Australia’s world-first trial of ice addiction medication

In a world-first, Australian researchers are trialling a new medication to help people who are dependent on crystal methamphetamine, or ‘ice’.

Called the N-ICE Trial, researchers are investigating if N-Acetyl Cysteine, or NAC, can reduce cravings for ice and help people stop using the substance.

The N-ICE Trial is being conducted at frontline clinical services in Wollongong, Geelong and Melbourne. Further information about participation in the trial can be found at www.nicetrial.info.

Funded by the National Health and Medical Research Council, the National Drug Research Institute (NDRI) at Curtin University is leading the randomised controlled N-ICE trial in collaboration with Deakin University, Monash University, the University of Wollongong, the University of Newcastle, La Trobe University and the Burnet Institute.

Lead researcher and NDRI Associate Professor Rebecca McKetin said previous studies showed NAC could reduce cravings for methamphetamine use and other substances including cocaine, cannabis and tobacco.

NAC is one of a new generation of medications being trialled for addiction. It targets glutamate changes in the brain that are thought to underpin drug craving and addiction.

“When someone first takes ice they experience the desirable effects of intoxication. But if they continue to use, and become dependent, changes occur in the brain that cause cravings, making it hard to stop using ice,” Professor McKetin said.

“NAC helps to reduce cravings by restoring the balance of chemicals in the brain that are involved in craving and drug seeking, making it easier for people to manage their desire for the drug.”

Dr Olivia Dean from Deakin University’s IMPACT Strategic Research Centre said: “NAC is an amino acid derivative that has many actions that might be useful for people who are trying to stop taking ice.

“NAC can protect against the neurotoxic effects of ice and it is hoped that, in addition to helping people dependent on ice cut down or stop their use, NAC will reduce the mood changes that are often experienced as a result of ice addiction.”

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Associate Professor Peter Kelly from the University of Wollongong, who is affiliated with the Illawarra Health and Medical Research Institute, said there was currently no approved medication to treat addiction to ice and this was a significant barrier to users seeking treatment.

“The main forms of treatment are counselling interventions and residential rehabilitation. For this reason trialling NAC introduces a novel approach to treating ice addiction,” he said.

“The hope is that NAC can help break the addiction cycle and help people stop using ice.”

Dr Brendan Quinn from the Burnet Institute in Melbourne explained: “Many people who use ice do not access these traditional treatment options.

“Over-stretched services with wait lists, the need for lengthy residential stays, stigma and fears about confidentiality are among the reasons people don’t get treatment,” Dr Quinn said.

“We are hoping this take-home medication can help people who aren’t accessing these conventional drug treatment options to reduce or stop their ice use.”

A website has been set up for people interested in the N-ICE Trial. For more information, visit www.nicetrial.info.

Background information:

What is methamphetamine?

Methamphetamine is a potent illicit synthetic stimulant drug. Street names include “ice”, “crystal”, “skates” and “tina”. Methamphetamine increases chemicals in the brain called monoamines, particularly the brain’s feel-good chemical dopamine. Long term use can alter the balance of these chemicals, producing cravings and dependence.

How many people use methamphetamine?

Despite a steady decline in the use of amphetamines in Australia over the past decade (in 2016 it was estimated that 1.4% of Australians aged 14 years or older had used amphetamines in the past year), there has an increase in the use of high purity crystalline methamphetamine (“crystal meth” or “ice”). Currently around 1% of Australians aged 14 years or over are estimated to have used crystalline methamphetamine in the past year. This figure has increased over the past decade and has recently stabilised.

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Addiction to crystal methamphetamine

Crystalline methamphetamine conveys a higher risk of dependence (addiction) than other amphetamines. Dependence is associated with cravings for the drug, compulsive frequent use, and an inability to refrain from using despite health and psychological problems. There are an estimated 160,000 Australians dependent on methamphetamine.

Treatment for methamphetamine use

In the 2016-17 financial year, there were 49,670 presentations to treatment services for amphetamines (most of which would be for methamphetamine), representing an almost five-fold increase on figures from 2009-2010 (10,027 presentations). Treatment for methamphetamine use currently includes providing counselling, detoxification, residential rehabilitation and similar psychosocial treatment options. There are currently no approved medications to help people who are dependent on methamphetamine to reduce their use.

N-Acetyl-Cysteine (NAC) as a promising medication to help people who use crystal meth

N-Acetyl-Cysteine (NAC) is one of a new generation of medications for addiction. NAC restores balance to brain changes that occur with addiction. It has been found to reduce craving for methamphetamine and other drugs. NAC also reduces the toxic effects of methamphetamine on the brain. NAC is a safe medication, which can be prescribed as a take-home medication, making it a potentially convenient and cost-effective treatment option to help people who want to reduce their methamphetamine use.

The N-ICE Trial

The N-ICE trial is a randomised controlled trial of N-Acetyl-Cysteine (NAC) for methamphetamine (“ice”) dependence. The aim of the trial is to see whether NAC can help people reduce their methamphetamine use. We will enrol 180 people who are dependent on methamphetamine to take NAC for 12 weeks. Recruitment for the trial has begun, and we will be recruiting participants to join the trial over the next 12 months. The N-ICE trial is being run out of frontline clinical services in three locations: Geelong, Wollongong and Melbourne.  Information on how to take part in the trial can be found at www.nicetrial.info.

Media release: N-ICE Trial media release &  N-ICE Trial Backgrounder