6 ms·

Vaccines against addictive drugs push forward despite past failures

49 points by fern12 9y ago

deleted 9y ago
[deleted]
tcj_phx 9y ago
> Rather than activate the receptor, another drug called naltrexone blocks the receptor and can decrease cravings over time. Naltrexone is essentially a vaccine against both opioids and and alcohol. My recovered-alcoholic friend found that Naltrexone eliminated her ability to consume large amounts of alcohol. But she drank "to make it all go away", and Naltrexone didn't provide any relief for her emotional problems. She took herself off Naltrexone and drank herself into a 2-year prison sentence for her 3rd DUI. She tried to stay sober after getting released, but was unsuccessful because of her anger at her ex-husband (which I somewhat helped her release). Gabor Maté [0] says that virtually 100% of his most-hopeless drug addict patients had experienced "adverse childhood experiences". [0] https://news.ycombinator.com/item?id=16023802 https://news.ycombinator.com/item?id=16023802 Last month I met "Henry" - our mutual friend said he was trying to get off "Black" (black tar heroin). A while later Henry tagged along with us... Mutual friend disappeared for a bit. Henry told me how scared he was of Black... That he'd once gone to Mexico with his family, thought he took enough to get him through the week, but started to go into withdrawal at the end of the trip. He also said how much he loves G (meth amphetamine), and that he'd tried to find some that day, but was unsuccessful. He then said, "A junky like me has to shoot something...", and said he'd used Black in the Taco Bell bathroom that afternoon, shortly before getting in my car. I told him I thought my friend (whom I've mentioned here before) was predisposed to addiction on account of her being adopted. Henry immediately said that he was adopted -- that he was found in a dumpster at 4 months old, screaming his little heart out. > But people struggling with addiction to cocaine or stimulants such as methamphetamine don’t have treatment options like these. They don’t exist. I've read some studies that found that Naltrexone is also helpful for reducing people's stimulant use, and that the anti-psychotics (anti-dopamine drugs) cause people to use more cocaine/amphetamine. Really there's no need for developing "vaccines" for "addictive drugs" - we have tools (naltrexone, the MAOIs, etc) that work well enough to address the reasons that people self-medicate with substances that cause long-term harm. Doctors just need to consider the full conditions of the person who can't limit their use of addictive substances to "recreation". It would also help to stop teaching addicts to be helpless in jail. This week I finally found the rest of a quote about 'feeling safe' that I've referenced for years [1]. Someone had asked about "ego" - the response was, "It's very important to develop an ego. When a person feels safe, the false-ego goes away." [1] https://news.ycombinator.com/item?id=15024780 https://news.ycombinator.com/item?id=15024780
- hookdump 9y ago
  Interesting points. Something else I'd point out is that science often goes through the trouble of finding paliative solutions rather than developing a fundamental understanding of the root causes. If you don't tackle the root causes of addiction, they'll respawn identically or in the form of other addictions, in my opinion. Re. your quote about the ego, I didn't quite get its meaning. Can you elaborate on it?
  - fake-name 9y ago
    I don't think any of the people involved in the science here want to be doing paliative solutions, but rather it's the best they can get funding for. It's much harder to fund "we have to completely rework our public health infrastructure" (in the US, at least), then "We can help save these lives in <insert relatively short timeframe>".
    - tcj_phx 9y ago
      > I don't think any of the people involved in the science here want to be doing paliative solutions, but rather it's the best they can get funding for. Elisabeth Rosenthal wrote An American Sickness about this phenomenon. This essay is a good preview: How Economic Incentives have Created our Dysfunctional US Medical Market - https://medium.com/@RosenthalHealth/how-economic-incentives-have-created-our-dysfunctional-us-medical-market-b681c51d6436 https://medium.com/@RosenthalHealth/how-economic-incentives-...
      - mattkrause 9y ago
        The claim in that article--"a lifetime of treatment is preferable to a cure"--is bonkers. It might be true if there was only one pharma company, but surely most companies would prefer that you buy their one-time cure than become a lifetime customer of their competitors. Diabetes is a particularly bad example because an ungodly amount of time and money has been spent trying to protect, repair, or regrow beta cells. Despite this, we have made very little progress. However, Accu-Chek is not bribing researchers to tank their experiments in the hopes of selling more test strips. The problem is that biology is absurdly complex and messy. Plus, we have a nice counter-example. Until recently, patients with Hepatitis C were treated with a long course of interferon (6 months to a year), with relatively mixed results and fairly nasty side effects. About 50% of patients did not clear the virus, and needed liver transplants. In 2013-4, Gilead got approval for sofosbuvir, which needs to be taken for only 12 weeks, has a much higher cure rate, and more mild side effects. To be fair, it is eye-wateringly expensive, especially in the US, but that's one way to make 'cures' work.
RcouF1uZ4gsC 9y ago
What is going to be an issue, is that opiods (like heroin, Fentanyl, morphine, oxycodone) actually have a clinical use apart from the abuse. So either the vaccine is very specific and just changing from say fentanyl to another of the many available opiods defeats the vaccine, or else it renders a whole class of drugs that may be legitimately used for pain management or anesthesia during surgery no longer able to be used for potentially the rest of the person's life.
- freedomben 9y ago
  My thoughts exactly. So somebody gets this vaccine and then breaks their arm or goes into surgery, and suddenly there is no pain treatment available to them because of the vaccine.
  - IntronExon 9y ago
    For you or me that’s a really valid concern, but the damage to someone from opiate abuse is so extreme I think they’d take that risk. In fact some might even see the inability of a well meaning medical professional to dose them with an opiate as a feature, not a bug.
    - hrktb 9y ago
      The hard part is that anesthesia is not just for comfort. I am not a doctor, but having the body in a low excitement mode for complex surgery must be an advantage. So resistance to anesthesia could mean no surgery beyond the most basic ones.
      - mattkrause 9y ago
        I wouldn't go that far. There are a lot of options for anaesthesia, and many of them are not opioids. For example, there is a whole set of halogenated ethers like sevoflurane and isoflurane (the most typical inhaled anesthetics). Their chemical structures and mechanisms of action are very different from opioids, so the vaccine-produced antibodies would not recognise or react with them. This is true for many of the other options (benzos, ketamine, even xenon gas). That said, opioids are useful. They are very good analgesics (pain relievers) and can be used as anesthesia in certain situations, like cardiovascular patients. However, for most people in most situations, there are other non-opioid options.
deleted 9y ago
[deleted]
adventured 9y ago
I've had a few friends that became addicted to opioids over the last ~20 years. It's terrifying to see what it can do to a person, how the addiction takes over. The only product I've seen work consistently to stop relapse and interrupt the craving, is Suboxone and the equivalent. It worked extremely well, returned them to a fully normal functioning state, but they couldn't stop taking it. The vaccination approach, even if it's unlikely to succeed, I certainly hope that it does, as every opioid addict I've known has ended up in a battle that never actually stops. It becomes a life-long struggle.
ibogatemp222 9y ago
It's unfortunate that iboga/ibogaine is illegal in the states. It would make this disaster incredibly moot if it were accessible and promoted. Source: self. Have used it, not for addiction, but know people who have, with unbelievable results.
Animats 9y ago
There have been previous attempts. There was "NicVax", which blocks nicotine somewhat. That made it to Phase III trials, but it wasn't very effective.
CodeWriter23 9y ago
There must be a dose where the volume of heroin outstrips the body’s ability to generate antibodies, resulting in opiates passing into the brain. Addicts who have taken the vaccine will increase their chance of overdose when they relapse because they know just one balloon isn’t going to do the trick. And slam 5 balloons instead. Also, opiate receptors serve a purpose in pain relief and feeling pleasure when the brain secretes endorphins. The article doesn’t cover whether endorphins will trigger the immune response in people who have been modified by the vaccine.
baxtr 9y ago
Wait, so we we invent some great drugs for very specific use cases, prescribe them to the masses, just to find out that we created an epidemic and, then, instead of going back to prescribing it only rarely, invent a new drug against the abuse!? I don’t get it

49 points by fern12 9y ago

deleted 9y ago

[deleted]

> Rather than activate the receptor, another drug called naltrexone blocks the receptor and can decrease cravings over time. Naltrexone is essentially a vaccine against both opioids and and alcohol. My recovered-alcoholic friend found that Naltrexone eliminated her ability to consume large amounts of alcohol. But she drank "to make it all go away", and Naltrexone didn't provide any relief for her emotional problems. She took herself off Naltrexone and drank herself into a 2-year prison sentence for her 3rd DUI. She tried to stay sober after getting released, but was unsuccessful because of her anger at her ex-husband (which I somewhat helped her release). Gabor Maté [0] says that virtually 100% of his most-hopeless drug addict patients had experienced "adverse childhood experiences". [0] https://news.ycombinator.com/item?id=16023802 https://news.ycombinator.com/item?id=16023802 Last month I met "Henry" - our mutual friend said he was trying to get off "Black" (black tar heroin). A while later Henry tagged along with us... Mutual friend disappeared for a bit. Henry told me how scared he was of Black... That he'd once gone to Mexico with his family, thought he took enough to get him through the week, but started to go into withdrawal at the end of the trip. He also said how much he loves G (meth amphetamine), and that he'd tried to find some that day, but was unsuccessful. He then said, "A junky like me has to shoot something...", and said he'd used Black in the Taco Bell bathroom that afternoon, shortly before getting in my car. I told him I thought my friend (whom I've mentioned here before) was predisposed to addiction on account of her being adopted. Henry immediately said that he was adopted -- that he was found in a dumpster at 4 months old, screaming his little heart out. > But people struggling with addiction to cocaine or stimulants such as methamphetamine don’t have treatment options like these. They don’t exist. I've read some studies that found that Naltrexone is also helpful for reducing people's stimulant use, and that the anti-psychotics (anti-dopamine drugs) cause people to use more cocaine/amphetamine. Really there's no need for developing "vaccines" for "addictive drugs" - we have tools (naltrexone, the MAOIs, etc) that work well enough to address the reasons that people self-medicate with substances that cause long-term harm. Doctors just need to consider the full conditions of the person who can't limit their use of addictive substances to "recreation". It would also help to stop teaching addicts to be helpless in jail. This week I finally found the rest of a quote about 'feeling safe' that I've referenced for years [1]. Someone had asked about "ego" - the response was, "It's very important to develop an ego. When a person feels safe, the false-ego goes away." [1] https://news.ycombinator.com/item?id=15024780 https://news.ycombinator.com/item?id=15024780

hookdump 9y ago
Interesting points. Something else I'd point out is that science often goes through the trouble of finding paliative solutions rather than developing a fundamental understanding of the root causes. If you don't tackle the root causes of addiction, they'll respawn identically or in the form of other addictions, in my opinion. Re. your quote about the ego, I didn't quite get its meaning. Can you elaborate on it?
- fake-name 9y ago
  I don't think any of the people involved in the science here want to be doing paliative solutions, but rather it's the best they can get funding for. It's much harder to fund "we have to completely rework our public health infrastructure" (in the US, at least), then "We can help save these lives in <insert relatively short timeframe>".
  - tcj_phx 9y ago
    > I don't think any of the people involved in the science here want to be doing paliative solutions, but rather it's the best they can get funding for. Elisabeth Rosenthal wrote An American Sickness about this phenomenon. This essay is a good preview: How Economic Incentives have Created our Dysfunctional US Medical Market - https://medium.com/@RosenthalHealth/how-economic-incentives-have-created-our-dysfunctional-us-medical-market-b681c51d6436 https://medium.com/@RosenthalHealth/how-economic-incentives-...
    - mattkrause 9y ago
      The claim in that article--"a lifetime of treatment is preferable to a cure"--is bonkers. It might be true if there was only one pharma company, but surely most companies would prefer that you buy their one-time cure than become a lifetime customer of their competitors. Diabetes is a particularly bad example because an ungodly amount of time and money has been spent trying to protect, repair, or regrow beta cells. Despite this, we have made very little progress. However, Accu-Chek is not bribing researchers to tank their experiments in the hopes of selling more test strips. The problem is that biology is absurdly complex and messy. Plus, we have a nice counter-example. Until recently, patients with Hepatitis C were treated with a long course of interferon (6 months to a year), with relatively mixed results and fairly nasty side effects. About 50% of patients did not clear the virus, and needed liver transplants. In 2013-4, Gilead got approval for sofosbuvir, which needs to be taken for only 12 weeks, has a much higher cure rate, and more mild side effects. To be fair, it is eye-wateringly expensive, especially in the US, but that's one way to make 'cures' work.

RcouF1uZ4gsC 9y ago

What is going to be an issue, is that opiods (like heroin, Fentanyl, morphine, oxycodone) actually have a clinical use apart from the abuse. So either the vaccine is very specific and just changing from say fentanyl to another of the many available opiods defeats the vaccine, or else it renders a whole class of drugs that may be legitimately used for pain management or anesthesia during surgery no longer able to be used for potentially the rest of the person's life.

freedomben 9y ago
My thoughts exactly. So somebody gets this vaccine and then breaks their arm or goes into surgery, and suddenly there is no pain treatment available to them because of the vaccine.
- IntronExon 9y ago
  For you or me that’s a really valid concern, but the damage to someone from opiate abuse is so extreme I think they’d take that risk. In fact some might even see the inability of a well meaning medical professional to dose them with an opiate as a feature, not a bug.
  - hrktb 9y ago
    The hard part is that anesthesia is not just for comfort. I am not a doctor, but having the body in a low excitement mode for complex surgery must be an advantage. So resistance to anesthesia could mean no surgery beyond the most basic ones.
    - mattkrause 9y ago
      I wouldn't go that far. There are a lot of options for anaesthesia, and many of them are not opioids. For example, there is a whole set of halogenated ethers like sevoflurane and isoflurane (the most typical inhaled anesthetics). Their chemical structures and mechanisms of action are very different from opioids, so the vaccine-produced antibodies would not recognise or react with them. This is true for many of the other options (benzos, ketamine, even xenon gas). That said, opioids are useful. They are very good analgesics (pain relievers) and can be used as anesthesia in certain situations, like cardiovascular patients. However, for most people in most situations, there are other non-opioid options.

deleted 9y ago

[deleted]

adventured 9y ago

I've had a few friends that became addicted to opioids over the last ~20 years. It's terrifying to see what it can do to a person, how the addiction takes over. The only product I've seen work consistently to stop relapse and interrupt the craving, is Suboxone and the equivalent. It worked extremely well, returned them to a fully normal functioning state, but they couldn't stop taking it. The vaccination approach, even if it's unlikely to succeed, I certainly hope that it does, as every opioid addict I've known has ended up in a battle that never actually stops. It becomes a life-long struggle.

ibogatemp222 9y ago

It's unfortunate that iboga/ibogaine is illegal in the states. It would make this disaster incredibly moot if it were accessible and promoted. Source: self. Have used it, not for addiction, but know people who have, with unbelievable results.

Animats 9y ago

There have been previous attempts. There was "NicVax", which blocks nicotine somewhat. That made it to Phase III trials, but it wasn't very effective.

CodeWriter23 9y ago

There must be a dose where the volume of heroin outstrips the body’s ability to generate antibodies, resulting in opiates passing into the brain. Addicts who have taken the vaccine will increase their chance of overdose when they relapse because they know just one balloon isn’t going to do the trick. And slam 5 balloons instead. Also, opiate receptors serve a purpose in pain relief and feeling pleasure when the brain secretes endorphins. The article doesn’t cover whether endorphins will trigger the immune response in people who have been modified by the vaccine.

baxtr 9y ago

Wait, so we we invent some great drugs for very specific use cases, prescribe them to the masses, just to find out that we created an epidemic and, then, instead of going back to prescribing it only rarely, invent a new drug against the abuse!? I don’t get it