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Houston scientists see hope in cocaine vaccine

Jan. 1, 2008, 3:06PM
Houston scientists see hope in cocaine vaccine
Baylor doctors say shots block the drug's high

The needle may be one of addiction's enduring symbols, but two Houston researchers hope injections of modified cocaine actually provide the first-ever medication for people hooked on the destructive drug.

The Baylor College of Medicine scientists have developed a cocaine vaccine, currently in clinical trials, that stimulates the immune system to attack the real thing when it's taken.

As a result, cocaine no longer provides a kick.

"For people who have a desire to stop using, the vaccine should be very useful," said Dr. Tom Kosten, a psychiatry professor who was assisted in the research by his wife, Therese, a psychologist and neuroscientist. "At some point, most users will give in to temptation and relapse, but those for whom the vaccine is effective won't get high and will lose interest."

Kosten, who joined Baylor 18 months ago, asked the Food and Drug Administration in December to green-light a multi-institutional trial to begin in the spring. It presumably would be the final clinical hurdle before the vaccine might be approved for treatment.

Approval would mark a breakthrough in the treatment of cocaine addiction, which now mostly involves psychiatric counseling and 12-step programs. Over the years, Kosten notes, more than 50 pharmaceutical options have been investigated and found wanting.

The vaccine also could raise interesting ethical questions involving who should get inoculated and what happens if confidential information about those receiving it becomes known. Although developed for therapeutic purposes — the number of cocaine addicts in this country is estimated at more than 2 million — the vaccine eventually is expected to be used for prevention, as well.

The questions include whether parents would be allowed to have their children inoculated; whether it would amount to coercion to make it a condition for lighter criminal sentences; whether employers might happen upon such information and use it discriminatorily; and whether to use it on pregnant addicts to protect the fetuses.

The questions don't just reverberate about this vaccine: Tom Kosten also is at work on vaccines for methamphetamine, heroin and nicotine. Two other nicotine vaccines are being investigated by other scientists.

"Anti-drug vaccines may provide an important weapon against addiction," said Frank Vocci, director of treatment research and development at the National Institute of Drug Abuse, which funded much of the research. "We're starting to see progress. We just need to see more."

Concept called 'clever idea'
No one denies the extent of the problem. Federal estimates put the number of Americans classified with substance abuse or dependence at 22.2 million and the cost to the country at $484 billion a year — almost three times the cost of cancer.

The Kostens' cocaine vaccine has been more than a decade in the making.

In concept, the idea seems simple. Cocaine (and many other drug) molecules are so small the immune system fails to recognize them and make the antibodies necessary to mount an attack. To help the immune system, Kosten attached inactivated cocaine to the outside of inactivated cholera proteins.

In response, the immune system not only makes antibodies to the combination, which is harmless, but also recognizes the potent naked drug when it's ingested. The antibodies bind to the cocaine and prevent it from reaching the brain, where it normally would generate the highs that are so addictive.

"It's a very clever idea," says David Eagleman, a Baylor neuroscientist. "Scientists have spent the last few decades figuring out reward pathways in the brain and how drugs like cocaine hijack the system. It turns out those pathways are difficult to rewire once they've seen the drug. But the vaccine just circumvents all that."

Kosten says the idea goes back to the 1950s, when scientists devised a vaccine to treat potentially fatal overdoses of the then-popular heart medication digitalis, and the 1970s, when researchers experimented with a heroin vaccine before abandoning it.

Kosten took up the idea in the mid-1990s, figuring cocaine was a better candidate because the enzyme for breaking it down is in the bloodstream, not the liver, like most drugs. While they were at Yale, he led the clinical trials and his wife conducted the animal experiments.

The most impressive result involved a study at Columbia University in New York, where users who had no interest in being treated were paid to be vaccinated. Those who got a low dose saw little change. Those who got a high dose reduced their drug use by more than 50 percent. In Kosten's words, "it didn't do what it used to do."

But one expert warns against expecting too much.

"Addiction vaccines are a promising advance, but it's unlikely any treatment in this field will work for everyone," said Dr. David Gorelick, a senior investigator at the National Institute on Drug Abuse. "Still, if they prove successful, they will give those working in drug addiction an important option."

To be sure, the vaccine is still a work in progress.

There also are questions about dedicated users' ability to overcome the vaccine if they ingest more cocaine than the immune system can fight off, and whether they'll simply switch drugs once they stop getting a high from cocaine.

FDA may act in a few years
Kosten acknowledges those are concerns. But he also notes that most users would have a hard time affording the amount of cocaine necessary to override the immune response, and that study participants didn't switch drugs when the cocaine lost its effect. Vaccines also could be combined — as is done with mumps, measles and rubella — if the concept pans out.

Vaccines' ethical concerns have occasioned academic papers, committee investigations and conferences. In a 2004 report, the National Academy of Sciences' Center for Studies of Behavior and Development lauded the new method's promise, but cautioned that it "poses distinct behavioral, ethical, legal and social challenges that require careful scrutiny."

"There are certainly important issues there, but I don't think any are insurmountable," said Dr. Peter Cohen, a Georgetown law professor and chairman of the District of Columbia Medical Society's physician health committee. "Overall, the benefits to society of such vaccines would outweigh the risks."

Addicts also will benefit from other treatment at the same time, such as behavioral therapies or counseling, says Kosten. Emphasizing that there was a reason drugs were used in the first place, he says the vaccine is not meant as "a stand-alone treatment."

Still, FDA approval could come within a few years, Kosten speculates, if he gets the go-ahead to conduct the Phase III trial next year and it succeeds. The trial would enroll about 300 patients at six sites around the country, one in Houston.

So, what will it mean to Kosten if and when that approval comes down?

"It'll be great," he said. "It'll also mean a new opportunity to make more vaccines and move on to more addiction problems."

By Rob77 on Jan 2, 2008, 06:11 in Friendly Talkzone.

Rob77 says on Jan 2, 2008, 06:14:

"If successful, scientists believe this may help reduce indecipherable and gibberish late-night posts on PBH."

BOYCOTT CITGO - CHAVEZ SUCKS!!!

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Lowell says on Jan 2, 2008, 06:30:

Once upon a time I used coke daily (in Colombia) for well over a month. The good un cut stuff. Upon finishing my stash, I bought no more. I experienced no problems from the lack of coke in my body and had no problem with not using. Much of the addictions must be psycological (sp?) in nature or the other crap people use to enhance it or cut it.

Alfred E. Newman. "What. Me Worry?"

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Rob77 says on Jan 2, 2008, 06:35:

My theory is of addictive personalities, rather than focusing on addictiveness of substances.

BOYCOTT CITGO - CHAVEZ SUCKS!!!

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elmodefoque says on Jan 2, 2008, 06:43:

coke is for losers
as the wife of the former jelly bean eating USA president and co -star of "bed time for bonzo" once said. Say no to drugs"

over 5 million colombianos in USA and only 27 barranquilleros, i'm one. CURRAMBA, EL MEJOR VIVIDERO DEL MUNDO!

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rocinante says on Jan 2, 2008, 08:22:

I never liked coke, and I agree with Lowell - I did a bunch for a few months and always hated it the next day as I smoked like a fiend (I'm not really a smoker), drank like a fish (I drink but not THAT much) and stayed up all night while doing it. I always wanted to jump off a cliff the next day - for what? I never got addicted and the cost of all those smokes, booze and the coke itself was nowhere near the cost of a few drinks and a hit of a joint.

From the report:

"At some point, most users will give in to temptation and relapse, but those for whom the vaccine is effective won't get high and will lose interest."...

And move on to Heroin and other strong drugs.

I agree with Lowell and I've seen this all too frequently: the addiction is in the person - mental - and not in the drug itself. If it's not one thing it's going to be another. All these rehabbed cokeheads smoke like fiends and pound coffee and who knows what else.

If this works and the "addicted" don't move on to equal or dangerous vices, great. But I'm highly suspect.

"World economic indicators point to a democrat winning 2008. It will surely be Obama. Peso 1400 by November" Feb 5, 2008

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elmodefoque says on Jan 2, 2008, 08:27:

if i was to be an addict, morphine would be my drug of choice.
I might be the only guy out there who welcomes kidney stone pains, why? i get shot up with sister morphine.

over 5 million colombianos in USA and only 27 barranquilleros, i'm one. CURRAMBA, EL MEJOR VIVIDERO DEL MUNDO!

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elmodefoque says on Jan 2, 2008, 08:38:

many disadvantages in being old but there are also a few advantages and the main one is that at this stage of my life I could pick up dangerous hobbies such as smoking, drugs, booze with etc. with out any long lasting effects/
. I'm gonna be dead soon anyway so might as well go out in a bang.
a heroin and coke addicted (speed ball) drunker smoking whore monger

over 5 million colombianos in USA and only 27 barranquilleros, i'm one. CURRAMBA, EL MEJOR VIVIDERO DEL MUNDO!

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Rob77 says on Jan 2, 2008, 08:38:

The vaccine is probably more for those voluntarily interested in quiting. Or maybe they could use it for heavy drug users who commit drug related crimes as a rehabilitation option, instead of long prison sentences.

BOYCOTT CITGO - CHAVEZ SUCKS!!!

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Lowell says on Jan 2, 2008, 10:24:

I like to mellow out. Pot has always been my thing. I had a short bit with reds/seconal when I was 18. nearly got adicted. Had good friends that took me into the country to dry out. Very afraid to even try morphine or heroin. I've had a bunch of surgeries in my life and enjoyed the glow from the strong stuff. Way to good.

Alfred E. Newman. "What. Me Worry?"

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PurpleFrog says on Jan 2, 2008, 14:36:

I am partial to PEPSI!

Photobucket

Thank you.....Goodnite Now!

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goin_south says on Jan 2, 2008, 14:45:

my question is...
...what coke addict is even gonna want to do the vaccine?
And, then there will be a nationally sponsored - by both para's and farc - colombian covert operation to blow the lab up... How's that for conspiracy theory, Gringoloid?

Some say: All things are better in...Medellin! ....Oscar Lopez just says it's better.....LATE!!! (WHERE EVER YOU ARE)

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Mr. Hollywood says on Jan 2, 2008, 15:01:

Just imagine the rush for a vaccine that made people get HIGHER with LESS cocaine.

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Chelesupercono says on Jan 2, 2008, 15:09:

Never knew that coke was physically addictive like heroine......coke is a stupid drug for stupid people.......now the herb?....well that's a gift from God.......Bless Him!!!!

never go to bed with someone crazier then you are, you will do it and you will regret it.......

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goin_south says on Jan 2, 2008, 15:11:

okay... johnny.. I think you mus be on the dark side of the moon too long

Some say: All things are better in...Medellin! ....Oscar Lopez just says it's better.....LATE!!! (WHERE EVER YOU ARE)

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Portena says on Jan 2, 2008, 15:35:

Cute photo of the dawg, purplefrog!

I feel better! I can smile at it now, I feel better. Ohhhh, better! Gnarls Barkley

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deathnova says on Jan 2, 2008, 16:28:

Good point GS, I was just thinking that those researchers might need to get some personal protection ;)

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rocinante says on Jan 2, 2008, 17:20:

Maybe if people who have never done coke get the vaccine they will never get addicted to coke. (lite shineth on dim head)

But addictive personalities will perhaps find something else to get addicted to.

"World economic indicators point to a democrat winning 2008. It will surely be Obama. Peso 1400 by November" Feb 5, 2008

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diabloblas says on Jan 2, 2008, 17:26:

i like all the drugs except meth..no moderation with that drug & it will definitely make you write bad checks.

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lpdiver says on Jan 3, 2008, 00:10:

gonna have to face it I a dicked da chocha! sung to the Robert Palmer classic of course!

t

"cook some rice!"

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