“America’s opioid crisis.” “The opioid epidemic is getting worse.” At a time when six Americans are dying every hour from opioid overdoses ... “They were dealing with a heroin overdose.” Do we need a new approach? Researchers, like Gary Matyas at the Walter Reed Army Institute of Research, think we do. “We’re working on a heroin-H.I.V. vaccine. We’re comparing the response to heroin in a mouse. ...” In animal studies, the vaccine blocks heroin’s effects by keeping it, and many other opioids, from reaching the brain. “This mouse: The heroin went into the brain. It made it run around like crazy. Whereas the vaccinated mouse behaved basically normally. This tells me that the vaccine worked.” The idea of a vaccine also represents an emerging shift in the way addiction is understood. “Addicted people have been considered poor character, bad personalities, liars, cheats, bad moral upbringing.” Former deputy White House drug czar Thomas McLellan says that for years, punishment ... “Mandatory minimum laws, sometimes up to life in prison ...” and abstinence ... “When it comes to drugs and alcohol, just say no.” were considered the best ways to prevent drug abuse, and reforming an addict’s personality the best form of therapy. “They developed residential programs where that really was the nature of the treatment: character reformation. Bring that character down and rebuild it.” But it turns out for many people, these programs don’t work. “Fifty percent will relapse within six months and most of those will relapse within 90 days.” Brain research published over the past decade or so has begun to explain why. “Addiction is best considered a chronic illness of the brain.” “This is drugs.” “And it’s not just like the old commercial.” “This is your brain on drugs.” “The use of drugs gradually erode motivation, inhibition, reward sensitivity and stress tolerance in your brain. If you take someone whose brain has been changed by drugs, ‘just say no’ is perfectly ridiculous.” “There is a true epidemic sweeping America, striking without warning.” “People ask me all the time, ‘Why don’t we have medications to treat addiction?’ Well, the truth is we do have medications, and many have been around for quite a long while.” “Methadone, a bitter, inexpensive, synthetic drug ...” Like methadone, a daily dose opioid that doesn’t produce the high. “Vivitrol is the new drug that we’re using ...” Or Vivitrol, a monthly shot that blocks heroin’s effects. Without these medications, the vast majority of opioid addicts will relapse. “It might be a little uncomfortable to lay on that side.” Thomas McLellan says that, combined with long term support and monitoring, medication doubles an addict’s chances of staying clean. But only about a third of treatment programs use this approach. “It’s been thought that medications are simply a crutch. You’ll hear over and over, ‘They’re just a substitution for another drug.’ They don’t believe in them. They don’t see the need.” And he compares the stigma around addiction treatment today to an epidemic from the early 20th century: tuberculosis. “Tuberculosis was not thought to be a medical illness. It was thought to be a lifestyle.” “Poverty and ignorance contribute to the spread of tuberculosis.” “Policymakers realized they had to do something. We’ll make a system of sanitaria and put them someplace way the hell out of town, away from us.” But tuberculosis is caused by a bacteria. “The research was clear. TB was actually a pathogen.” By the late 1940s, scientists had discovered both drugs and a vaccine that worked. “After penicillin, streptomycin — science’s latest weapon against some forms of tuberculosis.” But they were not widely adopted for years. “Because of political and financing and stigma issues, we didn’t implement evidence-based treatment for tuberculosis, even though we could have.” When it comes to drug use, despite mounting evidence that it’s a chronic disease, some officials still believe in “Just say no.” “Just say no. Don’t do it.” But the latest opioid crisis is starting to change some minds. “They need medicine to regain the dignity that comes with being in control of their lives. Having just one-third of treatment programs offer the most effective intervention for opioid addiction is simply unacceptable.” “Brain disease lasts for a long time, but it can be managed in the same way other chronic illnesses are managed. This is not a lost cause.” “This is our vaccine.” Gary Matyas is hoping his vaccine, which has been licensed to a drug company, will be a new tool for managing addiction. “We want to test it in humans to see what happens.” If it works, addicts would be vaccinated after they detox, when they are at highest risk of death from an overdose. “It would be part of their therapy for recovering, so if they mess up and take a dose of heroin, the heroin won’t work.”