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Because NAD is a supplement, its not regulated by the FDA and claims around efficacy dont have to be proven (which is required of prescription medications)

Nucleic Acids Res 19 , 11131119 (1991)

Similarly, the exposure of human dopaminergic SH- SY5Y cells to rotenone caused the nuclear translocation of nuclear factor B (NF-B) and the activation of caspase-3, suggesting that complex I deficiency induced by rotenone can induce NF-B-mediated apoptosis (Figure 3) [68]

Today marks a shift in that narrative

While theoretically closer to the injury, it doesnt offer the same direct concentration as a true local injection and lacks the simplicity of a standard abdominal subcutaneous injection