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NIDA

Dr. Thomas Kosten

May 29, 2015

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Dr. Thomas Kosten

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The vaccines that are being developed are nicotine, cocaine, methamphetamine, and opiates; those are the main classes.

The other drugs of abuse, for one reason or another, don’t lend themselves to vaccines.

These are medications that are optimally for preventing relapse.

That is, these are meant for people who have decided that they want to stop using the drug of abuse, that they've in fact been able to get some time abstinent or drug free because it is a competitive antagonist, which means if you use enough of the drug of abuse, you can override the blockade that it produces.

Ultimately, these are medications that are needed to be used in conjunction with other interventions.

I think that the use of behavioral interventions has been very effective and that would certainly be one of the things you'd join them up with.

The other is that these biological blocking agents don't take care of craving, and craving will persist to 6 to 8 weeks after you stop using the drug.

So, other medications may have a role in decreasing craving for the drugs of abuse.

So this is clearly part of a multi-modality intervention program and is best used for people who want to stop using cocaine, stop smoking, stop using methamphetamine.

If they're determined to keep using the drug in spite of the vaccine, then they may well try to override the vaccine.

Vaccinating prophylactically or vaccinating in advance may not be a very good idea unless you can show some very high risks that the person using the drug not only would use the drug, but would become dependent on the drug.

Many adolescents will experiment with various drugs including nicotine or perhaps even cocaine or marijuana, and because they use it once or twice or even three or four times, does not mean that they're going to become dependent on that drug.

In fact, the data for cocaine, as an example, it looks about every 10 users, 2 of them will become dependent.

The other eight will simply stop.

So that the likelihood that someone would become dependent because they've used the drug once or twice is actually relatively small.

If you do vaccinate, then I think it's important that the adolescent, the child, understand that they really are being vaccinated as a way to prevent them from getting an effect from the drug and prevent them from becoming addicted to it—that they can in fact override this vaccine.

They could in fact use more of the drug then they would ordinarily and then get a high from it.

That's very important because that might magnify the toxic effects of these drugs.

Say you have a nicotine vaccine that's fairly effective, and in order to override the nicotine vaccine, let's just say you have to use three or four times the amount of nicotine; are adolescents capable of smoking three or four cigarettes all at the same time?

Potentially.

And what would happen?

Well, what would happen from that is that they would start to get the effect of the nicotine and potentially the addiction to the nicotine.

But their exposure to the carcinogens would be three- to four-fold magnified.

So, the potential harm that would come from that would in fact be more than what might be the gain.

This page was last updated May 2015

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