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November 27, 2012 9:05 AM Stimulating Big Pharma to Invest in Medications for Stimulant Addiction

By Keith Humphreys

In my Wall Street Journal article on vaccines for addiction to stimulant drugs (e.g., cocaine and methamphetamine), I lament the fact that the development of these remarkable medications is moving slowly due to a lack of private sector investment. Grants from the U.S. National Institute on Drug Abuse are a pittance in comparison to the resources big pharma can bring to bear, but so far the industry has largely stayed on the sidelines.

I mention one reason for industry’s diffidence regarding stimulant drug vaccines in the article: Few doctors specialize in addiction. For a new medication that has to be prescribed, this would be constrain potential profit.

A related problem is that a disproportionate number of people with drug problems have no health insurance, further hampering the profitability of addiction-related medications. Pharmaceutical companies also fear liability risk because drug addicted people are at high risk of overdose, suicide and HIV contraction.

The combined effect of these barriers is to discourage pharmaceutical investment. Dr. Barbara Fox, CEO of Avaxia Biologics Inc, had a hand in producing the first cocaine vaccine in the early 1990s and subsequently founded a company that specialized in addiction therapies. She told me “I saw a huge social need that no company was meeting, so I thought it was a great opportunity. I should have realized that when no one is in a market space, there’s a reason!”. Her addiction-focused company could not raise significant funds and she has since founded a new company focused on other areas of pharmaceutical product development.

Recent federal government policy may ameliorate the situation. The Affordable Care Act expands health insurance, including among people addicted to drugs, which should make the addiction medicine market more financially attractive to medication developers. The same law also includes incentives for training health professionals that could increase the number of prescribers of any vaccine product that was brought to market.

Other supportive government actions are possible. Current government-subsidized liability protection for vaccine makers could be extended to manufacturers of cocaine and methamphetamine vaccines. The government could also consider designating addiction an orphan disease. Normally only rare diseases are so designated, but the attached federal incentives may be necessary to augment investment in addiction-related therapies. Neither of these potential policy changes qualifies as a hot topic in Washington at the moment, though there are certainly political players with a longstanding interest in addiction who might advocate for them when the next Congress is sworn in.

In the meantime, vaccine reseachers such as Professor Tom Kosten, whom I highlighted in WSJ, soldier on with limited funds from the government or from small firms and donors who are willing to take a chance. The scientists’ desire for more investment is palpable, but so is their determination to persist regardless. Reflecting on the fact that his clinical trial of a cocaine vaccine might have generated stronger results had he had access to the superior proprietary vaccine materials of large pharmaceutical firms, Kosten was philosophical rather than resentful. “They live in a different world”, he laughed, “Getting angry at them is like getting angry at God”.

[Cross-posted at The Reality-based Community]

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Keith Humphreys is a professor of psychiatry and behavioral medicine at the Stanford University School of Medicine.
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