In early August, US Health and Human Services Secretary Dr. Tom Price touted that an anti-addiction vaccine, for opioids and other drugs and substances, was under development. He called it “an incredibly exciting prospect.” Working toward fixing drug addiction has now become a pressing issue for countries internationally.
It is not such a crazy idea. Antibodies can be generated by the body’s immune system to stop addictive molecules from reaching the brain. This not only prevents intoxication or a “high” from the drug but also reduces or eliminates the craving or withdrawal symptoms associated with dependence and addiction. There are difficulties, but it has been done successfully in clinical testing with lab mice and non-human primates.
Unfortunately, it is not that exciting because:
- It is not a new idea
- It will not be available anytime soon, if ever
- There is little support from Big Pharma.
Anti-Addiction Vaccines Aren’t New
In 2009 a headline screamed, “New Vaccine May Immunize Addicts from Cocaine’s Pleasurable Effects.” And in 2011, “An Addiction Vaccine, Tantalizingly Close.” Part of the problem is that headlines are written after-the-fact by copy editors in a hurry, not the reporters, and are thus “tantalizingly” inaccurate. In eight years, anti-addiction vaccines seem little closer. That does not mean they are not still being looked at.
Since at least Dr Paul Ehrlich’s proposed “magic bullets” led to the syphilis treatment Salvarsan and Dr Jonas Salk created a polio vaccine, many people have attempted cures or vaccines for all sorts of problems, including addictions. Addiction, after all, is a disease.
Opioids are the scourge du jour, but nicotine and alcohol have longer histories of abuse, and a few decades ago cocaine was considered the top addictive drug concern.
Having the idea for a vaccine and actually creating one is not the same thing.
The Promise of Vaccines
The world has long had treatments for addiction, from inpatient substance abuse treatment centers to medication-assisted treatments (MAT) using maintenance drugs such as Methadone, Naltrexone and Suboxone. But they are expensive and often ineffective. In 1996, long before the current opioid epidemic, the United States spent almost $22bn dollars on heroin addiction treatment, according to one US National Institutes of Health study. Even so, fewer than 25% of heroin addicts on methadone maintenance remain sober, and more than half relapse after inpatient treatment ends.
The costs have only risen. Wired UK found that all illicit drug use cost the US government £291bn (almost $468bn in 2005), and the United Kingdom more than £15bn. Methadone alone costs UK £3.6bn. A vaccine could have better results and be less costly.
In 2016 the US National Institute on Drug Abuse (NIDA) funded 17 anti-addiction vaccine projects to the tune of 12.3 million. That is chump change considering the cost of drugs and drug treatments. NIDA estimates a nicotine vaccine would generate $2bn worldwide. So why is there not more money going into anti-addiction research and development?
Big Pharma Isn’t Interested
Business often piggybacks on science to help bring new cures to the public. Dr. Paul Ehrlich’s “magic bullet” treatment for syphilis would never have come to market as Salvarsan without the aid of Hoechst. Although private research groups such as The Scripps Research Institute and the Minneapolis Medical Research Foundation have been working on opioid vaccines, sometimes with government support, there has been far less support from the pharmaceutical industry in Europe and the US. Without such private industry support, it is difficult to even test the vaccines.
This is partly because Big Pharma is little interested in vaccines in general. The number of pharmaceutical companies making vaccines is declining. They are costly to produce, lawsuits are not uncommon, and most people need them only once or twice in their whole lives. Other pharmaceutical products, such as opioid painkillers and MAT (which also uses drugs), are far more lucrative.
Anti-addiction vaccine advocate and researcher Dr Kim Janda tried to market his own products at one time but used up a $60m venture capital purse without succeeding.
There are also problems with anti-addiction vaccines that may not be solved soon, if ever, especially with opioids.
In general, the European Medicines Agency (EMA) has not shown much interest in anti-addiction efforts, not even anti-abuse formulations and tech, according to Canada’s INC Research. However, in 2013, Wired UK reported that Celtic Pharma, a small biopharmaceutical company based in the UK – small pharma, not Big Pharma – had tested a cocaine vaccine on ten men who had no desire for addiction treatment. Within four minutes, half of the men felt a significant reduction in the cocaine’s effects, by up to 80%. The others experienced no significant results. The five reduced their cocaine consumption afterwards, feeling it was a waste of money.
Problems with Anti-Addiction Vaccines
Anti-addiction vaccines have been under development since at least the 1970s, and while there has been some success with nicotine, alcohol and cocaine, there has been little success with opioid anti-addiction vaccines. None of the three top opioid vaccines have even progressed to human trial, (although cocaine and nicotine have), which means they are years away from being put out on the market. Even if they do make it to market, they are not a panacea because:
- Anti-addiction vaccines do nothing about the desire for the drug, only its physical effects. Sometimes increasing the dosage restores the desired pleasurable effects.
- Opioids are not a monolith. While all opioids produce morphine-like effects, antibodies for one opioid probably would not prevent an addict from getting high on a different opioid. A heroin vaccine might also block morphine, but not oxycodone (OxyContin, Percocet), hydrocodone (Vicodin) or fentanyl.
- Frequency. Most vaccines are one-and-done, or at worst require renewal only after many years. Scripps’ heroin vaccine requires three initial doses, then must be renewed months later (although subsequent doses seem to last longer, suggesting a promising cumulative effect).
- Then there’s the problem of legitimate pain. Sometimes people need morphine or even stronger painkillers more than they need to not be addicted, such as with some cancers, terminal or otherwise. If a vaccine prevents the opioids from working, the patient may be in excruciating pain. Sometimes pain is good or necessary. It warns you not to grab a hot pot or punch a wall. Terminally ill patients don’t need to suffer pain.
Why Research Should Continue
Despite these problems, it is beneficial for research to continue into anti-addiction vaccines. While they are not perfect and trouble-free, neither is any other treatment. Substance abuse is so widespread that one must consider every option, and use every tool one has. If Big Pharma will not step up, governments may have to step in.
For instance, the US Army is working with Opiant Pharmaceuticals on an experimental heroin vaccine that also is an HIV vaccine. It is currently in rodent testing.
Other addiction treatments deserve similar deference or encouragement from governments, including research into the opioid replacement and anti-addiction properties of currently outlawed drugs such as cannabis and hallucinogens. One does not have so many alternatives that one can afford to let industry or the government ignore any of them.
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