It starts with a story about Mary Larson. Hard partying, Mary Larson had her first taste of cocaine in the ’70s and after that she quickly became hooked. She eventually lost her husband, her two preteen sons and her two story Concord, California home. It is a fairly familiar story for those of us who have also been touched by addiction or maybe rather ripped and ravaged. Mary’s youngest son knelt and sobbed, begging her not to leave. But she wasn’t even thinking of him. “I don’t want to live here.” is all she could think. “I want to get high.”
Mary hustled for nearly 10 years throughout the San Fran Bay Area to feed her 500 dollar a day habit. She robbed up to five Safeway supermarkets each day and worked as a prostitute at night. Her bottom, or low point, was in 2006 when a group of police officers chased her and hurled her to the ground after she stole a bottle of liquor. And during that moment, she thought of her youngest son, kneeling and pleading with her in front of their house.
So she checked herself into a rehab. Not just any rehab though, Larson checked herself into HealthRIGHT 360, a San Fransisco based drug rehab program that offers medical care, behavioral therapy, education and employment services. And her perseverance in rehab paid off. Today, at 58 years old, she is an events director at the same rehab that saved her life. Not only that but her sons call her every night.
As bleak as Mary’s story is, she is a lucky one. Of the roughly 23.9 million of Americans who have used illegal drugs, 105 die every day of an overdose. And now researchers want to make sobriety within reach of anyone who wants it, but not with rehab, with vaccines. Weill Cornell Medical College reported last May that an experimental vaccine that triggers the immune system to “attack” cocaine in primates, reportedly, preventing it from reaching the brain and producing its euphoric high. A human trial is already planned for the end of this year. The idea is that when addicts no longer get a rush from cocaine, they’ll stop using it, making relapse far less likely.
A vaccine “could be used for any addictive molecule,” said study leader and physician Roger Crystal. His group is also developing a nicotine vaccine. Other researchers are working on vaccines to block the effects of heroin, methamphetamine, and phenylcyclidine (PCP).
And of course there are people who are skeptical. Addiction vaccines have produced mixed results in clinical trials and pharmaceutical companies are hesitant to fund them. And if cocaine no longer has an effect, an addict will most likely just turn to another drug. After all, the vaccine only targets one substance not the addiction itself. And we all know drugs were a solution to our problem not the problem. So vaccines are merely taking away the viability of certain solutions.
A vaccine exposes the immune system to a harmless amount of pathogen it’s designed to protect against. The immune system recognizes the pathogen as foreign and churns out proteins called antibodies that attack if it reappears.
The idea for a cocaine vaccine came to Roger as he was walking past a Manhattan newsstand five years ago. A headline read, “Addiction: We Need a Vaccine.” He wondered could he actually make a vaccine against an addictive molecule such as cocaine.
Out of all the illegal drugs, cocaine is especially dangerous. Both the inhaled powder and the smokable crack cocaine account for roughly one third of drug related emergency room admissions. And unlike heroin or prescription pills, there are no medications specifically approved to curb cocaine addiction. So far, only behavioral therapy has been shown to help at all, but not for everyone. Combining therapy with the vaccine may be the key researchers think.
Addictive molecules like cocaine are too tiny for our immune system to detect. So the research group tethered a particle that mimics the structure of cocaine into larger cold-virus proteins. When the vaccine is injected into an animal, its immune system recognizes the viral proteins as foreign and triggers an attack against both the proteins and the attached cocaine look-alike.
Cocaine is a molecule that inhibits a protein called the dopamine transporter. This protein usually shuttles or transports dopamine (a feel good neurotransmitter) away from the space between nerve endings to be recycled, but when that process gets interrupted by cocaine, the body ends up with a surplus of dopamine, which produces an intense and euphoric high. To measure this effect, researchers hooked a scannable tracer onto the transporter protein.
Once the vaccine worked in mice, they move onto to test it in monkeys, whose biology is much closer to ours. When they injected the monkeys with cocaine, the results were, well, surprising.
Brain scans of unvaccinated monkeys showed ad drop in the activity of the tracer. Cocaine worked in these monkeys. In vaccinated monkeys, antibodies attacked the cocaine, leaving the dopamine transporter protein and the attached tracer untouched.
To produce a high, cocaine has to block 47% of the transporter molecules, but it blocked only 20% in the vaccinated monkeys. And when given a choice, the vaccinated monkeys chose M&Ms over cocaine, since the drug didn’t work anymore.
Crystal noted that a vaccine won’t be a silver bullet and will most likely be used alongside behavioral therapy. HealthRIGHT 360 CEO and recovered heroin addict Vitka Eisen agreed. “People also need jobs, safe housing … and social support,” she said. “Medication can be really helpful as part of a toolbox.”
But Stanford University psychiatry professor Keith Humphreys isn’t so sure. He cited a 2009 cocaine vaccine trial in which only 38 percent of vaccinated patients developed immunity. Plus, Big Pharma has shown little interest in such vaccines, since many doctors don’t view addiction as a legitimate medical condition.
It’s also possible that vaccinated cocaine addicts might just get their fix elsewhere. “I would have probably just switched addictions,” says Larson. “If you’re an addict, and you’re not already using, you’re looking for something else.”