Paul R. Pentel

Hennepin County Medical Center and University of Minnesota

Immunotherapies and depot medications (dosage forms designed to release a drug gradually over a prolonged period of time) are of particular interest as approaches to treating drug addictions because of their long duration of action. Clinical effects may persist for months, eliminating the need for daily medication and potentially improving patient compliance. At the same time, a long duration of action could help prevent patients from opting out of treatment prematurely and could prolong the duration of any side effects of treatment. These possibilities raise unique questions regarding the therapeutic role for such medications and their ethical implications. The purpose of this appendix is to present the scientific basis for vaccines and depot medications as a background for addressing these unusual and challenging issues.

The first study of immunotherapy as a treatment for drug dependence was a report in 1974 that a vaccine directed against heroin reduced heroin self-administration in monkeys (Bonese et al., 1974). This new treatment approach was not pursued because of concerns about whether heroin addicts might simply switch to a different opiate. This appendix considers more recent and ongoing efforts directed at cocaine, phencyclidine, nicotine, and methamphetamine dependence. Initial clinical trials have begun on immunotherapies against cocaine and nicotine, but only preliminary