COSTS AND BENEFITS OF A COCAINE VACCINE

Apparently there has been great progress toward what is (not quite precisely) described as a "vaccine" against cocaine. At a chemical level, this would be something that, when injected, generated antibodies against cocaine molecules, lasting for several weeks. The result of a "vaccination" would be that taking cocaine would have no, or only very weak, effects; the antibodies would grab it in the bloodstream before it could ever get to the brain. This seems much more promising than something that would prevent cocaine, once in the brain, from doing its thing in the synapses, since it shouldn't interfere with normal brain functioning.

I say the term "vaccine" is imprecise because a vaccination is usually thought of as prophylactic and long-lasting; this would be therapeutic and relatively short-acting. This is more like Naltrexone than it is like a flu shot.

The National Academy has a panel on this, and I've been asked to prepare a paper on benefits and costs. My draft outline is below.

Having thought about this for a day or so, I'm actually quite excited (not by the project, but by the prospect of a "vaccine"), despite my general skepticism about technical fixes in the substance abuse area. If cocaine abuse could be converted into a non-relapsing condition, and if the long-term health and functional impacts of a few months as a heavy cocaine user weren't too awful, we might be able to afford to relax drug controls quite substantially.

Comments welcome.



The costs and benefits of a potential cocaine vaccine depend on:

I. Technical characteristics of the vaccine itself
--Cost
--Side effects
--Efficacy level
--Efficacy duration

II. Populations to which it is applied
-- Voluntary drug treatment clients with existing dependency disorder
-- Voluntary drug treatment clients with abuse disorder, or no diagnosable condition
-- Children referred by parents
-- Drug users detected by workplace or school drug testing programs and offered vaccination as an alternative to separation
-- Offenders subject to criminal justice supervision
--Adults
--Juveniles

--With diagnosable disorder
--Without diagnosable disorder


-- Populations thought to be at risk

III. Health impacts of reduced drug consumption due to vaccination

IV. Drug market impacts of reduced drug consumption due to vaccination

V. Behavioral responses among current and potential cocaine users

-- Effects on initiation and progression to abuse or dependency

Persons considering initiation of cocaine use might be more inclined to do so if the presence of a vaccine limits, or appears to limit, the damage resulting if use develops into abuse or dependency. Similarly, those already using cocaine might become less vigilant about developing an unwanted habit.

-- Time-course of cocaine use after the efficacy period of the vaccination
[Note: May depend on provision and efficacy of relapse-prevention assistance.]

-- Substitution and complementarity across drugs, both contemporaneously and over time

[Note: Assumptions need to be made about the range of drugs for which vaccines exist; a cocaine vaccine might have greater benefits in the presence of a methamphetamine vaccine than it would in the absence of such a vaccine.]

-- Effects of vaccine-induced changes in drug consumption on other outcomes of interest:
-- Crime
-- Property
-- Violent
-- Drug sales
-- Prostitution
-- Public order

-- Employment
-- Family functioning

VI. Other programs and policies

In addition to its direct effects, the availability of vaccination as a response to cocaine abuse or dependency might support changes in a wide variety of other drug-related policies, and in public attitudes about cocaine users.