Comparing Treatment Approaches:

An analytic review of Immunotherapy for Cocaine Addiction by
Donald W. Landry (1997) and Buprenorphine Suppresses Cocaine
Self-Administration by Rhesus Monkeys by Nancy Mello et al. (1989)

The general unsuccessfulness of treating cocaine addicts has led to the development of new therapeutic approaches. Immunotherapy for Cocaine Addiction (Landry, 1997), and Buprenorphine Suppresses Cocaine Self-Administration by Rhesus Monkeys (Mello et al, 1989) are two examples of such approaches. Both deal with the addiction in a biologically therapeutic way, although combating the drug by very different means.
Landry has developed what he considers innovative compounds to destroy cocaine upon entering the bloodstream, similar to an immune response, therefore not allowing the drug to reach the brain. He is striving to deal with the physical dependence aspect of cocaine addiction, helping to "wean" patients off the drug. By destroying all effects, both main effects and side effects, of the drug, patients taking it would receive no "high", no positive reinforcement, and would gradually be able to become successful in a treatment program. The problem with this point of view is that cocaine has not been shown to be very physically addicting, as there are no major symptoms of withdrawal that the patient is trying to combat by self-administering more of the drug. By making the drug ineffective in the blood stream, addicts would not receive what is thought to be positive reinforcement through cocaine's effects on the dopaminergic systems in the brain, but there is no evidence to prove that it would therefore stop them from taking it in increasingly higher doses, until the amount of drug in the system outweighed the ability of the immunological response produced by the therapy.
Conversely, Mello views the addiction to cocaine in terms of positive incentive. She and her colleagues have addressed the reinforcing effects of cocaine, and theorize that dependency can be dealt with by taking away the reinforcement that comes with the self-administration of cocaine, leaving only the main physical effects of the drug. They believe that their technique of pharmacotherapy effectively antagonizes the reinforcing effects of cocaine, while giving minimal side effects. It is only a small step to infer that if this is successful in monkeys, it has the potential to be effective in humans. The fact that their perspective is one of measuring the rates of self-administration of cocaine, this is a logically effective way of dealing with the addiction, because it would take away exactly what they propose to be the reason people become addicted to cocaine: its positively reinforcing properties.
Mello states that dopaminergic neural systems play a critical role in cocaine reinforcement. She suggests that Buprenorphine affects cocaine self-administration, but that the precise reason for this effect is not known. She hypothesizes that either the opioid agonist or opioid agonist-antagonist combination is the reason by Buprenorphine has this result. By using the model of successful treatments for heroin abuse, she is attempting to parallel these actions to treating cocaine addicts, as well as those who use both drugs. Limiting factors of her study are that, in her view, her study is not directly applicable to humans, because self-administration and control of cocaine consumption as well as that of other drugs is much more difficult to monitor outside of a laboratory environment using animals.
Landry describes the mechanism of cocaine's actions as simply an addictive high. Reinforcing properties are important, but not the exact mechanisms that produce them. Landry's emphasis is on keeping the cocaine from reaching the brain at all. This would negate any potentially fatal biological effects from taking the drug. It would be a more appropriate treatment for addicts, as it reduces the entirety of the drug's negative impact on the body, not just stopping the reinforcement. This would be particularly useful with pregnant addicts. In the time until the patient gives birth, if cocaine consumption could not be controlled, this therapy should reduce the well-known impairments in the fetus development caused by cocaine.
The development of antibodies was to eliminate the possibility of replacing the cocaine addiction with an addiction to a treatment drug. Benefits of this treatment are numerous. It has the potential to be long lasting, and does not have the problem of patients adhering to the drug administration schedule, as it would be administered by the doctor about