Sunday, February 04, 2007

Child drug vaccines: the worst idea ever

The Evening Standard reports yesterday that:

“Babies could be vaccinated with brain-altering chemicals to stop them getting hooked on drugs and cigarettes in later life”

According to the story:

Newborns would have jabs which could prevent addiction to cocaine, heroin or tobacco, under secret Downing Street plans.

Details of the extraordinary proposal to stop the annual £20 billion cost of drug misuse are in a leaked No 10 policy document.”

Very few details are given about the alleged document, who commissioned it, who wrote it, or whether it is being taken remotely seriously other than that it is “reportedly being considered by Tony Blair's working group on crime” (although they don’t tell us who reported this). One quote is given, apparently from the document:

"A young person could be immunised and the drugs would never reach or affect the brain. Drug-related crimes could be reduced if vaccines can be successfully developed to reduce the craving."

Given the record of the Evening Standard (and stablemate the Daily Mail who ran the exact same story) with lame drug coverage it’s difficult to know what to make of this report. But if there is even a modicum of truth in it, it is very depressing news indeed. In a world a drug war idiocy this would be a new low. Here’s why:

Drug vaccines don’t really work

The idea of drug vaccines has been around for ages, but years of research have yet produce the products that the child vaccine idea requires.

There are products that prevent certain drugs from working, like naltrexone which is brilliantly effective at blocking the effects of heroin, but this isn’t a vaccine that you can give to children. It has to be taken orally every day, or delivered in controlled doses from a subcutaneous or stomach implant. There’s also Antabuse which is given to alcoholics that makes them vomit if they drink alcohol, but again that’s an entirely different concept to a vaccine, and these things are taken as part of treatment programmes rather than as prophylactics.

The new(ish) cocaine ‘vaccine’ works more like a classical disease vaccine, developing antibodies that will bind to cocaine molecules in the blood and in theory preventing them crossing the blood brain boundary and getting the user high (something similar may be on the cards for nicotine). The BBC covered this story back in 2004, and you can read about the product TA-CD, produced by the company Xenova here. The research, perhaps unsurprisingly, has been funded by NIDA, and there are some fairly positive reports of outcomes when used for problematic relapsing cocaine users. There may be a limited place in the drug treatment for such products, but that is an awful long way from mass vaccination of babies (on whom is yet to be tested anyway).

I went to a Royal Society of Medicine conference focusing on cocaine a year or so back, and I asked a panel of the world’s top cocaine and addiction boffins what they thought of the cocaine vaccine idea. They raised several key objections. One was that it might potentially prevent some legitimate medicines from working, since cocaine and various related drugs (mostly ending in ‘caine’) are still used today, mostly in local anesthesia for dentistry and ophthalmology. Even though there is not yet a vaccine for heroin the same problems would apply if it is developed. Rendering opiates ineffective – the implication of vaccinating all children against heroin - would be potentially disasterous, given that opiates remain the most widely used, powerful, effective and safe pain killers in the doctor's armoury. Heroin (diamorphine) is often given to pregnant women in childbirth, and I was given it a few years back when I had my appendix out. I would be pretty annoyed if I had had to suffer agonizing post-operative pain because of being vaccinated against becoming a problematic drug using offender 26 years previously, a career path I honestly have no interest in.

More worryingly was the suggestion from the boffins that real problem users would potentially resort to taking massive doses to overwhelm the vaccine’s immune response and achieve the desired high, in doing so increasing consumption and toxic risks.

Giving drug vaccines to children is profoundly unethical

Most of the hysteria about vaccines is media fueled nonsense (witness the MMR/autism debacle for example), but there are potential risks involved whenever you give drugs to people, especially children and especially infants. Aside from the risk, and even if there was none, vaccines would still take you into the legal/ethical quagmire of informed consent, similar to the issues around random drug testing of children in schools.

There is also the more contentious issue of whether the state can impose private morality by denying people rights over their recreational choices and their own bodies. Does the state have the right to proscribe certain pleasures to consenting adults, if that is what they choose? Especially if such activities are decriminalised in the future as they inevitably will be. Would we mass-vaccinate against legal drugs like alcohol and tobacco, not associated with offending to fund a habit? Would politicians be putting themselves forward for alcohol vaccinations?. Given that it would be impossible to know which children would become drug using offenders (you couldn’t, for example, just vaccinate poor people) you would have to vaccinate everybody regardless of whether they are the minority who go onto use illegal drugs, or the minority of them whose use becomes problematic. Like the drug laws generally, you would be penalising the majority for the sins, if you want to call them that, of a minority. Its a very different proposition to vaccinating against contagious diseases. Why shouldn’t I be able to enjoy a cup of coca tea because of a violent crack addict?.

Lots of very difficult to answer questions.

Even if vaccines worked it wouldn’t prevent problematic drug use, or offending

Vaccinating against a drug does not vaccinate against the desire for intoxication. If cocaine was no longer effective because of a population wide vaccine programme then the demand for stimulants would simply be met by other drugs, amphetamine perhaps or even, shock horror, methamphetamine. If people could no longer escape into opiates then we would inevitably see a huge rise in problem drinking and/or benzodiazepine and tranquiliser use. Maybe we could vaccinate against those to, but we couldn’t vaccinate against all 250 drugs scheduled under the UN drug conventions, and the 1000s of other prescription, over the counter drugs and unlicensed drugs that can be recreationally used and misused to varying degrees. Can we vaccinate against glue sniffing? The more you think about it the more of a ludicrous proposition it becomes. That said it is no less bonkers than the idea that eradicating certain plants from the world would stop people using drugs, even if it was possible, which it isn't.

Only a small proportion of drug users become problematic and end up offending as a result of their use. This offending is mostly to pay the over inflated price of illegal drugs, so if the main aim of a drug vaccine programme is to reduce crime, you would effectively using a pharmacological solution to solve a problem created by the policy of prohibition. There’s a much better ‘vaccination’ against prohibition and its called ‘legally regulated drug markets’ (patent pending).

The social, economic, and physiological factors that underlie problematic drug use and offending are many and complex. The idea that there is some pharmacological magic bullet that can sort it all out is absurd. These factors include social deprivation, mental illness, histories of abuse and being in care, having one or more drug dependent parent, poor education, lack of opportunity, homelessness, unemployment and so on. There are no vaccinations for any of these things as yet.

To be honest I don’t really buy this story, which I’m sure is either mistaken or spun into newsworthyness by the Standard/Mail. I don’t think that even our drug-war obsessed Government would give the child drug vaccines idea more than the most fleeting of consideration, it is so spectacularly impractical and stupid. Of course that doesn’t mean they won’t suggest it anyway regardless of whether think its a goer or not - to grab a few headlines and make it look as if they are doing something ‘tough’ to deal with the ‘drug menace’ (sniffer dogs and random drug testing in schools anyone?). I doubt it though.

If drug vaccines have any use at all it should be to provide a litmus test of policy makers and opinion formers; anyone who suggests vaccinating children against drugs as a genuine proposition for dealing with the drug problem immediately forfeits all intellectual credibility and should never be taken seriously again. Ever.


Maddy said...

Lets just hope that it's a premature 'April Fool' Story.
Best wishes

Anonymous said...

I reminded of a section in that interesting study of heroin use 'Junkie'. He quits using heroin, but because he still wants to get out of it falls upon alcohol with such abandon that his friends and family soon ask him to go back on the junk.

Anonymous said...

This is hilarious, anyone remember that story..There was on old woman who swallowed a spider? Seeing a strong connection to our drug policies there.

Anonymous said...

Something which concerns me especially with drugs such as opiates which are structually similar to endorfins using the opiod receptors, if one could create a molecule which would bind with the drug and keep it from crossing the blood brain barrier could we truely be sure to not be effecting some known or unknown precursor chemical used by our bodies to produce these endorfins in our food crossing the blood brain barrier as well?