“With fentanyl I stopped being me.” This is Albert Puñet, a former bank director who for two years was addicted to this opiate, 50 times more powerful than heroin. It was prescribed to him to combat the pain he suffered after a traffic accident in which he was almost left in a wheelchair. He took four fentanyl lollipops (very addictive) a day and his recovery, marked by addiction, has devastated his professional and personal life. After going through a detoxification center, he little by little feels like he is returning to who he was before, although it will never be the same. Retired due to his accident and having overcome the worst moment, he asks that the protocols that allow the prescription of an opiate that “should only be given to terminally ill patients” be reviewed and that stricter control be carried out.
This man from Tarragona decided to explain his case after hearing the story of Inma Fernández, a patient who on October 31 explained how she deals with fentanyl withdrawal syndrome while waiting to be admitted to a CAS (center for care and monitoring of drug addictions). ). The life of Albert Puñet, 39, changed forever in November 2018. He was a director of a banking entity and returning home from work on his motorcycle, a driver skipped the STOP sign and ran into him. After a journey to get a diagnosis, it arrived: spinal cord injury with incomplete tetraplegia at the C5 and C7 level. He had to operate.
He entered the hospital with a walker and left with a crutch convinced that with rehabilitation he would be able to work again, he remembers. But Albert was left with severe neuropathic pain, which is “constant with peaks of unbearable pain” because the spinal cord had dried up. And there “the real ordeal began.” He started with Tramadol, which is an opiate, of which he explains that he took 15 pills a day. To this he added the medication for the depression that he was diagnosed with. “I was so medicated that I fell asleep on top of my plate,” he says. He decided to leave her and started going through withdrawal syndrome. But the pain did not stop and he was referred to a pain specialist who prescribed him fentanyl for the first time. “He told me to take a lollipop (a quick-acting tablet to suck) when I had a pain crisis, but not to go beyond three a day,” he says. He did very well and remembers that he went from being a person “smothered in pain” to having “quality of life.”
In the pain unit where he was subsequently treated, slow-release fentanyl patches were added every three days. “I went from tramadol to fentanyl, which is like going from riding a scooter to flying,” he describes. Thus, with the lollipops “I controlled the crises” and with the patches “the constant pain.” But weeks later, in a visit with the neurologist, he reported that he was taking fentanyl and the specialist recommended that he not take it because he was “very addictive.” Before, no one had told him about the real risks he faced or the danger of addiction, because three years ago this opiate was not so well known. But he took away the pain and confesses that he did not listen to the advice.
And covid arrived and the pain became more intense. It went from three to four or five fentanyl rescues a day. “I wasn't aware that I had a problem… for me it was the solution.” Without controls due to the pandemic, she sought out the first doctor who had prescribed her fentanyl and managed to officially increase her dose to 4 a day. Although by then he was already taking this amount. He spent almost two years taking fentanyl, but a little later he started lying to get more doses. “I used to do trilerism,” he admits. He asked the doctor to advance the prescription under the pretext of a false trip when in reality he just wanted to have the medication first. “I always owed the pharmacy a box,” he explains.
During this time he experienced moments of significant discomfort that he began to relate to withdrawal syndrome and decided to take a test. Take a lollipop at a time without pain but with general discomfort. And she left in a stroke. This confirmed his fears: “I realized that he was a drug addict, a prescription junkie.” He tried to reduce, but withdrawal occurred. “You go from denial to rage… and shame” even with his wife, he says. Because her pain and his addiction were also taking a toll on his family life (he has two daughters, ages seven and nine).
This former bank executive laments that “when you take fentanyl it is already too late because it takes away the pain that prevents you from being with your daughters.” Albert admits that in one night he has taken nine lollipops to calm the pain: “I woke up with the stick in my mouth,” he describes. He perfectly remembers the Sunday in April 2021 when, lying in bed, his wife announced that she was going for a trip with the children and that she wouldn't know when they would return and that's when her mind started clicking because she thought she was losing her husband. family. But he knew that he would not be able to get out of this alone and he wrote “the most important email of my life” to the mutual insurance company to explain that he was “a fentanyl drug addict” and asking to enter a center. He subsequently admitted to Sandra, his wife, that he needed help.
They recommended that he enter Sant Pau, in Barcelona, which also has a drug addiction unit. She endured the month-long waiting list as best she could and was admitted in October 2021. The physical detox was 14 days but she was told that she would not leave until she had the pain under control as well. She tried MST, a type of extended-release morphine. And she spent two very hard days because of the monkey. She shared space with 13 other people in measures close to those of a prison and with only one call a day. She remembers that the ninth day was the first day she spent without pain and on the fourth day without pain, she was discharged.
The psychiatrist Fernando Denmark works in the Montserrat Montero ward in Sant Pau where Albert was treated. He explains that the addictions that most go through the Addictive Behavior Unit (UCA) do so mainly for alcohol and cocaine. They are also treating patients addicted to fentanyl. He assures that cases of abuse of this opiate have not increased, although he recognizes that after covid “perhaps there were more” because confinement did not allow patients who had been prescribed it to be controlled so well. With fentanyl it is sometimes substituted by a less addictive opioid or sometimes in patches. The waiting list fluctuates. The usual thing is to wait a month, although he confirms that it may take two or three months to enter.
Albert left Sant Pau two years ago. He does not know if he will ever be able to stop MST, but he would like to reduce medication to be “more awake.” Since then he has been monitored at the CAS in Tarragona and he has managed to reduce the amount of opiates he takes by half. He has the agreement to reduce the medication until he has quality of life and the pain is controlled.
And now that Albert has made part of the road to recovery, he reflects. He has mixed feelings because he believes that the medicine saved his life, but “it almost took it from me too” and demands that the protocols be reviewed because it cannot be that an opiate indicated for terminal patients is prescribed to treat chronic pain. “For a person who does not have a written ending, how can you prescribe that poison?” “I wouldn’t wish fentanyl withdrawal on my worst enemy.” He assures that each box of fentanyl cost 300 euros and wonders if it is not cheaper to admit patients. At 39 years old and because of the accident, he is retired today. But without fentanyl he feels that life smiles on him again. Pain is a friend that he has to deal with “it goes hand in hand, but I don't have to pay attention to it… although it is real.”
