When Kim Janda built the first cocaine vaccine in his Scripps Research Institute lab 25 years ago, he slapped it with a three-letter name: GNC. “It stood for ‘gold nugget cocaine,’ because we thought it was going to make us rich,” he recalls with a snort. “It sounds stupid now.”
That first iteration developed too few antibodies, and the second—its name simply graduated up the alphabet to GND—was too pricey, but they fueled a radical idea that became vaccinology’s holy grail: What if instead of just treating addiction with abstinence and self-help groups, it could be vaccinated against like measles or mumps? It would stop some 22 million seriously ill Americans from harming themselves with drugs. If they relapsed, it would be, in colloquial terms, “no fun.” Scientists have since tried in vain to make a viable drug-abuse vaccine, though many dismiss the goal as quixotic. After all, drugs aren’t viruses; they’re much tinier, more stubborn, and basically imperceptible to the immune system.
But Janda, a chemist who’s made these vaccines his life’s work, may have his gold nugget after all (figuratively this time, as “none of that money is gonna come to me”). In May, Ronald Crystal, head of genetic medicine at Weill Cornell, published his success using Janda’s GNE (the third iteration) in monkeys. Crystal attaches it to a cold virus to create a vaccine that, in his words, “eats up the cocaine in the blood like a little Pac-Man.” Crystal renamed the compound dAd5GNE, the “Ad” standing for adenovirus, or the common cold, his area of expertise. (He’s published hundreds of papers cataloging the adenovirus’s effects as a carrier.) By mid-2014, Crystal hopes to begin human trials.
Fighting drug abuse is serious business. Addiction kills more people than car accidents. A third of drug users are unemployed. With health-care costs, it amounts to a $180 billion-a-year sinkhole, and, since we’re tabulating, toss in the war Nixon declared on drugs in 1971, which has cost taxpayers another $1 trillion. The wreckage of life is incalculable—despair over seemingly unkickable habits, relapse rates that swell as high as 90 percent. Cocaine is especially insidious. It results in the most drug-related ER visits and has no substitute-drug helper, like methadone for heroin. In his memoir, Times media critic and ex-junkie David Carr says about smoking crack, “The narcotic was being inhaled while my soul was exhaled.”
That ending addiction has been a fruitless endeavor is not for lack of ingenuity: Researchers have repurposed drugs already on the market (Ritalin for ADHD, the anti-smoking medicine Chantix), tested electromagnetism, tried using cholera, foraged bacteria from coca-plant roots, and flooded addicts with lab-made antibodies. So far, nothing works well enough.
A typical vaccine, like what children get against tetanus, releases a tiny amount of the disease into the bloodstream, just enough to evoke antibodies, which commit its molecular fingerprints to memory. To make Janda’s GNE, researchers stuck a coke look-alike to a big protein carrier. Together, they stimulate the body to produce cocaine antibodies—or at least that’s the hope.
Some in medicine are dubious. “A vaccine is actually an old idea,” says Keith Humphreys, a Stanford psychiatrist who works with addiction. “And not much has changed in 25 years.” But Janda, a gruff, bald Clevelander, has also won accolades—“He has taken jumps, while the rest of us are content with iterative steps,” says National Institute on Drug Abuse deputy director Ivan Montoya—and even has a superfan, a Montana physician who penned a medical thriller in which “a scientist who has developed an effective cocaine virus” suffers “mysterious anaphylactic death” at the hands of the mob.
It was Janda’s reputation that drew Crystal, the Cornell geneticist, to the project in 2008. Crystal—hale, headstrong, and, at 72, an amateur alpinist—had a eureka moment when he saw a Newsweek cover line, THE HUNT FOR AN ADDICTION VACCINE. “I thought, What if we hooked cocaine up to an adenovirus?” he tells me. He cold-called Janda in California. “I didn’t know who he was. I just called him out of the blue and said, ‘I’d like to collaborate with you.’ ”
For Janda, the partnership made sense. He works in a cash-strapped lab; addicts don’t tend to attract pharma dollars, he complains. “Drug companies feel they won’t make enough money back.” The field’s biggest venture capitalist is an NIH subagency whose $1 billion budget is less than Pfizer spends to get one drug to market. Crystal had money, experience with adenoviruses and animal studies, and a facility to manufacture the drug to boot.
Crystal says he eventually sees us “thinking about addiction the same way you think about mumps and measles and polio, and eradicating it.” But of course, for all the talk of addiction being a disease, it’s vastly different from those. It’s not a mere physiological problem; it’s psychic, too. Even if you can cancel the effects of drugs, can you make us not want to take them? This problem became apparent three years ago in a study for a vaccine called TA-CD made by Baylor College of Medicine’s Thomas Kosten, Janda’s big rival. It was the first late-stage cocaine-vaccine trial, and the vaccine successfully blocked coke’s effects, but not the desire to get high. Some users took ten times more cocaine, and several went broke in hopes of finding the elusive buzz. Of the trial’s successfully vaccinated subjects, 53 percent managed to stay clean for more than half of the time they participated. “Thus, we need improved vaccines,” the study concluded. Nevertheless, doctors declared the work “groundbreaking.”
Crystal expects this won’t matter for them because they’ve tweaked the molecule to ensure a “more robust” immune re-sponse, but that still might not be enough. It’s on this point where the vaccine idea meets resistance from the rehab community, which is dominated by 12-step programs like Alcoholics Anonymous that have opposed alternative-drug therapies, including methadone and buprenorphine, on the grounds that addicts, being addicts, will just swap one substance for another.
“That’s one of my concerns, that people will treat a vaccine as all they need,” says Jack Feinberg, a clinical director at Phoenix Houses of Florida, a top U.S rehab provider. He stresses he’s hopeful, but knows addicts “often have lots of other life issues that need resolving that fixing their drug addiction won’t help.” Angela Garcia, a Stanford professor who studies addiction, agrees. “When a mouse no longer feels pleasure from a drug because of a vaccine, it doesn’t have the option of turning to another pleasure-producing substance,” she says. “But humans do.”
The prospect of the vaccine is already raising thorny ethical questions. Taking away a person’s ability to feel things, Clockwork Orange style, even if the feeling is a drug high, runs counter to our idea of free will. It may be decades away, but it’s not impossible to imagine teenagers getting vaccinated for drugs the way they are for HPV.
But for now, Janda’s biggest obstacle is time. Twenty-five years of chasing vaccines is starting to wear on him. In 2011, he guessed he has “eight or ten more years, then it’s someone else’s turn.” He tells me he plays to win but is “almost burnt out. You always have to be doing cutting-edge stuff.” In fact, he’s already working on GNF, the next big thing, in case the current trial doesn’t pan out.