169 - Acceptability of a Fentanyl Vaccine to Protect Against Overdose for Adolescents and Young Adults

Publication Number: 1158.169

Elissa R. Weitzman, Boston Children's Hospital, and Harvard Medical School, Brookline, MA, United States; Sydney Pierce, Boston Children's Hospital, Somerville, MA, United States; Ofer Levy, Precision Vaccines Program, Boston Children's Hospital, Boston, MA, United States; David Dowling, Boston Children's Hospital, Boston, MA, United States; Sharon Levy, Boston Children's Hospital, Boston, MA, United States

Background: Synthetic opioids, primarily fentanyl, are the most common drugs involved in overdose deaths, which have increased disproportionately among adolescents/young adults (AYA), with a near doubling of deaths involving fentanyl. Overdose-protecting vaccines targeting fentanyl are in preclinical development. If successful, a fentanyl vaccine would induce anti-fentanyl antibodies to specifically and selectively bind fentanyl (not other opioids) in the blood, preventing fentanyl from crossing into the brain and reaching the central nervous system where it can cause lethal respiratory suppression, i.e., overdose.

Objective: To investigate attitudes and beliefs regarding use of a fentanyl vaccine to protect AYA from overdose and strategies for implementation.

Design/Methods: Qualitative interviews conducted with a heterogeneous sample of AYA and adults recruited from an adolescent substance use clinic and public outreach, parents/guardians of AYA, healthcare professionals, and the public. Topics included knowledge, attitudes and beliefs related to use of a fentanyl vaccine to protect AYA from overdose. Interviews were audio-recorded, transcribed and analyzed for major and minor themes by two independent coders under a consensus driven process.

Results: Of 74 participants (66% female, mean age 32y (range 15–66 years)), 23% reported exposure to prescribed opioids for a medical procedure or injury, and 50% had a personal or family history of opioid use disorder or overdose. Attitudes were favorable regarding vaccination. Factors that shaped attitudes included: (1) behavioral and life course risks of AYA, including patterns of instrumental and escalating substance use, exposure to contaminated drugs/prescribed opioids for medical procedures, peer influence and low risk perception, (2) characteristics of target populations, including severity of youth substance use behaviors, family history of substance use disorder, and (3) implementation strategies, specifically questions regarding universal versus targeted vaccine promotion, parent/child consent requirements, settings for delivery, and spokespersons for vaccine promotion.

Conclusion(s): Among a diverse sample of participants selecting into research from clinical and community settings, attitudes toward use of a fentanyl vaccine to protect AYA from overdose were favorable. Implementation strategies for a future fentanyl vaccine will need to address issues specific to tailoring, targeting, and implementation to address beliefs about AYA substance use risk, questions regarding appropriate sub-populations for vaccination, and strategies for vaccine delivery and promotion.