Xavier Fábregas (Barcelona, 1961) has been working for 40 years in the field of drug addiction. It started in the eighties, when heroin was wreaking havoc. Then, those who fell into "the drug problem" were treated as mentally ill. In 2006, Dr. Fàbregas founded Mas Ferriol, a residential center specializing in the treatment of addictions and behavioral disorders.
This restored rural farmhouse in a privileged natural environment of Sant Miquel de Campmajor (Girona) is the only center in Spain that offers a 100% personalized entrance. There are only seven places available.
How has the profile of patients changed over the course of their career?
Now the range is more varied: from 18-year-old boys with very disorderly behavior to ladies of 70 years or more with depressive disorders; businessmen who started using at age 40 or people who have been using for decades, stop and relapse.
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. Every now and then an old rocker appears. The greatest prevalence of abuse occurs in cocaine, alcohol and marijuana. And increasingly, in methamphetamines. Now there is the threat of fentanyl, that maybe out of curiosity there are people who want to try it.
Are there already fentanyl addicts?
We haven't seen any. It is still very much confined to the Mexican mafias that trade with the US.
And cases of abuse of other opiates for pain?
Something related to tramadol, which is used for back pain or things like that. Sometimes there are faults in the system and it is not detected that there are people abusing a medicine whose prescription should be restricted to very short periods.
Heroin has a lower incidence. And cocaine?
It has completely opened its range of incidence: 20 years ago it was a drug of the upper classes; today it reaches all social layers; from teenagers to people in their 80s.
Marijuana?
It has become a much bigger public health problem than expected. The idea that smoking cannabis is not a problem is being shown to be untrue. Especially in young people, the hard core of those who start their consumption.
And it's linked to serious psychiatric illness…
With toxic psychoses, yes. The marijuana that is consumed today is not what a hippy planted on his terrace, but plants genetically modified to increase the percentage of THC, the psychoactive part of cannabis. And this is to the detriment of CBD (cannabidiol), the analgesic part used therapeutically for certain pains.
So what kind of maria is on the market now?
The one planted by mafias in industrial buildings. A cannabis that does not have a natural development because it takes place under forced conditions: sodium lights, hydroponic crops, rooting hormones, chemical fertilizers...
The Mossos say that Catalonia is the European garden of marijuana.
Is it like that. The mafias are present even in the cannabis associations, which have been distorted. Everything related to marijuana is associated with a high level of risk and violence. Look how many murders in Catalonia have to do with these mafias.
What are the mental health consequences of this adulterated marijuana?
Major psychotic disorders. We have patients who manifest a bipolar disorder, for example: alternating depressive episodes and manic episodes, of elation and a lot of energy. One of them paid the rent for three houses, one for each rise. He couldn't afford them.
Let's talk about alcohol.
We see young people who drink eight, ten, twelve beers in one go. When I was young I didn't know anyone with an alcoholic coma. Now it has become commonplace: I don't have a patient who hasn't seen this.
Are we aware of what an abusive dose of alcohol is?
And now! You ask a patient how much he drinks and he answers: "The normal". Then you quantify it and shout to the sky...
What are the most common designer drugs now?
Methamphetamines, Tusi (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 of purely recreational use?
Everyone starts using drugs for recreational use: to disinhibit themselves and connect with their environment. Most make limited use of it. It is even quite possible to abuse them for a while and leave them naturally when alternative interests are found: a partner or a job. Neither the substance nor the type of use is what determines whether you get hooked. The addictive factor is that this use of drugs ceases to be to connect and becomes to escape.
Are the young people of today more in danger than in other times because of their frustrated expectations?
There are more expectations than ever, but very few achieve them. They are bombarded with those wonderful lives of influencers, where everything is wonderful: the beautiful couple, the Lamborghini... It's incredible how young people in treatment aspire to unrealistic things: they want to be stockbrokers or set up a clothing company.
Do you meet young porn addicts?
This is very serious. They access a wild porn, of submission of the woman. Something pernicious in his emotional maturation. We see very beastly things: very young girls who have been raped while being placed and they don't seem to be traumatized because it has happened to many other girls around them. It doesn't seem strange to them.
This is barbaric...
We are experiencing changes that are very difficult to cope with. As a society we also need therapy: to stop, analyze our experiences and ask ourselves where we are going, what we want, why we need so many things that later, when we have them, do not satisfy us...
