Ethical Implications in Vaccine Pharmacotherapy for Treatment and Prevention of Drug of Abuse Dependence

Abstract

Different immunotherapeutic approaches are in the pipeline for the treatment of drug dependence. "Drug vaccines" aim to induce the immune system to produce antibodies that bind to drugs and prevent them from inducing rewarding effects in the brain. Drugs of abuse currently being tested using these new approaches are opioids, nicotine, cocaine, and methamphetamine. In human clinical trials, "cocaine and nicotine vaccines" have been shown to induce sufficient antibody levels while producing few side effects. Studies in humans, determining how these vaccines interact in combination with their target drug, are underway. However, although vaccines can become a reasonable treatment option for drugs of abuse, there are several disadvantages that must be considered. These include i) great individual variability in the formation of antibodies, ii) the lack of protection against a structurally dissimilar drug that produces the same effects as the drug of choice, and iii) the lack of an effect on the drug desire that may predispose an addict to relapse. In addition, a comprehensive overview of several crucial ethical issues has not yet been widely discussed in order to have not only a biological approach to immunotherapy of addiction. Overall, immunotherapy offers a range of possible treatment options: the pharmacological treatment of addiction, the treatment of overdoses, the prevention of toxicity to the brain or the heart, and the protection of the fetus during pregnancy. So far, the results obtained from a small-scale experiment using vaccines against cocaine and nicotine suggest that a number of important technical challenges still need to be overcome before such vaccines can be approved for clinical use.

Vaccines against Drug Abuse—Are We There Yet?

“…The underlying reasons are not clear, but could relate to vaccine design, individuals' genetic makeup, or a combination of both. As captured in the literature, this review also identified the importance of the drug abuser's personal motivation to discontinue using drugs as part of vaccine-based treatments [1,2,6,11,12,17,19,40,41]. These factors, as well as the complexities associated with addiction, may help to explain the challenges associated with clinical trials for vaccine-based treatments thus far.…”

“…Abused drugs are small, non-immunogenic molecules that remain undetected by the immune system, allowing them to cross the blood-brain barrier to the reward centers within the brain [3,[5][6][7][8][9][10][11]. Current treatments for drug abuse include psychotherapy, pharmacotherapy, and combinations of both [1,12].…”

“…The conjugate protein/macromolecular carrier is the component of the vaccine that is immunogenic, and is linked to the hapten. The overall structure is known as a hapten-conjugate protein/macromolecular carrier [1][2][3]6,9,11,[14][15][16][17][21][22][23]25,26,29,[32][33][34][35][36][37][38][39][40][41][42]. Adjuvants include aluminum-containing substances that enhance the immune response to an antigen, thereby producing stronger immunity [1,6,8,10,14,25,35].…”

“…The overall structure is known as a hapten-conjugate protein/macromolecular carrier [1][2][3]6,9,11,[14][15][16][17][21][22][23]25,26,29,[32][33][34][35][36][37][38][39][40][41][42]. Adjuvants include aluminum-containing substances that enhance the immune response to an antigen, thereby producing stronger immunity [1,6,8,10,14,25,35]. Adjuvants are common in vaccines against drug abuse.…”

The Power of Knowledge, Responses to Change, and the Gymnastics of Causation

“…Carfora et al (2018) discuss the emerging interest in immune therapies to treat addictions, a novel approach that has the potential to generate profound ethical challenges around consent and integrity of the person (imagining, for instance, mandatory treatment requirements by courts as one future scenario to emerge from such scientific knowledge). The review of J. Benjamin Hurlbut's book Experiments in Democracy: Human Embryo Research and the Politics of Bioethics, by Giulia Cavaliere (2018), describes the historical debates in the Unite States about human embryo research, an example of ethics-rich change if ever there was one.…”