Srinagar: Still in her college uniform, N got down from a sumo taxi and put on a mask before entering Kashmir’s state-run de-addiction facility in Srinagar. The 21-year-old college student said she will always remember it as the place where people hemmed her in and asked her about the medicines in the brown paper bag she was carrying.
That happened in 2022, close to the drug de-addiction centre of the Shri Maharaja Hari Singh (SMHS) hospital, a multi-speciality hospital in Srinagar, where the 21-year-old college student has been going for treatment for heroin addiction since last year.
“It was my worst nightmare come true," said N. “Middle-aged men and women ganged up on me as soon as they saw me coming out of the building. They shouted at me and demanded I tell them why I was there. I lied that the medicines were for my brother.”
Had it not been for the excruciating withdrawal symptoms after she stopped using heroin, N said she wouldn’t have risked going there again.
While experts have been issuing ever more dire warnings about the escalating drug crisis in the Kashmir valley, a conflict zone which has experienced violence, bloodshed and tragic loss of life in the past three decades, women drug users are ostracised.
Much like in many other parts of India, they are called debauched women or badmaash kori/badmaash zanaan, who corrupt the moral fabric of society in the valley, which is mostly Muslim. They cannot access institutional care.
A Crisis Of Drugs
Official data shared by the ministry of social justice and empowerment in parliament, as per new reports from 29 March 2023, said that over 1 million in a population of over 14 million in Jammu and Kashmir were involved in substance abuse (one out of 14 people in the union territory).
This number is higher than the February 2019 report by the National Drug Dependence Treatment Centre of the All-India Institute of Medical Sciences, which said that over 600,000 people in J&K were involved in substance abuse.
A study by the Government Medical College’s psychiatry department based in Srinagar, Prevalence and Pattern of Substance Use in 10 districts of Kashmir, as per media reports published in December 2022, said that Kashmir had surpassed Punjab and ranked second in the scale of substance abuse in India, just behind all the northeastern states combined. A survey from 2019 by AIIMS said that 1.2% of Punjab’s population were drug abusers.
The study said that 67,468 individuals had a dependence pattern on psychoactive substances; among them, 5204 individuals were opioid dependent, and heroin was a predominant drug used by them. The overall prevalence of substance use was 2.87%, while for any opioid was 2.23%.
Data from SMHS in April 2023 said that over 44,000 drug addicts visited Srinagar’s SMHS hospital for rehabilitation treatment.
“These patients were predominantly men. The number of women seeking treatment is still very low,” Yasir Rather, in charge of the drug de-addiction centre, told Article 14.
Rather said that about a dozen women addicts come again and again for consultations, but the number of consultations was not representative of the number of women who needed treatment.
“Most consultations are follow-ups,” said Rather in a conversation on 15 April.
Data from the ministry of social justice and empowerment in the Lok Sabha, as per news reports from 28 March 2023, said that in J&K, 36,000 women consume cannabis, 8,000 are addicted to opioids such as heroin, opium as well as pharmaceutical opioids like Codeine, Tramadol, Spasmoproxyvon and Tapentadol, and sedative addiction is prevalent among over 8,000 women.
The data said 5.34 lakh men were addicted to opioids.
Javaid Jeelani, a counsellor who has been working for 11 years at the Institute of Mental Health and Neuroscience (IMHANS), a state facility in Srinagar, asked why the survey numbers aren’t reflecting on the ground.
“Where are these women?” said Jeelani. “Opioid withdrawals are excruciating. Are no women interested in seeking treatment?”
The average monthly expense of heroin procurement by every person who used it was Rs 90,000, as per the Government Medical College’s psychiatry department.
Women can get trapped in a cycle where they have to give "sexual favours” in exchange for drugs or money, a male drug addict seeking treatment in Srinagar said.
"Young women often get trapped in a vicious and vulnerable cycle of sexual abuse as they rely on male acquaintances to procure drugs", said Arjuman Fayaz, a psychiatry PG resident with the Government Medical College, whose research focuses on women substance abusers in Kashmir.
Kashmir witnessed a spike of 24% in attempts to suicide from 2020 to 2021, according to the J&K Crime Gazette 2021. While there were 586 attempted suicide cases in 2021, the number was 472 in 2020.
Women comprised about 70% of the 10,000 callers at the Tele MANAS centre at IMHANS, a 24/7 tele-counselling facility for mental health, which was launched in Kashmir on 4th November 2022 under the union government's Tele mental health assistance and networking across states initiative announced during union budget 2022.
Anti-drug awareness programmes have been conducted in various schools and colleges across Kashmir. Some have been conducted in women's schools and colleges as well.
How It Started
N said her first encounter with heroin was with her boyfriend in 2020 when she was starting college.
“I had never even heard of heroin before. It is he who convinced me to try it,” said N.
After they broke up, N said she had intense cravings but no money or contacts to procure heroin. It had become increasingly difficult for her to function. She was restless, and it was difficult for her to hide from her family, which she called middle class.
“Around that time, I would rarely go to college and lock myself inside my room,” she said.
N found a group of women students with a “reputation” for doing drugs and made friends with them, hoping to procure heroin, but found out they only did “soft drugs” like hash, marijuana, sleeping pills and sedatives.
Most women users she knew had tried drugs for the first time with a man they knew and then showed other women. Eventually, it was a man who helped her get heroin again.
N said many of her new college friends—those with the “reputation”—started using heroin after she tried it.
“My ex-boyfriend had taught me to inject heroin directly into my veins. I did not know better and taught my friends too,” said N.
To conceal their addiction from their parents, N said that she went with friends who started bunking college and going to isolated places where they would pass the time while doing drugs and getting sober before going home.
“We did not want to draw our parent’s attention. They would have disowned us,” said N. “Not all women take drugs recreationally. Most are struggling in some way.”
N said that her friend, who was from a rich family, faced a lot of conflict at home.
“Her parents are separated. They send her money, but emotionally she’s neglected,” said N. “Even by society’s standards, she’s not a ‘bad woman’. If you see her report card, you wouldn’t believe she’s taking drugs.”
N said that she did not see her friend stopping.
“She’s in it till her family issues resolve or she stops getting affected by them,” she said.
In 2022, N decided to stop when it became impossible to hide the effect the heroin was having on her. She had severe backaches and would vomit often.
“I told my parents that I was depressed," she said. “They believed me, thinking it was a phase and I would outgrow it.”
Around the same time, N had also run out of money. She did not tell Article 14 how she got the money after her boyfriend stopped paying for it.
“I was left with no option but to seek professional help. So, I have been coming here, but my parents still do not know,” she said.
Her Treatment
N is on OAT (Opioid Agonist Treatment), for which she needs to collect medicines weekly or biweekly.
The treatment and medicines are free at SMHS and IMHANS.
N, who always wears a mask to conceal her identity, goes to the de-addiction centre in Srinagar on her own. It helps that the centre is located near the accidents and emergency wing of the SMHS, one of the largest tertiary care hospitals in Kashmir, where things are always chaotic.
“People assume you are going for general ailments,” said N. “Since I’m always alone, as soon as I enter the compound and move towards the psychiatry wing, I always feel people’s eyes following me.”
“Though, my experience with doctors here has been positive," she said. “I only feel uncomfortable waiting for consultation alongside male addicts.”
In addition to SMHS, N has to go to IMHANS in Rainawari, where she’s given medicines from the opioid treatment facility.
Some of the most commonly used medications for OST include methadone and buprenorphine—which are long-acting opioids and must be taken under medical supervision. Given that these medicines can be misused, there are strict stock dispensing and consumption rules.
N said that she has to go every week to get the medicines.
While she is keeping up with her treatment, N said she felt bleak about the future.
“At college, I was notorious as a drug addict. Some of my classmates would consciously avoid me. My old friends were scared of being seen with me,” she said.
N feared that she would forever have to live as a woman branded a drug addict.
“I can be drug-free, but my reputation will never be.”
Going Untreated
The 2016 Guidelines on Drug Prevention and Treatment for Girls and Women by the United Nations Office on Drugs and Crime said that women-centred treatment programmes achieve better treatment outcomes. Research (here and here) done in India's context said that women addicts prefer women-only integrated health services, women-only detoxification and rehabilitation services.
India has only four drug de-addiction centres exclusively for women—none in J&K.
Information given on 20 December 2022 by the minister for social justice and empowerment, A. Narayanaswamy, in Lok Sabha, said that India has only four separate drug de-addiction centres for women; two in Manipur and one each in Mizoram and Karnataka.
“Women who consume drugs often fear double stigma at the government-run facilities and have privacy concerns,” said clinical psychologist Mohd Muzaffar Khan, who runs a private de-addiction centre in Srinagar. “Their families do not want anyone to know.”
J&K's comprehensive drug de-addiction policy from 4 January 2019 does not prioritise gender-sensitive treatments, Article 14 found. Barring its recognition of the impact of drug abuse on women, its 4A’s strategy—awareness, restricting the availability of drugs, increasing affordability and accessibility to treatment programmes—makes no explicit mention of women-centred treatment. While the policy draft highlights separate wards and toilets for women in the infrastructure of existing drug de-addiction facilities, it does not go beyond it.
In AAGHAZ, the private de-addiction centre run by Muzaffar, approximately 57 men have been admitted in the past six months.
Of the six women who came to AAGHAZ for treatment since 2022—all addicted to heroin—three were admitted, and three were turned away and referred to in-patient facilities of government de-addiction centres.
This year, the management decided to stop more female admissions.
The management realised that women patients had different requirements which they couldn't provide, said Muzaffar. They felt that their centre needed to be more gender-sensitive. Since that wasn't the case, they stopped admitting women.
Fayaz, the psychiatry PG resident, said the progress has been protracted. While she’s tracking all new consultations and admissions of women seeking treatment, the list is barely increasing.
The 12 cases of women addicts referred to Arjuman for her research had women from different situations: rural and urban, single and married, literate and illiterate. Most women had started very young and were in the 16-28 years age bracket.
“A striking trend in all the cases of women addicts that I studied was that the initiation to drugs was due to personality disorders or instances of past trauma”, she said.
Arshid Hussain, a psychiatrist and professor at IMHANS, was visibly worried about the influx of “depressed mothers”—mothers whose sons were involved in or have lost their lives to substance abuse.
“The most worried women in Kashmir are mothers”, he said.
‘No One Comes To See Her’
Two beds were occupied in the women's ward of the drug de-addiction centre in Srinagar.
One of them by M, a 28-year-old heroin addict, and the other by her children, whom she has no choice but to take along to the centre because her husband and in-laws don’t want to take responsibility for them.
The message is that “immoral women” deserve no support.
When she first started using heroin, M never imagined that it would come to define her.
Happily married at 24, M’s life turned when her husband was booked under the Public Safety Act, 1978, a draconian preventive detention law widely deployed in the restive valley.
Following her husband’s incarceration in 2020, M got no financial help or emotional support from her in-laws or parents. After trying to care for her children, I was overcome with despair and found a temporary escape by having heroin.
Doctors said married women often sell off their gold, and many turn to peddling drugs to pay for their addiction.
Even though M’s husband came home in 2020, she struggled with her addiction and then found her own way to the de-addiction centre.
There was no creche facility at the hospital for her children, who stayed with her in the women’s ward when no one was there to care for them at home. They leave for school from there as well.
“No one comes to see her,” said the staffer. “Women lose support and respect very easily in our society. Addicts are deemed to deserve none.”
‘I Took Heroin To Feel Better’
At a private drug de addiction centre in Srinagar, T, 23, waited outside a counsellor’s chamber.
Her fear was palpable from behind her mask. Her replies were blunt.
“I had family issues. So, I took heroin to feel better,” she said.
T, who travels 70 km from Kulgam to Srinagar, has relapsed many times since she started treatment in September 2022.
“We cannot admit female patients any more. So, she has to come here every few weeks. Unfortunately, she relapses easily, and all previous efforts are sabotaged,” a doctor said, speaking anonymously.
T, who is unmarried, said that when her brother-in-law told her to help him deal heroin, she took the deal because she had to care for her ageing parents and elder sister.
“He offered me heroin and told me it would help me feel better,” she said.
As her family learned of her addiction, they convinced her to seek treatment, but she kept peddling because her family needed money.
“With easy availability, it is hard to keep away. Even if I try to quit, my brother-in-law coerces me back into taking it,” she said.
Three women were seeking treatment for heroin addiction at this private centre.
All three were unmarried.
“Women addicts are often manipulative in their answers for fear of being penalised,” said a doctor. “At every subsequent consultation, their story changes.”
“We read them between the lines,” the doctor said.
Married To An Addict
S*, a housewife from the Harwan area of Srinagar, lives alone with her young daughter. Her husband, a drug addict, used to hit her.
Initially, her family advised against filing a case against her husband due to stringent anti-narcotics laws and preventive detention laws reportedly being used against drug peddlers in Kashmir.
However, when S’s husband refused treatment, and the abuse kept increasing, she had no other option.
“I did not report him to the police for hitting me,” said S. “I wanted him to stop taking drugs.”.
“Initially, I wanted to leave him, but where would I go without security? I did not want to become a liability to my brother. He has his own family to take care of,” she said.
Her husband now languishes in jail, but her worries are far from over.
“My husband has squandered off all our money. He even sold off my jewellery to buy drugs,” said S. “I can’t get a job as I am uneducated. How will I take care of my daughter?”
(Tooba Towfiq is an independent journalist and researcher based in Kashmir.)
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