Get Your Flu Shot, Your Tetanus Shot…Your Addiction Shot

Tuesday, April 9th, 2013

vaccine2The concept of an “addiction vaccine” produces mixed feelings, especially in clinicians like myself—fascination, hope, doubt, even fear. While reading a recent Wired Magazine article about Dr. Kim Janda’s mission to immunize users against drug dependency, I found myself weighing the pros and cons. There’s no question that it would be extremely useful to have a vaccine that numbs the effects of a particular drug; if a drug doesn’t get someone high, there goes the motivation to use. But this “cure” comes with quite a few risks.

First, there’s no guarantee that a person looking to get high won’t just switch to another drug. We can’t vaccinate every addict against every drug in existence. This is similar to “whac-a-mole” process we’ve gone through with bath salts, K-2 and other synthetic drugs; each time we ban one version or ingredient, manufacturers produce another. It’s possible that a vaccine against cocaine, for example, might cause certain people to start trying to alter the chemical structure of cocaine in hopes of finding a version that’s vaccine-immune.

Second, we need to acknowledge the unlikelihood of a “magic bullet” solution to addiction. So many addicts demonstrate other behaviors – anxiety disorders, depression, co-occurring mental illnesses – that develop alongside their substance addiction. If people become reliant on a vaccine to “cure” addiction, would they ignore the other behavioral changes they need to make? As with psychiatric medication, a vaccine like this should only be used in tandem with therapy, recovery support, and other treatment services.

Third, we can’t count on an addicted client’s complete compliance with a treatment method like this. They may think, “Hey, I’ll snort a line at this party because it won’t have any affect on me—I’ve taken the vaccine!” This could end up turning what someone might see as a harmless social interaction, because they believe they’re immunized against the effect of the drug, only to find out they’re one of the people it doesn’t work on, leading to a major relapse. The biggest concern is overdose; if antibody levels are too low, the user may experience a weak high despite the vaccine—and take more of the drug in an attempt to increase the high. Talk about dangerous! Plus, if somebody were to smoke cocaine rather than snort or inject it, it would get to the brain even faster, which might trump the vaccine’s process. Finally, we don’t even know if a vaccine like this is safe, let alone effective. For all we know, there might turn out to be tremendous side effects.

Despite these concerns, having a tool like a vaccine in our tool chest could possibly allow us to lesson the intensity and duration of our treatment interventions. Perhaps somebody who would have needed inpatient treatment would now be able to be seen in an outpatient setting. Of course, many people who seek help for addiction at Phoenix House and other providers, have deeply ingrained behaviors accompanying their substance use. These require skilled therapy and hard work to change. As long as people understand that a vaccine is not a short cut to avoiding this, we’d be thrilled to have it.

Another “plus” is that the mere existence of a vaccine against drug dependency is a positive step; it provides additional proof of addiction’s status as chronic medical condition. As Dr. Janda explains, “People need to get over the idea of addiction being a moral failure…it’s nothing but a disease of the brain.” As more medical treatments are developed for addiction, perhaps more people will come to this realization—and, hopefully, the stigma surrounding addiction, treatment, and recovery will decrease.

The bottom line is that the introduction of an addiction vaccine is complicated, and there’s a lot to consider. Before implementation we would of course need to make sure it actually works—the FDA must pinpoint ways to safely test it, assessing efficacy and safety while differentiating between those it would help and those it wouldn’t. We don’t want people fiddling around with something like this, and we don’t want to be giving people false hope. But by all means vaccine research should go forward; it would be a tremendous additional tool to support people’s recovery. As we at Phoenix House know, treatment and recovery are never one-size-fits-all, so the more options to help turn someone’s life around, the better.

Jack Feinberg
VP & Clinical Director
Phoenix Houses of Florida

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