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The Other Pandemic

Dr Sheena Shah & Aamir Ahmad Amin –

The year is 3,000 BC. Halfway across the world, an Inca warrior is foraging through the dense tropical undergrowth on the Andes looking for a peculiar little shrub – the coca plant. For him, the simple act of chewing its bitter leaves provides a near instantaneous relief from altitude sickness and many different types of pain. Back in the village, a herbal tea is being prepared by the local shaman from the remaining stock of coca leaves that shall rouse men up for battle against rival clans.

Little does he know, however, that several millennia down the line, a psychoactive alkaloid known as cocaine derived from his precious shrub will have entrapped around 7.5% of Kashmiri drug abusers in its unyielding clutches thousands of miles away, most of whom will have started between 11 to 20 years of age.

The phenomenon of substance abuse itself is not something new in our part of the world,
although indeed, the sheer number and variety of drugs available today is a worrisome reality. Entheogenic use of cannabis has been recorded in sacred texts throughout the Sub-continent. It has even been suggested that the “soma” drink cherished by Aryans and celebrated in the Vedas, was, in fact, derived from an invigorating mixture obtained from the poppy plant, ephedra and cannabis. Despite their predominant rejection in Islamic normativity, the use of opioids or hashish to achieve spiritual ecstasy continues unabated at certain Sufi shrines in Pakistan and India. As such, psychoactive substances obtained from plants have found widespread use and even acceptance to varying degrees in nearly all human cultures and civilizations.

Likewise, the valley of Kashmir too has partaken in the historicity of drug use and trafficking. Poppy and cannabis are ubiquitous in the temperate region and have been cultivated for centuries by farmers in the South as additional means of income. Local newspapers often report stories of spare tyres filled with poppy straws, polythene bags stuffed with charas and thousands of bottles of codeine being seized in towns and on the national highway. Heroin, gushing out of Afghanistan like the fountain at the base of Zero Bridge, has been confiscated in shocking quantities near the LoC at Uri in North Kashmir.

The alarming truth of ever-growing recreational drug use in Kashmir, nonetheless, poses a stark contrast against what seems to have been a far more dignified approach towards psychoactive agents in olden days. Indications were partly medicinal and partly spiritual, but there was never a widespread conscious practice of using intoxicants for the purpose of fun and excitement, save perhaps drinking alcohol which was, nonetheless, frowned upon and discouraged. Falling in close proximity to the eastern horn of the infamous ‘Golden Crescent’ of narcotics trade between Iran, Afghanistan and Pakistan did not play a significant role in the spread of drug abuse in Kashmir, the socio-cultural ethos in which had effectively steered the population away from a full-blown drug crisis.

However, stating that drug abuse is rampant in Kashmir today is hardly an overstatement. There is no dearth of avenues or of people who wish to seek them out. Epidemiological surveys have shown that a typical “menu” for a young Kashmiri drug abuser, depending on the size of his or her pockets, ranges from easily available correction pens, dyes, paints and inhalants to full blown prescription drugs like amphetamines, benzodiazepines and barbiturates, as well as cannabis with its many forms and derivatives. Smoking, vaping, drinking, injecting, inhaling and other routes involving less conventional orifices are all practiced and explored locally. Furthermore, Kashmiris who travel to the rest of India and abroad for work have easier access to drugs and a plethora of choices available, given how easily the culture of substance abuse has creeped into the corporate world.

Among students living away from their families, a typical weekend in a college hostel at night is a sight worth seeing – card games, uproarious laughter and smoke billowing out of windows. For those who choose to exercise caution, the act is limited to more careful trysts with “bagging”, “sniffing” and “puffing” in the shadows, but is always a shared experience.

According to an epidemiological study conducted by the Department of Community Medicine (SKIMS) and the Department of Psychiatry (GMC) in 2013, the aim of which was to find out the prevalence and pattern of substance abuse, and its association with various socio-cultural and demographic variables among college students in Kashmir, it was revealed – not surprisingly so – that the most common causes for the initiation of drug use were failure in love affair (29.2%), peer group pressure (26.3 %), family discord (20.6%), curiosity of drugs (11.8%), present turmoil in the Valley (7.6%) and failure in academics (9.3%). Moreover, the primary sources of these substances were local grocery shops (52.6%) and friends (29.7%). This can be explained by the fact that tobacco and alcohol were also included among the substances mapped under this study. Nonetheless, the overall prevalence of substance abuse among college students was found to be a whopping 31.3%. It is plausible to think that, by now, the situation has only worsened following year after year of incessant conflict in the Valley. Furthermore, during the COVID-19 pandemic, the children for whom daily school was a means of escaping instability and abuse at home have been left hopelessly trapped and unprotected against the trauma which often leads to substance abuse.

As such, a decade or two down the line, the health setup in Kashmir is bound to deal with not only a barrage of problems that come with an increasingly zonked out younger generation, but also of health complications arising in people whose youthful indulgences will bear fruits in their middle and old age – superadding to an already exhausted and overburdened sector – poor physical health, poor finance, declined work performance, problems with family relationships and emotional problems being some of them.

All that can be done to halt the unrelenting march of drug abuse is, admittedly, as obvious as it is difficult. The key concept, however, is prevention at all levels. Facing the brunt of constant provocation and bombardment of stimuli from a world that seeks to normalize, glamorize and even glorify substance abuse as well as reckless behaviour, youngsters should be the main target of most activities aimed at reigning in the drug monster under control. The challenges in Kashmir are stupendous and manifold considering the decades of fleeting peace and political disturbance. Therefore, any model for battling drug addiction which is exported from a relatively stable, developed country needs thorough scrutinizing and modification based on the local requirements following meticulous research, prioritization and gap analysis, which is not possible without support from established government institutions.

It is a tragedy that Kashmir does not have a single functional self-help community like Alcoholics Anonymous or Narcotics Anonymous, that have been known to successfully rehabilitate even the most persistent abusers worldwide. The delay in government action and support continues to extinguish the flame of optimism that has been ignited by the work carried out by its own institutions such as the Institute of Mental Health and Neuroscience (IMHANS) and the Government Psychiatric Diseases Hospital, Kashmir. Social stigma, boycott and ignorance which ruthlessly strip drug abusers of their dignity and self-respect must be combated with sensitization and education. Substance abusers should be met with care and compassion – not stigmatizing behaviour and rebuke.

We all know someone who is involved in recreational drug use – perhaps a loved one or an acquaintance – and that person is not necessarily a bad human being, but rather someone who is and will be in need of our help sooner or later.

(Dr. Sheena Shah is post-graduate fellow at Govt. Psychiatric Diseases Hospital, Kashmir and Aamir Ahmad Amin is a final year medical student at Khwaja Yunus Ali Medical College)