Not every sudden death could be attributed to heart failure as drug overdose deaths are taking place silently and at an alarming pace. Khalid Bashir Gura spent days with addicts being treated by doctors to report that the crisis is about to overwhelm Kashmir. In February alone, only one hospital received more than 1800 patients
With every ticking second, the surge of patients at the SMHS Hospitals’ Drug De-Addiction Centre in Srinagar surges. Carrying a bundle of cramped prescriptions, the mother of a teenager waits for her turn in OPD. After a long wait, she makes her way past many gloomy parents and gets in. She stifles her sobs. Within months, after her son’s death due to overdose, she has brought her second son to the rehabilitation centre for detoxification.
“I had a relapse lately after my brother died. I was treated last year and I was recuperating. But I was enticed to do it again by the friend who gave me half a gram to alleviate suffering and find an escape,” said Ahmed, 19, in a croaky voice as he looks exhausted.
A school dropout, Ahmad was a fruit seller; he was lured into substances by peddler friends operating in the same area in Srinagar, where he was selling fruit. For almost a year, he was given it free. “Six years ago, I used to get the kick by weed. But it outlasted its pleasure and I started looking for something better,” he said as he started injecting heroin through the intravenous method.
Ahmad’s mother was hoping for happy days for the family after her son’s release from the jail, which according to her served as a rehabilitation and counselling centre for him as he started praying but died within days. His body soon was found lying on a deserted roadside.
“My elder married son has abandoned us,” she said. “My husband is a scrap dealer. I relied on this son to support in our old age.”
According to the doctor treating him, her son had died of a drug overdose and his body was lifted from a drain.
Before coming to the hospital, Ahmad’s secret morning breakfast, lunch and dinner was chasing heroin on a foil. His routine intake of heroin was 30 ml a day. He soon abandoned selling fruit as it could not fetch him enough money. From addict, he became a small peddler and started cultivating contacts and hunting for new ones to manage the growing expenses and thirst for heroin. Every day according to him it cost him around Rs 2000 and at times he consumed 1.50 grams.
A Friend Gave First Shot
“I will never forget that Friday. It was doomsday,” said Asif who now hopes to rekindle his passion to live a drug-free life after surviving drug overdose multiple times. “I want my respect and dignity back. I wish to be accepted as a part of society and family,” he said, almost crying.
Rehabilitation isn’t so easy and for the last eight days, he is detoxifying himself. Accompanied by his elder brother, AsifAsif, 27, is a father of two daughters. For the last nine months, he has been consuming heroin. He rues a day when he decided to board a friend’s car to Baramulla. He along with his friend, who is also admitted at the rehabilitation centre, soon reached Kupwara. A man near the nondescript border village gave him a packet and he consumed it in the car.
“We stopped the car at some distance at an isolated location. My friend took out a spoon and mixed Heroin and water with it. After heating, he filled it in insulin pen and injected it,” he said, narrating the details of that day. Out of curiosity he also tried it. “I thought I will die after my friend injected it in my vein. The world suddenly turned around. After reaching my home, I was restless,” he said. As his curiosity had turned him into an addict, the next day he called again his friend who declined to give. However, he soon found addict brethren helping him in accessing and availing the heroin to quench his thirst much easily. He describes that on a weekend at Pahalgam, he along with his group of friends who were consuming various drugs quenched their heroin thirst without inhibition in a hotel room.
For almost a month, he got his supplies free. Now an addict, his suppliers refused. “We do not have it, give money and we will get it,” he was told. Soon his descent into drug addiction started devouring his bank balance and material belongings at home. “I had to sell my car, scooty, my bank balance of around Rs 15 lakh, phones. My mother’s and wife’s earrings,” Asif said, with regret in his voice as he would consume 10 grams of heroin along with his cohorts.
Weeks ago, he recalls with horror, he lost his affluent friend who had gone for marriage shopping scheduled after a few months. He recalls seeing his friend’s frothy mouth and pale body lying motionless far away from home in Delhi’s hotel on a video call. He had died of a drug overdose. His friend according to him had taken more than a routine dose; as he had also died of gulping unadulterated cough syrup bottles and injecting heroin.
“It was her non-local aunt who had brought her to rehabilitation centre earlier as his parents were oblivious of it,” Asif said. “My friend was also a peddler who later became an addict.” His deceased friend’s non-local aunt’s son was also a peddler and addict.
The only inhibition of consuming drugs in the public sphere according to him is monitoring and raids by the local masjid committees.
This forced him to bring heroin home and lock himself in a bathroom to manage his heroin appetite. “On a Friday, I asked my mother, I will do ablution. As I prolonged my stay, my mother shouted. In haste I injected. It spilt to my hand and it bloated. I soon poured cold water over it,” he said.
“During overdoses, my brother has saved me multiple times. He has given me Cardiopulmonary Resuscitation (CPR),” he said as after shifting to the hospital he was referred to a rehabilitation centre newly established at Eidgah’s Wanganpora.
After three days on medication, he battled withdrawal symptoms as he was deprived of drugs. He broke windowpanes, tried to commit suicide with his wife’s scarf, as he screamed in the early days of his treatment, writhed in pain. He pleaded for one Titch (injecting heroin through intravenous method). He was let go by the family. Soon he contacted peddler and consuming half a gram of heroin, got unconscious.
“I was again referred to multiple rehabilitations. As beds were unavailable, I decided not to visit them. However, I continued with substance abuse every day,” he said. His family soon according to him with the help of police rehabilitated him. Pampered since childhood, according to him, his journey to heroin addiction started when he saw friends using weed to chase illicit drugs on a foil. “More than five friends and acquaintances I knew died due to drug overdose. Some were younger than me and married,” he said and witnessing their deaths induced fear in him.
According to him, when one takes multiple times to satiate thirst it leads to a drug overdose. “If a substance abuser is on medication for opioid dependence and simultaneously trying to satiate heroin thirst, it can also lead to overdose,” he said.
However, his addiction devoured him materially. “The cost of a single gram of heroin varies within districts. In Srinagar, it costs rupees Rs 7000 and in the South, it is around Rs 4000. However, in areas near the border like Kupwara and Tangmarg, the rates are very low,” he said.
Relapses and Failing Resolutions
Mukthar, 23, a class tenth government school dropout narrates his tale of fatal overdose history of four times. He is deprived of illicit drugs at rehabilitation for straight six days. Earlier, he was detoxified nine months ago. But peer pressure pushed him to lift the insulin pen and inject heroin again. He was in his washroom when he consumed heroin, again. Soon he lost consciousness. His father after breaking the door gave him CPR and rushed him to the hospital.
“In 2018 he along with his friends out of curiosity had injected heroin. We used to sniff and chase it on heated rolled foil,” Mukhtar said. “Most of my friends started getting ill and started throwing up but I experienced nothing.”
“I started disliking other drugs soon after consuming heroin through the intravenous method and soon the addicts’ shift from one pursuit to another to get effective and quick kicks,” he said.
However, as the reading down of Article 370 was followed by communication blackout and restrictions on movement, substance abusers like Mukthar faced hurdles in accessing the maal. But its prices sometimes during successive lockdowns spikes due to shortage.
But managing expenses proves cumbersome. “To overcome pain, sometimes I had to steal money to buy it. Sometimes my friends gave it,” he said as he averts eye contact.
Most of his addicted friends are diagnosed with co-morbidities as the sharing of syringes transmits diseases. “Sometimes we used to exchange the same syringes, and most of the times we purchased on our own. A packet with ten insulin pens also costs cheap and is easily available,” Mukhtar said, explaining the modus operandi. “We would put heroin on a spoon or any other object and pour water over it and heat it up with lighter to melt it. After that we inject 10-20-30 per ml as per thirst,” he said.
However, the fear element took over after he witnessed the death of more than five friends. If a person is alone; he said the chances of his death are more. “I promised myself every day to give it up. But if someone consumes it for once, his life is destroyed forever. There is no looking back.”
Mukhtar said he was a chronic stone thrower and it was also an addiction. “It was only after it I started abusing substances,” he said and we started from weed, alcohol and ended up injecting heroin in our veins.
Surge and Lack of OD Record
Experts managing the crisis said they are ringing bells for many years and their apprehensions are coming true.
Prof Dr Yasir Hussain Rather who heads the Drug De-Addiction Centre at SMHS Hospital said the hospital footfall is just the tip of the iceberg. “On an average, we see approximately 60-70 patients with new and follow up cases, daily. There has been an increase in the number of cases related to substance use. Presently 90 per cent of cases are heroin users and 70 per cent of them are using illicit drugs through IV mode,” said Rather. This mode of administration he said is dangerous and can lead to overdoses and deaths as it leads to the transmission of deadly infections like HCV, HBV, and HIV and also endocarditis i.e. infection of heart valves. “I won’t hesitate to say that we are currently witnessing Heroin Epidemic in Kashmir.”
In 2020, as Kashmir witnessed successive second lockdown, 7,403 patients visited the OPD. Srinagar emerged at the top with a footfall of 952, Anantnag 991, Bandipora 719, Pulwama 775, Kulgam 702, Shopian 680, Baramulla 811, Kupwara 892, and Budgam 542. In 2021 it witnessed a massive spike as the footfall in the OPD was 18164 patients in which 13124 were IV users.
In 2022, February alone saw 1834 patients visit the OPD including 1412 IV users. This may act as a prelude to an impending epidemic.
“What points more towards an epidemic is that there’s a scientific fact that in addiction maximum patients come to seek treatment once they have developed severe health and other social and financial problems,” Rather said.
Experts said the quiet deaths caused by drug overdose have spiked indicating heroin addiction has assumed horrifying proportions. They believe there is a need for proper investigation of death and cause needs to be attributed and recorded. Presently the hospital lacks any specific data on “drug overdose deaths”. They believe deaths tagged as “heart attacks” could be linked to drugs. The most seen hurdle in exact estimation of overdose cases according to Rather is that overdose cases are seen in multiple health facilities. “Till date, there is no proper aggregate record-keeping system created for this purpose and also stigma plays a role here where people don’t report it and try to cover it up to lessen the burden and conceptualised shame to the bereaving family,” Rather said.
= Dr Fazl Roub, Senior Resident, Department of Psychiatry, GMC Srinagar sketches scarier picture as on a daily basis they see 90-130 patients who are in the age group of 20-30 years from different parts of Kashmir.
As smoking secretly is the threshold, the common substances used afterwards are cannabis, brown sugar, heroin, SP tablets, Alprax, besides inhalants he said.
“Many patients have severe relapses after detoxifying,” he said. As the body has normalized after being deprived of drugs for some period, the tolerance reduces. “If the patient injects the same quantity of one gram presuming he will tolerate it, he gets overdosed.”
Unlike others whose parents accompany them, two adolescent cousins, both substance abusers wait in a queue. Both had overdosed.
Hilal, 27, a salesman, started with a weed 13 years ago and it was followed by chasing illicit drugs on a foil and then to get an effective kick during his days of unemployment he sought heroin through IV method.
To manage the expenses, he became a peddler also. “I would go to south Kashmir villages where it is cheaply available. I would buy it and sell it to other addicts also at rates available in Srinagar,” Hilal said. Initially, he started with a 5ml insulin pen and reached 20 ml. His weekly visits to south Kashmir now became daily frequent visits wherein he would buy heroin for not less than Rs 15000. Unlike north Kashmir where there are many checkpoints, the south is a smooth sail
“I had overdosed in an abandoned garden. Even though I had injected, around 15 ml I lost my consciousness. My friend later told me that my lips had dried and body turned pale,” Hilal said. “I used to get an effective kick by consuming around 50 tablets of ccccc along with heroin.” He admitted that more than three people in his acquaintance died of an overdose. “Often Afghani illicit drugs lead to overdose as they are crystal. But lately, the maal is adulterated and the kick does not last long. One has to frequently use it to quench heroin thirst,” he said.
Hilal believes deleting contacts could be helpful. “I dropped SIM card in Kangri to get rid of all those people,” he said.
However, his carefree cousin, 25, Shah, who is also a substance abuser, started three years ago when he saw his friend chasing heroin on a foil. Back then he had no idea of what his friend was doing with the white stuff and what he was getting into. His curiosity to experience it soon turned him into an addict and like others one drug didn’t prove to be much tasteful for a long time.
His transition from one drug to another was almost similar to his cousin’s.
“I was in the bathroom when I got overdosed. I turned cold and wet. For almost two hours I was inside. When family members contacted him, they slammed and broke the door,” Shah said as he had injected full 1 insulin pen double of his routine intake. “I had also consumed tablets and was floundering afterwards. He regretted that many of his friends and acquaintances died due to overdoses.
According to one of the doctors wishing anonymity, the new trend they are witnessing is the increasing footfall of young couples for treatment. “The newlyweds are mostly brought to the hospital by in-laws. All the savings and weddings gold have been exhausted by them. They are in the age group of 25-35,” the doctor said revealing that one of the couples had a three-year-old daughter. In most cases, it is the husband who introduces the wife to illicit drugs. “Most of the couples we talked to said they did it due to peer pressure or a wife did it ‘test’ which turned to addiction.”
As the official data suggested the staggering rise in cases, Dr Aaliya Khanam, senior resident, currently posted at Drug De-addiction Centre SMHS, explains the reasons for the phenomena. “On the ground level the account patients give us is that illicit drugs are easily available. We see patients across all districts mostly adolescents,” Khanam said and some outliers started in later parts of life due to diverse reasons. She attributed various reasons for substance abuse like peer influence, psycho-social stresses, genetics, environment, individual personality traits and other vulnerable personality disorders.
The head of the De-Addiction Centre, Rather said the most common reasons are the easy availability of heroin in Kashmir, with boredom and peer pressure playing major roles, sometimes people take it as a negative coping mechanism in order to deal with the psychosocial stressors. “We all are well aware of the Covid19 scenario, throughout the globe it has been seen that normal life came to a halt, which led to isolation, helplessness, hopelessness, uncertainty among people particularly youth which led to an increase in drug abuse,” he said.
Absence of Antidote
“There’s one drug namely Naloxone which is an antidote to opioids, which can reverse the effects of an opioid overdose if administered on time. This drug is an inexpensive drug but unfortunately, access to naloxone is limited to very few health centres,” Rather said. According to him, if it is available at all district hospitals and peripheral emergency centres and medical doctors are trained about how to use it in overdose situations- this can have beneficial results in saving lives of people who may otherwise die because of overdose.
(Names of the patients have been changed to protect their identity)