Could a vaccine prevent drug deaths and cure addiction? U.S. research draws mixed reaction in B.C.

Some researchers believe vaccines could be a powerful new tool to fight substance use disorder and overdoses, but some experts are expressing caution about the idea.

Columbia University neurobiology professor Sandra Comer is one of the leaders of a project developing drug-specific vaccines to produce antibodies that target particular drugs. 

Her team is in the early stages of human trials for an oxycodone vaccine.

"If the person ends up using oxycodone after they've received the vaccines, the antibody will bind to that chemical structure … and prevent it from getting into the brain," Comer said.

"The person won't experience the euphoric effects or the high that the oxycodone would produce."

Collaborator Marco Pravetoni, an associate professor of pharmacology and medicine at the University of Minnesota, said a fentanyl vaccine has shown promising results preventing overdoses in animal trials.

"Mice and rats that are vaccinated against fentanyl or carfentanil will not show the respiratory depressant effects of these compounds," Pravetoni said.

"That may prevent or reduce the likelihood of fatal overdoses."

Researchers believe these vaccines, if successful, could offer new approaches to substance use disorder treatment.

The reaction of substance use experts in B.C. ranges from cautious interest to downright skepticism.

Early stages

The researchers said the hope is the two-dose vaccine will be effective in a patient for six to 12 months.

By targeting specific drugs, Pravetoni said, the idea is to not neutralize drugs with medical uses — for instance, anesthesia or opioid recovery treatment. However, researchers also want to develop vaccines that can target a range of illicit street drugs which often have an unpredictable formulation.

"If you take fentanyl analogues, there are hundreds of them," Pravetoni said. "We want to kind of cover all these bases."

Comer said their vaccine development is in early stages.

The first goal is to ensure the vaccines are safe for human use, she said. Then the question will become whether or not they work.

Addictions ministry cool to idea

Cheyenne Johnson, executive director of the B.C. Centre on Substance Use, said the project is interesting but she has concerns about how well vaccines would work on an ever-shifting illicit drug supply.

"We know that that is completely unpredictable," Johnson said, adding patient choice needs to be considered. 

"There is quite a bit of evidence that … when we mandate treatment on people in terms of correctional facilities, in terms of youth, in terms of other health professions, that there really isn't great outcomes."

The B.C. Ministry of Mental Health and Addictions said it is monitoring the work.

"We welcome new research and initiatives that help provide options for treatment and recovery for people with addictions," a spokesperson wrote in an email.

"Right now, our government is focused on making proven treatments and supports for people with opioid use disorder more accessible."

Those treatments and supports, the ministry said, include recovery programs, a safe-supply program and decriminalization.

Root causes

Guy Felicella, a peer clinical advisor with the B.C. Centre on Substance Use who has lived with addiction himself, said a vaccine to allegedly cure addiction can't solve addiction's root causes.

"Trauma, especially childhood trauma, and even in my own life, I was trying to numb that pain," Felicella said. "I got off drugs. My life didn't get better. You know, it got worse. 

"I think it's a scapegoat to target substances instead of targeting the real issues of trauma and poverty and homelessness and penalizing people for using substances."

Garth Mullins with the Vancouver Area Network of Drug Users worries drug-specific vaccines will just cause people with addictions to shift their habits or for the drug supply itself to change.

"People will be driven towards the next thing," Mullins said. "It'll just incentivize this kind of arms race, which we see happening in the drug supply."

He says if the goal is to prevent overdose deaths, a regulated supply of pharmaceutical opioids is an easier solution.