Rapid Review

The prospects for immunotherapy in smoking cessation

Smoking has become one of the most destructive habits that humans have ever participated in. To address the issue, various therapies have been developed over the years that have targeted the major addictive component of smoking, nicotine. These therapies have struggled to address the growing epidemic due to their numerous and well-known limitations; however, currently, there is no go-to treatment plan for nicotine addiction. An alternative, less known form of therapy for nicotine addiction, immunopharmacotherapy, is currently in development and has shown exceptional promise in past animal studies. Vaccine candidates that have arisen from these studies have ultimately met failure in clinical trials, however, due to the lack of observed efficacy in the majority of study participants. Undeterred, current nicotine vaccine research continues and focuses on overcoming the limitations observed in previous vaccines through the optimization of existing technologies and the implementation of novel ideas. It seems likely that with enough time, support, and collaboration, an effective nicotine vaccine will someday make it to the market.

Cravings, intense desires to experience the effects of a drug, are widely regarded as significant impediments to overcoming addiction, although their role in relapse may be overstated. Scientists and clinicians wish to better understand the neurobiological and cognitive basis of craving so that they may develop psychotherapeutic, pharmacological and other medical methods to reduce craving and thereby drug use. The conduct of such research raises significant ethical issues. When recruiting individuals and conducting this research, scientists need to ensure that substance dependent participants have the capacity to provide free and uncoerced consent. This is especially the case in studies in which dependent participants are given their drug of addiction or provided with other inducements to participate (e.g. financial incentives) that may undermine their ability to fully consider the risks of participation.

Treatments for addiction that seek to reduce cravings may also carry risks. This includes psychotherapeutic approaches, as well as pharmacological and medical treatments. Clinicians need to consider the risks and benefits of treatment and carefully communicate these to patients. The desire to reduce urges to use drugs should not be employed to justify potentially harmful and ineffective treatments. The safety and effectiveness of emerging treatments should be assessed by well conducted randomized controlled clinical trials.

This chapter examines prospective neurobiological interventions on the horizon and discusses some of the ethical and social challenges that may arise from their future use. The use of neurobiological treatments for addiction can often serve competing goals. The usual aim of medical treatment is to alleviate or cure an affected person’s condition. Neurobiological treatments targeted at the individual may come at the expense of broader social approaches to reduce drug use such as taxation, education, and welfare initiatives or a failure to address the social problems that promote drug use and poor treatment outcomes. The most commonly used pharmacological approaches to treat addiction have involved either drug substitution or relapse prevention. In drug substitution, a patient is prescribed a drug that has similar but less harmful effects than the drug that is abused. Anti-craving drugs aim to reduce relapse by preventing or reducing the intensity of cravings. Drugs for which there is some evidence of anti-craving effects, from either animal studies or human clinical trials, include acamprosate, bupropion, disulfiram, ondansetron, and naltrexone.

This chapter examines prospective neurobiological interventions on the horizon and discusses some of the ethical and social challenges that may arise from their future use. The use of neurobiological treatments for addiction can often serve competing goals. The usual aim of medical treatment is to alleviate or cure an affected person’s condition. Neurobiological treatments targeted at the individual may come at the expense of broader social approaches to reduce drug use such as taxation, education, and welfare initiatives or a failure to address the social problems that promote drug use and poor treatment outcomes. The most commonly used pharmacological approaches to treat addiction have involved either drug substitution or relapse prevention. In drug substitution, a patient is prescribed a drug that has similar but less harmful effects than the drug that is abused. Anti-craving drugs aim to reduce relapse by preventing or reducing the intensity of cravings. Drugs for which there is some evidence of anti-craving effects, from either animal studies or human clinical trials, include acamprosate, bupropion, disulfiram, ondansetron, and naltrexone.

This chapter discusses ethical and policy issues in the translation of genetic and neuroscience research on addiction. Neuroscience and genetic research of addiction has the potential to improve the treatment and possibly the prevention of addictive disorders and lead to more humane and effective social policies to deal with persons with these disorders. Neurobiological theories of addiction attempt to identify the molecular and cellular mechanisms of how drugs act on the brain in ways that may impair control over drug use. Neuroimaging studies have identified changes in brain regions involved in the cognitive processes of salience, motivation, memory and conditioned learning, and inhibitory control. Researchers are now developing immunotherapies that treat drug addiction by blocking the psychoactive effects of a drug by either stimulating the immune system to produce antibodies or through the introduction of synthetic monoclonal antibodies into the blood stream. It is likely that immunotherapies would be most often used in situations that are inherently coercive, as treatment will often be the result of encounters with the justice system, such as a condition of release from prison or to avoid incarceration, in pregnant women, or parents involved in the child welfare system. The benefits will need to be balanced against rights of the individual to privacy and liberty.