History of Cocaine

Cocaine is a naturally occurring substance found in the coca plant grown in South America, and is one of the oldest known drugs. The leaves of the coca plant have been chewed by the indigenous people of South America for thousands of years to increase stamina for high-altitude work and for the euphoric feelings.

In 1859 the psycho-active ingredient in coca was isolated and named cocaine. It was considered a rather benign drug until the beginning of the 20th Century, when the negative aspects of its use became widely recognized. The sale and distribution of coca leaves and their derivatives were restricted in the USA under the 1914 Harrison Narcotics Tax Act. However, the law was not strictly enforced, and there was open use of the drug until further legislation in the 1960s.

Despite efforts to enforce drug laws, cocaine - particularly the smoked free-base form known as crack - was pushed into widespread use by organized criminal gangs during the 1970s and 80s, leading to the worldwide problems we know today. After cannabis, cocaine is the most frequently used illegal drug globally.

There remains an urgent need for treatments for cocaine addiction, since no effective pharmacological interventions are available for cocaine. With opiates ( e.g. morphine,  oxycodone, heroin), methadone, buprenorphine and naltrexone are available, although even these are far from effective treatments for addiction.

How can we make a cocaine vaccine?

Vaccines work by stimulating an immune response to an infectious foreign-object (such as a virus or bacterium). The body's immune system recognizes the foreign object as an infection by responding to certain proteins on the surface of the infectious agent. That is why we don't get an immune response to foods and other foreign-objects we put in our body (except in the case of certain food allergies).

  However, cocaine is not a virus so the immune system ignores it. So, in order to fool the immune system into recognizing it as a virus, researchers have attached cocaine particles to a protein that the immune system will recognize as being an infection. Easier said than done, but there has been work on doing this since the 1970s.

attaching cocaine particles to viral proteins

What would a cocaine vaccine do for us?

The idea here is that a vaccinated person who takes cocaine would not get high because the immune system would neutralize all the cocaine particles before they get to the brain and and attach to their receptors. Theoretically.

Do we have a vaccine yet?

The first effort at an anti-drug vaccine was carried out in the 1970s, in this case a vaccine against heroin and morphine. Nothing came of these efforts, probably partly because of the appearance of Methadone at about that time.

Further efforts were made in the 1990s and 2000s, this time looking for vaccines against cocaine, nicotine, and methamphetamine. Results have been modest, and most efforts have not yet gotten to the point of being tested in humans.

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A number of independent efforts at a cocaine vaccine have been made since the early 2000s, all with fairly disappointing results. The best-known of these efforts was the much-touted TA-CD cocaine vaccine in the mid-2000s, which didn't work any better than a fake (placebo) vaccine. In fact, the people who had the real vaccine ended up with more cocaine in their body, likely because they simply used more cocaine to overcome the vaccine and get high.

Ron Crystal, a New York-based doctor at Weill Cornell Medicine, has been working on a vaccine for cocaine for the past ten years. His vaccine, called dAd5GNE, was approved for clinical trials in late 2016. Phase I clinical trials will take about three years, and represent just a beginning to the work that must be done to get a working vaccine. Only 30 participants are going to be enrolled in this study, so this represents a very early stage in getting this vaccine to everyday use.

Dr. Crystal

In the past, cocaine vaccines haven't worked out well in clinical trials, mainly because they have unpredictable and short-lived results in humans. Hopefully, Dr. Crystal's efforts will pan out better.

Dr. Crystal's vaccine is in Phase I

Alternate approaches to a vaccine

Whenever we take in a medication or drug - or any other toxin - our body uses enzymes specific to that drug to break it down and get it out of the body (either through the liver or the kidneys). The duration of a "high" from a drug depends on how much of this enzyme we have and how fast it works.

Efforts are being made to develop an enzyme that breaks down cocaine super-fast, so that any cocaine we ingest is broken down so quickly that it doesn't even get a chance to make us high. This could be used in conjunction with a vaccine.

Bottom line

My area of research in addictions involves the psychology and brain workings that are involved in addiction and recovery. As a clinical doctor, I have had face-to-face contact with hundreds of people with addictions who want to get better. As a former alcoholic and addict I have some personal perspective as well. All my experience raises some red flags for me about this vaccine effort.

My book The Alcoholic / Addict Within (see below) explains the thought processes and behaviors that are at work in addictions, as well as the brain chemistry involved. A vaccine has little or no effect on these psychological and physiological processes.


For someone to find long-term, stable recovery from addiction - and happiness and peace of mind - one must deal with the emotional and mental baggage that led to the addiction and kept it going. Any chemical solution will not address these issues, and laying hope in such a chemical solution may lead people away from seeking out the help they need to address these issues. Therefore, any chemical "treatment" for addiction must be used in conjunction with a program designed to help the addict to heal from the mental and emotional causes.

Another concern is that the vaccine must be taken voluntarily, something that many addicts would not consent to. Its effects are short-lived, so frequent booster vaccines would be required.

As well, as has been amply demonstrated in clinical trials so far, anyone who has been vaccinated, even if the vaccine works, simply has to take in more cocaine in order to overwhelm the antibodies.

A vaccine does nothing to treat cravings for a drug, so it is unlikely to stop someone from seeking out that high, either by using more cocaine, or by using one of any number of other drugs.

Knowing the addicted mind, it is clear that if someone wants to get high they will do so. They can use any other drug, including alcohol, instead.

I recommend against placing too much faith in the future of drug vaccines. At best, they will be of use to people who make up their minds to get better as part of a program of recovery, such as the Twelve Step programs (Click Here), or SMART Recovery (Click Here).

  References:

Kinsey, Berma M, Kosten, Thomas R, & Orson, Frank M. (2010). Anti-cocaine vaccine development.Expert Rev Vaccines. 9(9):1109-1114.  Retrieved from ttps://www.medscape.com/viewarticle/729232_1

Weill Cornell Medical College. (2016, Aug 8). Anti-cocaine vaccine approved for clinical study in humans. retrieved from https://news.weill.cornell.edu/news/2016/08/anti-cocaine-vaccine-approved-for-clinical-study-in-humans