Vaccine to Fight Drug Addiction Is Needed

Vaccine to Fight Drug Addiction Is Needed

http://articles.latimes.com/1990-03-01/business/fi-2381_1_drug-addiction

INNOVATION

March 01, 1990|MICHAEL SCHRAGE
Pundits and politicos seldom miss an opportunity to decry "the drug epidemic" as a "plague" cruelly infecting the hearts and minds of today's youth. They talk tough about pushers and then ladle on the compassion for the victims of this "dread disease." But if drug addiction really is an illness, then we better start treating it like one. By now, we should all know that education, cracking down on pushers, offering treatment on demand or even strafing Colombia's countryside with coca-hungry caterpillars won't be enough. History strongly suggests that another approach is necessary to combat infectious disease. When polio epidemics crippled tens of thousands in the 1940s and 1950s, the best answer turned out not to be a cure but a prophylactic. Dr. Jonas Salk became a Nobel prize-winning American hero by crafting the polio vaccine. Within a decade, polio was effectively destroyed as a public health menace.
So where is the Jonas Salk of drug addiction? At a time when certain economists and policy intellectuals seriously argue that the best way to cope with addictive drugs is to legalize them, doesn't it make sense to at least explore the option of crafting a "vaccine" to prevent drug addiction? Or has the old-fashioned belief that "an ounce of prevention is worth a pound of cure" completely lost its currency? Developing a medicine capable of erasing drug-induced euphoria and/or reducing the physical cravings associated with addiction is a high-risk--but genuine--medical possibility. A vaccine would be a powerful way to reduce the demand for drugs. "Given what we've learned over the last 10 or 15 years of neuroscience, we can seriously consider designing drugs that cut down the euphoric effects of cocaine," asserts Dr. Marvin Snyder, the director of preclinical research at the National Institute on Drug Abuse. This option is not being explored as seriously as it should be. "This isn't pie in the sky but it simply isn't on the plate," says Dr. Herbert D. Kleber, William Bennett's deputy czar at the Office of National Drug Control Policy. "The technology doesn't yet exist. A vaccine would be at least five to 10 years away at the earliest." Current drug research focuses primarily on the biochemistry of addiction. The goal is to design medicines that could help cure addicts of their cravings and wean them off chemical dependency. The research has its roots in the Vietnam War. "Congress was desperately looking for a way to deal with all these addicted soldiers in Vietnam," Kleber recalls. Heroin was then the drug of choice, and the medical community simply had no useful understanding of how it affected the brain. But as sophistication about how the brain's elaborate networks of chemical receptors has grown, pharmacologists have been able to devise "antagonists" that compete with the drug for access to the brain's pleasure points. The presence of these antagonists in a person's system can effectively shut down a drug high. Naltrexone is a successful antagonist for heroin. NIDA's Snyder reports that the agency plans clinical trials for a 30-day Naltrexone-based heroin "blocker" by year-end to help treat addicts. No effective antagonists for cocaine or designer amphetamines have been found, and developing them poses enormous challenges. For example, NIDA's Snyder points out that it takes barely seven seconds for a puff of crack to hit the brain. But make no mistake: Sooner or later, researchers will find these antagonists, and we will have a powerful set of pharmacological tools to break the cycle of addiction. The issue then becomes, do we use these antagonists solely to treat addicts? Or do we also look to package them as long-term "vaccines" that can inoculate people against these illegal narcotics?
Obviously, drug addiction isn't polio or tuberculosis. The pathologies of these diseases are fundamentally different. Drug abuse is very much a matter of personal choice and, Kleber notes, "Vaccines for human behavior aren't the same as for viruses and bacteria," although he adds that "it should be one of the weapons available." "Drug addiction is a unique disease," says NIDA's Snyder. "The idea of vaccinating people to prevent a behavioral change is a completely new--and frightening--concept for me." Nevertheless, when Snyder looks at the "worst-case scenarios" that link drug addiction to the spread of AIDS, he acknowledges that figuring out "what is the risk-benefit of prophylactically treating 9- or 10-year-olds for drug abuse?. . . . That question may very well have to be raised."
We should consider making chemical intervention to minimize drug abuse mandatory in all of our nation's high schools. A national program to inoculate young people against drug abuse in, say, high school, would be unquestionably risky. No vaccine is completely safe, and we don't yet have one anyway. The Swine Flu fiasco of the 1970s shouldn't be forgotten. What's more, Kleber and others point out, "our street chemists are very sophisticated" and would try to design drugs that thwart a vaccine's effectiveness. Civil libertarians would no doubt howl that, precisely because drug abuse represents personal choice, requiring an anti-drug inoculation the same way that we require a polio shot would infringe on people's constitutional rights. Perhaps. In other words, it's OK to put fluoride in water to prevent tooth decay but heaven forbid that we take steps to prevent people from becoming addicted to hard drugs. Then again, NIDA's Snyder asks: "Should a pregnant addict be required to take this so that her child won't be born addicted to cocaine?" And these aren't even the hard issues.
Nevertheless, the real possibility of a vaccine--and our willingness to aggressively pursue it--forces us to re-examine our priorities in battling drugs. "What we're trying to do is prevent drug abuse by education and other prevention techniques," Kleber says. "That has a higher priority than coming up with a vaccine." Does anybody who has spent any time with young addicts honestly believe that drug education alone is enough? Is it truly more cost-effective and humane to treat people only after they have become physically racked by addiction? Or might it just make a smidgen more sense to medically intervene before drug abuse degrades into drug addiction? As for those champions of drug legalization--who seem as pathetically addicted to their economic arguments as crack heads are to their cocaine--please explain why government oversight of cocaine sales is morally superior to insisting that children get inoculated. We should grasp for whatever innovations might safely help us better cope with what this Administration insists on calling its "War on Drugs." No country in the history of mankind has ever won a war by simply treating the casualties.