Table 3.

Stakeholder’s Questions, Confusion, and Perceived Harms of a Fentanyl Vaccine

Perceived Harms of Using a Fentanyl Vaccine

Concern for stigma, and denial of problem as barriers

…there could be certain stigma like, people… thinking, oh, you were a drug addict, and you’re an opioid addict stuff like that. … When they check your [medical] record, then they see you’ve taken the vaccine, they may not really recommend certain treatment for you, because you’ve taken the vaccine. [Community, 25, Male]

I feel like if someone were to come in and I saw they had a fentanyl vaccine, there would be a – stigma put on them… If [a doctor] saw I had, like, a fentanyl vaccine, or I had an opioid vaccine, it might be like “oh I wonder if he has any history with this” or “I wonder if he struggles with this – and that’s why he got it”… because [a fentanyl vaccine] it’s not commonplace… people might put a stigma on it ‘cause they don’t know much about it. [Case, 25, Male]

[The fentanyl vaccine] might look bad to certain people. But I think it’s a good precaution to take… I think where there’s like a job that they are interviewing for and they saw that they took [the fentanyl vaccine], [the employer] might not trust them as much, or they might think of them in a different way. I think it should be made sure that people can’t judge based on that. [Community, 15, Female]

I think… it’s going to take some convincing for people to actually accept [a fentanyl vaccine]. And I think part of that has to with… being stigmatized and marginalized… I think people will be very resistant to [a fentanyl vaccine] like almost in denial in some instances like, oh, well I don’t, it’s not that bad of a problem or my kid with be fine or whatever it is. [Community, 29, Female]

I’m sure plenty of teenagers or college students who do drugs do not tell their parents they do drugs. So, I guess I’m worried about like, stigma from people being like, “well, my kid will never use drugs, so why would I get [the vaccine] for them”. [Community, 26, Female]

Controversy

I think we’re—I think it’s a tough environment right now to introduce a vaccine into—that could be, that could be controversial, given how scientists have for a long time struggled to control the vaccination-related narrative. I worry that, you know, just like how many scientific advances have been sort of … stopped by botched narratives, I think that there’s gonna be… some serious challenges with say, like ‘cause America gives outstretched voices to those who don’t, who are ignorant, as sad as that is. And so, … I actually worry about the vaccine for some reason, getting, that narrative going in such a wrong direction that actually hurts the progress that has already been made in raising awareness of the issue and treating opioid usage. And I just feel like if it goes poorly, it could actually hurt the rest of the field of opioid studies. [Community, 25, Male]

Vaccination creating a false sense of security

[People who are getting this vaccine] should know that this isn’t just like a guaranteed protection from using recreational – drugs recreationally… people might just hear about it and be like “This will keep me safe from all the chemicals that they’re adding to street drugs. I won’t have to worry about whether it’s authentic or not”. [Case, 18, Female]

Let’s say this vaccine comes out, one thing that would worry me is, people that do use drugs recreationally will be like, “Oh, if I take this vaccine, I’ll be safe. I can buy street drugs I won’t have to worry about fentanyl.” [Case, 18, Female]

Potential for increase of drug use and exposure to other toxins

If the person whoever is using and gets this vaccine, they go to use again and they can’t get high, at what point are they going to stop? Are there any adverse effects when taking those drugs due to the vaccine or are they just injecting themselves in hopes to get high? What other toxins would be in this drug that they may be ingesting, injecting, or whatever and, you know, if they’re trying to get high, you know, maybe they’re just going to keep dosing until they feel something. [Community, 28, Male]

I think people would start being careless [if they got the fentanyl vaccine]. It’s a possibility, they think they won’t die from it, but morphine and heroin still cause overdoses. And they still are deadly. Not as deadly, but still, deadly is deadly. [Case, 15, Male]

Loss of autonomy and pleasure through vaccination

Well, I think that for people who were fentanyl addicts, and they take the vaccine, the fact that they’re not able to get high anymore might make them really upset or very depressed… So, I feel like if you take that away for some people it could like really like mentally hurt them. Because honestly, me thinking about me never doing fentanyl again, it’s kind of sad to me, even though I want to get clean, because it’s so satisfying and like amazing to me. Like, I feel like it’s just disappointing, like really sad… I feel like [never using fentanyl again] would make me really kind of upset that I could never get high like that anymore and feel that joy and that feeling ever again. [Case, 17, Female]

I absolutely hated [suboxone] even though I was clean. And I wanted to remain clean. There was some psychological that I really didn’t like that I never, I didn’t have the choice to be clean or not. It was just taken off the table. It’s almost like… I don’t know… it’s somehow related to not being able to, like, kill yourself, basically. Like, you have that option, you always like kinda have that option, even though you know that you’re never going to do it. And then when someone takes that option away from you. I don’t know, there’s something about that option that I really did not like. [Case, 24, Male]

Questions, confusion, and misconceptions about a fentanyl vaccine

Concerns about the development of new synthetic opioids

If [fentanyl] is used in a clinical setting, then wouldn’t it make it kind of obsolete if everyone’s vaccinated against it?… so, if everyone’s vaccinated, oh, then it – yeah, then would they just make a more powerful opioid? [Community, 24, Female]

How long before some drug manufacturer changes their chemical composition of fentanyl, just by a little bit, and then all of a sudden, your antibody doesn’t work anymore because antibodies are kind of niche? [Community, 17, Male]

Opioids are always gonna be around, people are always gonna use them…will this encourage the production of like more powerful drugs, because then like everyone’s vaccinated against one of the most powerful ones. [Community, 21, Female]

Questions about how the vaccine would work in the body

So, when you say that it gets too large to enter the brain, I am just unsure how it leaves the system. Like, does it then just leave the system, or does it continue to build up in the body? Just, if not, it sounds like damage to the brain. [Community, 22, Female]

The first thing I would ask is how it works. Like does it work like a flu vaccine where you’re injected with a tiny amount of drug and your body becomes used to it? [Case, 22, Male]

I guess, I’m curious how it affects people who are already using drugs more maybe, but hopefully, if someone was not or not as often, maybe it would stop someone from developing a more severe addiction as well. [Community, 26, Female]

How is this vaccine aimed to work? I mean, I guess I’m kinda confused… I just don’t understand how a vaccination for something like fentanyl would work… because fentanyl’s not a disease. You know what I mean? It’s a medication that’s given… The use of fentanyl, or the use of alcohol, or the use of a barbiturate… somewhere in there is a conscious choice that they should take it and a conscious choice by a doctor that they should prescribe it, so I, I mean it’s not the chicken pox… are you aiming to create a vaccination that eradicates any type of addiction? [Community, 30, Female]

I honestly didn’t think that you could make a vaccine for anything that’s not like a virus, just anything not living. So I think it’s kind of incredible that this is even a possibility. [Community, 19, Female]

Questions about circumstance for use and eligibility criteria

[Asked who should get the vaccine] Who do you identify? Do you identify just IV drug users, but then fentanyl can be given several different ways? You can smoke it. You can snort it. Now it’s compounded and taken as a pill… Is [a fentanyl vaccine given to] the addict that overdoses one time, two times, three times? I don’t know. [Community, 62, Female]

Would there be some sort of benefit that if the majority or all of a population were to receive the vaccine, or would it really just be helpful to those who are, I don’t know, at higher risk for being exposed to these drugs and experiencing something negative from these drugs? [Community, 21, Male]

How would people be recruited for the vaccine… who would it be targeted for? Are you going to NA groups and like shopping around this vaccine, or are you going to transitional housing programs or [emergency rooms] things like that? I just think it’s hard with a vaccine for people who don’t have a lot of interaction with the healthcare system in preventative ways… If you’re actively using, I don’t think your first priority is to go to your PCP every year… So, how would this be implemented? [Community, 21, Female]

Confusion between protection and rescue intervention

So, you would take the vaccine. This would be like some syringe that you buy to have ready at hand after you take an opioid recreationally, or this is like a vaccine that many people would get at some, I don’t know, proactive or preemptive date. And then it would prevent overdoses in the future. [Community, 21, Male]

Correct me if I misunderstand how this would work, but it seems to me like one of the biggest advantages of a vaccine is (A) in theory, and I don’t know how the science is gonna play out, but I think you’d only have to get it once and (B) I would think that you’d be able to get that vaccine, you know, five minutes after ingesting an opiate, or ingesting fentanyl, because I would, I would assume that, I’d assume that if all its doing is negating your body’s ability to get that into the receptors, I would think that it would be safe to use it… [Case, 23, Male]

Misconceptions that vaccine blocks withdrawal, blocks addiction

I think it would help people that if doctors prescribe them medications, and they have withdrawal from it. But they wouldn’t have them because they’d have the vaccine. [Community, 16, Female]

I think you got a good market for that, the fentanyl vaccine. So, you know, the pain doctors who prescribe it and keep prescribing it could then say, okay, if you want to get off, there’s a vaccine, you know, so they can sell it in one package. You know, like right now you got a sore leg, you can have a pain relief, and then here’s a prevention so that you won’t get addicted to it or have that mental addiction to it. And so there you go. [Community, 58, Female]

It can just stop people from being addicts because if they tried to, if they tried to [pause] get high, they can’t unless they want to do it for no reason basically. [Case, 17, Female]

Yeah, like I said, it’s [the vaccine is] going to help in reducing drug addiction, drug use, and yeah, probably drug effects. [Community, 35, Male]