In one picture, H. Joseph “Joey” Ressler is smiling at his mother and lifting her off the ground. In another, a selfie, he's grinning like a little kid as two motorcyclists roar up from behind. He was just 24, and the future seemed limitless for the happy, talented young man.
“He could’ve had the world,” said his mother, Julie Ressler, of Lancaster.
But Joey, 24, died in April of an overdose, after a protracted battle with heroin and methamphetamines. He tried everything from inpatient rehab to Vivitrol, a monthly injection designed to prevent relapse. Nothing lasted.
"I really try to look at it as, I’m glad I had him for the years I did,” Julie Ressler said. “I am. He made my life better.”
Now she is among the survivors, advocates, and researchers who are wondering whether the real answer to the opioid crisis is a novel form of prevention, vaccines that would train the body to fight the effects of certain drugs.
Of course, the best drug prevention is to never start using. But to keep those in recovery from taking up the habit again, researchers are looking at an alternative that could help those for whom current therapies aren't enough.
How opioid vaccines work
Researchers in California have successfully tested a heroin vaccine on monkeys and have shown vaccines against fentanyl, oxycodone, and hydrocodone to be viable in rodents. Another team in Maryland has successfully tested a heroin vaccine on rodents.
With proper funding, both groups say, they could get their vaccines into human trials within two years.
These vaccines differ from current medication-assisted treatments because — just like inoculations against the flu, for instance — they spur the production of antibodies to fight the drug molecules as if they were invaders. Unlike available medications, which essentially brush opioids off of receptors in the brain, the heroin vaccines prevent the drug’s molecules from reaching the brain altogether, inhibiting any rewarding effects. A different vaccine would be needed for each type of opioid.
As promising as the concept sounds, the vaccines are no panacea. They would be effective only for those who were deeply committed to recovery, and wouldn't seek another kind of drug. Experts say that if they succeed, they would complement other available therapies.
“You would need to deal with the craving,” said Gary Matyas of Walter Reed Army Institute of Research in Silver Spring, Md., who is developing two different heroin vaccines. “You need [buprenorphine] or methadone to deal with (cravings). And probably you would need to get psychological support.”
Taken daily, methadone, Suboxone, or buprenorphine can mitigate the effects of heroin and help patients avoid painful withdrawal symptoms. Naltrexone (Vivitrol), a monthly shot, can help prevent relapse into alcohol and drug abuse. Narcan (naloxone), administered through a nasal spray, can reverse an opioid overdose, and so it is carried by many first responders.
However, methadone and buprenorphine are opioids themselves and can be abused, sometimes leading to overdose. These treatments are often criticized for being “substitute drugs."
Former U.S. Rep. Patrick J. Kennedy, of Brigantine, N.J. — who is in recovery for opioid addiction and now pushes for better access to evidence-based treatment — supports the vaccine research.
“We need to put everything we have on the table,” Kennedy said. “I would love to see more solutions for this illness.”
The Centers for Disease Control and Prevention reports that more than 52,000 Americans died from drug overdoses in 2015, up 11 percent from 2014. Heroin deaths increased 21 percent nationally, 21 percent in New Jersey, and 30 percent in Pennsylvania, according to recent figures from the CDC.
Where the research stands
Scientists have been working for decades on vaccines to combat addictive substances. Cocaine vaccines have so far proven ineffective because people fail to produce enough antibodies to them, said Charles O’Brien, vice chair of psychiatry and director of the Center for Studies of Addiction at the University of Pennsylvania.
But recent research into opioid vaccines appears more encouraging, so much so that it's attracting some commercial interest. Opiant Pharmaceuticals, which developed Narcan, recently licensed a patent for Matyas’ heroin vaccine.
Chemist Kim Janda at the Scripps Research Institute in La Jolla, Calif., a private nonprofit, is also creating vaccines for heroin, fentanyl, oxycodone, and hydrocodone. Early tests indicate that the vaccines for the latter three drugs in addition may help prevent deadly overdoses.
Neurobiologist George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, describes Janda's heroin vaccine as a “giant sponge” in the bloodstream.
“It sucks up the heroin and prevents it from getting to the brain and sucks up the metabolites and prevents them from getting to the brain,” said Koob, who has collaborated with Janda.
Janda's vaccines have worked in rodents; the heroin vaccine also has succeeded in monkeys. He estimates he needs $3 million to $5 million and two years or less to get his heroin vaccine ready to be considered for clinical trials in humans.
What's the holdup?
But Janda says he's used up most of his federal grand money, and interest from pharmaceutical firms hasn't led to more funding.
Matyas' work faces similar challenges. Opiant has several drugs in research, and "we have to prioritize how much money we put into each,” said Arvind Agrawal, executive vice president of medical affairs for the firm.
One reason this kind of research has not received more attention is that addiction treatment still carries some stigma, Agrawal said.
The financial risk is considerable. Antidrug vaccines offer a novel approach, and “drug companies are risk adverse,” said Phil Skolnick, director of the division of pharmacotherapies at NIDA.
Plus, the fact that people could get around the effects of the vaccines by simply choosing another drug is a barrier.
“I’m a little less enthusiastic simply because we already have a number of medications for the treatment of addiction, and our biggest challenge is getting the people into those treatments,” said Dave Metzger, scientific adviser at the Treatment Research Institute in Philadelphia.
'One good decision'
But those drawbacks shouldn't stop the development of drug vaccines, advocates said.
“They allow the patient to make, in theory, one good decision and to receive the vaccine and one or two boosters, instead of having to make a good decision every day," Skolnick said.
The vaccines could help those committed to recovery stay clean long enough to start repairing their lives.
“I don’t think these vaccines are going to cure heroin addiction, but they’re going to help along the way,” Koob said.
Caron Block's son has been clean five years from heroin and other drugs. But the Santa Monica, Calif., resident feels so strongly that more treatment options are needed that she started a CrowdRise online donation pool to raise money for Janda’s research.
“No one ever says to someone with cancer or diabetes, just go to a meeting, work the steps, and be of service, and you’ll be fine,” Block said.
Julie Ressler said that “we owe it to addicts” to get these vaccines to market.
“You’ve got to keep trying something, because what’s going on isn’t working.”