Srinagar: For the past 10 years, since he was 16, Shabir has been taking a daily cocktail of medical opiates, tranquillizers and anti-anxiety drugs. He rattles off their names with the speed of familiarity, “two or three pills a day of Alprax (a tranquillizer used to treat anxiety disorders) Codeine, Spasmo (spasmorelax—to control muscle spasms, agitation and seizures) and others."

Story in numbers: Muzafer Khan shows the calls recieved by the Stress Managment Helpline in its first week of operations. Javeed Shah/Mint

Shabir’s drug habit was triggered by depression. After his father died of cancer, he took over his job in the Public Health Engineering Department in Sopore, spending his whole 10,000 salary on drugs. This month, finally bending to pressure from his family, he checked himself into the Drug De-addiction Centre in Srinagar run by the Jammu and Kashmir police.

“I haven’t taken anything in the last 20 days," Shabir says, the muscles in his cheek and eyebrow twitching uncontrollably as he talks. “I had a dealer but I’d also buy them from the pharmacy. You can get everything on the black market: 15 painkillers for 80."

Cases of drug addiction, once so low as to be negligible in Kashmir, have shot up in the last 10 years, says Muzafer Khan, who runs the de-addiction clinic. Overwhelmingly, drug use is confined to 18-35-year-old males, he says, although women have been increasingly dependent on psychotropic substances, barbazol and sleeping pills.

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“Everyone is affected. Most visit local people in their mosque or a local physician who will prescribe a drug and then the patient won’t come for follow ups and keep taking the drugs instead," says Dr Khan.

Dr Khan opened the clinic three years ago, initially running it from the police hospital, but now at the police control room in a clinic with 10 beds. “There was a huge public response. Four thousand people have visited the centre, 550 have been admitted as in-patients," he says.

Today, there is a two-month-long waiting list for a bed. About 80% of in-patients are addicted to prescription drugs, in particular codeine-phosphate, spasmo proxyvon and alprazolam. “Most of these boys aren’t taking drugs for pleasure, they are taking drugs to escape," Dr Khan says.

Cycles of addiction

Depression, drug addiction and suicide are all interconnected in Kashmir. The easy availability of prescription drugs for depression is a quick route to addiction, and also a potential method of overdosing. It’s not surprising, then, that alongside the drug addiction rate, the suicide rate in Kashmir is climbing.

Cost of conflict: A 23-year-old being treated at the Psychiatric Diseases Hospital in Srinagar.

A study by psychiatrist Arshad Hussain at the Government Psychiatric Diseases Hospital looked at the case files of nearly 15,000 patients at Shri Maharaja Hari Singh Hospital in Srinagar. “Major depressive disorder with obsessive compulsive disorder (OCD) and substance use seemed to be highest predictors of suicide," the study found.

After household poisons and pesticides, the most common method of suicide was overdoses of drugs such as benzodiazepines and tricyclic antidepressants. “From maintaining suicide registers to making mental health available and accessible, we have a Herculean task on our hands," the study concluded.

Suicide helplines

In response, J&K police has opened Kashmir’s first ever suicide helpline. The “Stress Management Helpline," will launch officially in a week but is already operated 24 hours a day by four counsellors on a toll-free number; it’s also accessible via the emergency 100 line. Two police ambulances will be dedicated for emergencies (people who have already attempted suicide before they call). But there remains some doubt over the efficacy of a police-operated helpline; suicide remains illegal as well as socially and religiously unacceptable in Kashmir, and attempted suicides may be reluctant to put themselves at the mercy of the law.

For the same reason, reliable suicide statistics are notoriously hard to gather. The national rate is 10.9 per 100,000 according to the National Crime Records Bureau. In Kashmir, estimates differ wildly: from 2.5 per 100,000 to four-five per 100,000, depending on who you ask. It’s not a large number but it has risen very sharply since the beginning of the conflict.

While India’s rate has climbed steadily from 8.9 per 100,000 in 1990 to 10.9 today, in Kashmir the figure has jumped from 0.3 per 100,000 in 1989—a 10-fold increase, even by the most conservative estimates.

“Kashmiri has no word for suicide. That’s how rare it was," says Hussain. “It had almost no existence in the ’80s, the lowest rates in India."

Journalist and author Justine Hardy whose clinic, The Kashmiri Lifeline and Health Centre, is also about to launch a suicide helpline, says the high stress environment of the valley is to blame. “It’s the under-30s who have suffered the psychological impact of constantly living under the threat of attack," Hardy says. “The previous generation picked up the gun, this generation is frustrated in every way." Shabir’s age group is not just the most drug-addicted, it’s also the most prone to self-harm and suicide.

Drug peddlers

Recent police efforts to stem illegal importation and selling of prescription drugs have been conspicuous. This month, deputy inspector general Abdul Gani Mir announced that the J&K police would launch a crackdown on drug dealers in the city. Thousands of bottles of codeine-based prescription drugs were recovered in recent drug raids and a number of dealers have been arrested, Mir said.

Anecdotal evidence leads Mir to believe both drug addiction and suicides are on the rise. “There is an easy availability of the drugs in the market," he says. Prescription drug peddlers are “looking for an easy way to make money. A normal bottle of codeine might be 25-30, but when it is sold to the addict he is paying 100. That is a huge profit."

The problem isn’t limited to the black market. Most prescription drugs are easily available in any pharmacy. “It’s a big industry and no one is bothered to check," says Arif Khan, a doctor at Hardy’s clinic. “I can go to a shop and ask for any medicine and they will give it to me. Even the sweeper of the hospital will be prescribing drugs."

“We see more suicide cases day by day," says Mir. “As a police officer, subjectively, I have come to the conclusion that there is a connection (between suicide and addiction), but we cannot say for sure."

Suicides in villages are also becoming more common, says Dr Khan of Kashmiri Lifeline, with potentially lethal poisons available in every house and a shortage of the right antidotes in district hospitals. “These poisons work fast, in three-or four minutes, and it can be a three or four-hour drive to the big hospitals," Dr Khan says. “When I was working there, I would see them come in from faraway places—dead, dead, dead, dead, dead." He counts imaginary bodies on his fingers.

At the Drug De-addiction centre, Shabir acknowledges the lure of drugs to ease the frustration of the conflict. “Last summer, when the strikes came and we were shut indoors, was the hardest," he says. “People do more drugs when there is violence. When I took drugs I would feel that I was on my own and that the world was beautiful. I think then I realized that the real world is like this, and it’s better to be in this one."

(Next:Faced with the highest suicide rate in the paramilitary forces, the CRPF in Kashmir has started yoga classes and recreation programmes to combat stress and depression among its soldiers.)