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Addiction

We May Soon Have a Vaccine to Fight Opioid Addiction

Vaccine technology is a revolutionary step in treating human addiction.

Key points

  • The first experimental vaccine for opioid addiction is now in phase 1 clinical testing in the United States.
  • This opioid vaccine activates an immune response that generates antibodies against the oxycodone opioid.
  • The vaccine may also protect against death from an opioid overdose.

Today the United States is fighting two devastating epidemics simultaneously: SARS-CoV2, more commonly known as COVID-19, and opioid addiction, overdose, and death. The opioid pandemic, however, is now almost 20 years old and shows no sign of fading. According to the CDC, annual opioid-related deaths have quadrupled from 25,000 in 2003 to 100,000 in 2021.

Lack of treatment options is a major problem in treating opioid addiction, with only a handful of medications present on the market, including methadone, buprenorphine, and naltrexone. Needless to say, the current treatment options for opioid addiction are largely ineffective and the long-term implications of the opioid pandemic are devasting.

Enter vaccination technology for opioid use disorder as a new potential game-changer in the fight against the opioid pandemic. Ongoing work at the Center for Medication Development for Substance Use Disorders is heavily geared at developing an inoculation against opioid molecules with the potential for saving millions of lives devastated by addiction. If effective, this vaccine could work in ways that other treatments have failed and could dramatically alleviate the cost and burden of addiction treatment nationally.

Through the support of the NIH’s HEAL Initiative to develop new medications for treating opioid use disorder and preventing overdose, the first experimental vaccine for opioid addiction is now in phase 1 clinical testing in the United States. If it passes, this vaccine will advance to phase 2 and 3 trials for a true test of its efficacy in the public drug market as a new medication for drug addiction.

Understanding the science

The details of the science behind the addiction vaccine design are not too different from that of other vaccines. The vaccine is intended to trigger the body to produce neutralizing antibodies against its target, which in this case is not a virus, but a specific drug molecule.

The currently tested opioid vaccine activates an immune response that generates antibodies against oxycodone, a commonly abused prescription opioid. If an individual is to take oxycodone after receiving this vaccine, their body will mount a defensive attack against the molecule and destroy it. Importantly, the body’s rapid immune response would prevent oxycodone from crossing the blood-brain barrier, the gateway to the brain. In some cases, the vaccine may also protect against death from opioid overdose by respiratory arrest, which occurs when oxycodone enters the brain and binds to cells in the breathing center.

Could the vaccine alone treat drug addiction?

NIH HEAL Initiative
How an opioid vaccine works
Source: NIH HEAL Initiative

The theory-to-practice scenario for vaccine technology against drug addiction so far looks promising. In preclinical studies, animals that received the vaccine reduced self-administration of the opioid drug and were protected from drug toxicity including overdose and respiratory death. Moreover, because the vaccine is designed to specifically target oxycodone, it did not appear to interfere with other compounds present in the body including opioid medications such as naloxone.

The true application of vaccine technology to treat complex brain disorders such as addiction will be put to the test through human clinical trials. Whether the vaccine alone can treat drug addiction, which involves both physical and psychological factors, is unknown. To succeed, the vaccine must be able to not only prevent the drug from entry into the brain but must affect various psychological drivers of addiction. Directly or indirectly, the vaccine must impact drug reward and craving-related behaviors. Could a vaccine do that through re-programming the immune system, which resides mostly outside of the brain, to modify an individual’s response to a drug?

This is just one of the questions that may soon be answered as the vaccine moves through human testing. In the end, such vaccines may prove to be useful when used in combination with other treatment options including cognitive behavior therapy and pharmacology.

Opportunity for expanding vaccine therapy

If it works, however, the opportunity to expand vaccine therapy, which has transformed public health since the middle of the 20th century by preventing the spread of contagious diseases such as polio and smallpox, is nothing short of a revolutionary step in treating brain disease. The development of vaccines for drug addiction can now be added to a growing list of aspirational vaccine-based endeavors, which includes novel treatments for various cancers and diabetes. Inadvertently, the emergence of safe, non-mandatory, vaccines to treat drug addiction may go a long way to lessen vaccine hesitancy in society.

References

CA Baehr, MM Wu, SG Pandit, JA Umana, D AuCoin, M Pravetoni. Pharmacological Profiling of Antifentanyl Monoclonal Antibodies in Combination with Naloxone in Pre- and Postexposure Models of Fentanyl Toxicity. J Pharmacol Exp Ther 2022, 381(2):129-136.

M Pravetoni and SD Comer. Development of vaccines to treat opioid use disorders and reduce incidence of overdose. Neuropharmacology 2019, 158:107662.

ND Volkow, M Michaelides, R Baler. The Neuroscience of Drug Reward and Addiction. Physiol Rev 2019, 99(4):2115-2140.

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