Thirty-eight-year-old Kamran Ahmad (name changed) from Srinagar still gets goosebumps when he recalls the events that unfolded in the summer of 2022. A government employee, he had become a habitual user of heroin, he says, under peer influence. “I would take one to two grams of heroin per day,” recalls Ahmad.
To sustain the addiction, Ahmad sold his two cars and a shop, straining his relationship with his father, wife and child in the process. One day, his family decided to take him outside Jammu and Kashmir (J&K) for rehabilitation, to avoid social stigma. A drug de-addiction centre based in Chandigarh charged the family around ₹10,000 to pick up a reluctant Ahmad from Srinagar. An ambulance arrived with bouncers.
“I would get beaten up quite often at the centre, where I was kept in a dormitory-type facility. I was warned against breaking rules, like making noise or laughing loudly. If anyone did any of these things, the bouncers would punch them in the face. I was given no medication,” Ahmad says. He had two stints of rehab outside J&K.
According to the Ministry of Social Justice and Empowerment, an estimated 10 lakh residents in a population of 1.25 crore (or 8%) were drug addicts in J&K in 2019-20. The Ministry said that 1,08,000 men and 36,000 women were found abusing cannabis; 5,34,000 men and 8,000 women were found consuming opioids; 1,60,000 men and 8,000 women were found using sedatives of different kinds; and 1,27,000 men and 7,000 women were reported to be on inhalants.
A traumatised people
It is clear that Kashmir is in the throes of a dangerous crisis. On the one hand, over three decades of conflict have left the population scarred, and mental illnesses are rampant in the Valley. “Substance use and poor mental health have a bidirectional impact,” says Dr. Yasir Rather, an Associate Professor at the Institute of Mental Health and Neurosciences-Kashmir (IMHANS-K). “Poor mental health leads to substance use. Self-medication of benzodiazepine, codeine, etc. was prevalent till 2014. The latest trend shows use of hard-core drugs like heroin and cannabis.”
A mental health survey conducted in 2016 by the Médecins Sans Frontières and the Kashmir University suggested that 45% of people in the Valley faced distress, 41% adults had probable depression, 26% had probable anxiety and 19% had probable Post-Traumatic Stress Disorder. “An adult living in the Kashmir Valley, on an average, has witnessed or experienced 7.7 traumatic events during their lifetime. While 93% of people experienced conflict-related trauma, 94% experienced trauma due to natural disasters,” the survey said.
On the other hand, exposure to the virtual world, especially addiction to social media, is acting as a force multiplier. Nazia Jan (name changed), 18, attends a college in Srinagar for her Bachelor of Arts degree. She hardly misses classes and her performance in examinations is up to the mark. There is nothing outward to suggest that she’s a heroin user.
“I was influenced by the reels and write-ups on social media platforms about drug use by famous actresses such as Drew Barrymore, Lindsay Lohan and Marilyn Monroe. I began to taste wine first, then cannabis and now heroin,” says Jan, who is undergoing treatment in Srinagar. She developed relationships with multiple boys, including drug peddlers, who kept the supply moving.
Types of substance abuse
Dr. Arshad Hussian, Professor at the Department of Psychiatry at the Government Medical College, Srinagar, has mapped the trend of substance abuse in Kashmir: “Historically, cannabis was consumed by locals in the name of Sufism or spirituality. In the 1990s, when the conflict started, people took to prescription opioids to fight traumatic experiences. This was replaced by cannabis in the late 1990s, which was meant to make people feel better amid all the gloom. However, the heroin abuse that we’re seeing now at a mass level is perplexing. This generation is doing it for self-harm. They get high by inflicting pain on themselves, which is worrying.”
According to IMHANS-K, heroin was the most common opioid among 84.33% of the respondents surveyed in 2019-2020. It was also the most common opioid among Injection Drug Users (IDUs). Heroin is a costly drug and poses a financial burden for addicts. “The monthly average expense incurred by a heroin user is ₹88,183.58,” Dr. Rather says.
He also points to the worrying trend of sharing needles or syringes, which are key risk factors for transmission of infections like human immunodeficiency virus (HIV) and hepatitis C virus (HCV).
Of late, there have been reports in Kashmir of young men dying suddenly, and such deaths have mostly been attributed to cardiac arrests. However, doctors suspect many of these deaths could be due to drug overdose, especially heroin.
Dr. Muzaffar Khan, Clinical Psychologist at the police-run Youth Development and Rehabilitation Centre in Srinagar’s Eidgah for drug addicts, says he traced three deaths in Srinagar in a fortnight in March-April this year due to drug overdose. “Two were from Rambagh and one from the Parimpora area. Because of stigma, these deaths are attributed to cardiac arrests,” he says.
The trend of couples abusing drugs together is indicative of another dangerous trend taking root in Kashmir.
In 2022, Dr. Rather attended to a case, something he had not seen yet during his 16-year-old practice, from south Kashmir. He and a team of doctors, including gynaecologists and paediatricians, handled a newborn baby with withdrawal symptoms.
“Both parents of the baby were drug abusers. The father, who was using opioids and cannabis, managed to coax his wife into it. In the meantime, the mother conceived a baby. The good part was the case was reported to us. We had to adopt a multi-disciplinary approach to have the delivery in Srinagar and save the baby,” he says.
The psychiatrists decided on oral substitution therapy, whereby opioid-dependants are injected with opioid derivatives under medical supervision. “We prepared small doses as per the body mass of the baby, who was undergoing severe chest distress because of the withdrawals. It took us around three weeks to attend to the baby’s withdrawal and other symptoms,” Dr. Rather explains. “If the baby had not been treated on time, the chances of survival would have been slim. What is surprising is that the parents were well read, but they were consuming heroin.”
Dr. Rather attended to two babies in 2022 with withdrawal symptoms whose parents were drug addicts. “We saw a pattern where a drug addict marries another drug abuser once they consume drugs in peer groups. Mostly it is with mutual consent,” he says.
According to a IMHANS study, around 1.67% of the total drug abusers in Kashmir were women, with 16% of them married. “Women have different drug use patterns compared to men. Women working outside J&K or under peer pressure get hooked to drugs, mainly opioids. Besides, personality disorders such as borderline personality disorder and anti-social issues were also found among female drug abusers. There are cases where they are abused, even sexually, and used for drug peddling,” he says.
According to data at the Drug De-Addiction Unit of IMHANS, only 10 women came forward for treatment in 2020; this figure rose to 48 in the January-August period in 2022. Another IMHANS study found that Kupwara district in north Kashmir had a substantial number of female substance users followed by Budgam in central Kashmir. “In comparison to the rest of India where female substance use is dominant with alcohol use, in the current study female drug use is completely overshadowed by injection heroin use,” it pointed out. Doctors fear that female addicts could be reluctant to seek treatment due to factors such as the stigma attached to substance use and shyness.
Mapping the districts
Kashmir comprises 10 districts. The IMHANS-K estimated that the mean age was 17.64 years for first use of alcohol and 17.25 years for first use of cannabis in Srinagar district, whereas the other districts had an age range of 19-24 years for alcohol and an age range of 18-32 years for cannabis. “The district of Anantnag is reported to have the earliest use of pharmaceutical opioids with a mean age of 19.61 years,” the report says. Baramulla and Kulgam districts had the highest number of participants using opioids. The drug network was reported to be the highest in Shopian, while Pulwama ranked the lowest. For women alone, Budgam ranked the highest.
Dr. Khan thinks it is time to start screening in schools and colleges. “The students as well as staff should be screened multiple times a year. This will help to detect any trend very early and address it,” he says.
Educational institutions share his worry. Dr. Sameena Wani, principal at a government higher secondary in Srinagar, has submitted a report on drug and substance abuse in secondary and higher secondary school students of Srinagar to the District Institute of Education and Training, Srinagar, to frame a comprehensive policy.
Dr. Wani conducted a survey in 40 schools covering 3,100 students. “The findings show that less than 50% of the girl students were aware of the causes of drug abuse, while boys (68%) were more aware about the causes and consequences of drug abuse,” she says.
Both boys (25% from high schools and 27% from higher secondary schools) and girls (5.8% from high schools and 12.04 % from higher secondary schools) indicated that they knew other students who were taking drugs. The findings established that among boys, tobacco or cigarettes use was highest (65.09%) followed by morphine (45.06%), opium (40.84%) and bhang (34.4%). The responses from the girl students also indicated the same order: tobacco (47.36%) followed by opium (31.57%) and bhang (28.69%).
“A school-based intervention plan should include procedures that provide care, counselling and support, professional development and training for relevant staff,” says Dr. Wani.
Despite the epidemic levels of drug addiction, the Valley has very few de-addiction centres. The J&K government has inspected many facilities but is dragging its feet in issuing any fresh registrations. Dr. Khan, whose centre is a rare one to offer a de-addiction programme, calls for improving screening in hospitals across the Union Territory. Screening for drug abuse is mainly done in tertiary care hospitals. “We need to have life-saving drugs available in all district hospitals for drug overdose,” he says.
There are also other challenges. “There are incidents of drug addicts manipulating urine samples,” Dr. Khan says. “Many get urine samples shipped from online sites. It is not bad company that parents need to keep an eye on, but bad use of the Internet. Synthetic drugs and their sale online are another challenge.”
While opium is fast replacing cannabis fields in south Kashmir as the centre of supply, heroin gets smuggled across the Line of Control (LoC), especially into Kupwara, Baramulla, Poonch and Rajouri districts.
According to official figures, approximately 150 acres of illicit poppy cultivation and 407 acres of illicit cannabis were destroyed in 2021. “Fukki and Khash-khash (extract of poppy) trade has become an elaborate chain in south Kashmir. There are villages where, on the pretext of collecting home-grown garlic from women, vendors collect dry fukki. Women know who the peddlers are. It is exported outside J&K too,” Dr. Khan says.
The Ministry of Home Affairs, which suspended cross-LoC trade in 2019, cited narcotics smuggling as one of the reasons. However, narcotics smuggling has continued. According to the Baramulla police, the first three months of 2023 saw recovery of contraband, including brown sugar and heroin, worth ₹4.75 crore. The Baramulla police have registered 75 cases and arrested 113 persons dealing with drugs, including seven under the stringent Public Safety Act (PSA). In Kupwara, three people, including a Central Reserve Police Force personnel, were arrested for their role in smuggling 11 kg of heroin worth ₹70 crore from across the LoC. In Srinagar, 52 drug peddlers were arrested under the PSA last year, and a process has been initiated to seal the houses of “notorious peddlers,” says an official.
“Cross-border narco-trade has been going on for some time now. Pakistan is pushing drugs to generate funds for terrorism activities. Consignments of drugs, arms and cash have been seized in the Poonch-Rajouri belt, and some inter-state connections are also emerging. Comprehensive strategies are in place to foil inimical attempts,” says J&K Director General of Police Dilbag Singh.
The growing crackdown by the J&K police on peddlers may have resulted in a decline in the easy availability of heroin in Kashmir, but the growing number of drug users in J&K continues to compound the challenges for the administration.