There Will Never Be a (Useful) Addiction Vaccine

And here I thought all that addiction vaccine talk had been put to rest in 2009. Yet, there it was staring me in the face at the top of the on-line edition of The New York Times:

An Addiction Vaccine: Tantalizingly Close. Scientists like Dr. Kim Janda, above in his office with a model of the nicotine molecule, are at work on shots that could one day release people from the grip of drug abuse.

Actually, the article expresses more of an idea than a reality:

Imagine a vaccine against smoking: People trying to quit would light up a cigarette and feel nothing. Or a vaccine against cocaine, one that would prevent addicts from enjoying the drug’s high.

Though neither is imminent, both are on the drawing board, as are vaccines to combat other addictions. While scientists have historically focused their vaccination efforts on diseases like polio, smallpox and diphtheria — with great success — they are now at work on shots that could one day release people from the grip of substance abuse.

“We view this as an alternative or better way for some people,” said Dr. Kim D. Janda, a professor at the Scripps Research Institute who has made this his life’s work. “Just like with nicotine patches and the gum, all those things are just systems to get people off the drugs.”

Dr. Janda, a gruff-talking chemist, has been trying for more than 25 years to create such a vaccine. Like shots against disease, these vaccines would work by spurring the immune system to produce antibodies that would shut down the narcotic before it could take root in the body, or in the brain.

I had three thoughts:

Wasn’t all this squelched in 2009? Less than two years ago, in October 2009, addiction vaccines received a double-dose of bad news. Written in an article by the “Daily Finance,” “Smoking vaccine fails in clinical trial“:

(October 19, 2009) A report has been released showing that an anti-smoking vaccine has failed to reach its targets in a mid-stage study. In the year-long Phase II study, early indications showed the nicotine vaccine NIC002 couldn’t achieve a statistically significant improvement in continuous abstinence from smoking in weeks 8 to 12 after the start of treatment, compared to a placebo.

But the smoking vaccine thing was small potatoes (not really, when figured dollar-for-dollar in potential earnings) when a vaunted cocaine vaccine initiative went down in flames, as was reported by the “New York Daily News:”

(October 7, 2009) Battling cocaine addiction turns out to be tougher than researchers first thought. A widely reported experimental vaccine used to counteract coke addiction showed strong results — at least initially. But, as the medical news syndicate HealthDay now reports, it lost its effectiveness after a few months.

The vaccine works by increasing antibodies that bind to the drug, halting the high. Researchers tested the vaccine on 94 adults, selected from methadone maintenance programs. The subjects also received behavioral therapy. Thirty-eight percent of the study’s participants developed enough antibodies to curb their cocaine use. But after two months, the effects tapered off, reports Healthday.

 

Who believes this will succeed? The Times has regularly endorsed the biological model of addiction. The Times position on addiction makes clear how much the idea that addiction is a disease we will cure is a liberal chimera that may itself never be overcome.

As to who profits from such vaccines, well, who has sold the idea that people can’t quit smoking on their own, so that they must rely on nicotine patches, gums and other pharmaceutical aids? In the case of the anti-nicotine vaccination, you can see in this quote from the “Daily Finance” the persistence and motivation to find a workable vaccine:

Novartis (NVS), which bought the rights to the nicotine addiction vaccine from Swiss start-up Cytos Biotechnology in April 2007, will stay on-board for the duration of the trial, though the drug now seems unlikely to reach the market. Not only is the study result a blow to smokers hoping to quit; it’s also a blow to Cytos, which saw its shares slammed in the Swiss market on Friday.

Cytos is now unlikely to get its milestone payment from Novartis, leaving it to fend for itself. However, Cytos CEO Wolfgang Renner assured DailyFinance in an emailed statement that “The financing of our operations in the next two years are secured and are not affected by the latest results. So there are no immediate consequences from the newest result.”

Who can believe this will work? An antibody is a chemical created naturally by the immune system when an antigen (harmful substance) assails the body. When the antigen is a pathogen (infectious agent, or germ), as with tuberculosis or pneumonia or smallpox, the creation of a vaccine is relatively (not quite) straightforward. You identify a long-lived antibody to the pathogen and introduce it into the body.

But think of how much more difficult this process is when the so-called antigen (“so-called” because people generally don’t welcome or seek out pathogens, but they do cigarettes and cocaine) acts by stimulating neurochemicals — a much more diffuse process. First, the vaccine must act chemically to block the effects of the drug — a tricky process. Then, the brain must interpret the rewards from the neurochemical stimulus to be insufficiently similar to what they were previously. And, finally the user must reject the entire drug-use ritual (e.g., smoking a cigarette, snorting, smoking or injecting cocaine).

Consider the disappointing conclusion from the clinical trial of the cocaine vaccine reported in theArchives of General Psychiatry in October 2009: “Attaining high anti-cocaine antibody levels was associated with significantly reduced cocaine use, but only 38 percent of the vaccinated attained these levels and they had only two months of adequate cocaine blockade.” So, only a minority of recipients of the vaccine were chemically impacted as intended, and they on average achieved “significantly reduced cocaine use” (which is a far cry from elimination of a pathogen) that lasted only a brief period.

The (relative) disappearance of the urge to use cocaine may be short-lived only partly because of the disappearance of the cocaine antibody. There are three other factors (in addition to the chemical, brain-biological and ritual factors noted above) that work incessantly against an effective drug addiction vaccine: experiential, situational and life. Experiential means the addicts want that — or a similar — drug experience, but no one wants polio or tuberculosis.

Put simply, won’t those used to getting high on cocaine simply reject the vaccine in favor of the experience? In the cocaine trial, subjects received five vaccinations over 12 weeks with the irregular and receding benefits noted. What’s going to make addicts come off the street so regularly to have their highs blown away (if the vaccine even accomplishes that for them)? And, why won’t those who can’t get high on cocaine simply turn to another substance?

I believe they will. Consider the subjects in the cocaine vaccine trial — 115 methadone maintained subjects of whom about a fifth (18 percent) dropped out during this 12-week trial. “Most smoked crack cocaine along with using marijuana (18 percent), alcohol (10 percent) and non-prescription opioids (44 percent).” Obviously some could be using more than one additional substance, but it seems that between half and three-quarters of these selected subjects are already — while addicted to cocaine — using other substances. (Note, this has nothing to do with the particular vaccine or research trial — multi-drug use by addicts is a fact of street life.)

Situational means they’re going to hang out with people in places where they are accustomed to using these substances. Of course, we can tell them — help them — to stop hanging around with these people in these places. But that’s going to require that they build a new set of satisfactions to replace these familiar, accustomed, attainable ones — an elaborate, difficult life enterprise that no vaccine will ever accomplish. But, sigh, we can always dream.