A team of Gauri Kaul foundation went for a medical camp to the Institute of Mental Health and Neuro Sciences (IMHANS) in Srinagar to evaluate and talk to substance users voluntarily coming for de-addiction process. According to Prof, Yasir Rather, in charge of Drug de-addiction unit there, the number of patients coming there is just a tip of the ice-berg. For every single person seeking medical help there are at least 9 who are addicted to substance use but do not want any remedial help. The narrations of these individuals are very typical and can make interesting stories.
Chronic Addict: Mr AR,41 years old, from Anantnag district, had serious marital issues 20 years ago. He was depressed and advised by a friend to join a group that had developed a way to remain cheerful and in a good mood. He went to the joint and started consuming “Brown Sugar”(an adulterated form of heroin with impurities) which makes it much cheaper than the purified form of heroin. It creates a product more dangerous than heroin, because the user is not sure how much heroin is being consumed. Over the years brown sugar was replaced by pure heroin injections given intravenously (IV), as cruder forms were no longer available easily. The craving and withdrawal symptoms of severe body pains, feeling of uselessness and total lassitude never allowed him to be without it, even for a day. He sold his land in the process and also became a drug peddler. Ultimately somehow wise sense prevailed even at this late stage and he came to the de-addiction clinic of the IMHANS, where he is being counselled and treated by giving opioid substitution therapy. He is very grateful to the team at IMHANS for getting him a new lease of life.
Young and a recent substance addict: Master KM, a 16 year old boy while in school got introduced to the substance, IV heroin by friends and found it a great experience making him the happiest person till the effect lasted. Initially began with a small dose on alternate days but over a period of few months went on to 1 to 2 mgs per day. One mg according to him costs around Rs 4000-5000 in the market. Coming from a rich family he got the money from parents and other family members, on pretext of preparing for exams through coaching classes, getting computer software’s, video games and going for outings etc. The secret of his addiction got disclosed to his mother who brought him to the de-addiction clinic and it was his first day in the OPD at IMHANS. He looked totally washed out because he did not have his dose that day.
The medical problems seen by the doctors at IMHANS, besides the addiction as narrated to us were, hepatitis C, involvement of right sided valves of the heart and consequent difficult to treat pneumonias. These are consequent to using unsterilized needles and sharing the same between the group. Diabetes and high blood pressure were not an issue in the group examined by us, predominantly because the population seen by us was very young. It should also be borne in mind that many of the deaths reported in young person’s less than 30 years of age could be due to over dosage of the substance leading to respiratory depression. In order to overcome the embarrassment and the stigma attached to drugs, the family announces it as a heart attack.
Substance related trade is the third largest lucrative trade internationally after petroleum and arms. The addiction process is defined as “a chronic relapsing disorder characterized by compulsive drug seeking. Continued use despite harmful consequences and long-lasting changes in the brain”. There are persons who are vulnerable to getting hooked to it and get behavioural changes like drift in the attitude, temper, silliness, depression or criminal leanings as per major studies on this subject.
According to a recent report (2017) from the United Nations about 25.5 million people in world are suffering from drug abuse related disorders. Kashmir is also moving rapidly towards this vice. The common substances used by the drug addicts in Jammu and Kashmir includes: cannabis, brown sugar, heroin, strong pain killers like “Spasmo-Proxyvon”, tranquilisers and sleeping pills like, alprazolam, zolpidem etc, shoe polishes and thinners used in paints. However, it is IV heroin which is the most sought-after culprit agent in more than 90% cases.
According to Dr Yasir Rather, Srinagar and Anantnag districts are the predominant areas of substance dependence when it comes to opioid use and are distributed equally through these districts. The addicts are mostly young men and half of them less than 20 years of age. They are educated, skilled and coming from economically sound families. The common reasons cited by these persons are boredom, lack of recreational facilities and psycho-social stress. The total dependence on substance use, predominantly IV heroin, is 1.9%.The drug addicted population in Kashmir valley has been estimated to have been increased to about 2.5 Lakhs with a male preponderance. According to the experts, the small number of females addicted to drugs is usually those with underlying psychiatric problems. Opioid dependence is a very significant burden on the economy and as per the calculations made by Dr Yasir in the districts of Anantnag and Srinagar; the daily expenditure is around Rs 3.8 crores.
This addiction is very difficult to get rid of once established. The number of persons coming for de-addiction to IMHANSis steadily rising. In the last 4 years it has risen from 139 cases in 2015 to 495 in 2020 and has already crossed 550 in this year according to Prof. Maqbool Dar, Head of psychiatry department. The prevailing conflict like situation in the valley during the last two years and also the COVID outbreak has led to severe depression in the population there. This has prompted many towards drug usage and have foundit to be a good solution to get rid of stress. Indoor confinement, no physical classes in schools and colleges also gives it a fillip. Using of psychotropic drugs is a self-destructive pattern that causes distress and problems, and some use it for the purpose of creating pleasurable effects on the brain. Often however under the influence of various narcotic and psychotropic drugs, people see images, hear sounds, and feel sensations that seem real but do not exist, like getting a feeling that everyone around them is from army, carrying guns and threatening to kill. The effects are therefore very variable.
This problem of substance use needs to be taken very seriously. It is never too late to take very firm steps to minimize and get rid of it. It calls for a concerted action by all the stake holders. Opioid cultivators, drug peddlers, pharmacies selling psychotropic medicines need to be booked under the existing laws which should be strengthened to cover all the lacunae. Parents and teachers of these children have an equal responsibility to catch them at an early stage and treat them with empathy, love and patience. They need to consult professionals like those working in specific institutions like IMHANS and Govt Hospital for Psychiatric Diseases Rainawari. These centres are already doing good work which needs to be reinforced with more facilities and staff at all levels. Public at large needs to be made aware of these hospitals and similar medical centres. We cannot allow this increasing trend to ascend further as seen in the last few years. Healthy youth is our future.
The authors are very grateful to Prof Yasir Rather, in charge of Drug Deaddiction Unit, IMHANS, Prof Mohammad Maqbool Dar, the HOD of IMHANS, Dr Zubair Abdullah, Senior geriatric physician from JLNM Hospital for their help in getting all the information quoted in this article.
Ayeesha Rashid is an Intern at Gauri Kaul Foundation.
Upendra Kaul is Founder Director Gauri Kaul Foundation