Antidrug Vaccines: Fact or Fiction?
The Future of Treatment: Antidrug Vaccine
Substance use disorders (SUDs) frequently cause negative medical, psychological, and social outcomes, resulting in considerable personal consequences for the individual with the SUD, their families, and even society. Treatments for SUDs commonly focus on a combination of pharmacotherapy and psychotherapy, as it increases the patient’s chances of success and maintained sobriety.1 According to Staff Psychiatrist at the Michael E. DeBakey Veterans Administration Medical Center, Daryl Shorter, M.D., and Professor of Psychiatry, Pharmacology, and Neuroscience at Baylor College of Medicine, Thomas Kosten, M.D., a different class of medicine is currently underway: antidrug vaccines.1 Antidrug vaccines represent the ongoing development of cutting-edge pharmacological options that allow SUD treatment plans to more certainly reduce use of certain substances and establish abstinence and sobriety.1 Shorter and Kosten review antidrug vaccines in their article “Antidrug Vaccines: Fact or Science Fiction?”
Abused substances work by acting on the reward and reinforcement pathways of the brain.1 According to Shorter and Kosten, after the substance is introduced to the body—for example by inhalation, intranasal, oral, or intravenous route—they enter the brain and activate certain target neurotransmitters.1 The substances of abuse must be small enough to pass through the blood-brain barrier.1
Antidrug Vaccine: Fiction-Turned-Fact
While using a vaccine to treat chemical dependencies may sound very science-fiction-like, it may surprise you that they have been in the process of development for many years.1 For example, in 1972, Berkowitz and Spector published a report regarding a morphine vaccine. In rats, the administration of the vaccine resulted in the creation of antimorphine antibodies, which reduced the concentration of the drug in rats and decreased the use of self-administrated heroin in rhesus monkeys. Since then, additional development has been made regarding antidrug vaccines. It has been discovered that the vaccines bind drugs in circulation, reducing euphoric effects and symptoms of toxicity.1 The vaccines produce an active immunization, where the administration of the vaccine produces an immunological response to the agent, and booster injections amplify the initial response.1 Therefore, the immune system is prepared by the initial vaccination, and booster injections produce antibody responses.1 The antibodies bind to the substance of abuse, making it unable to pass through the blood-brain barrier, causing it to become trapped in the circulation system and cleared from the body.1 The individual will also no longer feel the euphoric effects of the substance.1
According to Shorter and Kosten, there are trials of a cocaine vaccine and a nicotine vaccine currently underway.1 The cocaine vaccine, TA-CD, produces cocaine antibodies.1 During the phase one trial of 34 patients, TA-CD induced the creation of cocaine antibodies in all of the subjects. The vaccine was found to be relatively safe, with all recipients reporting tenderness at the injection site and a few other adverse effects, such as tachycardia, elevated temperature, and hypertension.1 These adverse effects did not continue during 12 months of follow-up.1 In the phase 2a trial, TA-CD was administered at two dose levels: 100µg for four injections and 400 µg for five injections.1 Both groups developed cocaine-specific antibodies that lasted for six months, and antibody levels were higher in the higher-dose group. 1 Also, persons of the higher dose group were more likely to remain sober for six months compared with the lower-dose group.1 There were no serious adverse effects seen. The vaccine is currently undergoing a large-scale phase 2b clinical study.1
Regarding nicotine vaccines, there are three: NicVAX, NicQb, and TA-NIC.1 NicVAX is well-tolerated with only tenderness at the vaccination site experienced.1 Overall, the safety of NicQb was favorable, but there were reported effects of flu-like symptoms, as well as pyrexia, headache, nasopharyngitis, rigors, and myalgia. Similar to TA-CD, TA-NIC were able to produce a significant immunological response with high antibody levels. Higher quit-rates were seen with TA-NIC.1
Vaccine Trials Underway
Antidrug vaccines are a new area of development within pharmacology, which may be the top pick to treat chemical dependence one day.1 Clinical trials for cocaine, nicotine, methamphetamine, and heroine are currently underway, with future directions looking into booster injections to prolong the antibody effects.1
 Shorter, D. and Kosten, T.R. (2011, April 19). Antidrug Vaccines: Fact or Science Fiction? Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/display/article/10168/1846987
 Berkowitz B, Spector S. Evidence for active immunity to morphine in mice. Science. 1972;178:1290-1292.
 Bonese KF, Wainer BH, Fitch FW, et al. Changes in heroin self-administration by a rhesus monkey after morphine immunisation. Nature. 1974;252:708-710.
 Kosten TR, Rosen M, Bond J, et al. Human therapeutic cocaine vaccine: safety and immunogenicity. Vaccine. 2002;20:1196-1204.
 Heading CE. Drug evaluation: CYT-002-NicQb, a therapeutic vaccine for the treatment of nicotine addiction. Curr Opin Investig Drugs. 2007;8:71-77. Vaccine.