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B.O.N.D.S.

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