We read the article by Narasimha et al.[1] with interest. The authors have presented the data on the use of two drugs (N-acetylcysteine and baclofen) in a condition with very little pharmacotherapy options, cannabis use disorders (CUDs), with the caveat that it can only provide preliminary evidence as this was not a randomized controlled trial. These drugs are already in use for different indications.
The study gives data on 72 patients treated for the primary diagnosis of CUDs. But, 47 (65.2%) of their sample had a comorbid psychiatric illness and would have received some psychotropic medications. But curiously, they have not considered that this could also be a contributing factor to the benefits they attribute to the study drugs (N-acetylcysteine and baclofen) and/or psychosocial intervention. If they had considered this as a covariate in their analysis, the findings would have been different. There is evidence that combined treatment with psychotropics and other drugs is more effective in cases of substance use disorders with comorbidity.[2]
Further, they have not separately mentioned the outcomes for the 25 (34.8%) patients who did not have other psychiatric comorbidities and hence did not receive any other psychotropics, except the study drugs. Although a small number, this would be noteworthy. They have mentioned all other limitations. We agree with them that this study provides only very preliminary evidence that has to be evaluated by further studies.
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REFERENCES
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