Vaccinating Against Addiction

There is no magic pill, but one day there could be an inoculation against addiction to certain substances, including heroin and other opiates.

Dr. Kim Janda of the Scripps Research Institute, one of the country’s largest biomedical institutes, in San Diego, California, has been at work for over 20 years formulating vaccines against drugs like nicotine, cocaine, methamphetamine and, most critically at this time for many people in the Boston area, opiates.

“Why not develop a vaccine? There’s treatment, there’s methadone,” Janda said, “but that’s treating a drug with another drug.”

Janda was speaking during a presentation, “Treating Addiction Through Vaccination,” which was a portion of the Showcase series of the 6th Annual Collaborative, a two-day social innovation conference that brings social innovators and entrepreneurs together to discuss efforts and projects geared toward social change, on June 15  in the Seaport district.

“We’ve had very positive data with rats, mice, large primates,” Janda said. “Large primates are the closest you get to humans,” he added.

This means the results should translate to human populations.

During his presentation, Janda played videos showing two mice, both injected with stupor-inducing amounts of heroin. One of the mice sat, curled up and not moving, in a corner of the cage; this is behavior one would expect from an animal that had recently ingested large amounts of a powerful opiate.

Whereas the first mouse had not been vaccinated, the second rodent in the cage had been inoculated against opiates, and it did what any creature recently placed in a new cage would do: it explored the corners of its new container and attempted to get out. The sedating effects of heroin were completely absent.

“Drugs do not create an immune response,” Janda said, “but I’ve worked to trick the immune system by tweaking the drug at a [molecular] level.” Instead of the drug reaching the pleasure centers of the brain, the inoculated body’s immune system attacks it, invalidating the effects of the drug. The vaccine “essentially puts up a firewall against the drug,” Janda said.

By invalidating the effects of opiates, Janda said, a recovering addict who relapses will not have the biological desire to continue to use opiates, because they won’t work.

So where are these vaccines and how do people in recovery get access to them?

“This is unfortunately incumbent on a lot of dollars,” Janda said. “It’s really tough to get people to pay for a vaccine for crack addicts. Nicotine vaccines are funded. Why? How many CEOs are crack addicts?”

A large part of the struggle to get these vaccines on the market and make them accessible, Janda said, is changing the conversation around addiction.

“People look at addicts in a very different context. People view [addiction] as a moral failure on the part of the individual, and if you look at it that way, it’s very difficult to fund,” he said.

Right now the vaccines are ready to be submitted for an investigational new drug (IND) application, which, if passed, would allow them to be used in clinical human trials. But the IND itself costs around $1.5 million. The entire project, Janda estimated, requires about $10 million.

“And pharmaceutical companies don’t look at drug addicts as a good investment,” Janda added.

In February, President Obama announced a $1.1 billion budget to fight the opiate crisis, a funding initiative that mandates $1 billion to be spent on expanding access to treatment for addicts over the next two years.

According to the press release, this funding includes:

• $920 million to support cooperative agreements between state and federal government and to expand access to medication-assisted treatment (methadone) for opioid use disorders. States will receive funds based on the severity of the epidemic and the strength of their strategy to respond to it. States can use these funds to expand treatment capacity and make services more affordable.

• $50 million in National Health Service Corps funding to expand access to substance use treatment providers.

• $30 million to evaluate the effectiveness of treatment programs employing medication-assisted treatment under real-world conditions and to help identify opportunities to improve treatment for patients with opioid use disorders.

The president’s budget also includes approximately $500 million to expand state-level prescription drug overdose prevention strategies, to improve access to the overdose-reversal drug naloxone and to fund physicians to prescribe buprenorphine (Suboxone), a non-habit forming alternative to Methadone, as part of medicated treatment.

Yet, Janda noted that the entire budget is dedicated to treatment and expanding access to treatment—a noble and necessary tactic but one that often relies on some form of medication and also overlooks the need to expand the way we approach treatment.

Not a single dollar of the president’s financial initiative will go toward researching alternative treatment methods, Janda said.

There are currently very few happy endings in the narrative of opiate addiction, particularly among Boston’s homeless population. It’s no magic pill or potion, but with a vaccine against the addicting effects of these powerful drugs, Janda’s vaccines have the potential to be something magical.

If they’re ever funded, that is.

We need to reassess the way addiction is perceived, Janda said. How much funding does Alzheimer’s research get? If addiction were widely acknowledged as a brain disease, as Alzheimer’s is, this would be a very different story, he said.