N-acetylcysteine (NAC) is an over-the-counter supplement that has been identified in animal studies as a potential agent to help with drug craving. The authors conducted a systematic review of the literature and found 7 randomized controlled trials with 245 participants comparing NAC with placebo.
- The intervention periods ranged from 3 to 56 days. The studies looked at individuals with cocaine (2 studies), methamphetamine (1), nicotine (3), and cannabis (1) use disorders. NAC dosage ranged from 1200 to 3600 mg/day.
- Meta-analysis showed a significant clinical difference in drug craving between NAC and placebo groups. Hedges’ g = 0.94, which suggests a large effect size.
Comments: NAC appears to be a promising agent for help with craving. It is available over-the-counter, is reported to be safe, and has minimal side effects. It remains to be seen whether the observed short-term reduction in craving translates into reduction in use and improvement in clinical outcomes.
Darius A. Rastegar, MD
Reference: Duailibi MS, Cordeiro Q, Brietzke E, et al. N-acetylcysteine in the treatment of craving in substance use disorders: systematic review and meta-analysis. Am J Addict. 2017;26:660–666.