Q and A: Cocaine vaccine early trial promising in treating addiction

HOUSTON -- (Oct. 5, 2009) -- Below is the text-only version of Dr. Thomas R. Kosten's video Q & A.

What does this study on the cocaine vaccine show?

"The cocaine vaccine is something we've been working on for about 15 years. It has gone through a variety of clinical studies in humans, and this is the first placebo-controlled study that we've done of the cocaine vaccine. It's a very exciting study in that what we found was that the people who got vaccinated did in fact have less cocaine use than the people who weren't vaccinated."

What is the next step in researching the cocaine vaccine?

"The next generation of vaccines which we hope to be available in the next two to three years for human trials will probably be even more effective than the ones we have now. And we're also working on vaccines for methamphetamine, for nicotine, for opiates, and we could develop them for every drug of abuse except alcohol."

How does the vaccine work?

"Vaccination involves five different injections of the vaccine over a period of about two and a half months. They are roughly every two weeks and then there's a booster at four weeks. The levels of antibodies will start to rise to therapeutic levels after about six to eight weeks. They will then stay high out to about 16 to 20 weeks, and then they will rapidly fall off. So there's a window of about 8 to 16 weeks, about eight weeks, or two months, when you'll have sufficiently high antibodies that they should block the cocaine effects."

How long will the vaccine last?

"Our expectation is that most people will get this vaccine for about two years with booster shots being given every two months. At the end of the two years, of course, there will be people who will relapse sometimes, and as far as we can tell, if you relapse two or three years later, a single injection or potentially two injections would push the antibody levels back up to these high levels. You would then be kept from relapsing during the next couple of months and you could continue this. Whether you could continue vaccination for your whole life and continue to sustain those very high levels of antibodies is something that's completely unknown."

What are some of the side effects of cocaine use?

"Cocaine is a remarkably destructive drug and the effects it has certainly start with medical effects. People who smoke cocaine get significant lung damage from it and asthma and bronchitis of various sorts that will develop from that. It also has significant effects on blood pressure and blood vessels and the two major effects you see on the cardiovascular system are people having strokes and people having heart attacks."

What are some of the psychiatric effects of cocaine use?

"After the medical complications comes the psychiatric complications. Many of the patients of course become quite paranoid when they're using cocaine; it's a normal effect of large amounts of cocaine. Along with that paranoia, they can become suicidal. When they get suicidal, of course, sometimes they do complete the suicide and not just make the attempt. So those longer range psychiatric complications from repeated use are quite significant. How much that you damage your brain in terms of the ability to think and concentrate from chronic use remains an open question with cocaine."

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