Cocaine Cravings Can Be Blocked, Are We Beating Addiction?

Every once in a while, you come across a research breakthrough that makes you sit up and take notice. Emerging research into skin grafts and cocaine cravings are one of those unexpected breakthroughs in addiction research.

Apparently, skin grafts are useful for more than burns now!

According to the National Survey on Drug Use and Health, about 1.9 million people in the United States used cocaine in 2016. That also means there are about 200,000 people addicted to cocaine in the country… and that is a BIG problem.

As I mention in The Abstinence Myth book, addictions are created by the interaction of four factors – biology, psychology, environment, and spirituality. When it comes to biological interventions for cocaine, we’ve been left with very little despite decades of work. Opiate users have methadone and buprenorphine, but there’s nothing available to help take the edge off cocaine withdrawals. This makes recovery from cocaine a difficult process. What's more, there are no overdose-reversal drugs on the market for cocaine. Naloxone is in high demand for opioid overdoses, but for cocaine users, overdose may be fatal. Over the past few decades, researchers were experimenting with a vaccine, although no eventual product came ever came to market.

This new biological research into skin grafts may offer cocaine users a way to curb cravings and prevent overdoses and ultimately support addiction recovery.

Skin Graft Research: The solution to cocaine addiction?

A team of postdoctoral researchers at the University of Chicago have revealed that skin grafting an effective cocaine-degrading enzyme could be used in mice to reduce cocaine-seeking behaviors and make the mice less susceptible to overdose when given large amounts of cocaine.

Their findings, published in the Journal of Nature Biomedical Engineering, demonstrated that skin epidermal stem cells can be freely edited using CRISPR technology. What does this mean, exactly? Simply stated, the skin graft treatment that altered skin’s genetic makeup prevented the mice from searching for cocaine (controls cravings) and even stopped the mice from dying from a lethal dose of cocaine (prevents overdoses).

"Adapting this approach for humans could be a promising way for blocking addiction.” —Qingyao Kong

How does the skin graft procedure impact drug use behavior? Well, the skin grafted enzyme breaks down the substance (cocaine) before it triggers the pleasure response in the brain. We know the pleasure response is addictive in humans and so the skin graft acts as an immunization or blocker, against addiction. In this way, the approach is somewhat similar to the previously researched vaccine routes and to the naltrexone approach to preventing and reducing alcohol and opioid use. This is an exciting finding as this procedure may also be applicable to the enzymes that target alcohol and nicotine addiction. It means that the skin graft technique could be used in a range of chemical addictions.

To be clear (and more on this at the end of this article), biological interventions are only effective at resolving the biological factors relevant to a person’s addiction. They don’t, in and of themselves, resolve any other aspect of the issue. However, biology can be a major barrier for getting started, and so the help is useful.

Top 5 reasons why the graft works:

Are you still not sure how exactly a skin graft can treat addiction? Well, I’ve summarized the science for you so that it all becomes clearer:

1. The enzyme. Humans have a naturally produced enzyme called butyrylcholinesterase (BChE), which breaks down substances like cocaine into smaller molecules in the body. This enzyme can also be modified to fast-track cocaine metabolization and can be a possible treatment for cocaine cravings and overdoses. In the Chicago research study, researchers created skin stem cells that carried the BChE gene for the enzyme and transplanted it onto the mice. Once the genetically modified skin graft releases hBChE into the bloodstream, it quickly processes any cocaine that is consumed before the cocaine activates receptors in the brain. This means that the enzyme can not only reduce cravings, but it can stop the association between cocaine and pleasure.

2. It immunizes against overdose. The skin-grafted mice in the study did not get the pleasure response, also known as the dopamine spike, when they were administered large doses of cocaine. This meant they lost interest in consuming more cocaine faster than the control group. While half of the control group (no skin grafts) died of a cocaine overdose, none of the skin-grafted mice did.

3. BChE levels are higher when skin grafts are used. The researchers found that, compared to injecting the enzyme into the mice, the genetically engineered skin graft proved more effective in preventing cocaine use and overdose because the enzyme levels were higher and longer-lasting than a direct muscle injection.

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4. The enzymes do not affect the DNA more broadly. The mice in the study responded well to the skin graft and they continued to function healthily, producing high levels of BChE. There was no evidence of the mice immune systems rejecting the stem cells or the skin graft and what’s more, the researchers reported the mice to be healthy and well at one-year-old.

5. It’s long-lasting. The mice from the study are now a year old and continue to be healthy and producing BChE. This means the benefits of the skin graft procedure may be long-lasting.

Is skin graft treatment the future of substance addiction?

While this study is an exciting breakthrough in addiction research, it is still in the experimental phase. So, like previously studied vaccines, there is still no readily available product. We also know that not all substance metabolism works using the enzyme that was the focus of this study, so it may have applications to drugs like cocaine and alcohol, but it probably will not work for other substances such as opiates, meth, etc.

Also, it is somewhat difficult to conceive on when exactly a skin graft like this would be used. Would anyone seeking cocaine treatment benefit from it or only harder to treat cases? Would criminal justice involvement one day mandate it? Again, it isn’t clear from the research who would best benefit.

There are certainly advantages to focusing on the biological component of addiction, after all, it can be a strong driving force in maintaining addiction and difficulties with recovery. Compared to other gene therapies, this skin graft approach is minimally invasive, effective over the long-term, requires low-maintenance and could be relatively affordable. While that's positive news and addresses the genetic predisposition side of addiction, it doesn't address OTHER reasons why people use and abuse, to begin with.

Without addressing the WHY behind the addiction, potentially working with professional help to help break unhealthy thought patterns and habits, address past trauma, and resolving problematic environmental factors, even if you do end up quitting cocaine for good, your quality of life may not improve. And if these other factors do not change as well, a return to other addictions might be possible and the enzyme won’t be much help. As I’ve mentioned before – abstinence is not the only measure of recovery. Recovery is a journey that requires breaking unhealthy thought patterns, distancing yourself from things that don't serve you, and adopting healthy lifestyle habits.

You can read more about my views on the four “camps” of addiction – biology, trauma, spirituality, and environment that cause and maintain addiction in my book, The Abstinence Myth.