Nine years ago, a friend made Altaf Ahmed*, then 20 years old, drink a concoction of opioid-based analgesics and carbonated drinks. “After half an hour I started enjoying the effects of this syrup,” he said, recalling what led him to drug addiction. 

Mr. Ahmed was instantly hooked on the drug and began consuming 18 bottles of codeine phosphates every day. It was not long after this that he saw his friend injecting drugs as well. “He [the friend] used to mix doses of diazepam and pheniramine maleate with [buprenorphine] to make a 6 ml dose,” he said. 

For days Mr. Ahmed, 29, watched his friend inject the drugs for days. “He looked so relaxed after taking the drugs. I had resisted for a few days but he forced me,” he said. 

After succumbing to the peer pressure to drink the concoction, Mr. Ahmed was now injecting drugs, his dependence on the injected drugs had increased to the point he just could not miss his fix, even if syringes were not available. “Eventually, I used the same needle that he [the friend] had used.”

At that time, Mr. Ahmed was oblivious to the risks of sharing needles that had become a norm for him.

Pandora’s box of diseases

Within a few months, after he had begun sharing needles, Mr. Ahmed started fast losing weight and his strength. “My weight was 76 kgs in the first year of college” when he dropped out owing to his drug addiction, he said. “Then I lost weight, I weighed 47 kgs.”

The sudden loss of weight and visible signs of illness had made Mr. Ahmed anxious for the first time since he started taking drugs. “I wanted to get myself treated so I went to see a gastroenterologist,” he said, adding that the doctor recommended that he get tested for Hepatitis and HIV.

It turned out that Mr. Ahmed had contracted Hepatitis C, a disease that affects the liver among other parts of the body, by sharing needles. However, Mr. Ahmed was also trapped. Unable to afford the treatment that cost about 30,000 rupees, he had continued to inject the comparatively cheaper drugs.

Now fully aware of the risks, Mr. Ahmed still continued injecting drugs from shared syringes till one day when he could not move his legs. He was once again rushed to the hospital, where he now tested positive for the human immunodeficiency virus, or HIV. “I was HIV-1 and HIV-2 positive,” he said, adding that doctors could not begin treatment till he was weaned off the drugs. “The doctor gave me oral substitute tablets to get rid of intravenous substance abuse.”

The realization of having pushed himself into a grave situation that could have been avoided led Mr. Ahmed to develop anxiety disorders–he began to feel restless, shivered uncontrollably, and lost hope that he could afford treatment. “I used to self-harm. I consumed alprazolam tablets after being diagnosed with HIV. I consumed around 100 tablets [in a day],” he said. “I used to wake up in hospitals after 2 days.”

Now under treatment at the Institute of Mental Health and Neuro Sciences, Mr. Ahmed said that he regretted his drug addiction, which eventually became the reason for him suffering from other diseases. “I feel at risk every day, I regret my decisions,” he said.

Sharing is not caring

Senior Medical Officer at the Anti-Retroviral Centre at Kashmir’s premier healthcare institution, the Sher-i-Kashmir Institute of Medical Sciences, Dr. Mohammad Lateef Charoo said that the problem complicates when individuals with drug addiction share the same needle. 

“Diseases like HIV, Hepatitis C, and Hepatitis B get transferred to drug abusers only after taking [intravenous] drugs because the blood of one person comes directly in contact with the blood of another person,” said Dr. Charoo.

The center provides free treatment to HIV-AIDs patients at SKIMS but Dr. Charoo said that it was difficult to convince individuals with drug addiction to get tested. “We have hardly been able to screen 30 per cent of people from a few areas till now,” he said of the efforts to trace individuals with drug addiction. He added that most of those who were tested hailed from south Kashmir’s Shopian district.

Dr. Charoo believes that the reasons are “not as important as the fact” that those who have contracted HIV must be treated immediately. “I recently received two patients, they were brothers and both of them were drug abusers who died at an early age (23 and 27) because they did not listen to us,” he said. “They took the treatment very lightly.”

The sharing of needles is no longer an isolated concern in Kashmir. Recent pilot research by the researchers at the IMHANS on the risks of diseases arising out of sharing needles examined 300 individuals with drug addiction in the Srinagar and Anantnag districts of Kashmir Valley. The researchers concluded that 2 percent of both districts’ populations were involved in substance abuse. 

Dr. Yasir Rather, in-charge of the drug de-addiction center of the IMHANS and part of the research, said that the team had used the Benchmark Multiplier Method to arrive at the figure of 2 percent. “In this process, we identified seeds,” he said, referring to individuals confirmed to have drug addiction as “seeds” who later “recruit” more into substance abuse. “One seed would at least bring forward three to four more seeds. Hence, there is chain formation.”

According to the study, out of the 2 percent, about 1.8 percent were opioid users which means that at least 17000 people consumed opioids in Srinagar and Anantnag. Nearly half, more precisely 45 percent, of these 17000 opioid users injected the drugs.

The researchers further found that 91 percent of these individuals injected heroin into blood veins. “Most of them were doing it in pairs. Around 69% of them had a history of reusing needles and 71% had a history of sharing needles,” says Dr. Rather. “This revelation is very disturbing because taking intravenous drugs is a very dangerous trend of using drugs. It can be very lethal.”

Hepatitis C on the rise

Yousuf Khan* began taking drugs about 10 years ago when he was “forced” by his friend to consume spasmo proxyvon and codeine, both opioids. “I started taking drugs just for fun but then the addiction increased because I had understanding issues with my father,” says Mr. Khan, now 36. “I was really depressed.”

Three years ago Mr. Khan, a resident of north Kashmir’s Sopore, had begun consuming heroin. “When I started taking drugs [intravenously], I already knew about its side effects,” he said. “I couldn’t avoid the things which I knew were wrong because my mind was totally involved in it.”

Mr. Khan continued injecting drugs with his friends even when they were short of heroin supplies. “One day, my friends and I were sitting together and we didn’t have enough heroin,” he recalled having shared small amounts between his group of friends. “That is how we shared needles.”

Sometime after this had begun, Mr. Khan noticed his eyes had turned yellow and consulted a doctor who recommended tests for Hepatitis C. “The results showed that I was positive,” recalled Mr. Khan. “Then I did other tests also, and I came positive every time. The doctor said that the range was really high but I didn’t need to be scared because medicines could treat me.”

Just like Mr. Ahmed’s case, Mr. Khan also suffered from loss of appetite, weight, and strength. “I lost a lot of weight. I never even once had lunch in these 3 years. I never felt hungry,” he said adding that this was when his family had discovered his problem of drug addiction and forced him to seek medical help to get rid of it.

Now, on treatment for the past three years, Mr. Khan said the journey has been traumatic. “I cut my nerve the first time my family got to know about me,” he said. “I wanted drugs so bad and they were stopping me from taking drugs.”

Mr. Khan has, however, come a long way since then. Sitting in the doctor’s room at the drug rehabilitation in IMHANS, his face has visible signs of satisfaction as he spoke of the progress in his recovery. “ I am currently only taking Addnok 2mg but this might be the last day,” he said, with a smile. “After this, I will no more be a drug abuser.”

Dr. Zafar Ali Wani, a gastroenterologist at the Super Speciality Hospital in Srinagar, believes that individuals with drug addiction mostly share syringes because of the lack of awareness and shortage of money. In some cases, he said, the sharing of needles also spread the deadly Hepatitis B disease.

“Up to 2017 drug abuse was not that common but after 2018, drug abuse increased and drug abuse associated with Hepatitis C increased as well,” said Dr. Wani, from his personal experience of treating three to four Hepatitis C patients every week. “Since 2020, we have been receiving maximum patients who have hepatitis C because of drug abuse.”

*Names changed upon request

The story originally appeared in our 27 July – 2 August 2020 print edition.