Vaccines to combat the opioid crisis

In August 2017, US President Donald Trump declared the abuse of opioids by millions of Americans a national state of emergency and highlighted the staggering statistics associated with substance use disorder (SUD), which are at record highs. The NIH reported that in 2015, 2.6 million Americans suffered from opioid use disorder (OUD), which caused US$78.5 billion in healthcare, law enforcement, and lost productivity costs for prescription opioids alone [1]. A 2016 National Survey on Drug Use and Health reported that approximately 13 million Americans had misused opioids, including heroin, oxycodone, hydrocodone, and fentanyl, one or more times in the preceding year [2]. Most strikingly, the incidence of opioid‐related overdose deaths has quadrupled since 1999, with no signs of slowing. Currently, more than 90 Americans die each day from opioid overdose [3]. While the statistics are grim, an increasing commitment and more resources to develop new and efficient therapies for OUD gives hope for effectively combating the drug crisis. Earlier this year, the NIH launched a scientific initiative to combat OUD emphasizing three research areas: improvement of overdose‐reversal interventions; new treatments for opioid addiction; and alternative strategies to safely manage chronic pain [1].

A promising approach for treating addiction is immunopharmacotherapy: vaccination against a drug of abuse to induce a tailored antibody response, which prevents the drug from entering the brain and eliciting its psychoactive effects. Vaccines against heroin, oxycodone, hydrocodone, and fentanyl addiction have already shown great success in preclinical evaluation, but have yet to enter clinical trials. This commentary discusses the clinical potential for opioid vaccines along with the experimental and societal aspects that have so far prevented the development of this approach. Ultimately, the field is on the verge of delivering a vaccine with clinical utility.