I used to play the piano.

I started lessons when I was like 4 and it became a “requirement” when my parents realized I was pretty good at it.

It started off fun!

And then it wasn’t.

I hated practicing.

I hated lessons.

I only wanted to play when no one was home and I could just bang away with a thunderstorm or cry my messy high school breakup emotions away with a slow, sad Chopin.

We have a beautiful piano from my husband’s childhood home that looks nice in our house but no one plays it.

Sometimes too much of a good thing ruins it!!

And sometimes too much work can feel “boring”.

My patients are never boring! But the work of psychiatry and prescribing the same meds and giving the same consent talks can feel dull.

...GI upset, headaches, weight gain, decreased libido, growing rainbow armpit hair…

Ok, not that last one but I’m not allowed to make stuff up just to entertain myself!

So I rely on things like today’s topic to keep me interested and in awe of what’s going on in our mental health science world!

Today I’m sharing a few cool tidbits about a topic I (until this article) knew nothing about!

Vaccines for substance use disorders!

As in getting a shot to help minimize or quit tobacco, cocaine, meth, or opioids!

​Here’s the link to the article I read from a journal earlier this year, but I bet it’s not free.

So here’s a link to another good article covering the same stuff that I think you can access without any problems 🤞🏻

If you don’t want to read whole article about a bunch of detailed immunology minutiae for something that isn’t even available (there are no FDA approved SUD vaccines… yet) then just check out my quick notes about why this is cool and what some of the sticking points are!

How SUD vaccines work:

(Which is kind of similar to regular vaccines but against a drug and instead of a pathogen!)

Most of these vaccines work by creating antibodies that bind to specific drugs in the bloodstream. This keeps them from crossing the blood-brain barrier and reaching their target receptors in the brain. And keeping them out of the brain is important because it blocks the positive/desired feelings of the drug! Plus it limits the reinforcing effects of these drugs (the speed of effect and feelings caused that make people want more). A vaccine may even potentially reduce cravings and help prevent relapse.

So what’s in development right now?

Cocaine Vaccine

• The cocaine vaccine TA-CD has progressed to clinical trials
• In Phase IIb studies, 67% of patients achieved sufficiently high antibody levels after vaccination
• Patients with high antibody responses showed greater reductions in cocaine use compared to placebo

Nicotine Vaccine

• Nicotine vaccines have also reached clinical trials
• Results have been mixed, with some patients not making sufficient antibody responses for good effects clinically

Opioid Vaccines

• An experimental oxycodone vaccine is being tested in Phase 1 clinical trials at Columbia University
• It's goal is to prevent oxycodone from entering the brain, potentially reducing euphoria and overdose risk
• Researchers are also working on developing vaccines for heroin and fentanyl

Methamphetamine Vaccine

• Anti-methamphetamine vaccines are still in preclinical development so we don’t have much to report here

So why isn’t anything approved yet? Well, there are lots of challenges!!

• Antibody response variability: Not everyone makes high enough antibody levels for the vaccines to work effectively
• Drug-specifics: Separate vaccines are needed for different drugs so any variations in the chemical structure or make up of the drug could make the vaccine ineffective
• Duration of effect: Current vaccines may only provide protection for 3-6 months, requiring multiple booster shots and even though a daily pill may be a pain, getting a shot a few times per year may be even harder! (Did you get your flu vaccine yet? And that’s just once a year!)
• Motivation required: Vaccines work best for people who are motivated to quit. Which is also a big deal because some of the vaccine effects can be overcome by taking larger drug doses which is pretty much the opposite of what we want to have happen (and could be very dangerous!)
• Limited scope: Vaccines don't address underlying psychological factors or cravings directly, that’s what therapy is for! We can’t package all of those magical skills into a shot a pill or anything else “easy”. The work is what makes it so effective!!

So why bother? What are we really hoping for here?

• Long duration of action compared to daily medications
• Reduced toxicity to organs by deactivating drugs and bypassing metabolism in the liver or kidneys
• Potential for preventing relapse when combined with other treatments (you again!)
• (Hopefully) More cost-effective compared to some other addiction medications or the addiction itself

SUD vaccines are very cool and may become part of what we can offer for addiction treatment in the future since none are approved for clinical use, yet.

And they’ll still require therapists to support the changes needed to help manage an addiction.

Stuff like this is just so exciting to me!! I love reading about something in process, what’s going right, how they’re solving problems or hang-ups, and dreaming about how much good they’ll be able to provide some day!

I mean, yes, it would be even better if I told you about something magical you could offer right now (although I’m pretty sure I did that last week 😉) but it’s inspiring to be reminded that it’s not all boring same-old, same-old.

Which also reminds me how just because I’ve consented for Zoloft thousands of times, the person I’m consenting right now hasn’t ever heard my spiel. So I owe it to them to make it good! (Just not too creative).

I already told you I don’t play the piano anymore but I’m making a change. It used to be fun and I believe it can be again!

So I did some tweaking from what I imagine it means for me to play again and I have a solution!

Christmas Carols!

You know I’m a fan of holidays Reader, but especially Christmas, and especially the music!

So this year I asked each person in my family to pick their favorite song and I’ll learn the music and they’ll learn ALL the words (to ALL the verses!!) and we’ll have a holiday sing along!

Now that sounds like fun to me.

Keep it interesting!! (whatever that may mean for you, Reader!)

Cheers to healthy brains,

Dr. B

Jess Beachkofsky, MD

Your friendly online psychiatrist!

P.S. I know it’s not even Halloween yet and I’m talking Christmas but I’m not going to apologize! I need time to practice! Here’s what the fam picked: Jingle Bells, Deck the Halls, and Carol of the Bells (which has a lot of dings and dongs if you’ve never looked at the words before!)

P.P.S. I didn’t pick a song for myself. Suggestions? In the past I learned all these super fancy complicated versions but this time I just want it to be fun and easy! Send me your favs!