A Drug to End Drug Addiction - Page 2

[claddaghmom]

Originally Posted by zylph

It's not a vaccine against neurotransmitter receptors/reuptake receptors/neurotransmitters. It's a vaccine against cocaine itself (or nicotine or meth or heroin). Basically, the vaccine is an inactivated cholera toxin adjuvant (immune stimulator) hooked up to a derivative of the cocaine molecule. The immune system gets aggravated by the cholera toxin and makes antibodies against both the cholera toxin and the cocaine molecule. It's not a drug against sensations or normal functioning of the brain (the Time article seems to be worried that the nicotine vaccine could have cross-reactivity with the natural acetylcholine neurotransmitter, but they are pretty different molecules).

There are three reasons why this vaccine is not so effective (many boosters, etc. are required). One, because this vaccine is being tested in a country where almost nobody has cholera or has been vaccinated against cholera, two vaccine doses are needed in order to get the immune system good and pissed off about the cholera toxin and make antibodies against it and cocaine. Two, the cocaine molecule itself is pretty small and doesn't really bother the immune system a whole lot. Most good antibodies are against big things that you would find on pathogens - proteins or complex sugars. So to keep the levels of antibodies up, patients have to keep being boosted. Three, your immune system is good, but it's not that good. For this vaccine to be effective, it has to stop the cocaine from getting to the brain. For moderate/high addiction, the immune system has to clear out a typical dose of 50-100 mg of cocaine in a matter of minutes, if not seconds (that is a lot for it to handle). If you don't want to quit, you're just going to up your cocaine dose to where your immune system can't clear it out it in time.

As someone who has tried to quit smoking a few times, using the patch, etc., I have to say that making the drug not affect you (which happens when you use the patch) goes a long way in terms of prolonging the quitting behavior. If you slip and have a cigarette but it doesn't do anything, you feel terrible about slipping plus you don't even get the rush. This cocaine vaccine does not sound like a cure-all and will have to be paired with counseling for effective treatment. But it did make counseling twice as effective, and let's face it here, these types of vaccines are out there to try to stop some pretty profoundly unhealthy behavior.

Excellent post! Very clear. So basically it's going to make people shoot themselves sky high to flood their system to the point that their immune system can't clear it fast enough....

[zylph]

Originally Posted by claddaghmom

Excellent post! Very clear. So basically it's going to make people shoot themselves sky high to flood their system to the point that their immune system can't clear it fast enough....

Yes, that is one of the problems here, and why these vaccines will need to be used on people that are committed to quit and paired with some pretty aggressive counseling. Because if they keep using (and most highly addicted people tend to use near toxic doses anyway), they will be counting on the antibody response to protect them from what are toxic doses of the cocaine/heroin. This won't really be a problem with nicotine since nobody smokes enough cigarettes to get near toxic doses of nicotine.

There are also some fairly serious ethical problems if these vaccines were ever to be used prophylactically.

[littlecindy]

Originally Posted by ammiga

Everyone I know that kicked an addiction did it by replacing one addiction with another... but they moved on to a healthier addiction. The reason that this new vax will work is because people are replacing their cocaine addiction with the "addiction" to getting all those boosters. Pair that with the counseling, and many probably will kick the addiction.

Originally Posted by zylph

If you don't want to quit, you're just going to up your cocaine dose to where your immune system can't clear it out it in time.

I have to say that making the drug not affect you...goes a long way in terms of prolonging the quitting behavior. If you slip and have a cigarette but it doesn't do anything, you feel terrible about slipping plus you don't even get the rush. This cocaine vaccine does not sound like a cure-all and will have to be paired with counseling for effective treatment.

Originally Posted by zylph

that is one of the problems here, and why these vaccines will need to be used on people that are committed to quit and paired with some pretty aggressive counseling.

the trouble is...you can want to quit and not be able to... so even those committed to it can be committed and then they use just once, lose their momentum and are disappointed in themselves and go on a binge and then they'll use a TON to get around the immunity their body has. and stronger drugs are harder to bounce back from after a relapse than nicotine. you feel terrible for slipping after having a cigarette, but it doesn't alter your mind like cocaine or heroin, or even alcohol. so many overdoses happen because you compound that disappointment with a person who is so high they can't think straight.

it doesn't sound like this vaccine would create it's own physical dependence (like methadone), but i'm concerned about the mental/spiritual dependence.

relying on a medical treatment just seems antithetical to everything i've learned about recovery from addiction, both as an addict and as a worker in the professional CD environment. i've known people who quit smoking with a patch or pill and without. it takes several times either way. what i fear that all these interventions do is "what after?" if you use a crutch in the beginning, how do you deal with getting rid of the crutch. the fear of that has to be immense for an addict. hopefully that addict picked up many other tools during the time that they were using that crutch and so they'll be ready to be without it eventually. but knowing the mind of an addict, it is really hard to embrace those tools (going to meetings, connecting with other people, counseling). so any opportunity to NOT have to do those things, which are painful emotionally, an addict will take.

how will an addict stay clean and sane 3 months, 1 year, 10 years down the road after their first day clean? with a pill? probably not...i think it's better to learn from day 1 how to stay clean with the tools that you're going to need for the rest of your life. i just truly believe that addiction is first and foremost a mental, emotional and spiritual disease and it needs a mental, emotional and spiritual solution.

[zylph]

Originally Posted by littlecindy

the trouble is...you can want to quit and not be able to... so even those committed to it can be committed and then they use just once, lose their momentum and are disappointed in themselves and go on a binge and then they'll use a TON to get around the immunity their body has. and stronger drugs are harder to bounce back from after a relapse than nicotine. you feel terrible for slipping after having a cigarette, but it doesn't alter your mind like cocaine or heroin, or even alcohol. so many overdoses happen because you compound that disappointment with a person who is so high they can't think straight.

it doesn't sound like this vaccine would create it's own physical dependence (like methadone), but i'm concerned about the mental/spiritual dependence.

relying on a medical treatment just seems antithetical to everything i've learned about recovery from addiction, both as an addict and as a worker in the professional CD environment. i've known people who quit smoking with a patch or pill and without. it takes several times either way. what i fear that all these interventions do is "what after?" if you use a crutch in the beginning, how do you deal with getting rid of the crutch. the fear of that has to be immense for an addict. hopefully that addict picked up many other tools during the time that they were using that crutch and so they'll be ready to be without it eventually. but knowing the mind of an addict, it is really hard to embrace those tools (going to meetings, connecting with other people, counseling). so any opportunity to NOT have to do those things, which are painful emotionally, an addict will take.

how will an addict stay clean and sane 3 months, 1 year, 10 years down the road after their first day clean? with a pill? probably not...i think it's better to learn from day 1 how to stay clean with the tools that you're going to need for the rest of your life. i just truly believe that addiction is first and foremost a mental, emotional and spiritual disease and it needs a mental, emotional and spiritual solution.

I really agree with a lot of what you said - I've obviously struggled with one of the lesser addictions. And I still do think that there are people that these vaccines could help. Physical dependency is a huge part of addiction. There is a reason why chocoholism is not in the DSM IV (joking, but not really). I work on Hep C for a living - if heroin didn't exist, I wouldn't have a job. But I would much rather not have a job.

Not that I don't get what you're saying. I've worked needle exchange clinics. Heroin withdrawal is over within a few weeks, and is one of the most terrible experiences for a person (serotonin is really a key part of being alive). But people will put themselves through that again and again, because they haven't resolved why heroin was their crutch.