From The NY Times:
Scrambling for ways to contain America’s out-of-control opioid crisis, some experts in the field are convinced that one bit of good advice is to just say no to the enduring “just say no” antidrug message. Addiction, they say, is not a question of free will or a correctable character flaw, as a lot of people would like to believe. Rather, it is an affliction of the brain that needs to be treated as one would any chronic illness.
A drug that could block the delivery of opioids from blood to brain, giving addicts a path to recovery.
One possible approach, an experimental vaccine, draws attention in this offering from Retro Report, a series of short video documentaries exploring major news stories of the past and their lasting impact. This vaccine would be intended principally for men and women already hooked on heroin or related opioids like Oxycodone and fentanyl — people who would be at risk of death should they detoxify and then relapse, as all too many do.
If it works, the vaccine would stop opioids by effectively blocking them from reaching the brain by way of the circulatory system. At the same time, it would not interfere with other treatments for addicts, like methadone and buprenorphine, or with a compound like naloxone that reverses overdoses.
The vaccine is designed to create high levels of antibodies, said Dr. Gary Matyas, an immunologist who has been developing it at the Walter Reed Army Institute of Research, in Silver Springs, Md. “You inject heroin, the antibodies basically grab all the heroin, bind it all up, and the heroin can’t cross the blood-brain barrier,” he told Retro Report. “And so there’s no high.” Presumably, in time, the heroin would be expelled from the body like any waste product.
“It would be part of their therapy for recovering,” Dr. Matyas said of addicts. “If they mess up and take a dose of heroin, the heroin won’t work.”
But will the vaccine itself work? It still must be tested on humans, and that is not a speedy process; it could take a decade or more, Dr. Matyas said, for there to be “a licensed product.” Among the questions are how large the dosages would have to be and how often they would need to be administered. Nonetheless, he is encouraged by the success he has had with lab mice and rats.
A lot is riding on his experiments. Coming to grips with the opioid epidemic is obviously a national imperative as overdoses soar and more than 52,000 Americans die of them each year, an average of one every 10 minutes. While President Trump has proclaimed it a public health emergency, he has yet to offer specific solutions other than to urge the death penalty for drug dealers.
His health and human services secretary, Alex M. Azar II, has gone further, endorsing an expansion of what is known as medication-assisted treatment and saying he wished to “correct a misconception that patients must achieve total abstinence.” Speaking in February at a gathering of the National Governors Association, Mr. Azar said that addicts “need medicine to regain the dignity that comes with being in control of their lives.”
But that approach is not embraced by everyone in the Trump administration, and it is not clear where the White House will ultimately land on the matter of medicinal intervention. A notable advocate of abstinence is Attorney General Jeff Sessions, who invokes language borrowed from the long-ago “war on drugs” in framing substance abuse as a moral failing. Echoing verbatim the phrase made famous in the 1980s by Nancy Reagan, then the first lady, Mr. Sessions said in October that “we’ve got to re-establish, first, a view that you should just say no. People should say no to drug use.”
That’s probably reasonable advice to an adolescent who has yet to so much as puff on a marijuana joint or take a swig of booze, said Thomas McLellan, who was deputy director of the Office of National Drug Control Policy in the Obama administration. But it’s another story with someone already on drugs. “If you’re talking about a person who’s addicted to opioids and is in a very bad situation, ‘just say no’ is perfectly ridiculous,” Mr. McLellan told Retro Report.
He was equally dismissive of those who regard methadone maintenance and other regimens as no more than crutches that substitute one form of dependency for another. “As a matter of fact, they are a crutch,” he said. But he added, “They make crutches for people who are having trouble standing on their own.” The treatments are no different from, say, insulin injections for diabetics, guiding people through troubled moments when they are “very vulnerable to relapse.”
“They’re an insurance policy,” Mr. McLellan said. More to the point, he said, “they reduce craving and, most importantly, they prevent overdoses.”
Along that line, the vaccine being developed by Dr. Matyas, which is intended to be effective as well against H.I.V., the virus that causes AIDS, would in theory block heroin from reaching the brain and binding to protein receptors there. Thus it would (a) eliminate, or at least appreciably minimize, the euphoria that the drug produces in users who relapse, and (b) end the risk of respiratory depression that accompanies an overdose, causing the addict to stop breathing.
While it will take years for his discovery to be tested thoroughly and approved by the federal authorities, Dr., Matyas has faith in the potential to help turn this crisis around. In that vein, he invoked a famous addict, the actor Philip Seymour Hoffman, who died in 2014 having succumbed to what was believed to be a lethal mixture of heroin and other drugs.
The vaccine would not end an addict’s craving for opioids, the immunologist said. As with Mr. Hoffman, relapses are to be expected, and the vaccine would have to be re-administered at regular intervals. But by keeping users from getting high, the medication would greatly reduce the risk of overdoses. That’s the “true vision” of the vaccine, Dr. Matyas said: to ward off the pattern of relapse and overdose that killed Mr. Hoffman and ended a great stage and film talent.