A double-blind randomized controlled trial of N-acetylcysteine in cannabis-dependent adolescents.
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Am J Psychiatry. 2012 Aug 1;169(8):805-12
Authors: Gray KM, Carpenter MJ, Baker NL, Desantis SM, Kryway E, Hartwell KJ, McRae-Clark AL, Brady KT
Abstract
OBJECTIVE: Preclinical findings suggest that the over-the-counter supplement N-acetylcysteine (NAC), via glutamate modulation in the nucleus accumbens, holds promise as a pharmacotherapy for substance dependence. The authors investigated NAC as a novel cannabis cessation treatment in adolescents, a vulnerable group for whom existing treatments have shown limited efficacy.
METHOD: In an 8-week double-blind randomized placebo-controlled trial, treatment-seeking cannabis-dependent adolescents (ages 15-21 years; N=116) received NAC (1200 mg) or placebo twice daily as well as a contingency management intervention and brief (<10 minutes) weekly cessation counseling. The primary efficacy measure was the odds of negative weekly urine cannabinoid test results during treatment among participants receiving NAC compared with those receiving placebo, in an intent-to-treat analysis. The primary tolerability measure was frequency of adverse events, compared by treatment group.
RESULTS: Participants receiving NAC had more than twice the odds, compared with those receiving placebo, of having negative urine cannabinoid test results during treatment (odds ratio=2.4, 95% CI=1.1-5.2). Exploratory secondary abstinence outcomes favored NAC but were not statistically significant. NAC was well tolerated, with minimal adverse events.
CONCLUSIONS: This is the first randomized controlled trial of pharmacotherapy for cannabis dependence in any age group to yield a positive primary cessation outcome in an intent-to-treat analysis. Findings support NAC as a pharmacotherapy to complement psychosocial treatment for cannabis dependence in adolescents.
PMID: 22706327
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Limitations on using N-Acetylcysteine:
1. The patient or parents have to buy it. It is not covered by health insurance. This aspect already turns off many patients.
2. Cost is about $11 a month or $132 a year. Poor patients may not be able to afford this.
3. N-Acetylcysteine stinks – it has a very bad odor that can cause nausea. Try to get a teenager to swallow this voluntarily for years.
4. If Glutamate signaling is not excessive, blocking it using N-A-C may cause memory impairment.