A Potentially Life-Saving New Medication for Cocaine Users

Brad Girtz responds cautiously to my article on emerging vaccine therapies for cocaine addiction:

The harmful effect of cocaine is about more than its addictive properties…even recreational and occasional users of the drug put themselves at a higher risk of a heart attack or stroke due to its effect on blood pressure, the artery walls and the nervous system.

He is quite correct that the development of a widely-effective cocaine vaccine, like any other new treatment for addiction, would do nothing to reduce the health damage experienced by non-addicted users. And as Sally Satel and I have pointed out, this damage can be enormous both at the individual and population level. There is however a fascinating new medication being developed for the acute toxic effects of cocaine that could benefit non-addicted users as well as those who are addicted.

Around the roots of the coca plant is a bacteria which contains a remarkable esterase that breaks down cocaine with astonishing speed. Professor James Woods of the University of Michigan has sequenced the bacteria and can produce it in the lab. Rats injected with the esterase are unaffected by even lethal doses of cocaine.

The esterase doesn’t survive long in the body, so it isn’t intended as an addiction treatment. Rather, like naloxone (aka Narcan) for heroin overdose it has the potential to be life saving in crisis situations (e.g., the ambulance arrives to find some in acute cocaine overdose). The beneficiaries could include casual users who overdose as well as addicted people who for example are on an anti-stimulant vaccine and tried to override it with a massive dose of cocaine.

Unfortunately, as with cocaine and methamphetamine vaccines, private industry has shown only tepid interest in the esterase, leading the development process, in Dr. Woods’ word, to be “as slow as the dickens”. The life-saving possibilities of this esterase are another reason why we should use public policy to increase private investment in medication development for stimulant drug users.