Could Anti-Drug Vaccine Fight Addiction?

Aug. 19, 2004 -- A vaccine against highly addictive drugs could be offered to high-risk children in the United Kingdom, if a group of British experts has its way.

A government-appointed committee has proposed a national vaccination program for one of the fastest-growing child welfare concerns worldwide — drugs.

Under a program presented to British Parliament late last month, children in "high risk situations"— those whose family or socio-economic circumstances might make them more susceptible to drug addictions — would be vaccinated against highly addictive substances like cocaine, heroin and nicotine.

The rationale behind the proposal is simple — drugs and drug-related activities cost the government money, lots of it. So why not prevent addiction in the first place? If successful, claims the committee, it could save the economy billions of dollars each year.

"People could be vaccinated against drugs at birth as you are against measles," David Nutt, a member of the Brain Science, Addiction, and Drugs Committee, and drugs advisor to the British government, said in a published report. "You could say cocaine is more dangerous than measles, for example … addiction and smoking are major causes of premature death."

The vaccines would work like most other inoculations. Antibodies that recognize cocaine as an intruder are injected into the bloodstream. Once the antibodies have been introduced, they attach themselves to the cocaine molecules, preventing and "neutralizing" the effect of the drug. So, if a person vaccinated with the antibodies does take the drug, their body will not respond and they will not feel a "high."

'A National Program to Alter Behavior?'

Even in its very preliminary stages, the proposal has sparked controversy on both sides of the Atlantic.

"The very idea [of child drug vaccinations] would be highly unethical. We have a lot of information missing, particularly safety risks," says Dr. Max Mehlman, a law and biomedical ethics professor at Case Western Reserve University, in Cleveland.

"How are we going to know if it's safe?" he continues. "How will we even know if it's working? Are we going to give [children] cocaine [to test the safety or effectiveness]? It's absurd."

Agreeing with Mehlman is Dr. Mildred Cho, a bioethics professor at Stanford University in Palo Alto, Calif. She adds: "The prospect of launching a national program to alter behavior, possibly without consent and without examining the long-term effects much more closely is truly frightening."

Safety concerns involving children and the anti-drug vaccinations are even echoed by Xenova, a British biotechnology firm in Berkshire, England, now testing vaccines for cocaine and nicotine.

"Our vaccines have been created and tested only on consenting adults, and we have not been approached regarding any child inoculations," Veronica Cefis-Sellar, head of Xenova's Corporate Communications, explains. "We are not aware of any plans to introduce our vaccines to children."

Xenova's latest clinical trial of 132 cocaine addicted patients found the vaccine to be effective. Of those patients who had received the inoculation, 58 percent remained "drug-free" after three months. Cefis-Sellar adds that the anti-cocaine vaccine will probably not be made available to the public before 2006.

Could This Really Work?

There are currently two types of vaccines being studied; one which introduces pre-made antibodies and another which is designed to teach the body how to make its own.

The vaccination being tested by Xenova is the first kind and lasts only temporarily. Patients injected with this vaccine would require booster shots like those for tetanus with much more frequency — perhaps even as often as every few weeks to two months.

Expressing doubts the current inoculation would last until a child was old enough to experiment with drugs is Kim Janda, a professor of chemistry at the Scripps Research Institute in La Jolla, Calif.

"You'd need an almost constant booster," Janda says. "We have no idea if this would work in the long-term, and at this point, [an initial vaccine] definitely wouldn't last through the interim years" until the child is of an age to try cocaine.

"People have this idea that [an anti-drug vaccine] is a magic cure to surmount addiction," he adds. "It's just not realistic."

Is It Ethical?

Even if the vaccination were to last into adulthood, some doubt if it's ethical to use on children.

Dr. Donald Landry, an associate professor of medicine and director of the Division of Clinical Pharmacology and Experimental Therapeutics at Columbia University Medical School in New York, started his own study of artificial enzymes like those in the anti-cocaine vaccine back in 1991. Landry's lab was the first to identify and create the elements needed for the anti-cocaine vaccine.

Despite this, Landry is undecided about the British proposal. "The question really is whether we should sign up an entire population for the volitional action of a few," Landry explains.

"But we do it," he adds. "We now require the hepatitis B vaccine for every child in America [even though] the only people who are at risk are health workers, intravenous drug users or needle sharers, or people who are sexually promiscuous and often have unprotected sex. Not your average child."

Cho echoes his concerns. "This vaccine is encouraging the belief that we can make problems go away," she says. "The only way we're going to do that is by talking to our kids and knowing where they are and who they're with."

She continues: "It's not that there is no place for a vaccine like this. But it's not here with kids."

Back to the Future

Yet most experts would agree that if they worked well, immuno-pharmacological agents like these vaccines would change the world of addiction treatments.

"[Such a vaccine] could be good at controlling that craving that comes with withdrawal," says Dr. Paul Appelbaum, former vice president of the American Psychiatric Association, and director of the Law and Psychiatry program at the University of Massachusetts Medical Center, in Worcester, Mass.

But Appelbaum stresses the vaccine's "first use is treatments for people who already have an addiction and have made a voluntary decision" to quit.

He notes that Xenova's preliminary 58 percent success rate is unusually high. "If it's successful it could be extremely helpful," Appelbaum continues. Scientists currently know "that some people have a heightened susceptibility to general addiction. If we have the genetic ability to medicate, vaccinate, or block a specific abnormality, that would have an even broader impact."

Beyond preventing relapse, Janda suggests treatments like these anti-drug vaccines could even counteract overdoses.

However, single substance users are uncommon, as Appelbaum notes: "what we really should look at is a vaccine targeted against multiple addictions."

Ultimately, Janda and many others believe: "If you don't have the desire [to stop addiction], it's useless. There are so many drugs out there; you'll just find another drug," vaccine or no vaccine.