Heroin ‘epidemic’ in Kashmir: Female patients’ lonely battles and stigma

Covering her face with the corner of her headscarf, Asma* was hesitant as she walked through the narrow corridors of a de-addiction center swarmed mostly by men of different age groups. 

The 22-year-old resident of Srinagar is among the very few women who visit the Institute of Mental Health and Neuro Sciences (IMHANS) to get rid of her heroin use disorder, or opioid use disorder (OUD). 

Asma visits IMHANS every few days to collect her prescribed medicines to deal with withdrawal symptoms, including extreme body ache, fever, chills, and nausea. In the past year, Asma has come a long way from deadly OUD to controlling the cravings and preventing the pain, commonly known in Kashmir as tode.

According to a report published by the United Nation, Drug Control Programme (UNDCP), Kashmir has nearly 70,000 substance abusers — 31 percent are women.

‘I was in heaven’

When she would heat the foil with a lighter, she rushed to inhale the melted heroin. Within minutes, everything felt euphoric — “as if I was in heaven”.

Asma, a 19-year-old back then, had shifted to Chandigarh, in Punjab, to work as a beautician in a salon. When she saw her roommate taking heroin for days, she resisted the urge to give it a shot. 

A few days later, Asma was introduced to a mutual friend, also a substance user. Before she could realize it, both of them convinced her to take the first-ever drag of heroin. 

“After doing the heroine for the first time, I slept for two days straight and woke up with a heavy head and nausea,” said Asma. “I had never experienced anything like that before.”

She couldn’t think about it for another month. But a brief argument later with her parents pushed her off the edge, she told The Kashmir Walla. Asma asked her friend for more. “I was really depressed. I decided to do it again,” she said.

The foil, the lighter, and the smoke continued for another year and a half. Soon, she said, her cravings grew out of smoke. So she switched to intravenous heroin use, locally known as tichoo. “I was doing tichoo around four times a day,” she said, which continued for another year and a half. 

After three years in Chandigarh, Asma moved back to Kashmir. Then the search for the substance started in the Valley. “I met a friend and he injected heroin in front of me. I was so happy, I asked him for tichoo,” she recalled. 

Since her OUD, nearly all of Asma’s earnings have gone into purchasing heroin from peddlers. “I used to buy it for around 4,000 rupees for just three days,” she said, adding that when she didn’t have money, she called her friends and lied to them and borrowed money. 

In Kashmir, she paid 500 rupees every day to her peddler friend for a little amount of heroin that she finished in two injections. “I couldn’t stay away from it anymore,” Asma said. 

Then she got into a relationship in 2020 and her life turned upside down. She knew he was the one — and decided to marry him. Known for her substance abuse, her husband has been motivating her to completely take her hands off it.

“I broke my sim card and ended all my contact with people who used to do it with me or peddled it to me. They would keep calling me, asking me for money or forcing me to do it again,” said Asma. “This would give rise to cravings.”

In the past year, she has lost more than 10 kilograms of weight and suffered a miscarriage. “I am worried that the treatment [to stay off from drugs] might affect the pregnancy,” said Asma. But she has been continuing with the treatment, hoping to move on in her life and conceive again. 

The euphoria

Last year, Yasir Rather, in charge of the drug de-addiction center of the IMHANS, was consulting a woman, who had started smoking cigarettes at a very young age soon after her parents’ divorce. 

A friend suggested to her that “a better way of getting rid of stress was to consume brown sugar”, a type of opioid. “She started chasing brown sugar. There was an immediate effect because of which she felt euphoric and her stress level decreased,” Rather recalled, adding that the stress made her more vulnerable to OUD.

The patient continued to use brown sugar in absence of her mother, who went out every day for work. And soon when even high doses of brown sugar failed to take away her stress and anxiety, her friend suggested she switch to intravenous heroin, said Rather. 

Within no time, since 2017 the patient became dependent on the intravenous heroin and continued it, whenever she was alone at home. “She had sold her father’s two cars and around 4,00,000 rupees to buy heroin,” said Rather. “Many girls who knew that she was economically well off used her for getting heroin. They would go to her house and they would do it together.”

Last year, when her mother suddenly entered her room, she found syringes and heroin on her bed. She confessed about years of substance use. “Her mother brought her to the hospital for treatment,” said Rather, adding that after a year of treatment, she has been able to stay away from all sorts of substances. “She tells me that now she understands what life actually is.” 

Rather said that cannabis or opioids are the most common form of drugs used in Kashmir, however, the trend has been shifting toward heroin. “Opium is locally available in Kashmir which can then be converted into heroin,” he said. 

The city’s Shri Maharaja Hari Singh (SMHS) hospital received 489 OUD patients in its Out Patient Department (OPD) from April 2016 to March 2017, reported The Kashmir Walla. It rose to 3,622 in the next year’s corresponding time and further spiked to 5,113 patients from April 2018 to March 2019.

In August 2019, when Kashmir was locked down after New Delhi abrogated the limited autonomy of the erstwhile state, the number of patients spiked to 7420 — more than double in two years — from April 2019 to March 2020.

But amidst the rise, Rather said that the stigma is keeping women in Kashmir away from treatment. 

As per records reviewed by The Kashmir Walla, the IMHANS has received more than 1,700 heroin patients since 2012 —only fourteen were female patients. Fozia Ashraf, data manager at Oral Substitution Therapy Center at IMHANS, told The Kashmir Walla that  “currently there are six female patients. Three of them are elderly who got OUD through medication. Rest of the three started substance use with their partners,” she said. 

During his interaction with women patients, Rather found out that the main reasons for substance use amongst women in Kashmir include relationships with men doing substance use. “When their boyfriends do it, then they also get hooked on it,” said Rather, adding that among other reasons include mental health issues. 

But for Asma, life has changed, as she said that there are no chances of her using heroin again. “It is all in your head. Once you convince yourself that you don’t want to do it, things get better for you.”

*Names of people have been changed to protect the identity of the source upon request. 

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Covering her face with the corner of her headscarf, Asma* was hesitant as she walked through the narrow corridors of a de-addiction center swarmed mostly by men of different age groups. 

The 22-year-old resident of Srinagar is among the very few women who visit the Institute of Mental Health and Neuro Sciences (IMHANS) to get rid of her heroin use disorder, or opioid use disorder (OUD). 

Asma visits IMHANS every few days to collect her prescribed medicines to deal with withdrawal symptoms, including extreme body ache, fever, chills, and nausea. In the past year, Asma has come a long way from deadly OUD to controlling the cravings and preventing the pain, commonly known in Kashmir as tode.

According to a report published by the United Nation, Drug Control Programme (UNDCP), Kashmir has nearly 70,000 substance abusers — 31 percent are women.

‘I was in heaven’

When she would heat the foil with a lighter, she rushed to inhale the melted heroin. Within minutes, everything felt euphoric — “as if I was in heaven”.

Asma, a 19-year-old back then, had shifted to Chandigarh, in Punjab, to work as a beautician in a salon. When she saw her roommate taking heroin for days, she resisted the urge to give it a shot. 

A few days later, Asma was introduced to a mutual friend, also a substance user. Before she could realize it, both of them convinced her to take the first-ever drag of heroin. 

“After doing the heroine for the first time, I slept for two days straight and woke up with a heavy head and nausea,” said Asma. “I had never experienced anything like that before.”

She couldn’t think about it for another month. But a brief argument later with her parents pushed her off the edge, she told The Kashmir Walla. Asma asked her friend for more. “I was really depressed. I decided to do it again,” she said.

The foil, the lighter, and the smoke continued for another year and a half. Soon, she said, her cravings grew out of smoke. So she switched to intravenous heroin use, locally known as tichoo. “I was doing tichoo around four times a day,” she said, which continued for another year and a half. 

After three years in Chandigarh, Asma moved back to Kashmir. Then the search for the substance started in the Valley. “I met a friend and he injected heroin in front of me. I was so happy, I asked him for tichoo,” she recalled. 

Since her OUD, nearly all of Asma’s earnings have gone into purchasing heroin from peddlers. “I used to buy it for around 4,000 rupees for just three days,” she said, adding that when she didn’t have money, she called her friends and lied to them and borrowed money. 

In Kashmir, she paid 500 rupees every day to her peddler friend for a little amount of heroin that she finished in two injections. “I couldn’t stay away from it anymore,” Asma said. 

Then she got into a relationship in 2020 and her life turned upside down. She knew he was the one — and decided to marry him. Known for her substance abuse, her husband has been motivating her to completely take her hands off it.

“I broke my sim card and ended all my contact with people who used to do it with me or peddled it to me. They would keep calling me, asking me for money or forcing me to do it again,” said Asma. “This would give rise to cravings.”

In the past year, she has lost more than 10 kilograms of weight and suffered a miscarriage. “I am worried that the treatment [to stay off from drugs] might affect the pregnancy,” said Asma. But she has been continuing with the treatment, hoping to move on in her life and conceive again. 

The euphoria

Last year, Yasir Rather, in charge of the drug de-addiction center of the IMHANS, was consulting a woman, who had started smoking cigarettes at a very young age soon after her parents’ divorce. 

A friend suggested to her that “a better way of getting rid of stress was to consume brown sugar”, a type of opioid. “She started chasing brown sugar. There was an immediate effect because of which she felt euphoric and her stress level decreased,” Rather recalled, adding that the stress made her more vulnerable to OUD.

The patient continued to use brown sugar in absence of her mother, who went out every day for work. And soon when even high doses of brown sugar failed to take away her stress and anxiety, her friend suggested she switch to intravenous heroin, said Rather. 

Within no time, since 2017 the patient became dependent on the intravenous heroin and continued it, whenever she was alone at home. “She had sold her father’s two cars and around 4,00,000 rupees to buy heroin,” said Rather. “Many girls who knew that she was economically well off used her for getting heroin. They would go to her house and they would do it together.”

Last year, when her mother suddenly entered her room, she found syringes and heroin on her bed. She confessed about years of substance use. “Her mother brought her to the hospital for treatment,” said Rather, adding that after a year of treatment, she has been able to stay away from all sorts of substances. “She tells me that now she understands what life actually is.” 

Rather said that cannabis or opioids are the most common form of drugs used in Kashmir, however, the trend has been shifting toward heroin. “Opium is locally available in Kashmir which can then be converted into heroin,” he said. 

The city’s Shri Maharaja Hari Singh (SMHS) hospital received 489 OUD patients in its Out Patient Department (OPD) from April 2016 to March 2017, reported The Kashmir Walla. It rose to 3,622 in the next year’s corresponding time and further spiked to 5,113 patients from April 2018 to March 2019.

In August 2019, when Kashmir was locked down after New Delhi abrogated the limited autonomy of the erstwhile state, the number of patients spiked to 7420 — more than double in two years — from April 2019 to March 2020.

But amidst the rise, Rather said that the stigma is keeping women in Kashmir away from treatment. 

As per records reviewed by The Kashmir Walla, the IMHANS has received more than 1,700 heroin patients since 2012 —only fourteen were female patients. Fozia Ashraf, data manager at Oral Substitution Therapy Center at IMHANS, told The Kashmir Walla that  “currently there are six female patients. Three of them are elderly who got OUD through medication. Rest of the three started substance use with their partners,” she said. 

During his interaction with women patients, Rather found out that the main reasons for substance use amongst women in Kashmir include relationships with men doing substance use. “When their boyfriends do it, then they also get hooked on it,” said Rather, adding that among other reasons include mental health issues. 

But for Asma, life has changed, as she said that there are no chances of her using heroin again. “It is all in your head. Once you convince yourself that you don’t want to do it, things get better for you.”

*Names of people have been changed to protect the identity of the source upon request.