title: Ethical and policy issues in using vaccines to treat and prevent cocaine and nicotine dependence.
abstract: OBJECTIVE
  To describe the rationale of vaccines against cocaine and nicotine, to review progress in developing and trialing vaccines to treat dependence on these drugs and to discuss some of the ethical issues that may arise from their use in legally coerced addiction treatment or for prevention of addiction in adolescents.
  
  
  RESULTS
  Several randomized controlled trials of cocaine and nicotine vaccines for relapse prevention have produced mixed results. The studies demonstrate that it is possible to raise antibodies to cocaine and nicotine in humans. In abstinent patients who show high levels of drug antibodies, the rewarding effects of these drugs are attenuated. Phase 2 trials have not found nicotine vaccines to be superior to placebo because only a third of those vaccinated develop sufficient levels of antibody to block the effects of nicotine.
  
  
  CONCLUSIONS
  Vaccines are a novel approach to relapse prevention that need to more reliably induce immunity in a larger proportion of vaccinated patients if they are to protect against relapse after achieving abstinence. Vaccines are unlikely to prevent addiction in adolescents. Their use under legal coercion should only be considered after considerable experience with their use in voluntary patients.
authors: Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia. w.hall@uq.edu.au
authors: Wayne
authors: W
authors: Hall
authors: Coral
authors: C
authors: Gartner
mesh_terms: D019970:Cocaine-Related Disorders / Q000188:drug therapy*; D006801:Humans; D057766:Policy; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D014029:Tobacco Use Disorder / Q000188:drug therapy*; D014611:Vaccination / Q000941:ethics* / Q000331:legislation & jurisprudence*; D014612:Vaccines / Q000276:immunology / Q000627:therapeutic use*
chemical_list: D014612:Vaccines