ABSTRACT The Ultimate Vaccine to End Addiction By Jenny Meier Cocaine is one of the top three most addictive drugs and is especially a problem in America and other Western countries. Millions of people who suffer from cocaine addiction have trouble stopping the drug due to its addictive qualities. There are various treatment programs and plans to help those struggling, but many abusers continue to relapse. For the past couple of decades doctors and researchers have been working on a medical vaccine to “cure” cocaine addiction. This vaccine has gone through many trials and transformations in order to become more effective. Recent forms of the vaccine has proven to be effective in decreasing the amount of anti-cocaine anti-bodies, along with decreasing the amount of cocaine found in urine samples. However, these results weren’t consistent throughout all subjects since the vaccine had little effect on a portion of the examined group. Furthermore, all forms of the vaccine haven’t been able to significantly decrease subject’s desire to abuse cocaine. New forms of the vaccine are still in the works, and are expected to be perfected within the next ten years. Although anti-cocaine vaccines can significantly help addicts struggling to quit abusing, other drug treatment programs should be used with the vaccine. Keywords: addiction, cocaine, TA-CD, anti-cocaine vaccine, drugs, treatment, drug abuse, dopamine, Dr. Janda, Dr. Kosten, 12-step programs, self-help groups Multimedia How Cocaine Affects the Brain: http://www.youtube.com/watch?v=4OS2C4NemJI The Ultimate Vaccine to End Addiction 1 Comedian George Carlin once asked, “What does cocaine make you feel like? It makes you feel like having more cocaine” (1). The issue of addiction has always been a concern, however more Americans are becoming worried about the use of “harder drugs” like cocaine. Cocaine is most prominent throughout Western countries and is known as one of the top 3 most addictive drugs (2). In 2007 the National Institute of Health reported that 2.5 million people were addicted to cocaine in the United States, but only 809,000 of them were actually treated (3). Even with treatment programs, self-help groups, and one-on-one therapy, many people still struggle with sobriety. Various vaccines and pills have been developing to treat specific types of drug dependencies, and doctors continue to create more. For the past 50 years researchers have been working on an anti-cocaine vaccine. Although vaccines can’t replace other treatment programs, researchers are coming close in finding a vaccine that helps prevent addicts from desiring cocaine. This type of invention of a vaccine can provide significant help to the abuser. While people are aware of addiction, many don’t understand its complexity. Addiction is most commonly explained as a chronic compulsion or obsession to a certain vice so strong that the abuser loses control of his or her life. Medical News Today writes about cocaine dependency, warning, “People who are addicted may eventually prefer taking cocaine to any other activity – their lifestyles may alter completely as the addiction takes hold more firmly. There have been cases of mothers selling their child, professionals spending thousand of dollars on binges costing from $20,000 to $50,000” (4). Substance abuse can lead to health problems, loss of relationships, unemployment, problems with the law, disease, and death (5). Addiction doesn’t only have negative consequences for individuals, but for society as well. The National Institute on Drug 2 Abuse estimates over $600 billion annually is wasted due to productivity, health, and crime related costs (6). Even with these negative consequences once dependent, it’s hard for an abuser to stop using their drug of choice. Addiction can be triggered by a variety of reasons. Some people are more prone to addiction than others due to social pressure, stress, depression, age of user, and even genetic predisposition. For example, those who are younger become addicted faster due to lack of brain development, and those who live in an unhealthy environment are more likely to rely on drugs as an escape. Many people are beginning to look at addiction as a disease. Just as asthma targets the immune system, addiction targets the brain. Unlike diseases though, drug dependency isn’t “a mere physiological problem; it’s psychic, too. Even if you can cancel the effects of drugs, can you make us not want to take them?” (7). Unlike other diseases drug dependency is partially about desire and control, which is completely psychological and therefore can only be changed if the person’s mindset changes. With cocaine and many other substances, it’s hard to control one’s mind due to how the drug affects the brain. Cocaine contains chemicals that “fool” the brain into reacting a certain way. When something pleasurable happens – a promotion, sex, delicious food, a funny joke – dopamine is released into the nucleus recognizing that activity as enjoyable. It is estimated that “addictive drugs…can release two to 10 times the amount of dopamine that natural rewards do, and they do it more quickly and more reliably” (2). Using cocaine releases extreme amounts of dopamine, making the user feel euphoric, sociable, confident, and energized. The brain becomes so over stimulated, it stops releasing dopamine, allowing the body to calm down to normal levels. SEE FIGURE 1. When 3 dopamine is released naturally from a rewarding activity it stays in the body and gets “recycled.” Every time someone uses cocaine however, that dopamine can not be reused in the body. Therefore, normal pleasurable activities aren’t as pleasurable since less dopamine is being produced. In order to go back to a euphoric state more drugs are taken and the abuser begins to rely on cocaine and eventually becomes addicted (2). Continued abuse of cocaine also increases one’s tolerance to the drug continues to increase making it more likely for one to have extremely negative consequences, like severe impairment, overdosing, and even death. FIGURE 1 http://37.media.tumblr.com/be308170d713c051e43e5654b3d8c811/tumblr_mmw6y9aUwd1qb6etto1_500.jpg 4 To help prevent these negative consequences, researchers have been trying to find a viable anti-cocaine vaccine. Normally when a virus, disease, or bacteria enters the body, a person’s immune system elicits a response to fight FIGURE 2 – NIDA (8) the bacteria. Cocaine molecules are so small however, that when it enters the body the immune system doesn’t recognize it, so the coke goes into the bloodstream to the brain. To prevent this, scientists realized they needed two elements in the vaccine: an immunogenic protein and a hapten. SEE FIGURE 2. Immunogenic proteins are bacteria or viruses that enter the body and, if not fought off properly by one’s immune system, can make people sick. The vaccine however won’t have enough bacteria to make a person ill; it will have just enough to elicit antibodies that stop cocaine molecules from going to the brain. A hapten “is a molecule that shares some key structural features with the target drug” (8). It allows body to recognize cocaine so the immunogenic protein can attach itself and produce antibodies. One researcher describes the vaccines as “a big sponge for cocaine in the bloodstream” (1). SEE FIGURE 3. By “soaking up” the cocaine molecules, preventing it from entering the brain, the person vaccinated won’t be able to feel the psychoactive effects of the drug. Therefore it is FIGURE 3 – From NIDA (10) 5 theorized that the abuser won’t crave coke anymore since it’s hard to get high. Using this logic, various vaccines have been created, trialed, and altered. Dr. Kim Janda created the first credible anti-cocaine vaccine in 1995. After trying the vaccine out on rats, Dr. Janda found that vaccinated rats showcased less hyperactivity and lower levels of cocaine found in the brain (8). Year later Dr. Janda worked with another doctor to improve the vaccine’s formula using an immunogenic protein found in the common cold. As before, when they tested their vaccine on rats the vaccinated rats showed less behavioral responses. They also found that the vaccinated rats reported higher levels of anti-bodies in their blood. More surprisingly, Janda and Crystal found the vaccinated rats were less inclined to seek cocaine than the control rats. Currently, the Doctors are slightly altering the vaccine so it’s better matched for humans, and when tweaked properly, they plan to do a clinical trial with people. Janda and Crystal’s biggest rival is Dr. Thomas Kosten, who is working on an anti-cocaine vaccine called TA-CD. The TA-CD vaccine uses cholera agents to trigger an immune response. In 2009 Dr. Kosten ran a 24-week clinical trial with 115 cocaineaddicted participants. He gave half the subjects the TA-CD vaccine and the other half a placebo vaccine. Using urine and blood samples Dr. Kosten measured the participants’ anti-body levels and found similar results as Dr. Janda found years earlier when testing her vaccine on rats. Dr. Kosten found those injected with TA-CD had more antibodies, which translated to less urine tests that read positive for drugs. SEE FIGURE 4. He also found that those who were vaccinated showcased less psychoactive effects than those in the placebo group (9). Dr. Kosten’s trial has been the most successful one to date and is known to be groundbreaking. 6 FIGURE 4 – NIDA (10) Although TA-CD was a huge breakthrough, much still needs to be done. Only 38% of vaccinated subjects had 43 mg/ml of antibodies, and by week 16 there was no difference in antibody level between groups (3). SEE FIGURE 4. Furthermore, there was a large variety in how subjects responded to the injection; the scale varied from no antibody response to an extremely high one (9). Also, a main objective of the vaccine is to prevent addicts from craving the euphoric high. Although the serum blocked cocaine’s effect on the brain, subjects still desired to use. Since TA-CD prevents user from feeling coke’s effect, “some users took ten times more cocaine, and several went broke in hopes of finding the elusive buzz” (7). Most experts, including Kosten, don’t view the vaccine as a solution to addiction, but instead see it as an additional method to help fight dependency. They stress the importance of being ready to quit so addicts don’t have the same relapse experience as some of the subjects in the TA-CD trial. Addicts are encouraged, and in all clinical trials were required, to continue using other anti-addiction methods, as in 12-step programs and support groups. 7 Kosten, Janda, Crystal, and many other researchers continue to look for a highly effective anti-cocaine vaccine to help minimize abuse. Within the next five years more clinical trials will be done, including the biggest one yet with 300 subjects (1). Once the vaccine is perfected, doctors plan on giving it to children. The hope is if a child can’t get high and doesn’t feel cocaine’s effects, then he or she won’t become addicted. However, there are many ethical concerns about giving this vaccine to children. Some people believe that it should be the person’s choice if he or she wants the vaccine or not, and that many parents won’t want to inject their child with the vaccine. Opponents argue that addiction is extremely hard to overcome and since so many people are struggling, the vaccine could be a solution for cocaine dependency. A main fear for researchers is that addicts will view the vaccine as a cure and stop other programs ignoring the psychological factors behind dependency. Though there have been many scientific breakthroughs, dilemmas such as these explain why researchers believe it will be another decade or longer before reaching a true solution to cocaine addiction. References [1] Hylton, Hilary. "A Drug to End Drug Addiction." Time. Time Inc., 09 Jan. 2008. Web. 28 Feb. 2014. <http://content.time.com/time/health/article/0,8599,1701864,00.html>. [2] "Understanding Addiction." Help Guide. Harvard Health Publications, n.d. Web. 27 Feb. 2014. <http://www.helpguide.org/harvard/addiction_hijacks_brain.htm>. [3] Martell, Bridget A., Frank M. Orson, James Poling, Ellen Mitchell, Roger D. Rossen, 8 Tracie Gardner, and Thomas R. Kosten. Cocaine Vaccine for the Treatment of Cocaine Dependence in Methadone Maintained Patients: A Randomized DoubleBlind Placebo-Controlled Efficacy Trial. 2010. MS. West Haven, CT, West Haven. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878137/pdf/nihms202269.pdf>. [4] Nordqvist, Christian. "What is cocaine? How addictive is cocaine?." Medical News Today. MediLexicon, Intl., 5 Dec. 2013. Web. 3 Mar. 2014. <http://www.medicalnewstoday.com/articles/234239>. [5] Nordqvist, Christian. "All About Addiction." Medical News Today. MediLexicon International, Mar. 2009. Web. 02 Mar. 2014. <http://www.medicalnewstoday.com/info/addiction/what-causes-addiction.php>. [6] "DrugFacts: Treatment Statistics." National Institute on Drug Abuse (NIDA). Substance Abuse Mental Health Services Administration, Mar. 2011. Web. 01 Mar. 2014. <http://www.drugabuse.gov/publications/drugfacts/treatmentstatistics>. [7] Rainey, Clint. "Measles, Mumps, Rubella, Cocaine." New York Magazine. N.p., 20 Sept. 2013. Web. 03 Mar. 2014. <http://nymag.com/news/intelligencer/cocainevaccine-2013-9/>. [8] Whitten, Lori. "Animal Research Advances Effort to Develop Vaccines Against Cocaine, Heroin Abuse." Brain Facts. National Institute On Drug Abuse, 17 Sept. 2012. Web. 27 Feb. 2014. < http://www.brainfacts.org/diseasesdisorders/addiction/articles/2012/animal-research-advances-effort-to-developvaccines-against-cocaine-heroin-abuse/>. 9 [9] Kinsey, Berma M., Thomas R. Kosten, and Frank M. Orson. "Anti-Cocaine Vaccine Development." National Center for Biotechnology Information. US National Library of Medicine National Institute of Health, 1 Sept. 2011. Web. 27 Feb. 2014. < http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936703/>. [10] Whitten, Lori. "Cocaine Vaccine Helps Some Reduce Drug Abuse." National Institute on Drug Abuse (NIDA). National Institute On Drug Abuse, 1 Dec. 2010. Web. 28 Feb. 2014. < http://www.drugabuse.gov/news-events/nidanotes/2010/12/cocaine-vaccine-helps-some-reduce-drug-abuse>. "DrugFacts: Understanding Drug Abuse and Addiction." National Institute on Drug Abuse (NIDA). National Institute On Drug Abuse, Nov. 2012. Web. 27 Feb. 2014. < http://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuseaddiction>. Horvath, Tom, Kaushik Misra, Amy Epner, and Galen M. Cooper. "Biological Causes of Addiction." AMHC. Ed. C.E. Zupanick. N.p., n.d. Web. 28 Feb. 2014. <http://www.amhc.org/1408-addictions/article/48342-biological-causes-ofaddiction>. Whitten, Lori. "Cocaine Vaccine Helps Some Reduce Drug Abuse." National Institute on Drug Abuse (NIDA). N.p., 1 Dec. 2010. Web. 02 Mar. 2014. <http://www.drugabuse.gov/news-events/nida-notes/2010/12/cocaine-vaccinehelps-some-reduce-drug-abuse>. 10