Cocaine addiction may not be a traditional disease, but that hasn’t stopped researchers at the Columbia University Medical Center from testing a vaccine to dull the stimulant’s punch.
The researchers reported some success in their human laboratory study, though local addiction treatment centers in Harlem say that a vaccine will never be a direct cure for addiction.
The vaccine significantly blocked cocaine’s intoxicating effects in five out of 10 addicts, according to the CUMC study published this January in the journal Biological Psychiatry. In spite of this success, the study’s leaders are skeptical that this specific vaccine will become publicly available.
“It appears that this particular cocaine vaccine may not be optimal because only about half the people seem to develop ... [enough] antibody for it to be meaningful,” said Margaret Haney, leader of the study and a professor of clinical neurobiology at Columbia.
Participants who responded to the vaccine spent an average of $49 less on cocaine during the 13th week than they had in the first week of the study, Haney said, thanks to antibodies created by the vaccine. These immune system molecules attach to cocaine particles, keeping most of them from entering users’ brains.
The vaccine may have worked chemically, but subjects in a clinical trial conducted by Thomas Kosten at Baylor University took more cocaine to compensate for the blunted rush, though none overdosed. “That’s the primary concern we have with the vaccine approach,” Haney said.
Experts at local drug clinics are not surprised that the vaccine could potentially induce addicts to use more cocaine, and believe that the psychological aspect of addiction must be overcome before any other treatments can be successful.
William Perkins, clinical director of the nonprofit CREATE Inc., a program for chemical dependency treatment on Lenox Avenue in Harlem, said that he doesn’t believe there is a physical cure for addiction.
“The principles of recovery are admitting and accepting powerlessness of addiction. They [addicts] need to have the courage and commitment to change old thinking attitudes and behavior,” he said.
Elaine Schechtel, director of the chemical dependence program at the Upper Manhattan Mental Health Center, said that addiction is much more complicated than a simply physical problem. The center uses psychiatric treatment and individual and group therapies to help those suffering from addiction.
“It’s not the drug, it’s the drug world they’re addicted to. Just because they stop using one drug doesn’t mean they won’t start another,” Schechtel said.
Haney acknowledged that the vaccine will not prevent cravings and other psychological aspects of cocaine addiction. “It’s absolutely certain that you will have to undergo some behavioral or psychosocial therapy,” she said.
The vaccine may be more effective, she explained, for users undergoing traditional therapy. “If someone is clean for a couple of weeks, they might go back to using a small amount and that typically then results in a full relapse,” she said. “But if they have antibody on board, that presumably wouldn’t happen because the effects of that return to drug use would be blunted.”
Perkins thinks the vaccine could dull cocaine’s effects long enough to help addicts begin treatment. “Anything that could get somebody to stop for a period of time, long enough for them to think about what they’re doing, could be helpful,” he said.
The vaccine’s potential for inducing overdose is not the only reason why it may take time for the vaccine to gain FDA approval.
Columbia’s study shows that vaccine-boosted levels of antibodies are linked with increased heart rate. This is because antibodies don’t destroy cocaine, but rather block its effect on the brain, allowing it to continue being a stimulant in the bloodstream. Given that heart attacks are a leading cause of death in cocaine users, according to the National Institute on Drug Abuse, Haney said this could be problematic.
“The cardiac issue is one of concern, but I think it just needs further study,” she said.
Kosten from Baylor University is now leading a new effort to conduct the same clinical trial at six sites across the country to further explore the effects of the vaccine, which is not available outside of these studies. Columbia will be one of the participating sites in the trial.
“This is the first attempt to look at a cocaine vaccine,” Haney said. “So it might be that a better one will come down the road that produces antibody more effectively, but this is what we have to work with now.”
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