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With an estimated 15 to 39 million ‘problem drug users’ worldwide, narcotics abuse is a widely recognized significant public health burden. October’s F1000 Medicine Report, ‘Anti-addiction vaccines’, by Xiaoyun Shen, Frank Orson and Thomas Kosten describes a number of vaccines for cocaine, nicotine, methamphetamine and opiate addiction that are currently in development and in clinical trials. These vaccines induce the production of antibodies that block the effects of addictive drugs in the brain, potentially ameliorating morbidity and mortality associated with drug abuse. Most importantly, the report finds that some vaccines not only block the immediate behavioral and toxic effects of drug use, but also inhibit cravings, potentially helping those motivated to quit from relapsing.

Kosten et al. acknowledge that there are deeper ethical concerns around the acceptability of vaccinating those susceptible to addiction:

When addiction is considered a failure of will power or as willful misconduct, then treatment is generally directed toward the behavioral disorder, with little consideration given to direct medical intervention, so that even the addict may not recognize the potential benefit of therapeutic vaccination.

When does drug addiction move from being an individual’s choice to a neurochemical illness that medical practitioners should be obliged to treat, or even prevent, pharmaceutically? Much of the literature reviewed in Kosten et al.’s report suggests that this line is unclear. FDA approval of anti-addiction vaccines remains highly controversial for many reasons, not least the stigma that substance abuse is “a moral failure rather than a brain disease”.

Ethical concerns that arise around this emergent group of vaccines relate to a broader topic of debate that was highlighted recently at the London Science Festival. As part of Science Question Time, Clive Page (Pharmacology at King’s College London) led an audience-interactive discussion on ‘The Future of Drugs’ with expert panelists David Fox, Illina Singh, James Peach and Becky Purvis. Several fascinating questions were raised, with personalized and preventative medicine being particularly hot topics.

At the molecular scale, personalized medicine would entail profiling a person’s genetic, proteomic and metabolomic makeup, to determine their specific risk factors for any number of ailments. One hope is that this would lead us away from reactive medical care that treats symptoms, toward a focus on preventative practices. For those willing to confront their own list of risk factors and potential future medical ailments, choosing preventative medicine and behavioral options to lessen their chances of becoming sick is a welcome next-generation medical model.

However, while it may be relatively easy to convince individuals that they should have a right to know their risk factors for cancer, heart disease, and Alzheimer’s, might there be a slippery slope with regard to issues of personal addiction risk and treatment? On the morally shaky end of the scale, would it be acceptable to, in future, vaccinate ‘prone’ teenagers against a susceptibility to addiction? A medical ethics professor once told me, “when there is a slippery slope, a railing must be installed.” With pharmaceuticals of the future subject to an increasingly complex network of social, ethical and legal challenges, researchers and companies developing drugs must commit to open to debate with medical professionals, bioethicists, sociologists, patients and policy makers. Kudos to the London Science Festival for providing a venue for such critical discussion.