Drugs are not cheap, but the COVID-19 lockdown has made them particularly expensive. “One gram of heroin would cost me 1,500 rupees,” said an engineer in his thirties, who is based in Srinagar. “Now I can get it only at 5,000 rupees.”
He finds it impossible to work sober. His back and legs ache if he doesn’t take the opiate drug, and he feels constantly jittery. Even with his monthly salary of upwards of 1 lakh rupees, it is difficult to keep up with these prices. “A single day’s use was costing me 18,000 rupee,” he said.
Though he has been addicted to heroin for years, through curfews and shutdowns that are characteristic of Kashmir, two months ago, he finally paid a visit to the Institute of Mental Health and Neurosciences (IMHANS), the government-run psychiatric hospital in Srinagar.
The 30-year-old is still among the more fortunate. In the lockdown, at least two men under the age of forty have died in Kashmir due to heart attacks. They were, in all likelihood, triggered by an abrupt withdrawal from drugs or subsequent relapse, said Zubair Rashid, president of Cause, a non-profit based in Srinagar that connects people with addiction to psychiatrists.
“Addicts have always had contacts through which they are able to buy drugs,” he said. “But supply itself has been hit because manufacturing levels—especially of medicinal opioids—have decreased in the [COVID-19] lockdown.”
The engineer has been visiting along with his friend, a government employee who also struggles with heroin addiction. Both complain that their prescription is too weak and they need stronger medical drugs to fight the withdrawal.
Being forced to suddenly stop consuming drugs without medical supervision can lead to vomiting, diarrhoea, seizures, delirium, and cardiac arrest, apart from a host of mental health issues. Mr. Rashid said he has received multiple calls from family members of people with addiction who have grown increasingly violent while staying at home during the lockdown.
Since the drugs are also not completely off the market, dangers of relapse remain. When people stop using a drug cold turkey, an abrupt cessation of a substance dependency, their tolerance goes down drastically. If they relapse, they are at a greater risk of overdose because they are unaware that their body’s tolerance for the substance is not as high as earlier.
All rehabilitation clinics in Kashmir were shut down amid the pandemic with the abrupt nationwide lockdown on 25 March.
Such facilities had anyway been inadequate: with twenty-five beds, the drug de-addiction centre at the government-run Shri Maharaja Hari Singh Hospital (SMHS) is the only full-fledged rehabilitation clinic with a round-the-clock presence of psychiatrists and social workers in Kashmir. Apart from this, five-bed rehabs are also run out of the government medical colleges in Anantnag and Baramulla, and the police run two de-addiction facilities while the army funds another one.
Not only are these all shut down amid the pandemic, but many government-employed psychiatrists are also not seeing patients as the public hospitals out of which they practise have been focussed on testing and treating COVID-19 patients, including the SMHS. The de-addiction centre at the hospital, for instance, is now being used as a respiratory clinic.
With all the de-addiction centres shut, Dr. Yasir Rather, a psychiatrist at the IMHANS, admitted a few severely addicted patients to the general psychiatry ward of the hospital, alongside patients of other mental health disorders, including depression. Since the rehabilitation centre at the SMHS remains shut for the foreseeable future, the IMHANS has now created a separate makeshift drug de-addiction ward on its own premises.
While only a few psychiatrists are offering phone consultations, IMHANS is also the only government-run facility where people with addiction in Srinagar can consult with a medical professional in person. Wherein the access to drugs has dried up, people with addiction have been increasingly turning to medical professionals to help cope with withdrawal. “The number of patients has definitely risen in the lockdown,” said Dr. Rather.
Another reason behind the rise is that, locked indoors, people with addiction are now under a constant watch of their family members: it makes it difficult to conceal their disorder, especially when they begin exhibiting strong symptoms of withdrawal, said Dr. Rather.
Earlier, marijuana used to be the most common drug in the Valley, but over the past five years, there has been a sharp rise in heroin consumption, which has now emerged as the most common substance abuse case among his patients, said Dr. Rather.
The hospital records at the SMHS, reportedly, noted a sharp increase in the in-flow of heroin addicts. From 489 patients in Out Patients Department (OPD) between April 2016 and March 2017 it rose to 5,113 in April 2018 to March 2019.
Kashmir also falls close to the Golden Crescent, Asia’s most prominent region of opium production which spans Afghanistan, Iran, and Pakistan. The Valley is part of the route for drug trafficking into other Indian states.
Nearly every week, the police destroy poppy cultivation in one or the other part of Kashmir. Last month, the Jammu and Kashmir police was also given sanction to create a separate anti-narcotics task force with a hundred officials.
For now, like all economic activity, even the drug trade has been hampered due to the lockdown. In what Dr. Rather calls “a blessing in disguise”, this has induced people with addiction to seek the medical help that they needed all along.
This story originally appeared in our 8-14 June 2020 print edition.