Friday, July 21, 2017


Leader staff writer

Editor’s Note: This is the second in a series.

Dr. Nihit Kumar works with opiate addicts at the suboxone clinic at UAMS on Thursdays and does research on addiction on Fridays. He is also a specialist in adolescent mental health and child and adolescent psychiatry. The suboxone and methadone clinics are both housed in the Psychiatric Research Institute at the hospital. Both clinics treat opiate addicts. He works with other doctors on researching and treating opiate addiction.

“Folks that are opioid users are at a very high risk for overdose deaths,” Dr. Kumar said. “With meth you get really psychotic and you can die on it, but with opioids’ chemical composition, opioids are more likely to kill you than meth. It slows your breathing. When you start combining alcohol with opiates, or say Xanax or valium, with opiates, it’s definitely fatal.”

Why is the risk of overdose deaths high for opioid users? Because addiction to opiates is hard to kick.

“When a patient with opiate abuse transitions to buprenorphine, it’s not easy to transition them right away,” Dr. Kumar said. “There’s a lot of research going on here about what is the best way to transition to medication-assisted treatment.” Buprenorphine is one of several medications used in opiate addiction treatment and research.

“People say, ‘Well, you’re putting them on another medication while they’re using medication, so what’s the big deal?’” Dr. Kumar said. “It’s more about changing your life rather than depending on something. When people are addicted to a substance they are engaging in certain behaviors related to that addiction. They are constantly thinking about that substance. They are chasing the high.”

Withdrawal from opiates is extreme and often leads to relapse. “Those withdrawals are extremely bad, its almost feels like a bad flu. They have cravings, all the nausea, vomiting, irritability,” Kumar said. “You feel really sick. It is not life threatening, but when they go through these withdrawals its very hard for people to resolve themselves. Some people do it. Say you manage to get through these three or four days, five days. You’re done with it but you still have the cravings to use.”

The cravings, according to Kumar, trigger the memory of using. “Those cravings are pretty strong. Without medication, it is very hard for a recovering addict to maintain their sobriety without relapsing back on opiates. The relapse rate is in the 90 percents without medication assisted treatment,” Kumar said.

Addicts often obtain opiates through illegal means. They begin to ignore family, friends and even their job. Dr. Kumar says these behaviors are related to the addiction. “When they transition to a medication, we give it to them as a prescription. It is legal. They take it as prescribed,” he said.

This allows patients in the addiction clinics to start improving their lives. They are no longer chasing the high.

“The success rates in general for addiction treatment aren’t very good. That’s why there’s a push to increase success rates to get them on medication-assisted treatments. The success rates of those who try to quit without treatment is even lower,” Dr. Kumar said.

Why use opiates and opioids to treat pain?

“Opiates are the best painkillers we have. But when it comes to chronic pain, opiates in the long-term aren’t very effective,” he said. “The brain changes that happen with addiction – it doesn’t matter what substance you use, are the same brain changes.”

Addiction affects all parts of the brain, according to Dr. Kumar. “We think of addiction as any other illness, for example, heart disease. Heart disease has multiple causes, there’s not just one cause,” he said. “Addiction has many causes. Genetic factors – if addiction is in the family, you’re more likely to get addicted if you use a drug. There are environmental factors. If someone has a genetic risk factor but they never use substances, they won’t get addicted. Mental illness is kind of the same way. It has those same risk factors. What classifies addiction as a mental illness is that it has a lot to do with the brain.”

Dr. Kumar says there is often a concurrence of biological and genetic risk factors in addicts. “Mental illness also changes your brain in terms of the neurochemistry. You can see how they are related,” he said. “If you look at the population data, there is a high degree of co-occurring – people with addictions have mental illness and people with mental illness have addictions. Almost 60 to 70 percent of patients with opiate addiction have a co-occurring mental illness.”

The average age of patients seen in the addiction clinics are between 18 and 45 years of age.

While the clinic does see some heroin users, most of their patients are addicted to prescription pain medicines.