The great potential of immunotherapy will prove problematic if these new medications are incorrectly viewed as “magic bullets.” The failure of these medications to meet expectations when used outside research settings could undermine their acceptance and the willingness of government agencies and private firms to finance the research needed to develop them. First, like any medications, these new therapies will not be completely effective for all patients. Second, some individuals may be unwilling to even accept the first dose if they fear making a commitment to sustained abstinence from their drug of addiction for a variety of reasons, including fear that they cannot easily reverse the medication or return to their drug use to relieve protracted withdrawal symptoms or for other needs. Third, for a variety of reasons, some patients will not remain in treatment but will relapse to smoking or drug use. Fourth, some individuals may refuse treatment because the therapies may leave long-lasting markers in their systems, thus subjecting them to possible adverse effects, such as denial for health insurance.

Fifth, some patients who receive these medications—even completely willingly—could behave in ways that would undermine their effectiveness, for example, by switching to drugs that are not targeted by the medication and by attempting to test or override the blocking effect of the medication by taking larger amounts of the drug. Moreover, the existence of what are seen as safe and effective treatments for addiction could make experimenting with drugs seem less risky and hence increase drug use. Conversely, if treatment programs using these new medications succeed in substantially reducing the number of existing addicts, dealers may aggressively attempt to interest new customer bases, as well as engage in violent “turf wars” to maintain profits in their existing markets.

Recommendation 6 The National Institute on Drug Abuse should support studies of behavioral consequences, such as the increased potential for accidental overdose and changes in drug use patterns, which may include switching drugs, increasing drug dosage or overall consumption, changing the route of administration (e.g. nasal to intravenous for greater bioavailability) or, conversely, avoiding use of other addictive substances.

Recommendation 7 The National Institute on Drug Abuse should support studies that examine the extent to which the availability of immunotherapy medications might reduce the perceived risk of drug use and the effects of such changes on drug use behavior in various populations.

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