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
• • • •
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).
Stimulant use disorders. The United Nations Office for Drugs and Crime estimates that worldwide, more than 18 million people use cocaine and more than 35 million use amphetamines.14 There are currently no FDA-approved treatments for stimulant use disorders, and clinicians treating patients with cocaine or amphetamine dependence often are at a loss for how best to promote abstinence. Recent studies suggest that NAC may decrease drug-seeking behavior and cravings in adults who seek treatment. The results of studies examining NAC for treating cocaine use and methamphetamine use are summarized in Table 115-17 and Table 2,18,19 respectively.
Cocaine cessation and relapse prevention.Several small pilot projects15,16 found that compared with placebo, various doses of NAC reduced craving (as measured with a visual analog scale). However, in a double-blind, placebo-controlled study, NAC did not decrease cravings or use after 8 weeks of treatment in individuals with cocaine use disorder who were still using cocaine (ie, they had not yet become abstinent). Interestingly, those who were abstinent when treatment began reported lower craving and remained abstinent longer if they received NAC (vs placebo), which suggests that NAC may be useful for preventing relapse.17
Methamphetamine cessation and relapse prevention. One study (N = 32) that evaluated the use of NAC, 1,200 mg/d for 4 weeks, vs placebo found reduced cravings among methamphetamine users who were seeking treatment.18 In contrast, a study of 31 methamphetamine users who were not seeking treatment evaluated the use of NAC, 2,400 mg/d, plus naltrexone, 200 mg/d, vs placebo for 8 weeks.19 It found no significant differences in craving or use patterns. Further research is needed to optimize the use of NAC for stimulant use disorders, and to better understand the role that abstinence plays.
Appropriate populations.The most support for use of NAC has been as an anti-relapse agent in treatment-seeking adults.
