Rachel L. Tomko, PhD Research Assistant Professor Department of Psychiatry and Behavioral Sciences
Jennifer L. Jones, MD Resident Physician Departments of Psychiatry and Behavioral Sciences and Internal Medicine
Amanda K. Gilmore, PhD Research Assistant Professor College of Nursing and Department of Psychiatry and Behavioral Sciences
Kathleen T. Brady, MD, PhD Distinguished University Professor Department of Psychiatry and Behavioral Sciences
Sudie E. Back, PhD Professor Department of Psychiatry and Behavioral Sciences
Kevin M. Gray, MD Professor Department of Psychiatry and Behavioral Sciences
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Medical University of South Carolina Charleston, South Carolina
Disclosures The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products. This article was supported by National Institutes of Health grants from the National Institute of Drug Abuse (R25 DA020537, R01 DA042114, R01 DA038700, R01 DA026777, K23 DA042935, K02 DA039229, UG1 DA013727) and the National Institute on Alcohol Abuse and Alcoholism (T32 AA007474, R01 AA025086) and the Department of Defense (W81XWH-13-2-0075 9261sc).
Appropriate populations. Evidence is stronger for use of NAC among adolescents (age 15 to 21) than for individuals older than age 21.25,27 Further research is needed to explore potential reasons for age-specific effects.
Safety and dosing.Asafe and potentially efficacious dosage for the treatment of cannabis use disorder is 2,400 mg/d (1,200 mg twice daily).24,25,27
Clinical implications. Combined with contingency management, NAC might be efficacious for adolescents with cannabis use disorder, with treatment gains evident by the fourth week of treatment.24,25 To date, no clinical trials have examined the efficacy of NAC for treating cannabis use disorder without adjunctive contingency management, and research is needed to isolate the clinical effect of NAC among adolescents.
Tobacco use disorder
Cigarette smoking remains a leading cause of preventable death in the United States,28 and nearly 70% of people who start using tobacco become dependent.20 Existing FDA-approved treatments include nicotine replacement products, varenicline, and bupropion. Even though efficacious treatments exist, successful and sustained quit attempts are infrequent.29 NAC may exert a complementary effect to existing tobacco cessation interventions, such as varenicline.30 While these medications promote abstinence, NAC may be particularly beneficial in preventing relapse after abstinence has been achieved (Table 430-36).
