The notion of responsibility in regard to addiction has been debated copiously in the past decade, with the critical question being whether addiction is a choice or a disease with a biological basis. According to the American Society of Addiction Medicine (ASAM), addiction can be defined as a “primary, chronic disease of the reward and motivation pathways in the brain manifested in psychological, biological, and social pursuing of substance use” (ASAM). Since 2002, there has been a six-fold increase in the number of deaths resulting from heroin addiction and overdose, supporting the notion that heroin is highly addictive and fatal (NIDA). Because of heroin’s addictive nature, many behavioral therapies have fallen short at aiding addicts in overcoming the abuse and scientists have now changed their perspective on the issue. Instead of targeting the behaviors expressed as a consequence of heroin abuse, scientists have begun to study the biology of addiction and target compounds in the brain associated with reward and motivation by the development of a vaccine. Namely, researchers have changed their perspective on addiction as a choice to addiction as a brain disease. Not only does this treatment evaluation consider the dichotomy of addiction, it also proposes a mechanism of treatment that can universally address heroin’s effect on the brain on a biological level in all individuals.
Heroin is a synthetic opioid drug synthesized from morphine. To synthesize heroin, morphine is extracted from the opium poppy seed and reacted with acetic anhydride to produce the chemical. Once heroin is injected or smoked, it enters the body and is metabolized to a compound called 6-monacetylmorphine, or 6MAM, which resembles natural endorphins produced in the body. This molecular structure allows 6MAM to interact with and bind natural opioid receptors and initiate the dopamine reward pathway in the brain. This elicitation of the reward response directly motivates addiction and abuse of the drug. Byproducts of heroin metabolism in the body include 3-monacetylmorphine (3MAM) and morphine, which have related effects on the body. Researchers Joel Schlosburg, Leandro Vendruscolo, and team published a paper in 2013 on the Proceedings of the National Academy of Sciences of the United States of America, PNAS, in which they observed that each metabolite of heroin produced in the body following intake of the drug, and heroin itself, contains a nitrogen bridge in its structure (Schlosburg). They then developed a dynamic vaccine, the “heroin vaccine”, that targets this nitrogen bridge by presenting an epitope resembling the structure to the immune system. This allows the body to produce antibodies against heroin and its psychoaddictive metabolites and mount an immune response against the molecules before they reach the brain. Researchers tested this vaccine on rats in a pre-clinical stage and observed that heroin’s effect on the brain was blocked, resulting in a decrease in activation of the dopamine reward pathway in the brain and reduced addiction (Schlosburg). This treatment provides a method of targeting both biological and behavioral effects of heroin abuse by reducing reward seeking behavior via metabolic intervention of the morphine conjugate vaccine.
Arguments for such therapy have shed light on the notion that the body produces natural endorphins that bind to opioid receptors in the brain. This evokes the criticism that the vaccine is dangerous because it may elicit an immune response against the body’s natural endorphins due to their similar structure to that of heroin metabolites. However, the dynamic vaccine targets heroin and its active metabolites in the bloodstream whereas the receptors and natural endorphins are located in the brain. The vaccine is incapable of crossing the blood-brain barrier, which confines the antibodies to the bloodstream as well. Consequently, this treatment effectively does not target the body’s natural endorphins and solely sequesters heroin and its metabolites in the blood before they can enter the brain and initiate psychoactive pathways that contribute to the reward-seeking element of addiction.
Another argument, and perhaps the most debated one, is the criticism that efforts to treat addiction require money and since addiction is a choice, addicts need to take responsibility for their addictive behaviors, not taxpayers. According to critic Gerald McOscar, “addiction is not a disease.” In 2016, Governor Tom Wolf of Pennsylvania decided to secure $20 million in order to fight the opioid abuse of heroin in Pennsylvania, which aims to provide vital and life-saving care for those addicts struggling with the “disease of opioid addiction.” McOscar asserts that “this alleged ‘disease’ more closely mimics a bad habit brought on by a lifetime of bad choices…the realization that he alone is responsible for his situation and that he alone, if willing, may choose to do something about it (McOscar, G. K).” McOscar, like other critics with similar arguments, fails to understand the biological basis of addiction and continues to perceive addiction as a choice. Addiction stems from the dopamine reward pathway in the brain, which is responsible for actions that involve choices involved in motivation and reward, such as eating food or laughing – these release endorphins in the body, which is why they feel “good.” Although first engaging in the act of ingesting the drug is a choice, the addiction is not – it is a biological reaction initiated in the brain that motivates an individual to seek out the drug. For this reason, once addicted, addicts need biologically effective treatment in order to overcome their drug abuse, which can be provided by the conjugated vaccine.
An alternate counterpoint considers those who successfully recover from drug addiction as a result of current drug rehabilitation practices. There are addiction treatments, such as methadone, that address the biological basis of opioid addition to aid in recovery. Some might claim that the use of methadone and other conventional therapies to treat opioid dependence is sufficient. However, this treatment is only successful as long as methadone, a chemical that activates the reward pathway in the brain but does not confer heroin’s psychoactive properties, continues to be used as a maintenance drug. It is true that individuals with strong will can resist the urge to relapse. However, “recovered” addicts suggest that the desire to use opioids never goes away and their brain physiology is permanently altered by prior heroin use. Methadone is not a good solution for opioid dependency because it does not reduce that dependency over time, users still experience withdrawal symptoms and serious side effects comparable to those associated with opioid abuse, and overdose and fatality is not uncommon. The ineffectiveness of these treatment strategies calls for a new alternative, and the heroin vaccine proposes to truly resolve the disease of heroin addiction.
As of now, the authorization to initiate clinical trials has been met with much criticism due to the lack of funding by the government and pharmaceutical companies. The reason for the reluctance to fund the heroin vaccine is the idea that pharmaceutical companies that make big money off of prescription drugs like Methadone and Suboxone, which works as an opioid blocker, will lose their profits if such a vaccine is available on the market. This seems trivial given that the purpose of the medication is to treat heroin addiction yet these companies are ignoring the superior potential of the vaccine because it may cost them a profit. In the United States, heroin-related deaths are increasing with no treatment option that takes advantage of our own immune system to fight off disease. Now is the time to realize addiction is not a choice and help those individuals who suffer from heroin addiction to get the necessary treatment they need to overcome the abuse.
- Board of Directors (April 19 2011). Definition of Addiction. American Society of Addiction Medicine ASAM. Retrieved February 28, 2017, retrieved from http://www.asam.org/quality-practice/definition-of-addiction
- Dinker B. (n.d.). Heroin Vaccine – Why Pharmaceutical Companies Just Say No. Discovery Place Drug and Alcohol Recovery Programs. Retrieved February 28, 2017, from https://www.discoveryplace.info/heroin-vaccine
- McOscar, G. K. (September 8 2016). Take some responsibility: Addiction is not a disease. Connecting People Through News Daily Times. Retrieved February 28, 2017, from https://www.pressreader.com/usa/daily-times-primos-pa/20160908/281947427298235
- National Institute of Drug Abuse (NIDA) (January 2017). Overdose Death Rates for Heroin. Retrieved February 28, 2017, from https://www.drugabuse.gov/publications/drugfacts/nationwide-trends
- Schlosburg, J. E., Vendruscolo, L. F., Bremer, P. T., Lockner, J. W., Wade, C. L., Nunes, A., Stowe, G., Edwards, S., Janda, K., Koob G. (February 26 2013). Dynamic vaccine blocks relapse to compulsive intake of heroin. Proceedings of the National Academy of Sciences of the United States of America PNAS. Retrieved February 28, 2017, from http://www.pnas.org/content/110/22/9036.full