'Earlier two out of 10 patients used to be heroin addicts. These days 9 or even all ten of them are on heroin'.
Zaira is in the eighth month of pregnancy. Before giving birth to her second child, the 26-year-old from the disputed Indian-administered Kashmir wants to break free from heroin addiction.
Zaira’s husband, Nadeem, is a heroin addict as well. But the two of them started taking the drug separately with no influence over each other.
They fell in love a few years ago and got married, although their respective families opposed the match. Nadeem's drug use had left him on the brink of poverty. He lived the life of a freeloader, a burden on his family, who showed disdain for his wife Zaira.
With no support to fall back on, Zaira took a job at a local salon to help her husband get by. The "ill-treatment" she was subjected to by her in-laws and the long days of hard work at the beauty parlour exhausted her to the point that one day when one of her colleagues offered her a shot of heroin, she accepted it in the blink of an eye.
“I was not sure what it was but it felt good. I was euphoric and everything that had been troubling me vanished into thin air,” Zaira told her doctor at the hospital, “And then it became a regular thing”.
“Zaira was forced to take a job at a local beauty parlour to support her husband financially,” a family member tending to her at Srinagar’s Institute of Mental Health and Neurosciences (IMHANS) said.
Zaira felt euphoric with each heroin shot and her colleagues kept the supply running until her body came to depend on it. A few weeks later, as she couldn't fight her drug cravings, her colleagues started charging her money for every shot.
“And this is not just Zaira, it is the peddling pattern we get to hear about every day,” said Zaira’s doctor, Fazl’e Roub.
Roub has a doctorate in de-addiction psychology and has worked in the Indian state of Punjab before moving back to his homeland Kashmir.
While Zaira is on a detox program and hoping to get rid of her addiction before her due date, Roub is worried that like all other heroin addicts, she might end up relapsing.
For Roub, Kashmir's heroin problem became alarming when he compared the region's data with Punjab's, which is at the top of India's drug-affected states.
"I struggled with nightmares"
The population of Jammu and Kashmir state is 12.5 million, while Punjab's is 28.9 million. While the entire state of Punjab has 70,000 heroin addicts, there are 16,389 opioid users, most of whom use heroin, in just two districts, Srinagar and Anantnag, of Jammu and Kashmir, according to a recent survey conducted by the Institute of Mental Health and Neuro Sciences (IMHANS).
The first recorded case of heroin addiction in Kashmir dates to the early 1980s. The phenomenon was so rare that doctors flagged it to the Chief Minister's office, which is the highest governing post in the state.
But that was about it. There were no serious signs of rampant drug abuse in the state until the turbulent 90s came, pushing the state into substance abuse and mental health crisis. The situation was largely exacerbated by widespread human rights violations, one of the ugly manifestations of the Kashmir dispute which began between India and Pakistan in 1947 and took a violent turn in 1989 when an armed insurgency challenged India's rule in the region. To crush the resistance, India used brute force.
“As the violence subsided in the mid and late nineties there was a huge surge in drug abuse cases,” a senior psychiatrist and professor at Srinagar’s Government Medical College, Dr Arshid Hussain, told TRT World.
But the substance of abuse in those early years of addiction were cannabis, pain killers, cough syrups and other over the counter drugs.
Saleem Ahmad, who is clean now, got addicted to drugs at the age of 14. The trigger, he said, was the “Bijbehara Massacre” of 1993, in which the Indian Border Security Force (BSF) personnel killed at least 34 civilians on October 22. Ahmad was among the survivors of the massacre.
Recalling the event, he said he was a part of a peaceful procession that came under the BSF gunfire.
“For a couple of years, I could not even sleep. I struggled with nightmares: I could see bodies strewn across a cricket field that I used to play in."
One of his friends, he said, introduced him to cannabis, which helped him "stay sane".
Ahmad came clean about the cannabis abuse, thanks to the counselling he got from his family and psychiatrists.
“It was easier back then. Now with the introduction of heroin, it's really hard to come clean,” Hussain, the psychiatrist, said.
Several studies conducted during and after the period of utmost turmoil suggest that Post Traumatic Stress Disorder (PTSD) was one of the main reasons for people turning to substance abuse. Other factors like unemployment, peer pressure, family problems and natural calamities like the floods of 2014 have also played some role in pushing people to consume various kinds of drugs.
“And it is not only the turbulent 90s. We have witnessed widespread protests and civilian killings in 2008, 2010 and 2016 as well. Not to forget the lockdown and communication blackout of 2019. These things have also added to drug abuse in Kashmir,” said Nasir Patiguru, a social activist, who also runs a psychiatry clinic in Anantnag district.
Experts say the numbers are way higher than the IMHANS study came up with.
“Kashmir is a conservative society where people do not even acknowledge their smoking habits in public. And this study was based on asking people what substances they consume,” argues Dr Muzaffar Ahmad Khan, director of a de-addiction centre run by Jammu and Kashmir police in Srinagar.
"The numbers have to be higher than this".
Between 2016-2019, the IMHAMS grappled with the heavy influx of patients suffering from substance abuse. As per its records, 489 people sought treatment in the hospital in 2016. The number rose to 3622 in 2017 and a year later it exceeded 5000 cases. By 2019, 7420 more patients were registered. But because of the political turmoil caused by New Delhi's unilateral decision of erasing Jammu and Kashmir's nominal autonomy in the fall of 2019, which led to military curfews and communication gags, the number came down to 3536 in 2020. Then the pandemic came, restricting the movement of people and leading to the closure of several health centres.
“What worries us is if one person turns up for treatment, it means there are 9 to 10 others who are into drug abuse and are not seeking help yet. This is a thumb rule followed world over,” Dr Roub said.
“Our in-patient facilities are closed for now but people still come in for OPD visits".
Just a few days before talking to TRT World in late May, Roub had examined 45 patients, all of whom were addicted to heroin.
At least 40 percent of those turning up for treatment are students, he said, adding: “We have a 12-year-old boy admitted at our facility right now for heroin abuse,”
“Earlier two out of 10 patients used to be heroin addicts. These days 9 or even all ten of them are on heroin,” he said.
“It is getting scarier day by day”.
[NOTE: The female victim of heroin abuse has been identified by the pseudonym Zaira].