What if it were possible to treat addiction with a single shot, administered in a clinic in a few seconds, which would immediately produce a complete cure? That’s the Holy Grail for researchers into how to medically treat a wide spectrum of addictions — and for now, it remains just that: a dream. But Dr. Kim Janda, the Ely R. Callaway, Jr. Professor of Chemistry at the Scripps Research Institute, in La Jolla, California, has been pursuing a piece of the puzzle in a cure for addiction for many years: vaccines which offer the hope of treating some of the most tenacious addictions there are, by mobilizing the body’s immune system. I had a chance to interview Dr. Janda and his work is groundbreaking.
How do vaccines usually work? To understand how vaccines work, you have to know a little about how the immune system works. The immune system is a chemical system in the body that can learn to recognize dangerous disease-causing organisms like bacteria and viruses, and destroy them before they can cause illness.
Usually, you have to get infected before you become immune. As the virus or bacteria spreads in your body, cells like the white blood cells in your bloodstream gradually learn to recognize and attack those nasty bugs, and destroy them. There are lots of ways white blood cells can do this — some white blood cells will directly attack a bacteria, but others will produce chemicals called antibodies. Antibodies are basically chemicals that stick to the virus or bacteria, gumming them up so they can no longer function (think of antibodies as glue traps, for dangerous disease causing bugs).
The only problem is that it takes a while for your body to learn to recognize the bugs, which in the meantime may have killed you. Immunization is a way of teaching the body to recognize a bug ahead of time — without running the risk of making you sick. Usually a vaccine “shows” your immune system just a piece of the bug, so there’s no risk of you getting sick — if the whole bug shows up, your immune system will recognize it from the fragment it was exposed to, and kill the bug off just as efficiently.
Vaccines for addiction work basically the same way. Dr. Janda’s been researching vaccines against addiction to a number of substances, but the most promising are vaccines against addiction to prescription opioids like oxycodone and hydrocodone, and against heroin. They work by teaching the body — again, ahead of time, which is the whole point of a vaccine — to recognize the substance you’re addicted to, and attack it by producing antibodies (the “glue traps”).
Produce enough antibodies, and you’ll gum up the addictive substance so badly in the bloodstream, that it can’t get into your brain and nervous system at all. It sounds like exactly the sort of magic bullet that those struggling with chemical dependency, as well as doctors and clinicians who treat chemical dependency, have been looking for. However in our interview, Janda did point out that much as everyone hopes for a perfect cure for addiction, especially addiction to powerfully addictive substances like heroin and prescription opioids, there’s still a need for a desire to be drug free on the part of the addict.
I asked if it would be possible to defeat the immune response by just taking more and more heroin to which Janda replied, “That’s right. They could keep taking it, they could surmount it if they took enough. If you want to just take drugs, it’s not going to work . . . it’s for people who don’t want to take drugs anymore.”
As with many vaccines, a single treatment would confer a great deal of protection at first, but to maintain the effect, it would be necessary over time to have periodic booster shots. Janda said that while the first course of treatment could be expected to last three months, a booster shot would need to be administered periodically.
But the upside is considerable. There are, of course, drugs that do what an opioid vaccine will do: prevent the addict’s drug of choice, whether heroin or a prescription opioid, from actually connecting with nerve cells in the brain. Buprenorphine, Naloxone, and Suboxone (a combination of Naloxone and Buprenorphin) are all examples of drugs that treat addiction by sticking to nerve cells and preventing heroin or prescription opioid drugs from doing the same. However, the big gotcha here is that such drugs, because they stick to the same nerve cells that addictive drugs stick to, can themselves produce addiction — and they can under some circumstances, become drugs of abuse themselves.
With an effective opioid vaccine, there would be none of these problems. An opioid vaccine, as Janda put it, acts like a sponge that soaks up the addictive drug before it can get anywhere near nerve cells in the brain. Yes, you can theoretically take enough heroin or oxycontin, or what have you, to defeat the antibodies your immune system is producing, but in this respect an opiate vaccine is like any other treatment method: it works best if you really want to quit.
Another very big advantage of an opiate vaccine over other, current treatment strategies, is its low cost. Methadone, for instance requires daily intake of a substance highly addictive in itself, and which must be taken under the supervision of a medical professional. By contrast, vaccines cost pennies per dose, and would only need to be re-administered at an interval of several months.
And yet, despite their promise, researchers, including Janda, struggle to find even minimal funding for vaccines to treat heroin and prescription opioid addiction — this despite the fact that a sharp uptick in heroin and opioid addiction in recent years has taken a huge toll in both treatment dollars and lives. Why? It’s the same old story: there’s no money in it. In an interview with Time, Janda said:
“‘No pharmaceutical company is going to fund trials for heroin, no way,” . . . for meth? No way. Forget about it.’” The article goes on to note, “Janda has also worked on a meth vaccine. He has one for cocaine and one for a date rape drug too, but the heroin vaccine is the one he’s most confident about because it was proven to work in clinical trials on rats. ‘The heroin one has been our best success in over 25 years of working — it’s the best data we’ve seen.’”
And the obstacles just keep piling up. Dr. Janda revealed to me that he did manage to receive funding to pursue the next stage of research: testing his heroin vaccine in primates. The results were excellent, and yet, despite its huge public health implications, Janda and his co-researchers are struggling to get the paper reporting their results published in a peer-reviewed medical or science journal.
Janda told me, “We’ve done non-human primates, and it (the vaccine) works pretty well . . . we haven’t published yet. Science said it wasn’t broad enough interest for their readership.” Asked if this might be due to the stigma society attaches to addiction, Janda said, “Stigma? Um, I think you know, addiction, is like, this dirty little secret . . . they’ll publish on HIV or flu vaccines, but this, there just wasn’t any interest.”
Dr. Janda says he originally became interested in vaccines against injectable drugs like heroin, as a way of helping halt the spread of both addiction, and the transmission of AIDS, in developing countries. He said, “Really, it was for third world countries, where there’s been a higher incidence of injectable drug users . . . places where there are no clean needle exchanges, like Africa, Russia, China. I thought if we could vaccinate, we’d have an impact on heroin addiction and the spread of HIV.”
He adds, “After I published this stuff, though, it seems like we have a bigger problem in the U.S.”