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Addiction Vaccines - Can science win the war -

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Addiction Vaccines - Can science win the war on drug addiction?

Reporter: Dr Jonica Newby

Producer: Paul Faint

Researcher: Maria Ceballos

Camera: Julian Mather

Sound: Rodney Larsen

Editor: Chris Spurr, Ted Otten

Transcript

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5 April 2007

What if you were able to vaccinate your children against addictive drugs like nicotine, heroin,
cocaine or amphetamines before they were even old enough to try them?

Drug addiction remains a huge social and medical challenge. Treatments for nicotine, cocaine,
heroin and amphetamine addiction currently achieve limited success.

But imagine if there was a vaccine that would stop these drugs from having any pleasurable effect
on the brain and body... no rush, no high and no reward to get addicted to.

Well, that medical dream is about to become a reality. Vaccines against many common addictive drugs
are currently undergoing trials and look set to hit the market within five years.

But they do raise an ethical dilemma. If these vaccines can stop the effect of drugs why not use
them as a preventative? Why not give them to teenagers before they even try smoking, or using
cocaine or speed. Would you do it? Will governments mandate it?

These are just some of the mind-blowing ethical questions raised when Catalyst's Jonica Newby
visits the USA to investigate science's new war on drugs.

Transcript

Dr Jonica Newby: What if you were able to vaccinate your children against addictive drugs like
nicotine, heroin, cocaine before they were even old enough to try them?

...would you do it?

Narration: This is one of the mind-blowing ethical questions being raised by research developments
here in the US.

Scientists are in the final stages of developing a vaccine against nicotine, with cocaine and other
drugs not far behind.

We're about to see vaccines against addictive drugs.

And it's no surprise that the number one target is nicotine... (with an estimated 5 million tobacco
related deaths worldwide each year) its one of the most dangerous and addictive drugs on the
planet.

Henrik Rassmussen: Smoking is incredibly addictive and ...it is actually more addictive than heroin.
It is actually one of the most addictive substances known to Mankind. So it is incredibly
addictive.

April is a biology student, just one of the 1.3 billion people hooked on smoking... and like 80% of
smokers she started as a teenager.

Dr Jonica Newby: So tell me, how old were you when you started smoking.

April Hall-Hough: Thirteen.

Dr Jonica Newby: Thirteen! That's quite young.

Narration: And she can testify just how hard it is to kick the habit.

Dr Jonica Newby: How many times have you tried to give up?

April Hall-Hough: How many times? ... It's at least a bi-yearly event. Yeah.

Dr Jonica Newby: So you've tried everything?

April Hall-Hough : Pretty much. Pretty much. The most effective one ironically enough was quitting
cold turkey.

Dr Jonica Newby: Really.

April Hall-Hough : That actually held on for about a year before I folded in and started smoking
again. But the patch and the gum and most new fangled things that they've used... that they've come
out with, I didn't find effective at all.

Narration: And that seems to be the problem... statistics show that existing aids to quit smoking
just don't work that well.

Henrik Rassmussen: So there is certainly a desperate need for new and better approaches to smoking
cessation. Clearly the existing drugs don't work nearly as well as they should.

Narration: So why don't they work? Well, it seems that addiction is literally... 'all in your mind'...
or at least all in the brain.

When we smoke, the nicotine goes from our lungs into the bloodstream... and because it's a very small
molecule it's able to avoid detection by our immune system and pass through a membrane called the
'blood-brain barrier' and enter our brain.

Once inside... it binds to receptors on the synapses... triggering the release of a stimulant called
dopamine. This is what causes the 'rush' that makes us feel good... and gets us addicted.

And it's the same for other addictive drugs...

Over time, dopamine rewires the brain...

Dr Nora Volkow: And so its at that point that the dopamine system has generated a path that tells
you go get the drug even though you cognitively say I shouldn't take it it's bad for me. You cannot
stop it. It's sort of like a highway has been formed in your brain ...you cannot stop it. It's like
being in a car with out brakes.

Narration: And it also explains why when we try to quit and are deprived of the 'rush'... we
experience physical withdrawal symptoms.

April Hall-Hough: Headaches, nausea in some points, just extreme irritability, mood swings and
yeah, headaches right through here. Awful. I remember it clearly.

Narration: Which is why April signed up to be a medical guinea pig for a drug company trailing a
'vaccine' against nicotine.

April Hall-Hough : In the first few weeks they just do tests and they tell you to keep smoking and
once you have your first vaccine then you continue to smoke for about a month and they set a date
in the very beginning and hopefully you'll stick to that date.

Dr Jonica Newby: Thank you.

Dr Ali Fattom: We are going into the lab where this all started.... The organic chemistry lab...

Narration: We're all familiar with vaccines against diseases like measles or smallpox but how do
you make a vaccine against a drug like nicotine?

Dr Jonica Newby: So that's the secret brew there, the heart of the vaccine.

Dr Ali Fattom: That's part of it yes.

Narration: The key to the vaccine is a very large version of the nicotine molecule.

Dr Ali Fattom: The idea is to take a small molecule like nicotine which is not immunogenic, can't
be a vaccine on it's own and try to create it chemically in a way and put it and introduce it into
the body in a way that the body will recognise it as part of a big molecule that can generate
anti-bodies.

Narration: The theory is, once you've had the vaccine and developed the antibodies... when the
nicotine molecules enter your blood they bind to the antibodies... making them too large to cross the
'blood-brain barrier' ...stopping them from ever entering the brain. The result... no dopamine rush...

Henrik Rassmussen: The rationale...is... if you don't get the feedback, you don't get the benefit, you
don't get the rush... Everybody recognises that it's dangerous. Everybody recognises it costs money.
Everybody recognises its anti-social. And with all that stuff, if you don't get any benefit why the
hell then would you do it.

Narration: So it all sounds great in theory but does it really work?

April has certainly faced her challenges, with her boyfriend still a heavy smoker. But she's sure
the vaccine has made it easier.

April Hall-Hough : Being with a biology background I paid attention to how my body felt after
getting the vaccine, trying to psych myself out, you know, did I get the placebo, did I not get the
placebo. And I couldn't tell, to tell you the truth... until I actually quit smoking. The week before
quitting I cut down in my smoking to about 4-5 cigarettes a day and it was easy. It was actually
much easier than I'd expected and the quit day came around and I haven't picked up a cigarette
since

Narration: And it's not just nicotine. Vaccines could work on many other addictive drugs.

Not surprisingly, a cocaine vaccine is already in development.

Dr Bridget Martell: We've gone through the Phase 1 part. That's been published work. We've shown
that it's very safe and in that trial there was some indication that it was effective. And now
we've moved on to the Phase 2 part and we've finished the Phase 2 trials. Some of the data is still
being analysed but it looks very promising at this point.

Narration: And there are also trials underway for vaccines against opiates, PCP and amphetamines.

But addiction vaccines do raise an ethical can of worms...if they can block the effect of drugs then
why not vaccinate teenagers to stop them from ever becoming addicted in the first place?

Henrik Rassmussen: If these kids were to be vaccinated, they would still experiment, they would
still try to start smoking but they wouldn't develop the addiction because the antibodies would
prevent that from happening. And that's a very tantalising future application of a potential
vaccine... And I think it could have very dramatic implications for health systems throughout the
world if it is working as effectively as we believe it is going to.

Narration: So, would you vaccinate your children against addictive drugs?

April Hall-Hough : I'm a strong believer in free choice so I'll let my kids decide that. But it's
not a bad idea actually...

Henrik Rassmussen: As a parent, if there was a safe vaccine with a very high likelihood of
preventing any kid from starting smoking or taking cocaine or whatever else they might be applied
for I would have no hesitation in using it to be honest.

Narration: But do health authorities feel the same way?

Dr Nora Volkow: What you don't want to do is say you vaccinated these kids for nicotine but there
is an underlying vulnerability for drug abuse and addiction so these kids instead of taking
nicotine start for example taking methamphetamine or start for example smoking marijuana... So again
that is why I am very explicit we need to understand what are the consequences of vaccinating
someone against nicotine when they are going to be exposed to other drugs.

Narration: So we won't have to decide on that just yet... but if progress continues at its current
rate within five years we could see a new era in the treatment of addiction.

Dr Bridget Martell: The treatment of cocaine dependence and addiction is not very good. We have
psychotherapies and we don't really have any effective medication. This would revolutionize the
treatment of cocaine dependence.

Henrik Rassmussen: It's going to revolutionise the treatment of smoking. I don't think there is any
doubt about that.