The long running detox program at Cygnet
Hospital Harrogate, Detox
5,
was based on the BONDS protocol
(Beaini Opiate Naltrexone Detoxification System).
The BONDS protocols are now the basis of a new treatment service,
The BONDS Clinic,
treating:
Addictions
Weight loss
and Chronic pain.
Here is the abstract of the published research on BONDS
The full paper was published in Addiction Biology October 2000.
A COMPRESSED OPIATE
DETOXIFICATION REGIME WITH NALTREXONE MAINTENANCE: TOLERANCE, RISK
ASSESSMENT AND ABSTINENCE
BEAINI AY, LANGSTAFF P, CARR MP, CROSSFIELD JN, SWEENEY RC
and Harrogate Detox 5 Centre, Harrogate, UK
JOHNSON TS, Sheffield Kidney Institute, Northern General
Hospital, Sheffield, UK
Tel: +44 (0)114 271 5322
Fax: +44 (0)114 271 4410
email::
T.johnson@sheffield.ac.uk
Reducing methadone programs have until now provided the major route
for opiate detoxification. However these are not only slow and
expensive, but the patient generally has a degree of discomfort
resulting in a high level of drop out before completion of the
detoxification.
The development of rapid and ultra rapid detoxification protocols
based upon the administration of an opiate antagonist under
heavy sedation or general anaesthetic have revolutionised opiate
detoxification providing a mechanism for addicts to become clean in
a pain free procedure in 4 to 48 hours.
By necessity these protocols are reliant on high dependency
facilities which limits their use and, perhaps unfairly, been
associated with a high level of risk such that the UK Advisory
Council on the Misuse of Drugs have failed to recommend their
use.
Accelerated techniques still using precipitated withdrawal
(naltrexone) but over a longer period and without sedation have been
developed to minimise perceived risk. These generally use
either b2 adrenic receptor agonists or partial opiate agonists to
minimise withdrawal discomfort, but 20% of patients still fail to
tolerate the procedure.
BONDS
BONDS (Beaini Opiate Naltrexone
Detoxification System) as operated by Detox5 in the UK
is a 5 to 7 day procedure using moderate sedation over a 3-day
period to facilitate opiate clearance during which secondary
symptoms are pharmacologically controlled. Following this,
complete opiate displacement is achieved using a naltrexone
challenge after which the patient is discharged into
counselling with 12 month naltrexone / trazodone maintenance. In
this study we investigate patient tolerance, organ function and
abstinence rates on 504 patients undergoing this procedure.
Ninety nine percent of patients completed the detox procedure
with 90% of patients reporting that the withdrawal experienced was
better than expected, while 95% reported satisfactory or
better comfort during the procedure with not one patient
experiencing any pain. Blood biochemistry demonstrated significant
mean increases (p< 0.01) in markers of liver dysfunction (ALT,
AST, alkaline phosphatase, bilirubin, albumin and LDH), however with
the exception of AST these increases remained within normal ranges.
Some markers of renal dysfunction (serum creatinine and urea) also
showed significant (p<0.01) increases post detoxification but again
all remained within the normal range. Similarly cardiac markers
showed significant increases (p<0.0001) with creatinine kinase
(CK-MB) rising to fractionally above the normal range, however
no evidence of ECG abnormalities was recorded.
Abstinence rates post detox were high with 71%, 61%, and 51% of
patients free of opiates 3, 6 and 12 months post detox respectively,
while compliance with the naltrexone maintenance in opiate
free patients was 66%, 68% and 30% accordingly.
Thee BONDS procedure therefore provides a quick method of
detoxifying opiate abusers with little patient discomfort or risk to
health. Abstinence rates are at least comparable and generally
better to those reported for other programs.
Addiction Biology (2000) 5,451-462
A Compressed Opiate detoxification regime with Naltrexone
maintenance:
A.Y.Beaini, T.S.Johnson, P.Langstaff, M.P.Carr, J.N.Crossfield &
R.C.Sweeney