'NO' IN A NEEDLE

New Vaccines Meant To Block Drug Highs Could Help Break A Habit Or Keep One
From Starting

When Charles Schuster developed a vaccine that made monkeys immune to a
heroin high, he hoped the work might someday help recovering addicts. But
Schuster, now at Wayne State University, wasn't prepared for what happened
next. "I began to get calls and plaintive letters from parents all over the
world saying please won't you immunize my child so that they won't become a
heroin addict," he recalls. The idea of using a vaccine to prevent rather
than just treat addiction made Schuster "leery," and he dropped the research.

That was three decades ago. Now vaccines against vice are back, thanks to
biotech firms that have spent years and millions in federal grant money
pursuing them. Vaccines against cocaine and nicotine have just entered
clinical trials, and ethicists wonder what will happen if they work. While
traditional vaccines protect against diseases that no one wants to get,
vice vaccines would fight pleasures that many people cherish in spite of
their dangers. The shots might appeal not just to addicts trying to break a
habit but also to parents, schools, and governments, raising issues of
personal choice and social benefit so knotty that the National Academy of
Sciences will hold a meeting this week to consider them.

Blocking the buzz. The vaccines would work by spurring the body to create
antibodies against the drug. The immune system normally ignores small
molecules like nicotine or cocaine, so developers have to link the drug
molecule to a larger one. Once the immune system makes antibodies to the
combination, it will later recognize the naked drug, binding to it and
keeping it from reaching the brain, where it would generate a high.

Biotech firms Nabi Biopharmaceuticals and Xenova have already finished
initial safety studies of nicotine vaccines and are launching larger
trials. In its new safety trial, Nabi will also study how its vaccine
alters smokers' habits. Xenova has developed an anticocaine vaccine, which
Thomas Kosten of Yale University has tested in dozens of recovering
addicts. He says some who used cocaine afterward reported that it seemed
less exciting.

So far, scientists haven't been able to see firsthand how the vaccines
change a person's response to a drug, because it's unethical to give
nicotine or cocaine to a recovering addict. Not so if the test subjects are
users who don't want to quit, says John St Clair Roberts of Xenova. Last
week, Xenova said it was vaccinating 10 volunteers with its anticocaine
shot, then giving them the drug to see if the vaccine blocks its effect on
mood, heart rate, and blood pressure.

Even if these trials pan out, it will be several years before vice vaccines
hit the market. But eventually, say ethicists, institutions struggling with
drug abuse, from prisons to schools, might embrace them, and healthcare
workers might urge them on pregnant women. Parents also might want to get
their children vaccinated as a preventive measure. Nabi's Robert Naso is
upfront about the company's interest in someday marketing an antinicotine
vaccine to the parents of teens. "They'll still want to smoke at a party on
Saturday night and look cool," Naso says. "But hopefully it will prevent
them from becoming a two-pack-a-day addicted smoker." A cocaine vaccine
might hold a similar appeal. "Imagine your kid is growing up in a rough
neighborhood in Baltimore, where you have drug dealers all over," says
Thomas Murray, a bioethicist at the Hastings Center. "Wouldn't you be tempted?"

Xenova's St Clair Roberts says that his company currently has no plans to
market its cocaine vaccine for prevention. "I see that as being a
nightmare," he says. Scientists working in the field are "absolutely" aware
of all the tricky social issues their new vaccines might create, adds Paul
Pentel of the University of Minnesota, who has studied Nabi's antinicotine
vaccine. But they also see the shots as a potentially huge boon for
treating addiction.

Treatment rather than prevention is what today's vaccines would most likely
be best at in any case. The vaccines raise antibodies that last only
months, requiring frequent booster shots. And they don't totally block
drugs' effects; higher doses could overwhelm the antibody response.

But scientists are working to make the vaccines last longer and be
stronger. And they're making progress toward shots for other drugs, like
PCP and methamphetamine. So while the current vaccines can't guarantee
clean living, they might just represent a step toward a future when people
end up as slaves to virtue, rather than vice.