Researcher Develops Cocaine Vaccine | Hacker News Reader

Researcher Develops Cocaine Vaccine

singularityhub.com

87 pointsjamesbritt68 comments

This is an opinion piece that doesn't even look at the science. The ClinicalTrials.gov entry they link to as their source only lists one peer-reviewed study, and its conclusion is this (http://www.ncbi.nlm.nih.gov/pubmed/19805702):

  Attaining high (>or=43 microg/mL) IgG anticocaine antibody
  levels was associated with significantly reduced cocaine
  use, but only 38% of the vaccinated subjects attained
  these IgG levels and they had only 2 months of adequate
  cocaine blockade

That's not a stellar success. More importantly, if the Phase I trial revealed that some addicts had up to 5x the level of cocaine in their systems that's a big deal!

Cocaine doesn't just do damage to your brain. It can trigger heart attacks and death by causing the blood vessels that feed your heart to spasm and reduce blood flow. If a person under 40 walks into the ER and complains of chest pain, one of the first questions any competent doc will ask is whether they have recently used cocaine.

Apparently, they didn't see increased mortality in the small sample of people they studied -- but that doesn't mean it wouldn't kill significant numbers of people when deployed across a sizeable population.

So in summary, we have a vaccine that's immunologically ineffective on the majority of recipients, which doesn't eliminate their cocaine use (just reduces it, p=0.048), and which can cause some users to boost their cocaine ingestion to very dangerous levels, and thereby quite possibly increasing cardiac morbidity and mortality (which the vaccine producer may be found liable for).

Why aren't pharma companies lining up to produce this remarkable invention? It must be a conspiracy!!!

Edit: Fixed formatting of quote.

Cocaine doesn't just do damage to your brain. It can trigger heart attacks and death by causing the blood vessels that feed your heart to spasm and reduce blood flow.

Free cocaine does that. This immunization causes the body to produce cocaine-sequestering antibodies.

... some addicts had up to 5x the level of cocaine in their systems ...

To understand the implications of that ratio, you need to know the total cocaine binding capacity, which would require considerably more exotic laboratory tests.

A good point, but antibody sequestration isn't how they explained the vaccine's actions. Instead it's that the cocaine-antibody complex is too large to cross the blood-brain barrier.

So it's unclear whether the antibody response (which the study showed was limited) would sequester the cocaine enough to eliminate its systemic effects.

... the cocaine-antibody complex is too large to cross the blood-brain barrier.

If the cocaine were weakly bound, it would spend part of its time detached from the antibodies, and during those times be able to enter the brain in the usual way. Since the antibodies have a large effect on the psychological effect-response curve, the binding must be quite strong. Therefore cocaine is sequestered throughout the body.

I would really hope the pharma company couldn't be held liable. It's not like increased cocaine usage is a side-effect. It's a voluntary response to the drug's stated purpose. Of course you never know if common sense will actually be applied in such a case.

Its not so much a matter of it causing legal problems directly, as much as the press getting wind and starting in investigation that causes people to demand that their elected officals Do Something. Remember a while back when those anti-depressants were found to be associated with increased suicide risk? I was surprised that there was an outcry since "A dangerous time in depression occurs when a patient is coming out of the deepest part of the experience. At that point, they can mobilize their newly acquired energy to take their own life."[1] But, I never saw anything about that aspect in the news coverage.

[1]http://emedicine.medscape.com/article/288598-overview#aw2aab...

I instantly (and incorrectly) assumed that this was some conspiracy theory-laden story about how big pharma doesn't want to stop cocaine use and the war on drugs is too profitable and etc. etc. etc., but thankfully I was wrong. Here's the key line from the story:

  the dilemma is clear: What would happen if the media got
  wind that inoculated drug users were buying even more coke
  than before. It would be a public relations nightmare for
  any business.

So that's it - and it makes sense. Vaccine makes cocaine less effective, so people buy more (in the short term) to try and get the same high, until they finally realize that doesn't work and give up using it. Long term good, short term PR nightmare.

Yep I agree, the problem is this vaccine cures the drug effects but not the addiction or desire for drugs.

I think the best case for this vaccine is a therapy with vaccine and a supporting group or counsel, and this is made more for people trying to give up the habit (dependency) or for people not to start.

The problem is that patiens on the vaccine would have higher risks of overdose because they now take so much more cocaine. Also I wonder what percentage of them would try to switch to some other drugs.

Cocaine users tend to already buy as much as they can afford, or can use without dying. Hard to increase sales from that level.

I guess once you are hooked the vaccine can be challenging and lead to overdose.

But if you take this before getting hooked, it can just register in your mind that coke isn't fun and there is no high.

It's like my relationship with cigerettes. First few times I took it I was really nervous I would get hooked. Ultimately I found little joy from smoking. So I'm not much of a smoker but I'll average 5-10/cigarettes a month from social situations. My rule is that I can never buy cigs or smoke them at my will since it will mean I'm lusting for it. On the other hand if a friend offers one occasionally, I can smoke it.

"What would happen if the media got wind that inoculated drug users were buying even more coke than before. It would be a public relations nightmare for any business."

not to mention a public health nightmare! cocaine has effects on more than the brain.

also, their study is pretty sketchy: http://www.ncbi.nlm.nih.gov/pubmed/19805702

why are there so many individual differences? why does it work on some people but not others? shouldn't a vaccines effect be pretty standardized?

also, why after 20 weeks are the placebo and high-ig concentrations equal in terms of cocaine-free urine samples?

with questions like these, it seems pretty obvious why no one wants to roll into stage III with this in its current form. it's shitty to hear when it's your life's work but ... it sounds like it needs more work.

shouldn't a vaccines effect be pretty standardized?

No! Evolution guarantees that the immune system is not standardized.

If nobody will manufacture it then it is time to start a startup. Even with the potential PR problems of patients going broke buying more cocaine at first, they will probably be able to find investors. Remember that the google founders at first tried to sell their search engine. Nobody would buy so they had to start google.

They could probably even put the patients in a rehab facility to prevent them from buying more cocaine. Also, this problem should be the first thing that should mentioned to anybody that is listening to prevent the media of acting like they just broke the news on "the evils of using this vaccine that the manufactures were trying to hide" (you know how sensationalist they are) If they do that then news organizations will probably not be able to make a big deal about it.

Startups as we normally think of them don't really work when you have to spend tens or hundreds of millions of dollars to get your drug past FDA approval before you can start making money.

If the vaccine works, the big question is: who will buy it? The biggest market that I'd see is addicts who commit crimes and are required to have the treatment as part of a court ordered program. How big is that market? Pharma isn't about to spend millions on a phase III trial for a fairly small market.

If they really want to see their vaccine approved for use, maybe they should start their own company to produce it. If there is enough of a need for the vaccine, the should be able to find funding (VC or grants).

Now, I could really see their nicotine vaccine doing very well, since there are lots of people who would voluntarily take a vaccine to stop smoking.

I've worked at an addiction clinic. Addicts often do want to quit. Witness the success of disulfiram (Antabuse) and the numerous nicotine cessation products.

They might not All want to quit All the time, but many of them hit their bottom and look for help. The problem is that it's hard to stay sober even if you try.

One could imagine the government making this mandatory for all newborns just like the many other child hood vaccines. In 20 years, you would eliminate all cocaine addicts, as anyone trying cocaine would not get high the first time.

Interesting idea, not sure how practical or ethical it is though.

I wonder if it would bind to some percentage of naturally-occurring stimulants in some percentage of the population.

That's the kind of thing that can really can bring about the downfall of an entire civilization.

That goes against so many ethical and legal codes... This is how you end up with a repressed society.

Why don't you just suggest we start pumping the water full of happy-pills while you're at it?

Some have suggested adding trace amounts of lithium to drinking water in order to reduce depression and suicide. I don't think that's necessarily a good idea, but there is a scientific basis for it. http://bjp.rcpsych.org/content/194/5/464.abstract

Oh, I don't doubt that it would be possible to do it. I'm just saying that it's pretty much one of the canonical "Bad Ideas" (tm) from modern fiction.

It ranks right up there with "stop talking about sharks, you're scaring away the tourists" and "lets split up so we can cover more ground".

Even if the market is small if they charge several thousand dollars for the overall treatment they could potentially make billions of dollars. Specially considering that they can expand to other addictive substances like nicotine.

So, you're going to charge addicts (who have likely bottomed out) several thousands of dollars?

No, most probably the state (as in us) will have to pay for it. I don't understand your attitude. You want somebody to do all the work of bringing this new technology but then you don't want them to charge to at least recoup their investment and make some money for themselves.

People don't seem to get how awesome this is. Sell it to parents. You can guarantee (for some period of time likely) that your children have an artificial tolerance for drug use w/o any ill effects.

The only implication I would want to think about more is what happens next. If all or most high schoolers had been inoculated against hard drug use, does that just mean that people would buy larger quantities? Would the market simply adjust? Would more new designer drugs enter as alternatives?

"Sell it to parents. You can guarantee (for some period of time likely) that your children have an artificial tolerance for drug use w/o any ill effects."

I don't understand what you're saying.

He is saying that there might be a market for it among parents who want to remove from their children the ability to experience drugs.

Right. And how would they do that?

It sounds like you're advocating slipping your children some drug without their knowledge, in order to prevent them from doing cocaine.

Protip: My mom slipped me anti-depressants while telling me they were "vitamins". When I found out, I never trusted her again. Ever. I felt violated. Do this at your own risk.

Protip #2: If they want to do cocaine, you're not going to be able to stop them. I don't know the answer, but slipping your kids some anti-drug drug probably isn't it.

"It sounds like you're advocating slipping your children some drug without their knowledge, in order to prevent them from doing cocaine."

That appears to be what the original person you were responding to was suggesting. I share your concern.

People would just shift to other drugs.

This concept is nothing new; an analogous drug that provides tolerance for heroin already exists. But heroin addicts who are forced to take methadone (as opposed to those who take it to assuage withdrawal symptoms) typically just turn to other drugs.

This drug would be useless for parents - it shouldn't be used to try and force someone else not to use cocaine, since they'll just turn to other drugs. Its only potential use case is the current drug user who wishes to stop but is afraid of the withdrawal period.

Citation needed.

This is the first time that I've heard the claim that giving someone methadone actively causes them to go to substitutes.

Heroin is an opiate with many alternatives from oxcontin to the aforementioned methadone.

There are no generics for cocaine. It is a fairly unique drug that people either free base or snort.

The next jump for someone who wants to get "up" would be meth but you don't see these two being used interchangeably for the most part. I think this proposed drug has viability.

Absolutely. I've known parents whose kids have taken up cocaine and other hard drugs. The pattern has an inevitable up and down where the kids go through periods where they sincerely want to quit, and go through periods where they are lost to the drug.

If a vaccine like this existed, it would be easy to get addicts to use it in periods where they are trying to kick the habit. And that would (for most) end the nightmare. Unless you've been close to a family going through this, it is hard to explain how much of a difference that would make.

You can guarantee (for some period of time likely) that your children have an artificial tolerance for drug use w/o any ill effects.

Cocaine is used in doses (tens of milligrams) that are gigantic by the standards of the immune system. It takes aggressive immunization to create enough antibodies, which would produce frequent autoimmune disorders in a large population.

Or, you could just teach parents to be.... good parents.

Because good parenting can never lead to kids doing coke? Let's just agree to disagree on that one.

It's not a black and white thing, but good parenting certainly decreases the chances your child will go down the drugs path.

Why? Should "good parenting" also decrease the chances of a child drinking alcohol? Pot? Shrooms?

The apparent assumption here among many people that these substances are intrinsically bad is baffling to me. Where do you draw the line? Surely it can't be "legality", because several of the "schedule 1" drugs are completely harmless, and possibly even naturally occurring (in your own body!). If potential for bodily harm is the deciding factor, then we should be discussing alchohol "cures" looong before anything else. It is absurdly common and absurdly addictive.

> Why? Should "good parenting" also decrease the chances of a child drinking alcohol? Pot? Shrooms?

Yes.

Good parenting decreases the chances a child will break the law in general, or be in a self destructive place.

Parenting has a lot of influence on children contrary to some peoples beliefs...

Alcohol is legal and pot is not destructive.

Good parents should also teach their children the difference between legality and morality.

http://en.wikipedia.org/wiki/Lawrence_Kohlbergs_stages_of_mo...

I agree @ difference between legality and morality, but would disagree about pot. It's an antisocial disgusting habit.

Smoking tobacco is legal (for now), but is increasingly being made illegal (public places, restaurants, etc). Which is a good trend IMHO.

"Disgusting" is purely a judgement call, which I admit may have some value in the case of smoking it. Fortunately there are plenty of other ways to use it. Vaporizers are great, and cooking with it... just yes. (You also of course do not need to make a 'habit' of it. I haven't used it in over a year myself)

As for antisocial? Well I can't speak for your experiences but for myself and the people I know it has been nothing but the opposite. Everyone needs to decide for themselves, including your kids.

Aside: Interesting fact about those restaurant/bar smoking ban laws: the reason they need to pass laws specifically for that purpose is because air filled with second hand smoke does not exceed the relatively very loose air quality regulations OSHA has in place. If that smoke were put there by anything besides smokers, nobody would say a thing.

Seeing pretty women with little clothing is considered antisocial by some societies--and even amongst some of the Christians in America.

Where do you draw the line. I am ok with banning something for health reasons. Not so much merely because a subset of people find it "antisocial".

Seeing women with not much on isn't quite the same as making me breathe in your crap.

Anyone who's watched someone go through addiction and recovery knows that it's not that simple.

Next up: make vaccines that allow Mormon parents to render their children permanently unable to metabolize caffeine! Let Baptist parents permanently disable alcohol for their children! Let vegan parents artificially induce lactose intolerance in their kids! Hell, you could even let the socially conservative chemically neuter their children!

Edit: I guess most people think that crippling their children, quite possibly before they are mature enough to give consent, is fine and dandy.

> If the vaccine works, the big question is: who will buy it?

Maybe people who are addicted and want to stop using?

Or dealers will spike their injectables with it to make their addict clients all the more desperate? It's really rare to find an effective one-molecule solution to complex problems of human behavior.

As the article says, some subjects continued using more and more cocaine but eventually stopped since they didn't get its effects (which is the whole point of the "vaccine").

Still, I'm skeptical as there's no mention of problems due to withdrawal.

Thank you. I had the same reaction when I read the OP.

Did you read the end of the article? Big pharma's concern is not the market size but the PR fallout from producing a vaccine that causes some users to buy 5x more coke than they had in the past.

Why would there be enough demand for the drug to create funds from VCs and grants but nor enough demand for big pharma to do something? I have no idea about Phase 3 requirements but I imagine it is not a friendly to startups.

I read the entire article... they speculate that the concern of pharma is PR, but really, their guess is as good as mine as to why someone won't manufacture it.

Might not an effective approach be the opposite of this vaccine? Rather than trying to down-modulate the effects of (addictive substance here), if you instead up-modulate undesirable effects, then even a small dose would have less pleasure than before. Disulfiram (Antabuse) seems to be mentioned a lot in this thread, and that intuitively seems like a saner approach than "make it so they need more to get the same high".

I have little formal knowledge in the area, but wouldn't a cocaine vaccine ruin any medical potential for that class of drug?

That was my first concern. Cocaine is one of the oldest anesthetics, and still used in some limited circumstances. But there are a lot of derivative drugs, e.g novocaine that nearly ever dentist uses, which are basically cocaine without the dopamine high. Would this vaccine change novocaine's effectiveness in the patient?

It would be fairly easy to determine whether the antibodies bind to commonly used drugs that are derivatives of cocaine (this is basically what ELISA testing is for, and computer simulations would give you a general idea of whether it would bind or not). I would assume that this sort of testing would have been done prior to it being tested on humans, or at the very least would be done before it enters into common usage.

Discussions of "big pharma" aside, this seems like a classic case of treating symptoms and not causes. If you consider that the cases likely to present for vaccination are the more serious ones, you're going to be preventing people from taking one drug. If they have a serious need they will just take a different drug. Inoculate them against all the common drugs and they'll start mixing household chemicals and then you have a dramatically worse situation (google for the effects of 'krokodil' if you have a strong stomach). It would probably be better to help these addicts work through their problems so they don't need drugs. Leaving them unable to fill a need through conventional means just forces them down unconventional paths.

Why do we have such an obviously backwards approach to drug abuse? :(

Why do we have such an obviously backwards approach to drug abuse? :(

Because the intelligentsia have been taken over by a religion that says people are born pure and can be punished back into virtue if they get contaminated. Growing up in quiet high-IQ enclaves, their personal history is that unpleasant consequences teach better behavior. It is outside their life experience that there could be people who are too stupid to see logic, too distracted to notice lessons, too impulsive to act on logic, or too neglected in early childhood to develop susceptibility to social influences.

As patents start to run out on some of the most profitable drugs, big pharma is looking for a new business models and new drugs. In addition to the cocaine vaccine, there are reports that they are working on a vaccine for alzheimer's.

What I also find new about the Cocaine Vaccine is that traditionally vaccines are composed of biological agents that mimic or resemble a decease-causing microorganism. Cocaine addition and alzheimer's are not caused by a microorganism which would indicate that big pharma are cooping the word 'vaccine' for a new class of drugs.

Did you read the article? "Vaccine" is the appropriate word - the idea is to bind cocaine to inert cholera to make the immune system produce antibodies. It doesn't cure the addiction, it just makes cocaine ineffective.

It would be wonderful if they could produce an alcohol vaccine.

I then would like to see a law mandating its use for all people who who have a DUI.

Unfortunately the quantities of the active drug in your system when you abuse alcohol is orders of magnitude higher than for nicotine or cocaine. So it could well be that your body's immune system simply gets overwhelmed. (That or there could be real health consequences from the immune reaction.)

But it would be nice if it existed.

There is an equivalent - its called Antabuse (disulfiram). It inhibits the enzyme that metabolizes ethanol, causing the bad side effects of 'Asian glow' to a more severe extent. The idea is to cause negative feedback for alcohol.

Notice by its lack of blockbuster-ness and the fact that the market for alcohol is 1000x the market for cocaine, that this "cocaine vaccine" isn't good economics.

Antabuse only causes effects while you continue to take the medication. There is a world of difference between this and a treatment you take that provides prolonged resistance to alcohol.

> I then would like to see a law mandating its use for all people who who have a DUI.

The problem is that such vaccine wouldn't only work when you are in a vehicle or prevent you from making other stupid decisions. This really wouldn't address the root cause and would be a pretty egregious violation of an individual's freedom of thought.

The idea of the state having authority to permanately biologically alter an individual to control his or her behavior is a throwback to the time of lobotomies, which even the Soviet Union banned in the 1950s.

"Even the Soviet Union" is a bit misleading, though I understand where you're coming from. The USSR banned lobotomies in 1950, while in the USA it was banned... never (though some states individually did). In fact the USSR was the first major country to ban lobotomies. Lobotomies legally happen even today in the USA, though there's no longer the epidemic of wanton misuse.

I just say this because it's easy to get into the rut where anything the Soviet Union did was bad and everything the USA did was good. There's no reason per se to expect Soviet doctors to be particularly evil compared to American ones. Which isn't to justify the many many evil things the Soviet state did perpetrate.

Reply on news.ycombinator.com