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Substance Abuse: Kashmir sitting atop a volcano

Post by on Friday, July 16, 2021

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Substance use disorder is a multi-dimensional problem with social, economical, psychiatric, and legal perspectives. Issues related to substance use are on the rise and are becoming one of the common emergencies in hospitals. The age of onset of these problems is around adolescence which is the most productive age period, and the enduring and relapsing nature of the disease makes things worse. The youth essentially are rendered inactive, incapable, and indolent. 
Substance use comes with stories of emotional trauma and abuse, shame and guilt, humiliation and mortification, and a frequent threat of violence and separation that destroys families. It has also been shown to be associated with economic burden, emotional burden, relationship distress, family instability, parental disharmony. It also impacts a person’s ability to lead an organized life and may lead to housing instability, homelessness, criminality, and unemployment. 
Scientific data based on community surveys on drug use-related problems in Kashmir indicates an epidemic nature of the problem. Use as high as 3.8 percent has been reported amongst adult males. 
Death directly due to overdoses, cardiac arrests, seizures, and indirectly due to road traffic accidents as a result of substance use are occurring from time to time as is evident from hospital data and views/ mainstream media portals.
Deaths due to suicide have also seen a steep rise and patients with substance use are at particular risk of attempting suicide or dying from it. The geographical location of Kashmir makes easy transit of drugs possible which also contributes to the rising use of substances. Other factors that contribute to the substance use problem in Kashmir include the region being conflict-ridden and unemployment.
Many studies that have been conducted over the last 3 years have consistently shown a rising trend of substance use despite the presence of hartals, curfews, and lockdowns.
Studies have shown an alarming rise of all kinds of substances, especially opioids. Studies are also indicative of a changing trend from medicinal opioids such as SP tablets, codeine to more potent opioids such as heroin.
Lately, there has also been a steep and a significant rise in intravenous use of heroin leading to frequent overdoses; medical complications endocarditis, lung infections such as pneumonia; local complications such as abscess,  cellulitis and also a high risk of blood-borne infections such as Hepatitis B virus, Hepatitis C virus and HIVN and the major contribution to the global burden of disease due to infection by these blood-borne viruses is by Injection drug users.  
Presenting the data from our hospital, a study was conducted at GPDH between 1980-1988 which had only 189 patients registered with cannabis as the most prominent substance.
Further studies which were conducted around the 2000s showed a rise in the use of medicinal opioids in the form of SP tablets and codeine as well as cannabis. 
The national survey conducted by AIIMS in 2019 showed a prevalence of opioid dependence of 1.5 percent with at least 26000 active injection drug users in Jammu and Kasmir, the number being quite distressing and the year 2020 was no exception to the rise.
A study conducted by Dr.Yasir et.al showed at least 57 percent of users started the use of opioids at/ before 20 years of age with 37.7 percent of users having a history of overdose.  
Needle sharing and re-using the same needle which leads to most of the complications associated with opioid use was found in around 70 percent of users indicating the need for education and awareness amongst the users.
The recent rising incidence of sudden deaths due to unknown causes which is usually attributed to heart attack might be linked to drug overdoses considering the circumstances of such deaths.
Hospital statistics speak of the same story with a rise in treatment-seeking among substance users. While only 486 patients had come forward for treatment in 2016, as high as 9000 people were registered in drug de-addiction facility available at IMHANS-K  
The pattern of substance use among the patients who visited the drug de-addiction OPD  during the Covid times showed that the most common substance used as an opioid (94.38 %) and the most common route of administration was via intravenous injection ( 79.5 %). 36 % of the substance users started substance use/ relapsed during the lockdown and the most common reason contributing to it being peer pressure. 
Overall the downward trend in substance use was seen due to decreased availability of drugs during the lockdown.  
As the situation here in Kashmir is turning ugly with the passage of time, the onus lies with the police, government, psychiatrists as well as the whole community ( teachers, local preachers) to come forward and actively find ways to tackle the situation.  
The most concerning thing amid the rising substance use is the illegal trafficking and sale of drugs in our region. The police need to efficiently work against this menace. 
The government needs to set up more drug de-addiction centers and rehabilitation centers in the valley. The people in the community (teachers, preachers) should encourage the substance users to avail the drug de-addiction facilities.
Drug abuse scenario encompasses not just youth taking illicit drugs but it also is leading to untimely deaths, chronic illnesses, it’s taking youth not towards growth but towards disaster- this scenario looks like a volcano and we are sitting on it- ignoring its presence.

Dr Yasir Rather
Prof & Incharge of De-Addiction Center Department of Psychiatry, IMHANS, GMC Srinagar
Dr Ubaid Rasool, Registrar, Department of Psychiatry, IMHANS, GMC Srinagar

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