Heroin injected in the blood brings Kashmir to brink of Hepatitis-C epidemic, with addiction levels worse than in Punjab, the poison sweeping through the valley in just the last 5 years

Srinagar: A 12-year-old boy is among 14 patients currently admitted at Srinagar’s Institute of Mental Health and Neurosciences (IMHANS) for their heroin addiction.
Barring two of them, all have tested positive for Hepatitis-C, the boy included.
“The most unsettling facet of heroin addiction in Kashmir is that most of the addicts are young and more than 80 percent of them are testing positive for Hepatitis-C infection, and some for Hepatitis-B,” Dr Fazl’e Roub, in charge of the Drug De-Addiction Centre at IMHANS, told Kashmir Reader.
Dr Roub has a doctorate in de-addiction psychology and has worked in the Punjab region as well, where heroin addiction has reached levels of an epidemic.
The doctors attribute the rise in such infections to sharing and reuse of needles and syringes to inject heroin.
This is primarily for two reasons, Dr Roub says. “One is that heroin is a costly drug and injecting is a way of reducing the cost through dilution. The other reason is that injecting the drug gives the addicts a high which sniffing it cannot,” he says.
A gram of heroin in Kashmir costs between 3,000 and 12,000 rupees, depending on the market and the circumstances.
A study conducted by an IMHANS team in two of the most populous districts of Kashmir – Srinagar and Anantnag – shows that 71 percent of the addicts share a needle/syringe and 69 percent of them re-use these.
For the lack of any surveys, Kashmir valley does not have an exact number of heroin users or for that matter even the overall number of drug addicts. At present, the survey by IMHANS is more or less the only one.
This survey has put the number of heroin addicts in Srinagar and Anantnag, with a population of roughly two million, at 16, 389. The survey was conducted in 2020, under the guidance of Dr Arshid Hussain, Professor of Psychiatry at IMHANS, an associated hospital of Government Medical College (GMC) Srinagar, by Dr Roub and his colleague Dr Yasir Rather.
All three of them – Hussain, Roub and Rather – are of the opinion that the numbers are way higher than this. And they point towards several indicators to support their argument.
One is the rising number of addicts who are seeking treatment. The numbers have been growing alarmingly at IMHANS. In 2016, the number of people who sought treatment for heroin addiction was 489, in 2017 the number rose to 3,622, then to 5,113 in 2019 and more than 7,400 in 2020.
“The numbers have fallen to 3,536 in 2021 owing to the pandemic and the subsequent lockdown,” Dr Roub says. “But that is not the point. The point is, there is a thumb rule: for every addict seeking treatment, there are 10 others who do not. This will give you an indication of how serious the numbers are.”
That, though, will need an extensive survey to establish. For now the numbers at IMHANS speak for themselves. There are other de-addiction facilities in Kashmir, run by the police, but they have either been closed due to the pandemic or are only running their OPDs.
The OPD at IMHANS is another clear indicator of not only heroin use but the rise in use of IV injections to use the drug. On a recent Monday OPD, Dr Roub says, he saw 40 heroin addicts of whom 38 of them injected the drug.
“The prevalence of injection use is way higher than in Punjab, where out of 50 patients not more than 20 turn out to be injection users,” he said.
Another indicator, Dr Rather tells Kashmir Reader, is the number of people registered for Opioid Substitution Therapy (OST) at IMHANS. OST puts a patient on a medical opioid, with almost no side effects.
“The growth of these numbers is staggering as well. Between 2012 and 2015, only 59 people were on OST. The numbers rose to 112 between 2016 and 2018, to 300 in 2019, and now we have 500 people on the OST list, despite the lockdown,” Dr Rather said.
Also, there has been a clear shift since 2018. Before 2018, doctors say, only two out of 10 addicts turned out to be on heroin. “Now, 9 or even all 10 of them are on heroin,” Dr Rather said.
It might be a long while before we get an exact figure. The indicators, though, are scary, and even scarier the fact that more than 40 percent of the heroin addicts are students, followed by a huge chunk of public transport drivers.
“There seems to be no pattern to the whole thing,” Dr Hussain told Kashmir Reader.
According to the IMHANS survey, over 57 percent of these addicts experience their first injection before the age of 20 and more than 87 percent continue with daily injections.
Dr Hussain has been among the first doctors in Kashmir to have worked on drug addiction and he sees two key differences in the levels of addiction ten years back and now.
One, he says, is obviously the substance. “Before 2015 there were hardly any heroin users in Kashmir. Cannabis, shoe polish, and correction fluids were used as drugs. Such addicts had really good treatment prognosis,” he said.
The second part, he says, was that the addicts had a dark past, affected by the violence in Kashmir, were from a particular socio-economic background, and had family issues.
“But now, there are no sob stories, no abuse history, and they are rarely affected by violence. Heroin has erased all demarcated lines apart from the fact that it has really poor treatment prognosis,” Dr Hussain said.
The case of the 12-year-old boy admitted at IMHANS corresponds to Dr Hussain’s analysis. The boy’s father and uncle are heroin addicts as well, with no history of abuse or exposure to violence. The boy was, however, introduced to heroin by another relative, who is also a peddler.
The family members just kept falling for the drug one by one, despite a sound economic background but not much of an education.
“But then there are educated ones as well, government officials, students, managers,” Dr Hussain said.
Apart from the economic burden heroin addiction is putting on families in Kashmir (an estimated 3.6 crore rupees is spent on heroin in Anantnag and Srinagar every day, as per the IMHANS study), this menace is also taking an ugly turn with rising infections of Hepatitis-C and Hepatitis-B.
To understand the situation better, Kashmir Reader talked to Dr Nisar Ahmad Shah, head of the Gastroenterology department at GMC Srinagar.
“The situation is woeful to say the least,” Dr Shah says. “I sometimes cry at the prayer rug when I go home in the evening. Young brilliant men fallen to addiction and now battling serious health issues like Hepatitis-C and B. I sometimes think I might go into depression watching all this day in and day out.”
Dr Shah’s facility, since January this year, has started Hepatitis-C treatment for more than 300 patients. 72 percent of these patients, he says, are heroin addicts.
“Let me rephrase that for you. 216 out of these 300 patients are Hepatitis-C positive,” Dr Shah said.
The highest number of patients, 84, visited the hospital in March. The numbers fell because of the lockdown. “Otherwise, the numbers would have been way higher,” Dr Shah said.
Kashmir already has pockets where prevalence of Hepatitis-C is more than 30 percent. Kokernag area in south Kashmir’s Anantnag district is one such place. Dr Shah says his team, on a field visit to the Kokernag area, found 63 people positive for Hepatitis-C out of the 200 they tested.
“We ran out of testing kits, or else the number might have been higher. We did not anticipate such high prevalence,” he said.
In 2014-15, 20 people died in two villages of Kokernag area due to Hepatitis-C complications, while more than 1,200 people had tested positive in this time span.
With such high prevalence of Hepatitis-C already, the south Kashmir district also has a substantial number of heroin addicts. “And these are all young people who go to the barber, are sexually active, and need regular treatment owing to their addiction as well,” Dr Hussain said, adding that these people often prefer private chemists for their regular treatments given the fact that they do not want to disclose their addiction at a hospital.
Malpractices like sharing of syringes and needles at these chemist shops are still prevalent in many parts of Kashmir.
Dr Hussain believes that with all these factors summed up, it can be safely assumed that Kashmir valley is sitting on a ticking Hepatitis-C bomb, where the distinction between addicts and non-addicts will be blurred altogether.
“The infection is going to spread like wildfire, the way I see things, at the hospital,” he said.
Also, Hepatitis-C is not the only cause of concern. There are drug addicts who are also testing positive for Hepatitis-B, a more lethal and incurable form of the infection.
At Dr Shah’s facility, 98 Hepatitis-B patients were registered this year. 12 of them were heroin addicts.
“The number is smaller probably because the addicts are young people and have been vaccinated for Hepatitis-B. But it is a matter of concern nevertheless, as this infection has no treatment and often causes liver cancer,” Dr Shah said.
He has his fingers crossed and says he fears the day when the numbers of Hepatitis-B infections rise. For Hepatitis-C there is a national treatment programme and it is free of cost.
Apart from these diseases, drug overdoses are fairly common in these addicts. As per the IMHANS survey, about 38 percent of these addicts have experienced one or more overdoses.
In many cases, these overdoses turn out to be fatal. Mudassir Aziz, a clinical psychologist and head of a de-addiction centre run by the police in Anantnag, told Kashmir Reader that she has witnessed more than 10 deaths owing to heroin overdose.
“And that in just a couple of years’ time,” she said.
Mental disorders, lung diseases, miscarriage, heart infections and a flurry of other health issues are attributed to heroin use as well.
The law-enforcing agencies in Kashmir every now and then confiscate a haul of heroin and it is touted as a “success” against “narco-terrorism” by the authorities.
Unfortunately, however, there are no tangible efforts to tackle the menace neither from the civil society nor from the authorities. In absence of such efforts, the prevalence of addiction will inevitably keep rising.

Suhail A Shah