Drs. Oz & Roizen: A vaccine against opioids? What is narcolepsy?

If you can give someone a shot to save them from a heroin or opioid overdose, couldn’t you give them the same drug — sort of a vaccine — and stop opioid addiction in the first place? — Tim B., Alexandria, Virginia

 

Very smart question. Military scientists have been working on that problem since they received a $5 million research grant in 2012. What they’ve developed is a vaccine that may stop heroin abuse. But let’s back up a bit so we can explain how it works.

The reason that heroin and other opioids are so deadly is that they’re made up of very small molecules that pass swiftly between the blood/brain barrier and go right to the brain’s receptors. The “shot” you referred to is naloxone, and it works by binding to the opioid receptors in the brain, which blocks the effects of the opioid.

The way a vaccine works for the flu virus is different from the vaccine against heroin and opioids. For the flu vaccine, a dead strain of the virus is introduced to the immune system, which then produces antibodies against it. So when the real flu virus shows up, the immune system is locked and loaded. The antibodies attack the invading flu virus before it can replicate and make you sick.

The pending heroin vaccine is a bit different. It’s designed to stimulate the immune system to produce an antibody that latches onto the heroin molecule so that it’s too big to cross the blood/brain barrier. Then the drug cannot produce a “high.” The researchers hope that might make someone immune to the drug’s effects and help in overcoming an addiction.

So far, the vaccine is working in rodent models. The vaccine may prove useful in humans: Scientists are hoping it will prevent the withdrawal and craving symptoms for people who are addicted to opioids and heroin, and are trying to quit. That would help thousands who are desperately trying to be free of the addiction but don’t have access to the support and resources needed to make it happen.

I see ads on TV for narcolepsy treatment. Is this a real disease, or just some trumped up disorder? — Dave V., Lancaster, Pennsylvania

The sleep disorder narcolepsy is no joke. According to the National Sleep Foundation, narcolepsy affects roughly 1 in 2,000 people, and it’s often misdiagnosed. That means that there are approximately 180,000 Americans currently suffering from this condition. That’s a lot of people falling asleep at the wheel, at work and, like those ads, on a date at the movies. But that’s not the worst of it.

People who suffer from narcolepsy also can experience cataplexy, which is partial or total loss of muscle control during waking hours. Normally, muscle relaxation happens during REM (rapid eye movement) sleep, which is when dreams occur. REM sleep normally starts about an hour or so after you fall asleep. Your brain keeps your muscles limp and relaxed so that you don’t act out your dreams. Cataplexy happens when muscles go limp while you’re awake, and that can be very dangerous. This disrupted sleep cycle also can cause hallucinations and extremely vivid nightmares, which is why narcolepsy can be misdiagnosed as a seizure disorder or worse.

People with narcolepsy and cataplexy all have extremely low levels of the naturally occurring brain chemical hypocretin, which promotes wakefulness and regulates REM sleep. Researchers believe that the immune system mistakenly targets brain cells that produce hypocretin, so narcolepsy could be an autoimmune disorder.

Narcolepsy can be effectively treated with medications and behavior modifications, but it needs to be properly diagnosed first.

If you think you or someone you know has narcolepsy — it affects men and women in equal numbers — contact the Narcolepsy Network (www.narcolepsynetwork.org; 888-292-6522) to find a doctor and/or a support group. You can learn more at the NIH website for the National Institute of Neurological Disorders and Stroke (www.ninds.nih.gov).

Mehmet Oz, M.D., is host of “The Dr. Oz Show,” and Mike Roizen, M.D., is chief wellness officer and chair of the WellnessInstitute at the Cleveland Clinic.

 

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