Page 250 - Pagetit

7. ETHICAL ISSUES IN NEUROSCIENCE RESEARCH ON SUBSTANCE DEPENDENCE TREATMENT AND PREVENTION

Preventive use of drug immunotherapies
Animal studies have shown that it is possible to induce the formation of
antibodies to substances such as cocaine (Fox et al., 1996; Carrera et al., 2000).
These antibodies in the blood combine with the substance to prevent it
reaching the brain to exert its effects (Fox et al., 1996) (see Chapter 4). Animal
studies show that antibodies against cocaine markedly attenuate its stimulant
effects and block self-administration in rats (Carrera et al., 1995; Johnson
&Ettinger, 2000). If cocaine immunotherapies prove safe and effective in
treating persons with cocaine dependence, they could be used to prevent
cocaine dependence in adolescents and young adults, as well as in adults
and in legally coerced treatment. Such possibilities have been raised and
briefly discussed (Cohen, 1997, 2000). Similar arguments will no doubt arise
with the proposed preventive use of nicotine immunotherapies.
If a controlled clinical trial demonstrates that nicotine and cocaine
immunotherapies are safe and effective treatments of these types of substance
dependence, then a number of ethical issues concerning their use in
voluntary treatment of substance dependent adults need to be addressed
(Cohen, 1997; Hall & Carter, 2002). The preventive use of cocaine and nicotine
immunotherapies would be ethical in the case of adults who voluntarily
decided to use them after being informed of any risks. The immunotherapies
would need to be shown to be safe and effective for this purpose, with higher
standards of proof generally required for the safety and efficacy of preventive
measures (Hall & Carter, 2002). The foreseeable risks of using the
immunotherapy would have to be communicated to the person, who would
have given informed consent to its use, and steps would need to be taken to
protect the person’s privacy. Under these conditions, the voluntary
administration of a cocaine immunotherapy to consenting adults who
considered themselves to be susceptible to cocaine dependence would be
ethically acceptable (Hall & Carter, 2002). However, such use is likely to be
unusual.
A potentially unique feature of active immunization against cocaine is that
it may, in principle, have long-lasting consequences, namely, creating
antibodies that can be detected in the blood of treated patients for some
months or years. These antibody levels may not be sufficiently high to be
therapeutic but the fact that they could be detected raises the ethical issues
of privacy and discrimination (Cohen, 1997).
Of special concern is the possible loss of privacy by recovering cocaine-
dependent individuals if employers and insurance companies had access to
this information. Employers and insurance companies often obtain detailed
personal medical information and, on occasion, blood samples from potential
employees or clients. Because the community often strongly disapproves of
cocaine dependence, the loss of privacy by a recovering cocaine-dependent
individual may lead to embarrassment, at best, and to social stigmatization
and ostracism by people in their social environment and in the wider

229

Chapter_7 229 19.1.2004, 11:50