- [Jes Burns] Opioid addiction is one of the most devastating health crises we face.

- You know, I come from a family of individuals who had addiction.

I got started very early.

- In high school, was on the dance team, was active in sports, got hurt and went to the doctor.

Doctor started me on opiates.

- By the time I was 19, I was homeless.

- When you have people that love you the most, you take advantage of them the most.

- I mean, when you're staying up for, like, four or five days, and you're hallucinating, and you think no one loves you and no one cares, you know, it was extremely bad.

- I feel like it stole my soul.

- It feels like you're in a box.

- It feels like despair.

- I was down to where I didn't value myself.

I didn't value life.

(soft music) - But what if there were a way to protect people struggling with addiction, a treatment that could prevent accidental overdose for months at a time, while potentially helping them break the habit?

Well, that's "All Science, No Fiction."

(pensive, hopeful music) (graphic popping) (music fades) - [Courtney Marecki] Is 10,000 my smallest?

Nope, I got a 3,000, that's what I want.

- [Jes] Making a vaccine from scratch takes planning.

- [Courtney] I need this.

I need this.

And I need buffer too.

- [Jes] It takes precision.

- It's very similar to if you're baking a cake and you accidentally substitute salt for sugar.

I will get something that resembles a vaccine, but it's not gonna work.

- [Jes] And it takes a lot of math.

- So you really have to be able to do math, not only in your planning but also on the fly.

Run through a lot of math.

If the math maths.

There's a math equation that goes into it, but I won't bore you with that.

- Please do not.

(laughs) But all the trouble is worth it for University of Washington biochemist Courtney Marecki because she's developing vaccines for opioids, like oxycodone, heroin, and fentanyl.

- I'm someone who has a family that has a history of addiction, and struggled with it in my family's life, and it's something that I don't want other people to experience.

- [Jes] And this experience is more common than you'd expect.

In a 2023 poll, nearly 30% of U.S.

adults said they, or a family member, had experienced opioid addiction.

- So if I can have a small part in making the world a better place for other people to not go through what I went through, that's my personal motivator.

(machine beeping) - [Marco Pravetoni] I never thought in the past we'd get this far.

All of a sudden, it's become, like, more real.

I mean, it becomes more, we can actually do this, we can have an impact.

(dramatic music) - [Jes] For millions of years, humans have evolved immune systems to fight off harmful invaders in the body, like bacteria and viruses.

Our bodies are very good at this.

But sometimes, they can't act fast enough.

Vaccines give our bodies a running start.

They train our immune system to recognize the invaders and make specialized antibodies that can attack much faster than your body could normally.

But opioids are a challenge.

- [Courtney] These opioids are very, very small molecules, and they enter the brain very easily because of their size.

And they enter the brain undetected by the body's immune system because they're not large enough to elicit an immune response.

- [Jes] Opioids getting through the brain's protective barrier is great for pain relief.

That's where the drugs do their work.

But it can also lead to addiction (exhale of breath) and overdose, which happens when the drug dulls your brain function so much that you stop breathing.

Tens of thousands of people in the United States die from opioid overdoses every year, mostly from fentanyl.

And Oregon and Washington rank among the highest for opioid overdoses in the country.

- The one overdose that I remember the most, and it's because I was with the mother of my first child, and I had got some heroin.

- And I remember waking up, and I was like, "Bro, where are we?"

He was like, "We're at the hospital.

You overdosed."

And I was like, "No."

- You know, they brought me back to life with Narcan.

- Paramedics standing over me, my chest hurting really bad, and feeling really confused.

Almost defensive.

'Cause to me, I don't know what happened.

- The only thing that I really cared about in that moment was getting high again.

- My addiction, for so long, was a secret.

My parents' friends didn't even know I went to prison.

Because they were embarrassed.

(soft music) - And I remember thinking, like, if there was something that I could do that could just take this away, you know, I'm ready, I wanna stop.

- Instead of getting high, I think what changed is it was kind of like, do I wanna choose life or do I wanna choose death?

- [Jes] A vaccine for opioids could make choosing life a little easier.

So how does it work?

First, Marecki had to solve the problem of opioids being too small for your immune system to recognize.

So she built a vaccine component that engages in a little biological deception.

- We mimic this opioid by making a copycat molecule called a hapten that is opioid-like in structure but not in behavior.

- [Jes] Then, they take those decoys and attach them all over the surface of a comparatively massive protein they know the immune system will see.

- That's like putting a small smiley face sticker on a stop sign.

The stop sign would be the protein.

It's something that's large enough for the immune system to recognize it and say, "Oh, I need to make an antibody."

We now have a formulated vaccine.

- And so now this is what you would be, take you to the next stage of testing?

- Yes, and our next stage of testing is, it's in vivo work.

We need to put it into a living system.

(dramatic music) - [Jes] Inside the body, the team's vaccine goes to work.

The immune system learns to recognize fentanyl as an unwelcome guest.

Then, when the actual opioid shows up, your immune system sees it and sounds the alarm.

(alarm beeping) It sends out antibodies that bind to the drug, making the fentanyl too large to squeeze through the barrier that protects the brain.

- The vaccine or the antibody are not just, like, preventing the drug to get to the brain.

Seem also to have effects on craving.

We see that, like, in animal models or even in our preliminary clinical data with oxycodone vaccine.

- [Jes] So not only would the vaccine prevent people from overdosing, it could help people reduce their dependency on the drug.

And early data suggests that the vaccine's effects may last up to a year.

What's your success rate for coming up with a successful vaccine that can go to the next stages of testing?

- My success rate, I feel... I don't know, it's kind of weird to say, (chuckles) it's been 100%.

Because on the projects that I have worked on, we have successfully been able to take one to clinical trials, and one we are preparing to go into a pilot clinical trial.

- [Jes] So far, the Pravetoni Lab has produced three different opioid vaccines that are in or ready to start human trials.

And they're tracking newly-emerging drugs as well.

- Every day is a challenge, and it's a new challenge.

Especially when you read the newspapers and you see there's a new item that has made it onto the illicit drug market.

We now have to figure out: How can we get ahead of this?

How can we mitigate the risks to this for the sake of public health?

- The hope is that all of their vaccines can provide a safety net and treatment for opioid users.

It's protection that could keep people alive.

- There's a lot of aftercare involved in treatment with addiction.

And if I knew, as a counselor, that I had a year of clarity with a client, I would consider my chances of helping that client way higher.

- I think it could help people, but I also believe in recovery in multiple pathways.

- I went to this church service and the pastor just kept talking about forgiveness.

- You know, I found my connection through culture, I found my way of healing in culture.

- We need people, you know?

We need lives.

These are our next, you know, generation.

- It could be huge.

It could be something that alters the path for so many people.

- If there was a way to reduce the opportunity for overdose, there would be more lives, there would be more people that we could serve, there would be more people that would hopefully find recovery.

(pensive music) - I myself have considered, even with how long I've been sober, taking something just as a preventative measure.

'Cause I see people who've been in recovery a long time, and things happen, and they make a decision to go back out and use.

And they die.

And the collateral damage oftentimes is the most heartbreaking.

You know, families, children they leave behind, and I've seen that happen quite a bit.

So I think it could be beneficial, and some people would do it.