Author: 
Nikki Semenza, CADCA's Public Policy Associate

You Can’t Treat Your Way out of an Epidemic…But Can You Vaccinate It?

Routine vaccinations have reduced or even eradicated many deadly diseases; in the 1950s, polio was a public health crisis claiming the lives of over 20,000 children a year. After the polio vaccination was created and added to a child’s routine vaccination schedule, it practically wiped out the spread of the disease.

The concept and research behind developing a vaccination to combat addiction is nothing new. Research into heroin, cocaine, and nicotine vaccinations have been studied for the past 50 years. It has been gaining increased attention due to the former Department of Health and Human Services Secretary Tom Price stating that he is hopeful for a preventive vaccine. Additionally, several groups of scientists have published findings on the effects of a heroin vaccination based on animal research.

Driving the creation of such a vaccine, undoubtedly, is the devastating impact of addiction on human life. According to the National Institute on Drug Abuse, one in seven people who try addictive substances will become addicted. Further, the abuse of illicit drugs costs the economy $193 billion each year in healthcare, crime prevention, and loss of productivity, the National Institute on Drug Abuse stated. The human toll on opioid overdoses alone hit 60,000 deaths in 2016.

From a science-based perspective, it is no easy endeavor to create a vaccination to create immunity against drugs like heroin or opioids. Vaccinations require the immune system to respond to large molecules by producing antibodies. Drugs are miniscule particles. The same receptors that produce euphoria from drugs like opioids also cause overdoses due to respiratory depression. Thus, if a vaccination could neutralize the effects of the drugs, it could reduce overdoses. Researchers believe that such a vaccination could be a component of comprehensive treatment, citing it can help those in recovery.

A challenge of vaccinations for particular drugs would be how to vaccinate for all illicit substances. There are many types of drugs, even multiple kinds of opiates, so there would need to be a plethora of vaccinations. Vaccinations against certain illicit substances (e.g., heroin) might just fuel the abuse of other drugs (e.g., cocaine). Further, individuals with substance use disorders might be using more than one drug at a time. How would a vaccination account for polyusers? Or for drugs that are cut with other dangerous substances?

Vaccinations are worth exploring as a viable treatment and even prevention strategy. However, vaccinations may overlook the comprehensive blend of individually and environmentally-focused efforts needed across multiple sectors of a community to address substance use and misuse. Changing the environment, through changing social norms and reducing access and availability through systems and policy changes, must remain a constant overarching goal in reducing population-level substance use and misuse.

The environment, particularly the rise in synthetic drugs, is constantly changing as well. It might be the opioid epidemic in certain communities now, but it could be meth or cocaine next. Research into an opioid vaccination may pivot if another crisis emerges.

The best way to mitigate the scale and scope of an epidemic is through supporting local, community-level prevention. Vaccines coupled with prevention—if a vaccine comes to market and can be disseminated at population-level--could be helpful in reducing the likelihood of individuals using and misusing drugs.