NAC is another potential avenue of efficacious pharmaceutical cannabis use treatment, based on several studies, including one in 116 adolescents given either 1,200 mg of NAC or placebo twice daily (Am. J. Psychiatry 2012;169:805-12). These treatments were combined with 10 minutes of talk therapy for the 8-week duration of the trial. In this trial, there was only a 40% attrition rate, and the study group was twice as likely as controls to turn in cannabinoid-free urine each week. The results have led to a multicenter National Institute on Drug Abuse–sponsored trial of 300 people and NAC along with paid urine tests, although Dr. Levin said she was curious how NAC would perform without the contingency management of having to pay for the urine. “That would have to be another study,” she noted.
Perhaps seeing partial cessation as a viable endpoint also might improve outcomes. It’s a larger question that has already come up for debate in studies of alcohol abuse where abject abstinence is not always the required outcome. It’s a point worth considering for cannabis use, said Dr. Levin, particularly when it can take weeks for cannabinoids to leave the urine. “Maybe continuous abstinence is too high a bar,” Dr. Levin said. “You talk to people who want to go from using all the time to maybe just smoking a joint at night. Who is to say that is the wrong outcome measure?”
Dr. Levin said she has received financial support from U.S. World Meds and GW Pharmaceuticals.
wmcknight@frontlinemedcom.com On Twitter @whitneymcknight