Table 4.

Stakeholder Opinions About the Durability of a Fentanyl Vaccine and Concerns About Pain Management

Perceived Benefits of a Lifelong Vaccine (Extended Durability)

Ability to cover chronic relapsing course of addiction

I feel like if you’re also trying to prevent something like this, a life-long vaccine makes more sense because people go through different cycles of encounters with these kinds of dangers throughout their life, whether knowledgeable or not of the situation. [Community, 25, Female]

Lifetime. Once you’re an addict, you’re always an addict, so it’s like, you know, if the addiction isn’t ever going to leave you. Even if you’re in recovery you’re always going to have the work of program and recovery in order to stay in the mindset to not go back. So, you know, a vaccine that was long-term would be in the same vibration and communication of a lifetime of recovery. [Community, 55, Female]

I think that having as a lifelong vaccine would be more effective… You’ll find that people who are [using drugs] in their youth sometimes when they get into difficult situations in their later years in life tend to want to go back to getting such – to help them psychologically. [Community, 34, Male]

… because [my son] stopped taking it [Vivitrol] just a couple of months before he died. He had been on for almost four years at that point. And he said “I just don’t think I need it anymore” … because it was presented as something …, you probably won’t need this forever… instead of, … you have been an addict, and you will probably need this for your whole life… And I think that it would be the same with fentanyl. [Community, 63, Female]

Reduced risk of nonadherence to booster model and logistical challenges

Getting [the fentanyl vaccine] annually might be a bit of a deterrent from getting it, you know, people have busy live, it’s hard to get a vaccine for something you don’t even think will be a problem. A lot – most people who develop addictions to fentanyl don’t think they’re – no one plans on getting an addiction. [Community, 21, Male]

So, I feel like the one-year thing, also then you have the other issue of like encouraging other people to come back to take another, and the frequency to go back and get another shot, should that be required later on, it becomes harder and harder. [Community, 25, Female]

Yeah, I’m more on the camp of the one and done… Follow-up care is always a problem, especially if you’re talking about disadvantaged populations. They’re not even going to get their flu vaccine, you know? I see these kids every day, I see families, like are they really gonna come back and get a, a opioid vaccine every year or every two years or whatever, you know? [Community, 25, Male]

Ease of one-time payment

Economically, you know, people – especially those who like don’t have health insurance, that seems like a lot easier for them to pay for this vaccine once as opposed to have to get it annually. [Community, 21, Male]

Perceived Benefits of a Booster Vaccine (Limited Durability)

Ability to use fentanyl for future pain management

The only reason… I would be concerned if [the fentanyl vaccine was] for life is if somebody really got into an accident or they did get cancer and [fentanyl] was the only thing available to them to manage the rest of their life… I’d be concerned if it’s like a lifelong vaccine… And the other reason would be people do recover from this, and you know, maybe it doesn’t need to be lifelong… I would be a little apprehensive if it was more lifelong than if it was something that you would take a booster for or that it was yearly or something like that. [Community, Female, 56]

If [fentanyl] is used in a clinical setting, then wouldn’t it make it kind of obsolete if everyone’s vaccinated against?… My mom, her surgery they gave her fentanyl, so if everyone’s vaccinated… would they just make a more powerful opioid?… Yeah, then I don’t know if everyone should get vaccinated. [Community, 21, Female]

Flexibility in decision making

I think the booster where you get a shot every couple of years would be good. Because I think if it was for life, I don’t know if people would want to commit, some people would, but I don’t know if other people would want to commit to something so long lasting… generally speaking, [people] don’t like commitment. So, you know, so that’s why I thought the one that you might do every couple of years would be better than a lifetime one. Because you know, they don’t know “Well, how will I feel in 10 years. I might not want it then”, you know? [Community, 42, Female]

You know, you mentioned you’re making a decision of a lifetime. You know, one thing to keep in mind with this high-risk population, especially is that they live day-to-day, they live hour-by-hour. The will not – if you tell them this is forever, you’re going to have a hard time selling that. Even for them taking a Vivitrol shot for a month is sometimes hard to conceive. [Community, 56, Female]

Lack of autonomy with lifelong vaccine

There’s the [Narcan] shot and [it is] a preventive thing they put in that lasts a month. And you can’t, you can’t get high on any opiates. It’s like, one of the ingredients that’s in suboxone. And that’s that opioid blocker, is the one that they, in the shot. And I absolutely hated that 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. [Community, 24, Male]

Maybe it is better as a booster because then, if someone’s parents vaccinate them against this, then in the future they can stop because they want to. I think people should have the choice and with a lot of vaccine we don’t have the choice because we’re a baby when we get them, or like young. Maybe it would be better if they had a choice. [Community, 23, Female]

Concerns about pain

Concerns about pain management after vaccination

If I was to one day, in like, you know, had a car accident, and I was in severe, severe pain, and if they were going to give me an IV drip of an opioid and it wasn’t going to do anything for me, like it wasn’t going to relieve any pain, I would, I would second-guess about the getting vaccine. [Community, 25, Male]

A lot of my clients who do end up having any type of surgery and are offered painkillers, they don’t take them because they’re so afraid it’s going to resume their active use. [Community, 42, Female]

If I were to get the vaccine, I would really want someone to sit down with me and say if you needed surgery, this is what we would do for you. Like really just get a specific idea of like what are the alternative protocols, just because so many anesthetic protocols are dependent on fentanyl. Do we know that for sure that there are things that are effective, do we know the dosages of those things? My intuition was that I would want [the vaccine] because I want the safety that it would provide, but I would just want to make sure that if I ever needed surgery or some other treatment that I would be taken care of. [Case, 24, Nonbinary]

For an epidural… That’s like a super common procedure for laboring women, right? They all got fentanyl in epidurals, right? So, I told you before I would get this vaccine, if I couldn’t have an epidural for childbirth, I would not take the vaccine. [Control, 31, Female]

Special concerns of people with a history of pain

I have _____ [condition], which can lead to emergency surgical interventions pretty frequently. Someone with a condition like that might be a bad candidate [for the fentanyl vaccine] just because there’s someone who is going to need frequent, medical interventions where fentanyl can be useful. I think someone with a progressive pain condition… we might want to keep fentanyl open as a treatment option… I think if that person also happened to have an opioid use disorder, it [the fentanyl vaccine] would be a more complicated balancing act conversation with their physician. [Case, 24, nonbinary]

So, most people, most of my clients [who have a history of OUD] that have had surgeries, just, you know, struggle through with, like, Tylenol and things like that. Which I always think is so incredible. [Community, 42, Female]

I don’t consider myself addicted [to opioids], but I do consider myself dependent… I know I couldn’t stop my medication tomorrow; I’d have to wean off of it… So, I don’t want it [fentanyl] taken away from people, like me, who need it for chronic pain. I think it is a necessity right now because I don’t have an alternative… The medication that I take, it doesn’t take the pain away 100%, but it does take it away enough so I can function. That’s why I think [fentanyl] needs to be available. [Community, 58, Female]