While authorities and society are fighting the Covid-19 pandemic, Kashmir’s hidden epidemic, the drug abuse, is reporting an exponential rise. Professional surveys suggest the drugs trade has a multi-crore transaction on daily basis as the new generation of the well-to-families is lured by momentary pleasure, reports Khalid Bashir Gura
For over a week, Sahil, 32, is admitted at the Institute of Mental Health and Neuro-Sciences (IMHANS) in Srinagar. A resident of a non-descript village of Baramulla, he recalls the day, eighteen years ago, when he was first introduced to drugs by one of his relatives.
Preparing to appear in the Board examination, Sahil was tense and looked for refuge. His relative who was already an addict lured him by making him believe that his problems will vanish if he tried a shot.
Now, Sahil is a father of two boys aged 10 and 6. At the hospital, his brother is attending on him.
For Board Examinations
The words “just try,” by his relative. Sahil recalls, destroyed him.
“My father used to give me a lot of money. I was born with a silver spoon,” he said. “At times when my friends had no money, I would lend them and we would together consume substances. At the time one strip of a drug called SP cost Rs 16. I gave them Rs 100”.
Initially, he consumed four tablets and later he took more of it and his dependency on drugs began to grow.
“If I had a quarrel with anyone, or was scolded at home, I felt I needed tablets to keep tension at bay,” Sahil said. “After consuming them I felt I was immune to anything. With time, I also started to delude myself that if I do not consume tablets, I will not be able to work or live”.
Thereafter began his descent into the abyss of debilitating addiction. The unavailability of a drug, he said, gave him a near-death experience.
“Initially he started consuming opioid tablets that are recommended by doctors as pain killers,” said the counsellor treating him who wished to remain anonymous.
Sahil recalls each and every tablet he used to consume and how his addiction increased from a few tablets to many strips a day.
“Once they start doing it, the craving grows that ultimately ends with overdoses,” said the counsellor. “Most of the times they use codeine. All this is available easily”.
Sahil, on the other hand, talked with his head down, averting eye contact.
“When I had my board exams, my first priority was to search for drugs. I was restless, agitated till I found them. This wasted my time and money,” he said.
Eventually, Sahil failed in the examinations. All the while his parents were in denial and used to think that Sahil attended school, and also appeared in examinations. This deprived Sahil of parental oversight. After consuming substances, according to him, he was in ‘some other world’ and not in a position to carry out the routine work.
“I used secluded places to consume substances, as I had the fear of being seen or caught,” Sahil said. “When my family came to know, I denied and kept inventing stories because I feared that if my family discovered I am a drug addict they will be horrified”.
Sahil continued to ‘evade suspicions’ even after his marriage in 2009. “My wife suspected but I kept denying it,” he said. “The craving for drugs, their accessibility and availability made me restless”.
Later found employment in the police department. But his addiction could not remain secret for long. He would snort heroin at SOG camps, he said.
For Sahil, the secret breakfast was in his personal wardrobe. “Until I did not take one strip, I could not start a day,” he said. “I would lock myself up till I consumed the tablets”.
He knows all people in his district dealing and distributing drugs. “I got acquainted with the market, peddlers, and dealers of drugs when his relative gave him a bogus prescription and asked him to go a specific shopkeeper,” Sahil said. “My friends used to procure drugs from Baramulla”.
According to Sahil, there is a spike in the costs of drugs as nowadays each strip of the drug that he is addicted to costs more than Rs 500. “Initially I used to buy the drug at Rs 50. Similarly, the codeine bottle costs Rs 800,” he said.
Sahil believes that lockdowns, hartals does not stop the distribution of addictive drugs. “Even if mobile phones do not work we know where to go and get it as our location and spot is fixed,” he said.
He sought assurances from his counsellors that if his addiction will go away at all. They console him by saying: “Everything will be alright.” Sahil complains of body aches, pain and sleeplessness. “I am craving for it. I want to get rid of it,” he mumbled.
Rs 23 Lakh For Heroine
The phone of another substance abuser continues to ring. Danish, 25, is a resident of Sopore, a businessman who is admitted at IMHANS for last four days. Eldest among his siblings, Danish is a father of a three-year-old boy. Married in 2016, he started using heroin in the same year.
His world fell apart when his wife discovered ‘insulin syringes’ in his wardrobe. “She raised hue and cry. I tried to delude her by saying that it belongs to my friend who is a diabetes patient but she didn’t believe me,” Danish said.
According to Danish’s councillor, initially, he used to take SP tablets, cannabis but later started sniffing heroin by heating it on silver foils and subsequently took recourse to injections. “When I first started using heroin it cost Rs 2300 per gram and now it costs more than Rs 6000,” said Danish.
The heroin, he said, destroyed him and his family financially. “Once I took Rs 23 lakh from my own shop. Wherever I could find money, I used to give it to peddlers. Later I sold my bike for a cheap price” said Danish
When pressurized by the family to reveal where he spent the money he stole from the family shop, he had no option but to admit doing drugs.
There were five other people who used to do drugs with Danish at deserted places.
The codeine, Danish said, cost around Rs 1000 a day, but heroin is costly. “Heroine costs thousands of rupees. Every day I used to take more than 1 gm of heroin,” he said.
Besides being addicted to substances Danish is also suffering from Obsessive-Compulsive Disorder (OCD) said his counsellor. He washes his hands repeatedly, takes more than normal time washing or bathing and is particular about cleanliness and arrangement of things around him. There are other distressing thoughts that repeatedly come to his mind and to seek relief he turns to drugs as they provide him temporary respite.
According to Danish even those who consume substances also become peddlers to earn money and keep their addiction going. Many men, women and even children are involved in peddling in his hometown, he said.
“The addicts never get access to the dealer,” said Danish. “There are many players and distributors who are the reason behind the spike in the prices”. One gram of heroin, according to him, costs Rs 7000 in Srinagar, Rs 3500-4000 in Kupwara and Rs 5000- 6000 in Sopore.
Another patient who spoke softly with a sense of guilt is Nazir, 20, a resident of Tangdhar, a second-year undergraduate student at Government Degree College Bemina.
A heroine consumer for more than a year, it all started when he was a teenager and started smoking cannabis. “It was my friends who introduced me to it. They said it gives pleasure and you will enjoy it. I tried and got addicted from the first shot,” Nazir said. There are dealers and distributors everywhere, he said. “I used to sniff the drug by heating it on silver foils along with my friends. Later we shifted to injecting heroin through syringes,” Nazir said. The sense of guilt and fear always accompanied him as he thought he brought disgrace to his family and belied their expectations.
“No one in my family has been a substance abuser. I used to consume the drug mostly when everyone was asleep at home or with my friends in the playground or at other less-visited places,” Nazir said. “Later when I used to wake up late and my friend circle changed, everyone complained to my family about my company”.
Nazir started demanding more than the required money from the family, the addiction became difficult to hide.
The peddlers were just a phone call away even when he came to Srinagar for studies. At times when he was short of money, his other addictive friends would lend him.
2 Percent Population Affected
According to counsellors some of the traits of the cases, they deal with are anti-social personality traits, lack of guilt, lack of remorse, callousness, irresponsibility, frustration, pleasure-seeking personality, and an underlying mental illness where the person feels an omnipotent control over his surroundings.
Associate Professor Department of Psychiatry and Head of the de-addiction unit at IMHANS Dr Yasir H Rather said the number of patients being treated at the facility is “the tip of the iceberg”. “Only acute cases with heroin addiction are referred here,” he said.
Due to Covid-19 most of the government-run Drug De-addiction Centres (DDCs) were shut across the country. In Kashmir, except the DDC in north Kashmir’s Baramulla district, all others were shut.
According to a recent survey by IMHANS, the researchers estimate about two per cent of the population in Srinagar and Anantnag districts are addicted to drugs. The survey also found that easy availability of the substances, psychological stress, and peer pressure, lack of awareness about addiction, curiosity, experiment contributed to the increasing use of drugs by youth.
It has been seen that in conflict areas, gradually with time, drug use increases as the doctor on an average sees more than 50 cases (new and old) in the OPD with 10-12 new admissions. Heroin users in Kashmir especially, since 2016, have seen a surge, said Dr Yasir.
Mudasir Aziz, a psychotherapist, who counsels persons with drug addiction and psychiatric ailments at the government-run Drug De-addiction Centre (DDC) in south Kashmir’s Anantnag differs.
According to Aziz, it is people’s lack of coping skills, problem-solving methods, stress management, anger management that makes them fall prey.
“We as professionals consider drug addiction as a disease. Over the years I have seen patients with psychiatric ailments who wanted relief and redressal to the problems. In order to cope, they started from smoking and subsequently graduated to doing drugs as they lacked proper coping mechanisms,” said the doctor who questioned as to why not everyone resorted to drugs and only a minuscule section of population did.
“I have not encountered a single case where I may have treated a patient specifically for drug-addiction. They already have underlying mental illnesses.”
The doctor negated the availability of drugs as the reason for drug addiction. “When there were no substances available in the market people used to take cannabis, SR solution”, he said. “Everyone is at risk as the genders do not make one immune to dangers.”
The Covid-19 Impact
As Covid-19 began and lockdown forced people indoors, the availability of drugs became an issue for the users. This resulted in some of them developing withdrawal symptoms and they sought treatment. There was thus surge of patients reporting at IMHANS.
With the increasing footfall of patients at IMHANS, the doctors complained that they lack skilled manpower like counsellors, psychiatrists, social workers, psychologists and de-addiction specialists.
“We have a staff shortage,” said Dr Mohammad Maqbool Dar, head of the psychiatry department at the Government Medical College, Srinagar adding that due to Covid-19 most of the rehabs were shut. The de-addiction centre at SMHS was converted into an isolation ward. At IMHANS, the doctor said, they tackle the inflow from all parts of Kashmir.
In order to tackle the stigma attached to drug addiction, the doctors in recent drug de-addiction policy have recommended to the policymakers to mainstream and integrate the DDCs in hospitals and not reinforce taboos about the drug-addiction by establishing separate DDCs especially one controlled by police. “If we overcome stigma we may see more patients seeking treatment,” Dr Dar said.
The kind of severe addiction cases, doctors are coming across has made them recommend this policy. “There is a need for continuous medical back up with some cases that use IV methods or heroine that results in other medical complications like Hepatitis-C, septicaemia, Hepatitis–B, etc. The treatment even though is free at the government hospital, they still have to pay around Rs 4000,” said doctors.
In their studies, the doctors found that the pattern of high-risk behaviour like overdosing was prevalent among 40 per cent of patients.
According to Dr Yasir, after 2016 there has also been a surge of patients from South Kashmir especially those addicted to heroin. With Kashmiris lacking alternative coping mechanisms to de-stress themselves like the sports, entertainment this, according to doctors, increases the tendency to do drugs.
“We need to encourage sports culture in our society. The people have no alternatives to channelize their energy in a productive, positive way. That is why they seek pleasure in destructive activities,” said Dr Yasir. “In teenagers, dopamine chemical rush is natural and the teenager always looks for ways to have it. If the environment is productive like sports culture or other avenues, the youth will seek pleasure in such activities and flourish”.
The drug users usually start with consuming nicotine, cannabis, medicinal opioids and graduate to brown sugar, heroin and injections, according to doctors and counsellors treating them. Most of the present cases, according to doctors, start with injecting heroin which they say has become easily available.
According to doctors, the penetration of drugs is so deep in the society thinking that only a certain group of youth is involved is a fallacy. The protective barriers like being married, religion, are also falling. The drug abuse, doctors say, is prevalent across the social spectrum.
“I have seen cases where the married patients and those offering prayers fell prey due to lack of ability to cope with the stress,” said Dr Yasir.
As the security guards outside the ward frisk every incoming visitor at drug-de addiction ward, many attendees complained of difficulties of keeping a check on every visitor.
“Unlike police-run drug-de-addiction centres, the IMHANS wards are open to other patients as well which can sometimes lead to a breach in security,” said Dr Maqbool.
As the institution is not an exclusive rehabilitation centre, the doctor said they can’t keep patients confined as it may also lead to other problems like stigmatization.
The parents of most of the addicts are still grappling with reality. They beg doctors to help their children overcome addiction. The doctors’ psycho-educate them to see the addiction as a disease rather than a character flaw.
The cause of frustration with most parents is that when their ward relapses. According to doctors and counsellors, drug addiction is a disease and when the addict is exposed to the former environment and gets access to old contacts he develops fresh craving.
There is an important role for parenting in a child’s development and upbringing. In most of the cases, it was found that bad parenting was responsible. The lack of proper care, guidance, supervision especially by working parents and in nuclear families or made the wards fall prey to drugs. The departure from earlier conventional family setups has added to stress and loneliness.
Many Kashmiris studying in other states or abroad also fall prey to the menace. According to doctors the sudden unfettered freedom from home and family and being exposed to new cultures and situations, coupled with lack of supervision, and peer pressure made many children fall prey to drug addiction.
The youth especially teenagers who start modelling and emulating actors are at risk as they think it is cool to do drugs. The lyrics of Punjabi songs that are very popular these days among Kashmiri youth sensationalize alcohol and use of substances and behaviours that promote drug use, said Dr Yasir.
A study on pattern and prevalence of substance use and dependence in Kashmir with a special focus on opioids carried out by Dr Yasir in collaboration with World Vision India calls for large scale intervention. According to the study, there is poor utilization of treatment services, which need to be augmented so that substance abusers from non-urban areas are able to avail services without hindrances. There are only three de-addiction centres for a population of 1.25 crore.
The study that focuses on two districts – Srinagar and Anantnag – reveals the average monthly expenditure of one opioid user at Rs 68626 with daily expenditure at Rs 2287.5
According to the study, opioid dependence poses a significant burden on the economy as the daily expenditure on the consumption of the drug in districts of Srinagar and Anantnag is Rs 37, 490, 329.
With heroin being the most widely used opioid in these two districts, the study also reveals that the demographic profile of the users is 97 per cent young males, most of them educated, skilled, are from economically sound families. Further, the common reason for use is lack of peer pressure, boredom, lack of recreational activities and relief from psychological stress.
The study further reveals that the socio-demographic profile of substance users is changing in Kashmir. The easy availability of drugs, instability, and inadequate rules governing trafficking of drugs can be cited as reasons for spreading the substance abuse to new demographics that includes youth from affluent families. The total prevalence of substance dependence in the two districts is 1.95 per cent and the total dependence of opioid dependence is 1.80 per cent.
(Some names have been changed to protect the identity)