New Opiate Vaccine

[ayjay]

^except you could become dependent on another drug.

In terms of research into effectiveness of different pharmacotherapies for opioid dependence, methadone comes out as the winner. Naltrexone comes out as a losing proposition, not because of it's total blockade effect, but because of poor compliance, and HIGH MORTALITY RATE. (for example, see NEPOD http://www.nationaldrugstrategy.gov.au/pdf/mono52.pdf ). I'm not convinced a vaccine would offer significantly different results to naltrexone.

As far as choice v. legal choice - a vaccine removes choice altogether; many people choose to do things even if those things are illegal. I think it's a bit of a stretch to go from "no such thing as safe drug use" to "no drug use is always the best". We could probably make sure that no-one made any dangerous choices if we cut off their arms and legs and attached them to a feeding tube - but is this the kind of world you want to live in?

Oh - and btw - try not getting your kids vaccinated in Australia and see how much shit you have to go through. Strictly speaking, it's not compulsory, but there are sanctions applied and a fair amount of paperwork to go through - not to mention the continuous guilt trips from a variety of variously informed sources.

 

[BilZ0r]

^ It would be a lot better than naltrexone because you can't take more and still get high, and you'd only need to dose once a month.

 

[ayjay]

^there are naltrexone implants available - these were not evaluated in the above, but also not approved by TGA. Some clinics still implant them. They normally place 3 impants under the skin on the stomach. It is pretty hard to override this - most people don't bother. I have heard reports of people ripping out their implants though (which you couldn't do with a vaccine) - or simply taking other drugs. For example, one person I spoke to successfully remained abstinent from opiates with an implant, but got rather heavily into speed and GHB.

This kind of effect happens naturally across drug using communities due to market forces anyway - availability of one drug goes down, so use of other drugs goes up. I think the phrase is "inelasticity of demand". I'm not saying that vaccines, or even naltrexone, can't be part of overall strategies to combat drug related harm - but they sure aren't a 'magic bullet' either.

I'm interested in your opinion on my point about choice too...

 

[gomer1985]

Fuck that! That's a good way to increase the suicide rate. If the courts forced me to get something like that, and I had no way to get high; I would likely commit suicide.

 

[raybeez]

^^^

I'm sure many frustrated heroin addicts would feel this way. It makes me think that a heroin/morphine vaccine would fuel trends like the recent occurences of fentanyl (and related analogues) being sold as heroin on the streets.

The demand for injectible street opiates will not just 'vanish' as a result of a vaccine, and suppliers will rapidly shift to synthetic (and more potent/dangerous) opiates.

I'd love to hear someone like blahblahblahblah's thoughts on this...

 

[BilZ0r]

^ That's definately a good point....

I personally suspect that a better solution than all of these would be, if someone could come up with an even weaker partial agonist that buprenorphine, so you could dose someone high enough and actually saturate their opioid receptors; and then use that as an implant.

Antagonists throw people into serious withdrawals, which isn't going to help the situation.

 

[-=navel=-]

like said, i think the use of other depressants will only rise if something like this is used.

 

[ayjay]

Interesting suggestion BilZOr - but I don't think it would be any better than providing daily doses of buprenorphine. The exception would be in circumstances where accessing your daily dose is not viable. For example - SWIM just went to a country where methadone is a prohibited substance. Taking 29 days worth of methadone tablets into that country required a lot of last minute wangling to get a special permit, and nearly didn't happen. A depo shot or implant (if it was available) would have avoided this issue.

Most people on opiate substitute therapy are happy to take their dose - because they are taking an agonist. Compliance with antagonist therapy is a different story. The existing problems around substitute therapy (in Australia anyway) are IMO

- difficulty in accessing prescribers and dispensers
- difficulty in accessing daily dispensing regime
- overly regulated and regimented dispensing
- no injectable option
- poor access to psycho-social supports

Remember - agonist substitution for opiate dependence is the gold standard for managing opiate dependence. Wasting time exploring vaccines, antagonists etc is - well - killing people.

For a nice literature review of the effectiveness of various strategies to prevent drug related harm, you might like to track down a copy of The prevention of substance use, risk and harm in Australia - a review of the evidence (Wendy Loxley et al 2004). You used to be able to download it from the Federal Department of Health and Ageing website - not there anymore

 

[BilZ0r]

Well big doses of bup still get people pretty high... people need to get over this searching for a high thing that opiate dependent individuals seem to be constantly chasing... whether they're on methadone or bup, you get people IVing it and working out ways to potentiate it.

If the dose was a saturating dose, it would have two benifits a) the decreasing phase of the depot would still have maximum effect and b) no potentiating effect would do anything.

 

[ayjay]

people need to get over this searching for a high thing .

Well - that's the $64 question, isn't it. Treatment is a way of addressing the "need to get high". If the treatment doesn't do this in any way, then it's not going to have an impact.

The problem with a pharmacotherapy that has no agonist properties is simply reduced motivation to take it. That's the beauty of agonist pharmacotherapy - it addresses many of the needs (relating to their opiate use) of opiate dependent people, while significantly reducing the attendent harms.

There are definitely harms associated with injecting pharmacotherapies. However, from a harm reduction perspective, the obvious solution is to provide people with the option of an injectable agonist pharmacotherapy.