Need for strategic communications and stakeholder engagement to advance acceptability of an overdose preventing vaccine targeting fentanyl.

BACKGROUND: Fentanyl is a synthetic opioid, exposure to which has led to hundreds of thousands of overdose deaths. Novel vaccines are being developed that might protect against fentanyl overdose. Proactive attention to strategic communications and stakeholder engagement may smooth uptake of a novel vaccine given known challenges around vaccine hesitancy and concern for stigma related to substance use. METHODS: Qualitative interviews (N = 74) with a purposive sample of adolescents/young adults with opioid use disorder (OUD), family members of persons with OUD, experts in substance use treatment and harm reduction, and community members were conducted and thematically analyzed to discern attitudes toward a fentanyl vaccine, and directions for communications and engagement. RESULTS: Major themes reflected personal concerns for biomedical risk and system-level concerns for alignment and integration of an overdose preventing vaccine with prevailing beliefs about addiction and associated frameworks and philosophies for treatment and response. CONCLUSION: Acceptability and implementation of a novel fentanyl vaccine targeting overdose will need precision communications that address biomedical, moral/spiritual, and structural perspectives about the nature of addiction. Education about the purpose and limits of a fentanyl vaccine, partnerships with diverse stakeholders from throughout the opioid response ecosystem and interweaving of a vaccine strategy into comprehensive prevention and treatment are recommended.

Returning Genetic Information About Risk for Alcohol Use Disorder to Adolescents: Findings of a Preliminary Qualitative Study of Precision Prevention.

Introduction: Alcohol use disorders are heritable, with genetic factors predicting approximately 50% of the risk. Returning information about genetic risk could promote avoidance of alcohol, reducing alcohol use disorder risk. This study explored attitudes toward a precision prevention model of alcohol use disorder targeting adolescents. Methods: This study conducted interviews with adolescents and adults to explore attitudes about precision prevention of alcohol use disorders. Interviews were recorded, transcribed, and thematically analyzed to identify perceptions about acceptability, salience, potential harms, and benefits. Results: Among N=13 participants (mean age 28.6 years, 7 female), 5 had undergone genetic testing, and 6 had a personal or family history of substance use disorder. Attitudes were favorable toward precision prevention of alcohol use disorders for adolescents. Perceived benefits included the potential to engage youth, motivate behavior change, protect family by sharing genetic information, and prompt insight into family problems. Perceived harms included the potential for anxiety, false sense of immunity from alcohol use disorders should genetic testing indicate no heightened risk, and experience of stigma from disclosure or breach of privacy. Conclusions: This qualitative study identified the potential harms and benefits of a precision prevention approach for addressing alcohol use disorder risk targeting adolescents, along with appreciation for the complexities of the model. Research is needed to elucidate operational, ethical, and communication strategies to advance the model.