New Treatments for Addiction Behavioral, Ethical, Legal, and Social Questions (2004) / Chapter Skim
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1 Introduction and Background
1 Introduction and Background
Pages 7-15
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From page 7... ...
As part of these research-based interventions, the National Institute on Drug Abuse (NIDA) is funding the development of new classes of medications to treat drug addiction.
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From page 8... ...
Some of these issues will marry traditional vaccine concerns, such as establishing and monitoring safety, ensuring efficacy, and financing and distributing the medications, with traditional drug abuse treatment issues, such as ensuring patient adherence to treatment, using these therapies in a variety of settings, and dealing with coercive legal methods that are sometimes used to "motivate" treatment initiation. In addition, less traditional issues may also be raised, such as who should be immunized or treated with a depot medication and when, and who will decide.
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From page 9... ...
Finally, in Chapter 4 the committee looks at potential adverse behavioral responses to the use of immunotherapies and at the difficult practical, ethical, and legal issues of consent, particularly for vulnerable populations. MEDICAL BASIS OF IMMUNOTHERAPY Vaccination (active immunization)
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From page 10... ...
The medical rational for using immunotherapies for treating or preventing drug abuse is similar in concept to more traditional immunological applications. However, the primary action of an antidrug antibody in the serum is to reduce drug levels in the brain by binding the drug before it enters the brain (Pentel and Keyler, 2004)
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From page 11... ...
The antibody response will not increase if a vaccinated individual uses the small drug molecule itself; only the circulating antibody at the time of drug use will be protective. Because cross-linking of surface antibody on B cells is required to stimulate antibody production, the same drug hapten-protein vaccine must be used for boosting the immune response on later occasions.
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From page 12... ...
. For treating drug abuse, monoclonal antibodies could be used in three clinical scenarios: to treat drug overdose, to prevent drug use relapse, or to protect certain at-risk populations who have not yet become drug dependent (e.g., adolescent children who have begun using cocaine)
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From page 13... ...
Vaccinations with an antinicotine vaccine might be appropriate in patients who are attempting to stop cigarette smoking. Advantages and Potential Disadvantages of the Therapies Both active and passive immunotherapy require high-affinity antibody binding to be medically effective, and both have potential strengths and weaknesses.
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From page 14... ...
Finally, there are ethical considerations, however remote, for the use of vaccines. Active vaccination can stimulate long-lasting immunologic memory that could serve as a marker of past immunization and could stigmatize an individual for extended periods of time, or even over their entire life if tests were available for detecting memory immune cells.
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From page 15... ...
This consideration of the medical basis for immunotherapy and sustained-release formulations for treating drug addiction has led to one major recommendation by the committee, but several recommendations in subsequent sections are also related to the medical basis for these therapies. Recommendation 1 The National Institute on Drug Abuse should support basic immunology studies on increasing the stability and longevity of antibody blood levels and on developing combination therapies to simultaneously treat a variety of abused drugs.
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