. This mixed methods study sought to understand incarcerated individuals' perspectives on VR for overdose prevention and explore physiological arousal associated with use of VR equipment. Study participants were 20 individuals, stratified by gender, with an opioid use disorder at a county jail. Qualitative interviews assessed acceptability and perceived utility of VR in the jail setting. Thematic analysis indicated high levels of acceptability and potential utility in the following areas: (a) mental health and substance use interventions, (b) community reentry skills training, and (c) communication and conflict resolution skills. Heart rate variability (HRV) data were collected continuously during the interview and during VR exposure to explore whether exposure to the VR environment provoked arousal. Physiological data analyses showed a significant decrease in heart rate (HR) [ b  = -3.14, t (18) = -3.85, p  < .01] and no arousal as measured by root mean square of successive RR interval differences (RMSSD) [ b  = -0.06, t (18) = -1.06, p  = .30] and high frequency-HRV (HF-HRV) [ b  = -0.21, t (18) = -1.71, p  = .10]. This study demonstrated high acceptability and decreased HR response of VR among incarcerated people who use drugs.