Xavier Fábregas (63) has been working in the field of drug addiction for 40 years. He started in the 80s, when heroin was ravaging our country. At that time, the first hospital drug addiction units were created in Barcelona that were not integrated into the psychiatric services of hospitals. Until then, those who fell into what was called “the drug problem” were treated as mentally ill. In 2006, Dr. Fàbregas founded Mas Ferriol, a residential center specialized in the treatment of addictions (alcohol, cocaine, marijuana and other drugs) and mental health (depression, personality disorders, abuse, dual pathologies and all types of personal crises - grief, separations, post-traumatic stress disorders, etc.-).
It is a restored rural farmhouse in a privileged natural environment in Sant Miquel de Campmajor (Girona). It is the only center in Spain that offers individualized admission, with only 7 places available, where a multidisciplinary team made up of doctors, psychologists and socio-therapists (there are no ex-addicts, like other centers) is committed to a “100% personalized” treatment. ” aimed at recovering the physical and psychological well-being of the patient. La Vanguardia chats with Dr. Fàbregas about how “the drug problem” has evolved in recent decades and the type of addictions that currently concern him most.
How has the patient profile changed throughout your career?
It has fundamentally changed in that there is now much more variety in all aspects. We serve from 18-year-old kids with very disordered behavior, school failure and consumption of several substances at the same time to women over 70 years old with depressive disorders; We have entrepreneurs who started using at age 40 and people who have been using for decades, stopping and relapsing. The fan is much more varied.
Have the substances most prevalent among addicts also changed?
At the end of the last century the star drug was heroin, which is now a fairly residual part of treatments. At most, an old rocker appears from time to time, but he is no longer the drug problem in the less marginal environments. There are few people who start with heroin. The highest prevalence of abuse occurs in cocaine, alcohol and marijuana. And increasingly, in methamphetamines. Now there is the threat of fentanyl, which perhaps out of curiosity there are people who want to try it.
Are you already encountering cases of fentanyl addicts?
No, we haven't seen any yet. Yes, some patients have told us that they know someone in their environment... but we do not know if they are talking about real consumption or if it is something they imagine or have been told. At the moment it is very limited to the Mexican mafias, who are trafficking in the United States, where it is a huge public health problem. Luckily, in Europe we have highly developed drug-surveillance systems that are currently acting as a stopper so that this does not get out of hand...
And cases of abuse of other opiates for pain?
We have seen some related to Tramadol, a medication that is dispensed for back pain or things of this nature. Sometimes there are flaws in the system and prescriptions are obtained or it is not detected that there are people who abuse a medication whose prescription should be limited to very short periods.
Something similar happened with oxycodone in the United States, which caused the opioid crisis in the late 90s...
Exactly. This is explained very well in the book 'The Empire of Pain' and in a series (referring to Dopesick). The Sackler family pharmacist introduced oxycodone into the legal market, ensuring that it was harmless and did not cause addiction. They took advantage of the fact that they ran a medical journal to falsify reports and studies. The difference is that fentanyl, which is certainly used for chronic pain and is also useful in anesthesia, has entered directly through drug trafficking. And it has a very addictive component that we do not know if it is being mixed with other drugs or medications.
We said that heroin has a lower incidence today. What about cocaine?
It has completely opened its range of influence: 20 years ago it was a drug for the privileged classes; Now it runs freely through all social strata. It is taken by everyone from teenagers to people over 80 years old, because the ease of access is spectacular. Cocaine has a special characteristic: it doesn't get you hooked right away. The first few times there is no great perception of risk. That is what makes it dangerous, because there is less care when assessing its possible consequences compared to, for example, heroin.
And marijuana?
It has become a very important public health problem. Very recently, the conclusions of a multicenter study at European level in which the Hospital Clínic participated were presented, showing that marijuana causes a series of medical and social complications much greater than expected. And this is something that we are emphasizing because the idea that smoking cannabis is not a problem, that it is controlled, etc. It is being seen that it is not true. And especially among young people, which is precisely the hard core of those who are starting to consume it.
And it is closely related to serious psychiatric complications...
Toxic psychoses, yes. A very important issue is that right now the marijuana that is consumed is not what a hippy planted on his terrace, but genetically modified plants to increase the percentage of THC, which is the psychoactive part of cannabis. And that is to the detriment of CBD (cannabidiol), which is that other relaxing or analgesic part that is used in therapy as a treatment for certain pain.
There is a lot of confusion about that... Has marijuana had too much good press?
This happens precisely because sometimes we read things that focus on the CBD part, but we forget about the problematic part, the THC. The marijuana of a few years ago was more proportionate; Now they are unbalanced plants. They no longer produce that feeling of leverage, that idea of relaxing and listening to music with friends.
What kind of marijuana is on the market now, then?
The one planted by mafias in urbanizations and industrial warehouses. Plants that do not have natural development. Plants that grow with water and sunlight give one harvest a year; the ones now give five. It is a cannabis that is produced under forced conditions: sodium lights, hydroponic crops, rooting hormones, all types of chemical fertilizers...
That is not a natural substance...
Of course not. A simile that I think is very useful: if you eat a chicken that has been raised running in the countryside and eats natural foods, it will probably be healthy; but if you eat a chicken that has been in a cage, that has never run, fattened with antibiotics and hormones...
Then you get tits...
Clearly, that won't be healthy. They are those chickens that when you eat them, the bones are soft and break easily. Well, the same with marijuana: today almost everything is in the hands of the mafias.
The Mossos say that Catalonia is the marijuana garden of all of Europe.
It's like that. Mafias are present even in cannabis associations, which have been distorted. Everything related to marijuana is already associated with a very significant level of risk and violence. Look how many murders in Catalonia have to do with mafias that traffic marijuana, even with agents involved in networks.
What consequences can the proliferation of this type of “adulterated” marijuana have for the mental health of consumers?
It has significant psychiatric consequences, obviously. Psychotic disorders. We have patients who have bipolar disorder, for example: depressive episodes alternate with manic episodes, excitement and a lot of energy. I have a patient who has paid the deposit on three houses, one each time he has had a high. And he couldn't afford them...
And in young people? ADHD diagnoses have increased a lot...
It's not that there is more ADHD. The thing is that it was underdiagnosed before. And it is important to diagnose it well to prevent school failure and drug use. It makes a huge difference in academic and social results in people who sometimes do not control their impulsivity and we did not know why.
But do all hyperactive children have a “disorder”?
No, some are simply 'egg-takers' to whom no one has set limits. There are two main symptoms of ADHD. On the one hand, attention deficit, children who get bored or distracted because they are not interested in what they do. Before, they were sent to vocational training, because it had a more practical aspect, and in this way it was possible to recover a percentage of these kids who failed in school. And then there are the hooligans, many of whom were hyperactive and at greater risk of falling into abusive consumption. If both conditions occur, the diagnosis is quick, but in cases where only one of the two symptoms appears it is much more difficult.
Let's talk about alcohol.
Another problem that has spread to all layers of society. We are seeing kids who drink 8, 10, 12 beers in one sitting. When I was young I never knew anyone who had an alcohol coma. Now I don't have any patient who doesn't know someone around them that has happened to them.
Are people aware of what an excessive dose of alcohol means?
No way! The amounts that are toxic at the brain and liver level are much lower than we perceive. When you ask a patient how much he drinks, he answers: “normal.” Then he quantifies it and you put your hands on your head...
What is normal, then?
The daily limit would be four pints of beer for a man and two pints or a gin and tonic for a woman. From six for them or four for them we are already killing cells, both in the brain and the liver.
What are the most common designer drugs now?
Methamphetamines, Tusi (known as pink cocaine) and ketamine. Substances whose production is very difficult to control because they do not need natural precursors like the coca plant but are manufactured by a chemist in a bathtub.
Are they drugs for purely recreational use?
All drugs are started for recreational use. The problem is not the substance itself, but a condition that makes people vulnerable to getting hooked. Everyone who takes drugs suggests that they will do it in a controlled way: to have fun, to lose inhibitions, to connect with their environment. And the majority makes use limited to those circumstances. It is even very possible that they abuse for a while and then it ends naturally, when that person finds alternative interests: a partner, studies, a job. The classic example is the bottle: if all the kids who make the bottle ended up alcoholic, we would have to set up concentration camps. Therefore, neither the substance nor the type of use is what determines whether you get hooked. The addiction factor is that this use of drugs stops being to connect and becomes to disconnect.
Or to stop suffering.
What we call anesthetic use: people vulnerable to things they cannot stand or do not know how to handle. That is when they go from using these drugs to socialize and turn them into drugs for solitary use, to escape and cover up those deficiencies.
Are young people today more in danger than in other times due to their frustrated expectations or a more uncertain future?
Absolutely. There are more expectations than ever, but very few achieve them. They are continually bombarded with those wonderful lives of influencers, where everything is easy, with wonderful partners, the convertible Lamborghini... This is something unattainable for millions of people. It is incredible how many kids we see in treatment who aspire to things that are not realistic at all: they want to be stock brokers, start a clothing company, etc.
Aspiring to be an influencer or entrepreneur as you once aspired to be a football player...
With an added difficulty: that it is something that you can apparently achieve. You post a video on TikTok and the algorithm may highlight it and thousands of people will see it. But that is not going to have continuity because for that to work you need very professional structures, and even so you have to work a lot to avoid losing track and going out of fashion on the networks.
Do you come across many young people addicted to porn?
That is very serious too. You press a button and you access a very wild, very mechanical porn, very about abuse, about the submission of women. This is harmful to the emotional maturation of young people. We encounter very brutal things: very young girls who have suffered rape while high and it does not seem to cause any type of trauma because it is something that has happened to many other girls they know. They don't give it the slightest importance.
Themselves?
Yes Yes. For some, it is normal to be harassed in a bathroom, to be groped, or even to be raped. They do not consider it so strange, although it will surely have repercussions on their lives that we have not yet been able to study.
This is barbaric…
It is. We are experiencing a series of brutal changes, very difficult to digest. At the level of society we need to reflect, in the same way we do in therapy: stop, analyze our experiences and feelings and ask ourselves where we are going, what we want, why we need so many things that later, when we have them, they do not satisfy us at all...
In the end, we have not come out of the pandemic better.
When we realized that we didn't know the older lady who lived upstairs, and that maybe she needed something from us, the confinement ended. Then we forgot everything. And it's only been four years.
