NAD+ Infusions for Addiction Therapy: Is It Risky?

Some wellness spas offer nicotinamide adenine dinucleotide (NAD+) intravenous infusions as a treatment option for substance use disorder (SUD). While the treatment may have some benefits, one IV spa owner warns that NAD+ may have addictive qualities, which could lead to more substance use issues in some people.

Statistics show that in 2022, nearly 49 million people aged 12 or older experienced substance use disorder (SUD). In the United States, alcohol is the most common substance misused, with cocaine, cannabis, tobacco, and opioids coming in close behind.

Treating SUD is complicated, and the detoxification process can be physically and mentally challenging. Treatment for the disorder typically involves psychotherapy and medication delivered in an in-patient or out-patient setting.

However, as more IV and wellness spas pop up across the country, a new alternative therapy for SUD has emerged involving infusions with NAD+ — a compound believed to have anti-aging benefits.

Some experts suggest NAD+ can help tame withdrawal symptoms and other challenging aspects of SUD recovery. Yet, others warn that this trendy infusion treatment may have addictive qualities, and people using it could unknowingly be trading one addiction for another.

What is NAD+?

NAD+ is a component of living cells that plays a key role in many of the body's functions. Dr. Pamela Tambini, a double board-certified physician in internal medicine and addiction medicine and Medical Director at Southeast Detox, tells Wellnesspulse that NAD+ is like a powerhouse molecule for the body.

"It involves energy production, DNA repair, and keeping your cells functioning optimally. Think of it as the fuel that helps your body's engines run smoothly," Tambini explains.

As people age, their NAD+ levels decline, which can lead to slower cell repair, less energy, and an increased risk of age-related health conditions.

Tambini says that maintaining healthy NAD+ levels gives cells a better chance to remain healthy and resilient, which is why there's so much focus on its role in longevity and overall wellbeing.

NAD+ infusions vs. supplements

The U.S. Food and Drug Administration (FDA) classifies NAD+ as a dietary supplement. The Agency does not approve supplements before manufacturers market them to consumers but monitors adverse event reports and takes regulatory action if needed.

NAD+ is available over-the-counter in pill form; however, pills are less bioavailable than NAD+ administered through an IV, as drugs delivered directly to the bloodstream are quickly absorbed into the tissues, bypassing the digestive process.

Since the FDA defines dietary supplements as oral formulations, IV products fall into a regulatory gray zone, which might explain how NAD+ injection therapies became available in some holistic wellness clinics.

Can NAD+ infusions treat SUD?

The FDA has not approved NAD+ as a treatment for any health condition, including SUD.

Despite the lack of approval, Tambini says that NAD+ therapy is sometimes used as part of addiction treatment, particularly during detox and early recovery.

"It's typically administered through intravenous (IV) infusions and aims to restore the body's natural NAD+ levels, which can be depleted by prolonged substance use," Tambini explains. "The idea is that by replenishing NAD+, the brain and body can recover more efficiently from the neurochemical imbalances caused by addiction."

According to Tambini, NAD+ can:

• Help restore brain chemistry disrupted by substance use
• Ease withdrawal symptoms
• Repair damaged cells
• Restore energy levels during the detoxification process

NAD+ may also reduce substance use-related inflammation and oxidative damage in the brain.

Still, Tambini warns that NAD+ is "not a silver bullet."

"NAD+ therapy isn't a standalone solution," Tambini explains. "It's most effective with evidence-based approaches like behavioral therapy, counseling, and medication-assisted treatment (MAT)."

NAD+ infusion side effects

NAD+ therapy is generally considered safe when administered under the guidance of a trained provider, Tambini tells Wellnesspulse. However, side effects can occur, including nausea, headaches, or abdominal discomfort during or after the infusion.

Recently, the FDA received adverse event reports related to NAD+ injectable drug use. These events included severe chills, shaking, vomiting, and fatigue, with some individuals requiring medical treatment.

The Agency said the adverse reactions resulted from drug compounders using non-sterile food grade NAD+ to make IV infusion products, which can be contaminated with microbes and endotoxins.

Moreover, since there is little long-term research on NAD+, it's unclear how extended use might impact people with SUD.

It's also expensive, with some programs costing thousands of dollars and not covered by insurance.

The dark side of NAD+ IV infusions

Robert Wheeler, co-founder and CEO of Rapid Recovery, a small chain of IV spas in Louisiana and Texas, tells Wellnesspulse that while his facilities offer NAD+ infusions, his personal experience with the treatment has led to concerns.

Wheeler says that he undergoes every treatment before offering it to patients. When he tried NAD+ infusion, the experience opened his eyes to a potential problem with this alternative SUD therapy, one that has him wondering if NAD+ will continue to be legal to use.

To put it bluntly, I loved it too much.

Wheeler

He explains that they start everyone with the lowest dose (250 mg) to check their tolerance before letting them move to 500 mg. Wheeler started with the same dosage of 250.

For the first five minutes of the infusion, Wheeler thought he was going to have a heart attack. He experienced increased respiration, rapid heart rate, and chest pain. Still, he "toughed it out" since he knew these side effects were possible.

"When that infusion was over, I was a new person," Wheeler articulates. "I felt like a cross between Elvis and Einstein. I woke up in the mornings feeling like I couldn't be stopped, I crushed work, I stayed on task, I didn't procrastinate, my mind didn't wander."

These positive effects lasted for about four days. On the fifth day, Wheeler says he still felt good, but the effects began to wear off, and he felt more like his old self and less like "NAD SuperBob."

"So, I thought, 'I should probably go get another dose of NAD.'" Wheeler explains. "That's when I decided not to do it anymore. I can see how it could become addictive very quickly. I have somewhat of an addictive personality anyway, and that was enough to scare me off."

Patient monitoring is needed

Since his experience with a NAD+ infusion, Wheeler says that he carefully monitors patients. Still, other than those referred by neurologists for weekly infusions, his spas have no patients who frequently undergo treatment.

Moreover, Wheeler believes none of his patients are currently misusing NAD+ infusions but says he wouldn't be surprised to see it happen eventually.

"It's used in a lot of substance abuse programs to wean people off other drugs, so it's clearly just being substituted," Wheeler adds. "I'd hate to see anyone firing off 200 bucks a week and be miserable when the funds wear out."

Wheeler concludes, "Its use really should be restricted to those folks who have signs of [cognitive decline] like Alzheimer's, dementia, etc. The rest of us might love it, but we don't NEED it."

It's important to note that research on NAD+ infusions is still ongoing, and more studies are needed to fully understand its effects and potential for treating SUD. Therefore, people interested in NAD+ therapy should consult a health professional before undergoing infusions.