SRINAGAR: For decades, Kashmir’s drug story was told in familiar tones. The accounts were of heroin smuggled from across the Line of Control, cannabis traded in backstreets, young men and boys chasing powdered drugs escape in abandoned houses, and needle-strewn parks.
But in recent years, a quieter and more insidious crisis is taking root not in back alleys but inside the clean, brightly lit corridors of hospitals. This is not the familiar menace of contraband smuggling and drug peddling. This is a problem growing in the heart of the very institutions meant to heal.
Medicines such as Buprenorphine and Vernor-N, prescribed at treatment centres like the Institute of Mental Health and Neurosciences (IMHANS) in Srinagar, are meant to break the grip of illicit substances. They ease withdrawal, reduce cravings and offer a safer alternative to heroin. But for some patients, these tablets - crushed, dissolved and injected, or taken in dangerous quantities - have become a replacement for intoxication.
Unlike street drugs, these medicines come with a doctor’s signature, a printed label, and the authority of the health system itself. Families often feel relieved when their children are enrolled in treatment, unaware that a different dependency may be quietly taking hold.
To understand this emerging problem, Kashmir Times spent a week inside IMHANS and the de-addiction unit at SMHS Hospital. Our reporters spoke to patients, their families, medical professionals and counsellors. The picture that emerged was complex - a mix of genuine recovery, painful relapses, and in some cases, dangerous stagnation.
On a cold Monday morning, a long queue stretched outside the pharmacy window. Young men, some still in school uniforms, others in their twenties or thirties, stood silently clutching tokens. Most were waiting for their weekly supply of medication — tablets intended to keep them away from heroin and other drugs. The mood was subdued, the silence broken only by the shuffle of feet.
Inside the waiting room, the air was thick with anxiety. It was a space where hope and despair seemed to coexist, where each person was fighting an invisible battle that few outside could comprehend.
Some patients had walked in of their own accord, desperate to change. Others had been brought by parents or siblings, their hands firmly on their shoulders, as if afraid they might bolt.
“I feel suffocated here,” one of our reporters noted in field notes. “There’s a heaviness in the air, there’s grief that hasn’t settled, anger that hasn’t found words. It’s not easy to stand in a place where healing and harm feel so closely intertwined.”
Outside the building, a small group of patients agreed to speak with the reporter. Their names cannot be published for privacy reasons, but their stories echoed the same frustration.
“We want to quit this medicine,” said one man in his late twenties. “But we haven’t received proper treatment or regular counselling here.” Another added: “We get counselling only after seven weeks. That’s too long. By then, it’s hard to hold on.”
A boy who looked barely out of his teens suddenly stood up, his voice breaking with anger: “I’ve been taking this medicine for the last eight years.”
These are not the words of people rejecting medical help. They are the words of patients who feel stuck in a system that hands out medication but cannot match it with consistent, human-to-human care.
Among the patients was Zakir (name changed), 24, from Srinagar. The only son in his family, he grew up in a loving home with supportive parents and a married sister. But in his late teens, he drifted into heroin use.
“My parents gave me everything,” he said, looking down. “Love, support, care. But I lost my way. I became unrecognisable to them and to myself.”
The strain on his family was devastating. His mother suffered three heart attacks during his years of addiction. “Each one broke her, and broke my father too,” he recalled. “One night, after her third stroke, my father looked at me with tears in his eyes and said, ‘If you don’t quit, you will kill us, bury us with your own hands.’”
That night, Zakir cried for hours. The next morning, he walked into a hospital and asked for help. He began treatment with Vernor-N, three tablets a day. “The cravings were terrible, especially in the morning and evening,” he said. “But I managed.”
The doctors never advised him to reduce his dosage, but Zakir made the decision himself. “Slowly, I cut down to half a tablet in the morning and half in the evening. I wanted to feel again. I wanted to live again.”
Today, Zakir runs his father’s business and is proud to be clean. “By Allah’s mercy, my mother is fine now. This is not the end of my journey, but the beginning of a life I almost lost.”
For Some, Much is Already Lost
Unlike Zakir, some addicts reach out for help only after much damage has been done.
A young man, barely in his early 30s, was being carried to IMHANS by three people. He couldn’t walk. His body looked frail, lifeless.
I asked the security guard, "What happened to him?" The reply hit hard. “He’s been using heroin. Injecting it in his legs, because the veins in his arms are all blocked,” the guard said.
“We see many like him. Some even lose their legs… the wounds get infected, and there’s nothing left to save”.
Despite repeated attempts, Kashmir Times was unable to get a statement from senior IMHANS doctors. Hospital officials declined to comment, and no authorised spokesperson was willing to address the issue on record.
However, few doctors at IMHANS spoke on conditions of anonymity. They admitted that though these medicines prescribed to the patients to wean them off the deadly drugs are supposed to be tapered off gradually and then stopped, the hospital continues to provide them their regular supply of the tablets.
They reasoned, “if we don’t provide medicines like Buprenorphine and Vernor-N, they’ll find it elsewhere, from the streets, the black market. It’s easily available. But there’s more to it than just treatment.”
Giving medicines in hospitals, free of cost, is not just about withdrawal. It’s about protection, they added. It is also aimed at protection from the spiral of crime — theft, violence, even murder — just to afford the next dose.
“Every pill given at a hospital is one less bought illegally. This means, one less risk. One more chance at life,” one of them said. “It’s about saving young lives — their money, their dignity, their future.”
While the doctors were discussing the ongoing crisis of drug addiction with the Kashmir Times, a substance user walked into the hospital asking for medicine.
The doctors initially refused. He had already received a week's dose just three days ago. But then, one doctor noticed something unusual.
His right hand. The middle finger was turning black. An infection. The doctors immediately sent him for a checkup.
A doctor told us that "If the infection has spread, we may have to amputate the hand."
This is the harsh reality. Addiction isn’t just killing minds. It’s destroying bodies.
The scale of Kashmir’s drug crisis is staggering. Official data presented in Parliament puts the number of drug users in Jammu and Kashmir at nearly 10 lakh, around 8% of the population. In 2023, the Standing Committee on Social Justice and Empowerment estimated the figure at 13.5 lakh, including young women.
A survey by IMHANS found that 90% of drug users in Kashmir were aged between 17 and 33, which is the most productive years of life. The study also highlighted that heroin was the most commonly abused substance, followed by prescription drugs.
Psychiatrist’s dilemma
One doctor who did speak was Dr Sabreena Qadri, Senior Consultant Psychiatrist at Paras Hospital. She described substance use treatment as “very difficult” for both patients and doctors.
“Patients experience a significant withdrawal burden, which becomes stressful not just for them but for the treating physicians as well,” she said.
She explained that treatment generally follows two routes: detoxification or opioid substitution therapy (OST). “If a patient has used substances less frequently and not through intravenous methods, we go for detoxification. For those with long-term or IV use, OST is the safer choice.”
Medicines like buprenorphine, she explained, are designed to produce a similar effect to illicit drugs but in a controlled, medical setting. “The aim is harm reduction — to prevent overdose, HIV transmission, sudden cardiac arrest, or death.”
But misuse remains a constant risk. “Some patients dissolve these medicines in water and inject them. This defeats the purpose,” she said. “That’s why regular counselling is essential. You can’t just hand out refills without psychological support. Patients need both.”
Dr Qadri said that earlier, plain Buprenorphine tablets were commonly supplied in Opioid Substitution Therapy (OST) programs. However, once the potential for intravenous (IV) abuse was recognized, these tablets were replaced with a combination of buprenorphine and naloxone.
Naloxone is an opioid antagonist that is not absorbed orally but becomes active when injected, causing unpleasant effects and thereby discouraging IV misuse. Currently, this combination formulation is the standard in all government OST centers, she further elaborated.
In addition, most individuals now seeking deaddiction treatment are dependent on pharmaceutical drugs such as Tapentadol and Pregabalin, which are frequently sold at three to four times their usual price without a prescription, the psychiatrist added.
Most addiction specialists agree that medication alone is not enough. “Counselling works only if the patient is motivated,” Dr Qadri said. “Without that internal drive, even the best treatment plans may not succeed.”
Gaps in Treatment
Yet, patients at IMHANS told Kashmir Times that counselling sessions were infrequent and often delayed. Some said they went weeks without speaking to a counsellor, relying only on their weekly medicine pickup.
Addiction experts say this gap creates the perfect conditions for substitution therapy to become dependency therapy. Without regular psychological support, the medicine stops being a bridge to sobriety and becomes a new prison.
Kashmir’s crisis is not only medical but also social. With such a high percentage of young users, there is a real danger of losing an entire generation to cycles of dependency — whether on heroin or on the very drugs meant to replace it.
In the quiet queue outside IMHANS, a young man stood with his hands buried in his pockets, eyes fixed on the ground. He had been free from heroin for six months, but was now dependent on buprenorphine.
“At least I’m not dying from it,” he said. After a pause, his voice dropped: “But I’m not living either.”
For Kashmir, that is the silent tragedy. The fight against drugs is no longer just about ending heroin use. It is about ensuring the cure does not become the curse.
(The identity of the reporters who worked on this story is being withheld for fear of reprisal)
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