If you read news online, you may have seen headlines in your news feed over the past week that look like these:
If you, a friend, a family member, or a loved one has an opioid use disorder (OUD), misuses opioids, or uses other illicit drugs like methamphetamine, cocaine, or benzodiazepines, you know the phrase in that third headline – game changer – might not be an exaggeration, if what the headlines suggest is fact, rather than fiction.
That’s why we dug deeper, and found an article published not by a news outlet – organizations that write headline to get clicks – but by the University of Houston, the university where the team that formulated the vaccine conducted their research.
This article – Fentanyl Vaccine Potential ‘Game Changer’ for Opioid Epidemic – provides a solid overview of the research presented in this peer-reviewed journal article, published on October 22nd, 2022:
That title is literally a mouthful.
In the rodent model in laboratory conditions, an immune system based vaccine blocks the action of fentanyl.
What that means is that the science is real, and if the vaccine works in human trials, then it could, indeed, be a game changer.
Vaccines for Addiction: Is the Concept Plausible?
The short answer is yes.
Vaccines work by triggering the immune system to create antibodies. We create antibodies specific to countless pathogens in our environment. When a pathogen – think virus or bacteria – enters our body, antibodies attach to the pathogen, tagging it as an invader for other immune cells to recognize and destroy.
An addiction vaccine has the potential to work in almost the same way. It would trigger the immune system to create antibodies to a substance of misuse. In this case, the target is fentanyl. Theoretically, the antibodies attach to the target substance in order to disable it and prevent it from acting on our nervous system, where it creates reinforcing effects such as euphoria. That’s where an addiction vaccine may differ from a typical vaccine: the goal is not necessarily to destroy it, but rather, to prevent it from binding to receptors in our nervous system that result in reinforcing effects like euphoria, and, perhaps more importantly, to prevent the negative effects that lead to fatal overdose.
That’s the concept, and it’s sound.
Let’s back up just a moment and clarify why this is newsworthy to the general public and relevant to our work in OUD treatment.
Between 2019 and 2021, over a quarter million people in the U.S. died of drug overdose, and almost three quarter of those deaths involved opioids.
Here’s the data, as published by the Centers for Disease Control (CDC):
- 2019: 67,697 total drug overdose fatalities (50,178 opioid-related)
- 2020: 78,056 total drug overdose fatalities (69,061 opioid-related)
- 2021: 107,306 total drug overdose fatalities (73,453 opioid-related)
That’s why a fentanyl vaccine – fentanyl is a synthetic opioid 50 times more powerful than heroin and 100 times more powerful than morphine – could legitimately change the game, and alter the course of the opioid crisis in the U.S.
The Data: Can a Fentanyl Vaccine Prevent Fentanyl Overdose and Fentanyl-Related Euphoria?
The short answer, again, is yes.
The research at the University of Houston Drug Discovery Institute – funded in part by the Department of Defense – is in the animal testing phase, and not yet in the human clinical trial phase. That means that if everything goes well, from this point forward, a viable vaccine may be available in years, rather than decades.
The “if everything goes well” in this scenario means replicating positive experimental results in human trials, which include:
- Stimulating an immune response in humans
- Blocking the analgesic properties of fentanyl in humans
- Blocking the euphoric properties of fentanyl in humans
- Ensuring the vaccine targets fentanyl and not other opioids
What that set of bullet points implies is that in the experiments in the rodent model, scientists observed:
- A significant immune response: test subjects produced antibodies, which were boosted by an immune adjuvant – a helper chemical – to achieve levels that meet criteria for effectiveness
- The antibodies bound to fentanyl and blocked its pain-relieving qualities
- Bound antibodies blocked the euphoric properties of fentanyl
- The vaccine-produced antibodies did not affect the action of other therapeutic opioids, including:
- The antibodies blocked the ability of fentanyl to cause physiological responses associated with fatal overdose
If researchers can replicate those results in humans with no negative side effects, then with regards to the opioid crisis and fentanyl, this can be a legitimate game changer.
But how does it work?
Preventing Fentanyl from Reaching the Brain
In essence, when an antibody produced by this experimental vaccine attaches to fentanyl, it prevents fentanyl from crossing the blood-brain barrier and entering the brain. That’s a major achievement: the fentanyl can’t get to the brain. Therefore, it can’t act on the brain. Which means it can neither produce a euphoric effect nor the physiological problems that lead to fatal overdose.
There’s more to the results than that, though.
The specificity of the molecule is important. The results show that the vaccine-produced antibody binds to fentanyl, but not to buprenorphine, methadone, or oxycodone. That means people on medication assisted treatment (MAT) with buprenorphine or methadone can continue their MAT program and take the vaccine, and that people in severe pain can take analgesic opioids and take the vaccine, and everything will work as planned. The MAT medications will keep patients in recovery, the analgesic medications will relieve pain for those who need it, and the vaccine will make relapse to fentanyl impossible.
Let’s back up again and remind ourselves that as of now, the vaccine is in the animal testing phase. There are hurdles to clear in the future – and this vaccine may not clear them. But the evidence to this point is, indeed, promising.
Here’s how Dr. Colin Haile, a lead researcher on the vaccine project, describes the results:
“We believe these findings could have a significant impact on a very serious problem plaguing society for years – opioid misuse. Our vaccine is able to generate anti-fentanyl antibodies that bind to the consumed fentanyl and prevent it from entering the brain, allowing it to be eliminated out of the body via the kidneys.”
This step forward could reduce the impact of fentanyl on the opioid crisis, prevent relapse to fentanyl, and save lives – that’s a big deal.
We’ll close this article with perspective on addiction vaccines:
- In SUD treatment, any medication – vaccines included – is part of a comprehensive, whole person approach to recovery
- Counseling is part of any SUD treatment program involving medication
- Therapy is part of any SUD treatment program involving medication
- Lifestyle changes are part of any SUD treatment program involving medication
- Community support is part of any SUD treatment program involving medication
We make these points to remember that where the disordered use of substances is concerned, it’s unrealistic to expect a magic bullet, and more practical to view any potential vaccine that researcher produce in the future will be part of an integrated, comprehensive approach to treatment that addresses the whole person, and any medication will be part of a larger solution, and unlikely to be a solution by itself.
According to the research team, human clinical trials will begin soon.
We’ll keep our eyes open for the results of those trials, and report them to you here as soon as they’re available.