Common Sense for Drug Policy Presents: Modified Cocaine: Replacement Therapy or Vaccine?

Could modified cocaine treat individuals who are diagnosed with cocaine addiction? On January 1, 2008 the Houston Chronicle ("Houston scientists see hope in cocaine vaccine") reported that 'The Baylor College of Medicine scientists have developed a cocaine vaccine, currently in clinical trials, that stimulates the immune system to attack the real thing when it's taken. As a result, cocaine no longer provides a kick. 'For people who have a desire to stop using, the vaccine should be very useful,' said Dr. Tom Kosten, a psychiatry professor who was assisted in the research by his wife, Therese, a psychologist and neuroscientist. Kosten says the idea goes back to the 1950s, when scientists devised a vaccine to treat potentially fatal overdoses of the then-popular heart medication digitalis, and the 1970s, when researchers experimented with a heroin vaccine before abandoning it. Kosten took up the idea in the mid-1990s, figuring cocaine was a better candidate because the enzyme for breaking it down is in the bloodstream, not the liver, like most drugs."

The Chronicle article explains, "Cocaine (and many other drug) molecules are so small the immune system fails to recognize them and make the antibodies necessary to mount an attack. To help the immune system, Kosten attached inactivated cocaine to the outside of inactivated cholera proteins. In response, the immune system not only makes antibodies to the combination, which is harmless, but also recognizes the potent naked drug when it's ingested. The antibodies bind to the cocaine and prevent it from reaching the brain, where it normally would generate the highs that are so addictive."

It was noted that, "The vaccine also could raise interesting ethical questions involving who should get inoculated and what happens if confidential information about those receiving it becomes known. Although developed for therapeutic purposes — the number of cocaine addicts in this country is estimated at more than 2 million — the vaccine eventually is expected to be used for prevention, as well. Vaccines' ethical concerns have occasioned academic papers, committee investigations and conferences. In a 2004 report, the National Academy of Sciences' Center for Studies of Behavior and Development lauded the new method's promise, but cautioned that it 'poses distinct behavioral, ethical, legal and social challenges that require careful scrutiny."

"Kosten, who joined Baylor 18 months ago, asked the Food and Drug Administration in December to green-light a multi-institutional trial to begin in the spring. It presumably would be the final clinical hurdle before the vaccine might be approved for treatment. Over the years, Kosten notes, more than 50 pharmaceutical options have been investigated and found wanting."