Figure 1.

Adjuvanted fentanyl vaccine to prevent opioid overdose. A, Fentanyl activates reward circuit signaling, contributing to opioid use disorder (OUD) and overdose risk via lethal respiratory suppression. B, Vaccination using fentanyl (a hapten) chemically linked to a carrier protein (eg, CRM-194). Adjuvants enhance vaccine immunogenicity, via enhancing the quality and quantity of antigen presenting cell maturation and costimulation, T helper-polarizing cytokine production and antibody production, resulting in broad and durable immunity against fentanyl. C, Antibodies prevent fentanyl from crossing the blood brain barrier, binding to opioid receptors, and activating reward circuit signaling processing and risk of lethal respiratory suppression. (Illustration adapted from Banks et al 2020 [15]).