Vaccines to treat opioid use disorders and to reduce opioid overdoses

摘要

As the incidence of opioid-related fatal overdoses continues to rise in the United States, new therapeutic strategies for opioid use disorders (OUD) are needed. One proposed solution is active immunization with anti-opioid conjugate vaccines, which selectively reduce the effects of their target opioid through production of drug-specific antibodies. As opposed to pharmacotherapies (e.g., methadone, buprenorphine, and naltrexone) targeting opioid receptors in the brain, opioid-specific antibodies operate through a pharmacokinetic mechanism by sequestering the target opioid in serum and reducing its distribution to the brain. Anti-opioid vaccines could provide safe and cost-effective interventions that offer several advantages over current small molecule medications: long-lasting protection that reduces the burden of compliance; no abuse liability or risk of diversion; and due to their selectivity, vaccines do not interfere with endogenous opioids, or with nontarget opioids prescribed for pain management or for treatment of OUD. To improve clinical outcome, vaccines could be used in combination with other medications for OUD.