Last week The New York Times ran an article on Dr. Kim Janda’s 25-year quest to create “vaccines” against drug addiction:

The scientific principle behind Dr. Janda’s vaccines is, as he put it, “simplistically stupid.” Much like vaccines against disease, they introduce a small amount of the foreign substance into the blood, causing the immune system to create antibodies that will attack that substance the next time it appears.

The difficulty is that molecules like cocaine, nicotine and methamphetamine are tiny — much smaller than disease molecules — so the immune system tends to ignore them. To overcome that, Dr. Janda attaches a hapten — which is either a bit of the drug itself, or a synthetic version of it — to a larger protein that acts as a platform. The last part of the vaccine is an adjuvant, a chemical cocktail that attracts the immune system’s notice, effectively tricking it into making antibodies against a substance it usually wouldn’t see.

If successful, the resulting intervention would fight addiction by preventing vaccinated people from experiencing a drug’s psychotropic effects.  The theory is that if a cocaine addict no longer obtains a “high” from the drug, there will be no reason for him to continue to use it.

As an initial matter, this premise seems questionable.  A drug’s “high” may be what initially makes it attractive to users.  But once addicted, the calculus becomes more complicated.  While addiction can have an important physical dimension, it also has complex emotional and social components.  Simply removing the pleasurable experience associated with a drug may not be sufficient to deter addicts from continuing its use.  This may be why Dr. Janda has created several vaccines that have worked in laboratory animals but failed in human clinical trials.

If we had vaccines that were effective in treating addiction, this would be an immensely valuable therapy that presumably would be attractive to many addicts.  However, some might resist being vaccinated, raising questions about when it may be appropriate to vaccinate them against their will.  If a court determined a person’s addiction rendered him a danger to himself or others, it could order compulsory treatment using the vaccine.  While this might be proper in some cases, it has troubling implications in the context of the United States’ drug laws, which are hyper-politicized, ill-conceived, and unfair.  For example, while it might be proper to force treatment on a true addict, US governments and anti-drug groups tend to define any use of illicit drugs as “abuse.”  (See, for example, the National Institute on Drug Abuse’s marijuana fact sheet: “How is Marijuana Abused?  Marijuana is usually smoked as a cigarette (joint) or in a pipe.”).  The warped assessment of drugs’ relative dangers that is reflected in US drug policies (e.g., classifying marijuana as a narcotic) heightens the prospects for a vaccine to be forcibly administered to people who – judged by a more rational assessment – would not meet the standard for compulsory treatment.

These issues take on even greater importance in the context of preemptive vaccination.  Even if these vaccines were not effective in treating addicts (e.g., for the reasons discussed above), they might still be effective in deterring non-addicts from using certain drugs.  If vaccinated people could not experience the psychotropic effects of these drugs, presumably the drugs would not be attractive to them.  In light of the enormous toll of drug abuse on individuals, public health, and society, there would be compelling reasons to promote the use of this kind of intervention preemptively – for example, by vaccinating children.

Whether one thinks vaccinating children against psychotropic drug experiences is a good idea probably depends on the extent to which one believes some of these experiences can be valuable.  American society is decidedly split on that issue.  To state and federal governments, drugs like marijuana and MDMA are simply a scourge, and their stated policy objective is to wipe out the use of these drugs.  On the other hand, there would be no need for drug enforcement if there were not enormous demand for these drugs.  Presumably that demand reflects users’ assessments that these drugs do offer some value.  This seems especially true with respect to drug users who are not addicts and who use drugs that, while potent, aren’t particularly addictive.

A spate of recent science is adding to drug users’ anecdotal assessments of the value of some psychotropic drug experiences.  Researchers at Johns Hopkins are studying the use of psilocybin (a psychedelic compound found in certain mushrooms) to treat anxiety in terminal cancer patients.  The Multidisciplinary Association for Psychedelic Studies (MAPS) is using MDMA (found in the street drug “ecstasy”) to treat Post-Traumatic Stress Disorder.  To the extent these drugs have therapeutic benefits that are products of their psychotropic effects, inoculating children against experiencing those effects could deprive them of potential therapies.

Some psychotropic drugs can also provide valuable experiences that are neither therapeutic nor “recreational.”  Many indigenous cultures have long used psychedelic compounds as central parts of their spiritual rituals.  And in a recent study at Johns Hopkins, most study participants given psilocybin identified the experience as “among the most personally meaningful and spiritually significant of their lives.”  More than year after taking the drug, a majority of these participants (none of whom had previous experience with hallucinogens) “continued to rate their 8-hour experience in the lab as similar in significance to life events such as the birth of a first child.”  Sixty-four percent reported enhanced life satisfaction or an improved sense of well-being.

By analogy, consider a vaccine that prevented people from enjoying foods that are high in saturated fat.  (Dr. Janda has also tried to develop vaccine for obesity, although it is designed to work in a different way.)  If it reduced the amount of saturated fats people consume, it could make a big contribution to public health, and to the health of vaccinated individuals.  But vaccinated people might also miss out on the joys of eating ice cream.  While there is no problem with giving an adult that choice, it would be ethically problematic to administer the vaccine against someone’s will (e.g., on the grounds that his inability to resist high fat foods made him a danger to himself) or to give it to a child.

Creating vaccines that could effectively treat or prevent drug addiction would be enormously beneficial for addicts, their families and society.  But it would also raise some ethical concerns that serve as a window on the questionable premises underlying American drug laws.  Sadly, the history of those laws suggests few policymakers would be interested in peering through that window.

Matt Lamkin
Twitter: @lawbioethics