March 10, 2025 • 19 mins
This episode delves into the role of N-acetylcysteine (NAC) in treating cannabis use disorder, exploring scientific studies and their findings. Listeners will gain insights on the efficacy of NAC, its potential in addiction treatment, and practical considerations for use.
• Overview of cannabis use disorder statistics and the need for treatment options
• Explanation of N-acetylcysteine and its mechanism of action in addiction
• Review of clinical trials evaluating NAC's effectiveness in reducing cannabis use
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To contact Dr. Grover: ammadeeasy@fastmail.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to the Addiction Medicine Made Easy
podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:21):
For 14 years, I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
Today, we will be talking aboutusing N-acetylcysteine to treat
(00:44):
cannabis use disorder.
Now this episode comes from oneof my patients who has cannabis
use disorder.
She, at her first appointmentwith me, asked about using
N-acetylcysteine often referredto as NAC or NAC for cannabis
use, and I hadn't heard of this.
So I told her I needed toresearch it and I finally had
(01:07):
time to dig into this topic.
Now I went to the scientificliterature to research this
topic and on the NationalLibrary of Medicine, I found a
great paper on the topic ofN-acetylcysteine for cannabis
use disorder.
The author of the paper isRishi Sharma and the article is
entitled N-Acetylcysteine in theTreatment of Cannabis Use
(01:29):
Disorder a Systematic Review ofClinical Trials.
It was published in AddictiveBehaviors in 2022.
I wanted to give you all aheads up.
This episode is a review of ascientific article, so it will
be a little more science-y thansome of my recent episodes.
All right, let's dig in.
I always love the introductionsection, as it gives us a great
(01:53):
background of the topic.
The authors begin by remindingus that cannabis is a commonly
used substance with high ratesof cannabis use disorder and
cannabis dependence.
It's estimated that 22 millionpeople globally have cannabis
use disorder, also known ascannabis addiction, and as many
(02:14):
as 30% of regular cannabis usersdevelop cannabis dependence,
meaning that they willexperience withdrawal symptoms
when they stop.
Now, interestingly, the authorspoint out there are no
FDA-approved medications forcannabis use disorder.
And that brings us back toN-acetylcysteine, which I will
(02:35):
refer to as NAC for the rest ofthe episode.
Nac is an antioxidant moleculederived from the amino acid
cysteine that is involved withthe synthesis and metabolism of
glutathione.
A quick pause here.
The authors didn't discuss whatglutathione is, so I wanted to
(02:56):
jump in.
Glutathione is a key moleculein multiple metabolic processes.
It is an antioxidant and isinvolved with the synthesis and
storage of multiple keycompounds in the body.
Back to the article.
The authors go on to share thatresearchers have tried to use
NAC for the treatment ofmultiple addictions, including
(03:17):
nicotine, alcohol, cocaine,methamphetamine and cannabis.
They move on to discuss why NACmight be useful in treating
addiction, which is that itaffects glutamatergic
transmission.
And if you're wondering whatthat means, it refers to
signaling in the brain involvingthe neurotransmitter glutamate.
(03:40):
Another quick break-in from me.
Glutamate is an excitatoryneurotransmitter, meaning that
it is a brain chemical that actsas a natural upper in the brain
.
You may remember from some ofour episodes on alcohol and
alcohol withdrawal that alcoholreduces how well glutamate works
, which is one of the waysalcohol functions.
(04:03):
As a downer, it reduces howmuch excitation there is in the
brain by reducing the functionof glutamate.
Back to the article.
The authors note that repeateduse of an addictive substance
results in excessive amounts ofglutamate in the reward center
of the brain, and that rewardcenter of the brain is also
(04:24):
known as the nucleus accumbens.
Too much stimulation byglutamate can cause damage to
the neurons in the brain, and soone target for treating
addiction is glutamate, and weknow that some medications for
addiction work through thispathway, like acamprosate and
topiramate, also known astopamax.
(04:45):
Nac, by being a potentantioxidant, is thought to have
the potential to reverse some ofthe damage caused by too much
glutamate with addiction in thereward center of the brain, and
NAC also upregulates theglutamate transporter in the
reward center of the brain aswell, allowing the excess
(05:07):
glutamate in the state ofaddiction to be removed, which
reverses some of the changesfrom addiction in the brain and
prevents further damage to thereward center of the brain.
Now that was pretty complicated.
Let me simplify and summarize.
Addiction involves damage tothe reward center of the brain
(05:28):
by there being too muchstimulation from the brain,
chemical glutamate.
Nac helps to heal this damageand reduces the amount of
glutamate stimulating the rewardcenter of the brain.
Hopefully that makes sense.
It's actually pretty cool ifyou ask me, but then again, I'm
a giant geek, particularly whenit comes to addiction medicine.
(05:48):
Okay, the authors move on topoint out that research on NAC
has shown efficacy in treatingmultiple addictions, including,
as I mentioned before, cocaine,methamphetamine, alcohol,
nicotine and cannabis.
Right now I am asking myselfwhy haven't I heard about this
sooner?
It sounds like I could beadding this in to the treatment
(06:10):
regimen for all of my patients.
My apologies for gettingexcited.
Okay, back to the article.
The authors decided to look atthe research on using NAC for
cannabis addiction, which bringsus to the methodology of this
paper NAC for cannabis addiction.
Which brings us to themethodology of this paper.
(06:33):
This is a systematic review ofrandomized controlled trials
looking at NAC for the treatmentof cannabis use.
The authors used excellentmethodology when conducting
their review, which I will skipover to avoid us getting too
lost in the details, but if youwant to check out the methods,
it is a well-done analysis.
A quick point from me.
There are many different typesof study design, and randomized
(06:53):
controlled trials are the bestdesign, which gives us the most
accurate information.
So let's unpack this a bit.
Randomized controlled trials,also called RCTs, are the
strongest form of medicalevidence because they are
designed to eliminate bias andensure that any differences in
outcomes are due to thetreatment itself, not other
(07:15):
factors.
In a randomized controlledtrial, participants are randomly
assigned to either thetreatment group or a placebo or
control group, which helpsbalance out differences between
individuals such as age,lifestyle or health conditions.
This makes the results morereliable and allows doctors to
determine whether a treatmenttruly works.
(07:37):
Compared to other types ofstudies, randomized controlled
trials provide the highest levelof confidence that a medication
or intervention is effectiveand safe.
So this review article looks atrandomized controlled trials
looking at NAC for cannabis usedisorder.
So this article is an analysisof all of the best research
(08:00):
studies on this topic.
So, with that in mind, what didthey find?
Well, the authors identifiedeight randomized controlled
trials looking at NAC forcannabis use disorder randomized
controlled trials looking atNAC for cannabis use disorder,
and in the article resultssection they actually summarized
the results of each of thestudies.
The first study was a randomizedcontrolled trial of 116
(08:25):
adolescents and young adultswith cannabis dependence, which
showed a significant decrease incannabis use in the NAC group
as compared to placebo.
They found that patientstreated with NAC were more
likely to have a urine drug testthat was negative for cannabis
as compared to placebo, and itwas statistically significant
(08:45):
with an odds ratio of 2.4.
The second study was adouble-blind placebo-controlled
trial of 302 adults withcannabis use disorder and it
didn't show any difference interms of cannabis use between
the NAC treatment group and theplacebo group.
So that was a negative study.
The third study they reviewedwas a study of 89 adolescents.
(09:08):
They found that adolescentstreated with NAC self-reported
less cannabis cravings, but whenthey did the statistical
analysis comparing thoseadolescents treated with NAC to
those treated with placebo, thedifference was not statistically
significant.
So this was another negativetrial Next up.
The authors looked at a smallstudy of 54 adolescents.
(09:31):
When they compared thoseadolescents treated with NAC to
those who received placebo, theNAC group had reduced
impulsivity, improved medicationadherence and a higher
likelihood of having a negativeurine drug test.
And they were actually lookingat urine drug tests specifically
to detect cannabis use.
(09:52):
And in this study thedifference between the groups
was statistically significant.
Okay, on to the fifth study,which was a study of 300 adults.
In this study, the adults whoreceived NAC were more likely to
be abstinent from cannabiscompared to those treated with
placebo, and these results werestatistically significant.
(10:15):
Okay, study number six.
This study involved 302 adults.
In the adults who received NAC,there was reduced cannabis
craving, reduced cannabiswithdrawal and reduced frequency
of cannabis use compared to theadults who received placebo,
and the results werestatistically significant.
(10:37):
The authors noted that theeffect of NAC was greater in
women than men.
All right.
Study number seven.
This was a study of 74adolescents with depressive
symptoms who used cannabis.
In the group that received NAC,there was a higher rate of
cannabis cessation as comparedto the group that received
(10:57):
placebo, and the results werestatistically significant.
And finally, study number eight.
Very interestingly, studynumber eight was done by the
same author as study numberseven.
This was a study of 302 adultswith cannabis dependence and
depressive symptoms, and yet inthis study there was no
(11:19):
difference in the rate ofcannabis cessation in the NAC
group as compared to the groupthat received placebo.
Let's sum up the results ofthese eight studies Now.
I can certainly sum it up, butlet's see what ChatGPT says when
I ask it for a summary of theseeight studies.
Here we go.
(11:40):
This is what ChatGPT had to say.
Quote the effect ofN-acetylcysteine, also known as
NAC, on cannabis use appearsmixed, with some studies showing
significant benefits, whileothers do not.
Nac appears to have moreconsistent benefits in
adolescents, with multiplestudies showing reduced cannabis
(12:00):
use cravings or increasedcessation.
In adults, the results are morevariable, some trials showing
significant reductions in useand withdrawal symptoms, while
others do not.
Notably, nac may be moreeffective in adults with
cannabis use disorder who do nothave comorbid depressive
symptoms.
So ChadGBT was pretty good.
(12:22):
Now it's my turn.
Here we go.
The results from these studiesare inconsistent.
Here we go.
The results from these studiesare inconsistent.
Nac appears to have somebenefit in reducing cannabis use
, but we haven't found aconsistent trend yet.
So I think we can all agreethat ChadGBT sounds way smarter
than me, but our conclusions arethe same.
Now, the next thing that theauthors looked at were side
(12:44):
effects from the NAC, to quotethe authors.
Quote NAC was found to be safewith a minimum incidence of
adverse effects in most studies.
End quote.
Some of the side effects thatwere reported included
irritability, heartburn,insomnia, abdominal discomfort,
hot flashes, headaches and vividdreams.
(13:05):
In one study, adverse effectswere more common in the placebo
group.
There were six cases of seriousside effects in the placebo
group, with only one in the NACgroup.
So overall, nac is safe andwell-tolerated and I have to say
side effects from placeboalways make me smile.
(13:25):
In terms of the dosing of NAC,it was the same in every study
it was 2400 milligrams per day.
However, the review articledidn't give much explanation of
how this was done, so I had todig in a little bit.
Unfortunately, addiction ingeneral and cannabis use
disorder are not FDA-approvedindications for NAC.
(13:48):
So I looked up NAC on UpToDate,but I couldn't find anything
about how to prescribe NAC foraddiction or cannabis use.
So I logged into my electronichealth record and opened up the
chart of our test patient.
It turns out, I can prescribeNAC in the form of 600 milligram
oral capsules, nac in the formof 600 milligram oral capsules,
(14:12):
and there's also a 600 milligramextended release capsule too.
I then went back and looked atthe studies that this article
reviewed, and 1,200 milligramsof NAC orally twice daily was
the way that it was dosed.
Now I tried to figure out thedifference between regular and
extended releaseN-acetylcysteine, and I really
couldn't find any information onwhen one is used versus the
(14:34):
other.
But the studies that I reviewedall just said NAC and not
extended-release NAC.
So my assumption is that it was1,200 mg of regular NAC used
twice daily orally.
Okay, back to the article.
Here we go, getting to thediscussion section.
The authors looked at what theyfound in their review of the
(14:58):
eight randomized controlledtrials looking at NAC for
cannabis use, and they tried toprovide us with some good
summary data, and theirconclusion was the same as mine
and ChatGPT's, which is thatthere seems to be some signal
that NAC works for cannabis usedisorder, but we haven't figured
out exactly who it works forand in what clinical
(15:20):
circumstance.
The authors then, in thediscussion section, went on to
discuss some of their thoughtson why there were mixed results.
The studies had differentdurations and study outcomes,
which certainly could explainwhy some studies showed a
difference while others did not.
The authors then looked atstudy limitations.
Most of the studies had verysimilar limitations.
(15:43):
Some patients dropped out ordid not follow up, and not
everyone took their medicationNAC or placebo reliably.
So that's probably not a majorreason why some studies showed a
benefit while others did not,as medication noncompliance and
dropping out of the study werelikely pretty similar across all
of the studies, and with thatthe authors moved on to their
(16:05):
conclusions.
With that, the authors moved onto their conclusions.
Quote in summary, it ispremature to conclude that there
is a strong level of evidencefor NAC use in cannabis use
disorder.
In this review we found thestrength of the evidence
available on which to make arecommendation as strong, but
the results of the studies areequivocal as to whether NAC is
(16:28):
helpful for treating cannabisuse disorder.
The studies collectively offermixed results for diverse
clinical endpoints such asabstinence, frequency of use,
cannabis cessation, cravingwithdrawal and medication
adherence.
Collectively, these problemsprevent us from fully
understanding the efficacy ofNAC for cannabis use disorder
(16:51):
and indicate the need for futurewell-designed, rigorous and
high-quality randomizedcontrolled trials with
homogenous endpoints to developan evidence base that can more
decisively provide an estimateof NAC effectiveness, which, to
me, is spot on.
There seems to be some signalthat NAC helps for cannabis use,
(17:12):
but we haven't worked out allthe details yet.
What do we do with thisinformation?
Or, better yet, what are sometake-home points from this
article?
First, there is some limitedevidence that N-acetylcysteine,
also known as NAC or NAC, dosedat 1,200 milligrams twice daily
(17:36):
orally can reduce cannabis use.
Second, more research is neededon the optimal clinical
scenario in which NAC will helppatients using cannabis.
And third, in the meantime, nacis overall a benign medication
that is generally well toleratedIn patients who want to reduce
(17:58):
or stop their cannabis use whohave not responded to other
interventions.
It would be reasonable to try,so long as the patient knows
that the data on NAC forcannabis use is preliminary and
the patient is on board withtrying it.
Before we wrap up, a huge thankyou to the Montage Health
(18:20):
Foundation for backing mymission to create fun, engaging
education on addiction, and ashout out to the nonprofit
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdosesTo those healthcare providers
out there treating patients withaddiction.
(18:41):
You're doing life-saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together we can make it happen.
Thanks for listening andremember treating addiction
(19:02):
saves lives.
You.
Welcome to the Addiction Medicine Made Easy
podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:21):
For 14 years, I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
Today, we will be talking aboutusing N-acetylcysteine to treat
(00:44):
cannabis use disorder.
Now this episode comes from oneof my patients who has cannabis
use disorder.
She, at her first appointmentwith me, asked about using
N-acetylcysteine often referredto as NAC or NAC for cannabis
use, and I hadn't heard of this.
So I told her I needed toresearch it and I finally had
(01:07):
time to dig into this topic.
Now I went to the scientificliterature to research this
topic and on the NationalLibrary of Medicine, I found a
great paper on the topic ofN-acetylcysteine for cannabis
use disorder.
The author of the paper isRishi Sharma and the article is
entitled N-Acetylcysteine in theTreatment of Cannabis Use
(01:29):
Disorder a Systematic Review ofClinical Trials.
It was published in AddictiveBehaviors in 2022.
I wanted to give you all aheads up.
This episode is a review of ascientific article, so it will
be a little more science-y thansome of my recent episodes.
All right, let's dig in.
I always love the introductionsection, as it gives us a great
(01:53):
background of the topic.
The authors begin by remindingus that cannabis is a commonly
used substance with high ratesof cannabis use disorder and
cannabis dependence.
It's estimated that 22 millionpeople globally have cannabis
use disorder, also known ascannabis addiction, and as many
(02:14):
as 30% of regular cannabis usersdevelop cannabis dependence,
meaning that they willexperience withdrawal symptoms
when they stop.
Now, interestingly, the authorspoint out there are no
FDA-approved medications forcannabis use disorder.
And that brings us back toN-acetylcysteine, which I will
(02:35):
refer to as NAC for the rest ofthe episode.
Nac is an antioxidant moleculederived from the amino acid
cysteine that is involved withthe synthesis and metabolism of
glutathione.
A quick pause here.
The authors didn't discuss whatglutathione is, so I wanted to
(02:56):
jump in.
Glutathione is a key moleculein multiple metabolic processes.
It is an antioxidant and isinvolved with the synthesis and
storage of multiple keycompounds in the body.
Back to the article.
The authors go on to share thatresearchers have tried to use
NAC for the treatment ofmultiple addictions, including
(03:17):
nicotine, alcohol, cocaine,methamphetamine and cannabis.
They move on to discuss why NACmight be useful in treating
addiction, which is that itaffects glutamatergic
transmission.
And if you're wondering whatthat means, it refers to
signaling in the brain involvingthe neurotransmitter glutamate.
(03:40):
Another quick break-in from me.
Glutamate is an excitatoryneurotransmitter, meaning that
it is a brain chemical that actsas a natural upper in the brain
.
You may remember from some ofour episodes on alcohol and
alcohol withdrawal that alcoholreduces how well glutamate works
, which is one of the waysalcohol functions.
(04:03):
As a downer, it reduces howmuch excitation there is in the
brain by reducing the functionof glutamate.
Back to the article.
The authors note that repeateduse of an addictive substance
results in excessive amounts ofglutamate in the reward center
of the brain, and that rewardcenter of the brain is also
(04:24):
known as the nucleus accumbens.
Too much stimulation byglutamate can cause damage to
the neurons in the brain, and soone target for treating
addiction is glutamate, and weknow that some medications for
addiction work through thispathway, like acamprosate and
topiramate, also known astopamax.
(04:45):
Nac, by being a potentantioxidant, is thought to have
the potential to reverse some ofthe damage caused by too much
glutamate with addiction in thereward center of the brain, and
NAC also upregulates theglutamate transporter in the
reward center of the brain aswell, allowing the excess
(05:07):
glutamate in the state ofaddiction to be removed, which
reverses some of the changesfrom addiction in the brain and
prevents further damage to thereward center of the brain.
Now that was pretty complicated.
Let me simplify and summarize.
Addiction involves damage tothe reward center of the brain
(05:28):
by there being too muchstimulation from the brain,
chemical glutamate.
Nac helps to heal this damageand reduces the amount of
glutamate stimulating the rewardcenter of the brain.
Hopefully that makes sense.
It's actually pretty cool ifyou ask me, but then again, I'm
a giant geek, particularly whenit comes to addiction medicine.
(05:48):
Okay, the authors move on topoint out that research on NAC
has shown efficacy in treatingmultiple addictions, including,
as I mentioned before, cocaine,methamphetamine, alcohol,
nicotine and cannabis.
Right now I am asking myselfwhy haven't I heard about this
sooner?
It sounds like I could beadding this in to the treatment
(06:10):
regimen for all of my patients.
My apologies for gettingexcited.
Okay, back to the article.
The authors decided to look atthe research on using NAC for
cannabis addiction, which bringsus to the methodology of this
paper NAC for cannabis addiction.
Which brings us to themethodology of this paper.
(06:33):
This is a systematic review ofrandomized controlled trials
looking at NAC for the treatmentof cannabis use.
The authors used excellentmethodology when conducting
their review, which I will skipover to avoid us getting too
lost in the details, but if youwant to check out the methods,
it is a well-done analysis.
A quick point from me.
There are many different typesof study design, and randomized
(06:53):
controlled trials are the bestdesign, which gives us the most
accurate information.
So let's unpack this a bit.
Randomized controlled trials,also called RCTs, are the
strongest form of medicalevidence because they are
designed to eliminate bias andensure that any differences in
outcomes are due to thetreatment itself, not other
(07:15):
factors.
In a randomized controlledtrial, participants are randomly
assigned to either thetreatment group or a placebo or
control group, which helpsbalance out differences between
individuals such as age,lifestyle or health conditions.
This makes the results morereliable and allows doctors to
determine whether a treatmenttruly works.
(07:37):
Compared to other types ofstudies, randomized controlled
trials provide the highest levelof confidence that a medication
or intervention is effectiveand safe.
So this review article looks atrandomized controlled trials
looking at NAC for cannabis usedisorder.
So this article is an analysisof all of the best research
(08:00):
studies on this topic.
So, with that in mind, what didthey find?
Well, the authors identifiedeight randomized controlled
trials looking at NAC forcannabis use disorder randomized
controlled trials looking atNAC for cannabis use disorder,
and in the article resultssection they actually summarized
the results of each of thestudies.
The first study was a randomizedcontrolled trial of 116
(08:25):
adolescents and young adultswith cannabis dependence, which
showed a significant decrease incannabis use in the NAC group
as compared to placebo.
They found that patientstreated with NAC were more
likely to have a urine drug testthat was negative for cannabis
as compared to placebo, and itwas statistically significant
(08:45):
with an odds ratio of 2.4.
The second study was adouble-blind placebo-controlled
trial of 302 adults withcannabis use disorder and it
didn't show any difference interms of cannabis use between
the NAC treatment group and theplacebo group.
So that was a negative study.
The third study they reviewedwas a study of 89 adolescents.
(09:08):
They found that adolescentstreated with NAC self-reported
less cannabis cravings, but whenthey did the statistical
analysis comparing thoseadolescents treated with NAC to
those treated with placebo, thedifference was not statistically
significant.
So this was another negativetrial Next up.
The authors looked at a smallstudy of 54 adolescents.
(09:31):
When they compared thoseadolescents treated with NAC to
those who received placebo, theNAC group had reduced
impulsivity, improved medicationadherence and a higher
likelihood of having a negativeurine drug test.
And they were actually lookingat urine drug tests specifically
to detect cannabis use.
(09:52):
And in this study thedifference between the groups
was statistically significant.
Okay, on to the fifth study,which was a study of 300 adults.
In this study, the adults whoreceived NAC were more likely to
be abstinent from cannabiscompared to those treated with
placebo, and these results werestatistically significant.
(10:15):
Okay, study number six.
This study involved 302 adults.
In the adults who received NAC,there was reduced cannabis
craving, reduced cannabiswithdrawal and reduced frequency
of cannabis use compared to theadults who received placebo,
and the results werestatistically significant.
(10:37):
The authors noted that theeffect of NAC was greater in
women than men.
All right.
Study number seven.
This was a study of 74adolescents with depressive
symptoms who used cannabis.
In the group that received NAC,there was a higher rate of
cannabis cessation as comparedto the group that received
(10:57):
placebo, and the results werestatistically significant.
And finally, study number eight.
Very interestingly, studynumber eight was done by the
same author as study numberseven.
This was a study of 302 adultswith cannabis dependence and
depressive symptoms, and yet inthis study there was no
(11:19):
difference in the rate ofcannabis cessation in the NAC
group as compared to the groupthat received placebo.
Let's sum up the results ofthese eight studies Now.
I can certainly sum it up, butlet's see what ChatGPT says when
I ask it for a summary of theseeight studies.
Here we go.
(11:40):
This is what ChatGPT had to say.
Quote the effect ofN-acetylcysteine, also known as
NAC, on cannabis use appearsmixed, with some studies showing
significant benefits, whileothers do not.
Nac appears to have moreconsistent benefits in
adolescents, with multiplestudies showing reduced cannabis
(12:00):
use cravings or increasedcessation.
In adults, the results are morevariable, some trials showing
significant reductions in useand withdrawal symptoms, while
others do not.
Notably, nac may be moreeffective in adults with
cannabis use disorder who do nothave comorbid depressive
symptoms.
So ChadGBT was pretty good.
(12:22):
Now it's my turn.
Here we go.
The results from these studiesare inconsistent.
Here we go.
The results from these studiesare inconsistent.
Nac appears to have somebenefit in reducing cannabis use
, but we haven't found aconsistent trend yet.
So I think we can all agreethat ChadGBT sounds way smarter
than me, but our conclusions arethe same.
Now, the next thing that theauthors looked at were side
(12:44):
effects from the NAC, to quotethe authors.
Quote NAC was found to be safewith a minimum incidence of
adverse effects in most studies.
End quote.
Some of the side effects thatwere reported included
irritability, heartburn,insomnia, abdominal discomfort,
hot flashes, headaches and vividdreams.
(13:05):
In one study, adverse effectswere more common in the placebo
group.
There were six cases of seriousside effects in the placebo
group, with only one in the NACgroup.
So overall, nac is safe andwell-tolerated and I have to say
side effects from placeboalways make me smile.
(13:25):
In terms of the dosing of NAC,it was the same in every study
it was 2400 milligrams per day.
However, the review articledidn't give much explanation of
how this was done, so I had todig in a little bit.
Unfortunately, addiction ingeneral and cannabis use
disorder are not FDA-approvedindications for NAC.
(13:48):
So I looked up NAC on UpToDate,but I couldn't find anything
about how to prescribe NAC foraddiction or cannabis use.
So I logged into my electronichealth record and opened up the
chart of our test patient.
It turns out, I can prescribeNAC in the form of 600 milligram
oral capsules, nac in the formof 600 milligram oral capsules,
(14:12):
and there's also a 600 milligramextended release capsule too.
I then went back and looked atthe studies that this article
reviewed, and 1,200 milligramsof NAC orally twice daily was
the way that it was dosed.
Now I tried to figure out thedifference between regular and
extended releaseN-acetylcysteine, and I really
couldn't find any information onwhen one is used versus the
(14:34):
other.
But the studies that I reviewedall just said NAC and not
extended-release NAC.
So my assumption is that it was1,200 mg of regular NAC used
twice daily orally.
Okay, back to the article.
Here we go, getting to thediscussion section.
The authors looked at what theyfound in their review of the
(14:58):
eight randomized controlledtrials looking at NAC for
cannabis use, and they tried toprovide us with some good
summary data, and theirconclusion was the same as mine
and ChatGPT's, which is thatthere seems to be some signal
that NAC works for cannabis usedisorder, but we haven't figured
out exactly who it works forand in what clinical
(15:20):
circumstance.
The authors then, in thediscussion section, went on to
discuss some of their thoughtson why there were mixed results.
The studies had differentdurations and study outcomes,
which certainly could explainwhy some studies showed a
difference while others did not.
The authors then looked atstudy limitations.
Most of the studies had verysimilar limitations.
(15:43):
Some patients dropped out ordid not follow up, and not
everyone took their medicationNAC or placebo reliably.
So that's probably not a majorreason why some studies showed a
benefit while others did not,as medication noncompliance and
dropping out of the study werelikely pretty similar across all
of the studies, and with thatthe authors moved on to their
(16:05):
conclusions.
With that, the authors moved onto their conclusions.
Quote in summary, it ispremature to conclude that there
is a strong level of evidencefor NAC use in cannabis use
disorder.
In this review we found thestrength of the evidence
available on which to make arecommendation as strong, but
the results of the studies areequivocal as to whether NAC is
(16:28):
helpful for treating cannabisuse disorder.
The studies collectively offermixed results for diverse
clinical endpoints such asabstinence, frequency of use,
cannabis cessation, cravingwithdrawal and medication
adherence.
Collectively, these problemsprevent us from fully
understanding the efficacy ofNAC for cannabis use disorder
(16:51):
and indicate the need for futurewell-designed, rigorous and
high-quality randomizedcontrolled trials with
homogenous endpoints to developan evidence base that can more
decisively provide an estimateof NAC effectiveness, which, to
me, is spot on.
There seems to be some signalthat NAC helps for cannabis use,
(17:12):
but we haven't worked out allthe details yet.
What do we do with thisinformation?
Or, better yet, what are sometake-home points from this
article?
First, there is some limitedevidence that N-acetylcysteine,
also known as NAC or NAC, dosedat 1,200 milligrams twice daily
(17:36):
orally can reduce cannabis use.
Second, more research is neededon the optimal clinical
scenario in which NAC will helppatients using cannabis.
And third, in the meantime, nacis overall a benign medication
that is generally well toleratedIn patients who want to reduce
(17:58):
or stop their cannabis use whohave not responded to other
interventions.
It would be reasonable to try,so long as the patient knows
that the data on NAC forcannabis use is preliminary and
the patient is on board withtrying it.
Before we wrap up, a huge thankyou to the Montage Health
(18:20):
Foundation for backing mymission to create fun, engaging
education on addiction, and ashout out to the nonprofit
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdosesTo those healthcare providers
out there treating patients withaddiction.
(18:41):
You're doing life-saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together we can make it happen.
Thanks for listening andremember treating addiction
(19:02):
saves lives.
You.
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