Vaccines against drug abuse (NOT!)

A really bad idea about how to use a really promising technology.

What if someone who would like to quit smoking cigarettes or crack but finds it hard to do so could get an injection that would keep the molecules of the drug in question from getting from his bloodstream to his brain? If he took the drug, he would get little or no psychological effect from it; the behavior, like all unrewarded behaviors, would extinguish fairly quicly.

If such a treatment existed, some forms of drug dependency would suddenly become curable rather than merely treatable. (Here’s the fairly optimistic National Academy report on the topic, which includes my chapter on benefits and costs.)

The technology seems to be within reach; a nicotine therapy is well along in human trials, and a cocaine therapy shows promise, though it has yet to be subjected to the double-blind acid test. (Alcohol is a no-go for technical reasons, and there are so many opiates and opioids out there that there might not be much use in making one or two of them unusable by a given patient; the new treatments are molecule-specific.)

The idea is either to teach the body’s immune system to respond to the drug molecules as if they were pathogens (by making antibodies to them), or to make the antibodies in a factory and then inject them directly into the patient.

Since this is the same principle by which vaccination against infectious disease works, it seems natural to call the proposed therapies “vaccines.” But calling them vaccines would be profoundly misleading, since vaccines are used prophylactically, to prevent disease, while the new anti-drug treatments would be used therapeutically, to treat already established cases of drug abuse (or, perhaps, as secondary prevention in individuals — especially adolescents — who had started to use an abusable drug but not yet become diagnosably drug-abusing or dependent).

As a policy proposal, mass preventive immunization against the abuse of some drug just doesn’t pass the giggle test. The useful life of a treatment is likely to be three months or so, though it could be repeated. Each treatment is likely to cost hundreds of dollars, which is tiny compared to the cost of active cocaine addiction and small compared to the cost of active tobacco addiction but huge compared to the risk faced by a randomly-selected child of becoming dependent on any one drug within a three-month window.

That’s why those working on these new treatments prefer to call them “immunotherapies” rather than “vaccines”: to keep anyone from thinking that we can prevent cocaine abuse the way we prevent polio.

Apparently, it didn’t work. The Independent reports that the British government is seriously studying the idea of mass immunization.

There are three possibilities here: (1) The Independent has gotten the story entirely wrong; (2) Someone in Her Majesty’s Government has been smoking something; or (3) The story is satire. The fact that the primary person quoted is “Professor Nutt” argues for #3, but #2 still seems like the most likely interpretation. Sigh.

It just goes to show that, just when you thought you had a foolproof idea, someone comes along and invents a higher-performance fool.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

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