Five-day detox
Detox 5 is a detoxing programme that takes only five to seven days to complete. It uses non-opiate based sedatives and pain relief to ease withdrawal symptoms. The detox is accompanied by naltrexone, which is a drug that stops heroin having any effect on the user. Sharon Pulling, ward manager and nurse at the Detox 5 clinic in Harrogate, North Yorkshire, explains how patients benefit from the Detox 5 method.
When people choose the Detox 5 route, is this because they've had bad experiences of trying to detox in other ways?
'Usually when people come to us they've tried to go cold turkey. But because heroin and all opiates have such a physical addiction, when they just stop taking heroin the body goes into withdrawal. They've also usually tried substitute prescriptions of methadone and other drugs. They come to us because it's easier to do it with us. They get one-to-one nursing, their own room with their own bathroom, and lots of medication to help with the symptoms of withdrawal.'
What sorts of people become Detox 5 patients?
'All sorts of people come in here, but their histories tend to fall into two categories. You get people whose drug career has been quite long – 10 years or even longer – and this is their last resort. Those patients do very well, because they're just using to stop going into withdrawal. They hate the drug and they want it out of their lives. They tend to have just used opiates. The other sort of people are quite young and have done everything – they might have started off with solvents and done ecstasy, cocaine, cannabis... And then they've tried heroin, and this one's different: it's really got them. They want to knock it on the head straight away.'
What happens when a patient first arrives with you?
'The first thing we do when we get to see them is make sure that they know what's going to happen to them this week. We go through the stages of the programme and make sure that it's really what they want to do. What quite often happens is that it's what the parents want or what the partner wants, but it's not necessarily what the patient wants. We want to establish who's here under pressure, because that person really can't stay. There's no point in doing the detox if they don't have any chance of staying opiate-free long term. They need all sorts of things, such as family support, but self-motivation is the clincher.'
What happens after patients go home?
'They go on to Aftercare Support, which is telephone follow-up. People get a couple of calls in the first week, and then a call every week for 12 weeks. In the beginning, they need lots of advice on diet and sleep – more physical things – and after that it's more about getting back to work and practical things. Over the weekend, the staff nurses take turns at being the nurse-on-call with a mobile phone, so that the patient can access a trained nurse at any time. If we can just get them over the first three months they'll be in a much better state to continue with their new life.'
How does the naltrexone work after the detox?
'Heroin addiction is a relapsable condition and the naltrexone stops the relapse. You can use heroin every day, but it won't work. The idea of the naltrexone is to put some time between the patient's experience of heroin. If they don't feel those effects for a long time they're going to create some distance and use that time to build up other parts of their life.'
Do you have to pay for Detox 5?
'We're independent sector, so most people have got the money to fund the treatment. But there's about a quarter of patients who've been funded by their local authority. Not everybody who comes here is wealthy – when this is someone's last-ditch attempt, we often get people who have maybe saved for two years to afford it. It's £3000.'
In the long-run, is this cheaper than long-term methadone treatment, for example?
'I think it is, because even though methadone is cheap to make, the way that it's administered – because it's a controlled drug it has to be administered by two people – is costly. But you need that initial money.'
Do you think in future this method will become more widely available?
'Detox 5 isn't for everyone, but it's a treatment option and it should be available to more people, I would say. Not everybody wants to go on methadone, not everybody wants to go on another opiate, and with people who are fairly new to drug use there's an argument for getting it knocked on the head very early before they get too entrenched in the drug culture. I think there should be options for everybody in all sorts of treatment.'