Contents lists available at ScienceDirect Drug and Alcohol Dependence journal homepage: www.elsevier.com/locate/drugalcdep Full length article Leveraging immersive technology to expand access to opioid overdose reversal training in community settings: Results from a randomized controlled equivalence trial Natalie Herbert a , Sydney Axson b , Leeann Siegel c , Kyle Cassidy c , Ann Marie Hoyt-Brennan b , Clare Whitney b , Allison Herens d , Nicholas A. Giordano e, * a Woods Institute for the Environment, Stanford University, 473 Via Ortega, Stanford, CA, USA b School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, USA c Annenberg School for Communication, University of Pennsylvania, 620 Walnut Street, Philadelphia, PA, USA d Division of Substance Use Prevention and Harm Reduction, Philadelphia Department of Public Health, 1101 Market Street, 13th Floor, Suite 1320, Philadelphia PA, USA e Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, USA ARTICLE INFO Keywords: Opioid Naloxone Harm reduction Equivalence trial Virtual reality ABSTRACT Background: Immersive video (e.g. virtual reality) poses a promising and engaging alternative to standard in- person trainings and can potentially increase access to evidence-based opioid overdose prevention programs (OOPPs). Therefore, the objective of this equivalence study was to test whether the immersive video OOPP was equivalent to a standard in-person OOPP for changes in opioid overdose knowledge and attitudes. Methods: A team of nurses and communication researchers developed a 9-minute immersive video OOPP. To test whether this immersive video OOPP (treatment) demonstrated equivalent gains in opioid overdose response knowledge and attitudes as in-person OOPPs (standard of care control), researchers deployed a two-day field experiment in Philadelphia, Pennsylvania, USA. In this equivalence trial, 9 libraries were randomly assigned to offer treatment or control OOPP to community members attending naloxone giveaway events. In this equiva- lence design, a difference between treatment and control groups pre- to post-training scores within -1.0 to 1.0 supports equivalence between the trainings. Results: Results demonstrate participants (N = 94) exposed to the immersive video OOPP had equivalent im- provements on posttest knowledge (β=-0.18, p = .61) and more favorable attitudes about responding to an opioid overdose (β=0.26, p = .02) than those exposed to the standard OOPP. However, these minor differences in knowledge and attitudes were within the equivalence interval indicating that the immersive video OOPP remained equivalently effective for community members. Conclusions: Community partnerships, like those between public health departments and libraries, can provide opportunities for deploying novel immersive video OOPP that, alongside standard offerings, can strengthen community response to the opioid crisis. 1. Introduction Since 2000, the United States has experienced a 200 % increase in the rates of deaths by overdose that involve opioids, including opioid pain relievers and heroin (Centers for Disease Control and Prevention, 2016). In response to this unprecedented number of deaths by opioid overdose, the state of Pennsylvania, along with more than 40 other states in the nation, have enacted standing orders of naloxone (in- cluding intranasal naloxone, Narcan®), a fast-acting opiate antagonist. This means that naloxone, which has been shown to prevent death by reversing opioid overdoses (Connors and Nelson, 2016), is available for anyone, without a prescription from their pharmacy. Standing orders and other programs to increase access to naloxone assume that moti- vated individuals will regularly carry naloxone and be prepared to re- spond to an opioid overdose after receiving training from a pharmacist, public health expert, or even an online source (“Naloxone Prescription for Overdose Prevention, 002–2018 Standing Order DOH 1”, 2019). Thus, ensuring access to evidence-based training on naloxone admin- istration and opioid overdose response is an important harm reduction intervention in the fight to reduce deaths by opioid overdose. https://doi.org/10.1016/j.drugalcdep.2020.108160 Received 5 February 2020; Received in revised form 23 June 2020; Accepted 23 June 2020 ⁎ Corresponding author. E-mail address: ngiorda@emory.edu (N.A. Giordano). Drug and Alcohol Dependence 214 (2020) 108160 Available online 02 July 2020 0376-8716/ © 2020 Elsevier B.V. All rights reserved. T