Substance abuse is a serious problem affecting a large number of people especially youth in Kashmir and is taxing the already existing healthcare and social systems in the region. With this alarming trend, Kashmir Observer sat down with Dr. Akhtar Purvez, an addiction specialist and physician-scientist, author.
Born in Kashmir, he is currently in Lincoln Memorial University, USA, as Clinical Adjunct Professor. He brings with him a wealth of expertise in addiction medicine and health policy advocacy.
On his recent visit to the Kashmir Valley, Dr. Purvez shared his opinion on the diverse realities of substance abuse, its prevalence, causes, and the urgent need for concerted action. He highlighted evidence-based strategies for prevention, education, and community support in this interesting exposé. Just recently, Dr. Purvez spent some time at the Valley discussing potentially heated topics about drug abuse.
Let’s get in on this important discourse with Dr. Purvez, who throws light on the very serious situation regarding substance abuse in Kashmir and measures that can be taken to tackle such an issue.
KO: You would know that we commonly refer to it as drug addiction, but it compasses much more. Please help us understand the terminology better:
AP: According to the Diagnostic and Statistical Manual of Mental Disorders or DSM-5, a substance use disorder (SUD) is a medical condition that involves a pattern of substance use that leads to clinically significant impairment or distress. It is a chronic disease characterized by compulsive drug seeking and use despite adverse consequences.
KO: What is the prevalence of SUD?
AP: Here are the numbers. Worldwide, the World Health Organization (WHO) reports that approximately 5.5% of the global population aged 15–64 used drugs at least once in 2020. In the United States, in 2021, about 61.2 million people aged 12 or older (21.9% of the population) used illicit drugs in the past year.
In India, a 2019 survey by the Ministry of Social Justice and Empowerment found that about 2.8% of Indians aged 10–75 years (31 million individuals) were current users of illicit drugs. In Kashmir, recent studies indicate a significant rise in substance abuse.
A 2022 survey by the Institute of Mental Health and Neurosciences (IMHANS) in Srinagar revealed that Jammu and Kashmir has even surpassed Punjab, known as the drug menace capital of India. Official figures from the Jammu and Kashmir Government indicate that 41,110 affected sought treatment for drug abuse in Kashmir in 2022, nearly double the number from the previous year, which was 23,403.
KO: What are the Common Sources of Substance Abuse?
AP: Substance abuse often stems from prescription medications especially drugs prescribed for chronic pain, such as opioids, can lead to dependency if misused. These include medications like codeine, hydrocodone, oxycodone and morphine. Some of these are usually prescribed for short-term use for post-operative pain or after acute injuries.
Then there are illicit drugs that are substances obtained from street dealers, including heroin and synthetic opioids like fentanyl.
KO: What is the extent of annual drug-related deaths? What are the global and regional Statistics?
AP: Worldwide, WHO estimated approximately 500,000 deaths globally in 2019 due to drug use, with opioids accounting for the majority.
In the United States, In 2022, there were about 107,500 overdose deaths. If we put that in perspective, that means a staggering number of almost 300 deaths PER day. That is, despite very advanced infrastructure and systems in place there to limit morbidity and mortality.
In developing countries, the situation is worse. In India, specific national statistics on drug-related deaths are limited; however, the increasing prevalence of substance abuse suggests a rising trend.
In Kashmir valley, while exact figures are scarce, the surge in substance abuse indicates a growing number of drug-related fatalities.
KO: What are the substances commonly abused and associated with higher mortality?
AP: Certain substances are more frequently abused and linked to higher death rates: A common, and damaging culprit includes heroin, prescription painkillers, and synthetic opioids like fentanyl. Then there are stimulants such as cocaine and methamphetamine.
Other groups include benzodiazepines that are often prescribed for anxiety but can be addictive.
In the U.S., synthetic opioids, primarily fentanyl, were involved in over 70,000 overdose deaths in 2021.
KO: What are the risks associated with substance use disorder
AP: Substance use poses several risks that include health complications such as cardiovascular diseases, liver damage, and mental health disorders. An overdose can potentially lead to death.
In addition, there are multiple social issues such as strained relationships, unemployment, theft, and other legal issues.
KO: What is the Impact of online information and social media
AP: While the internet may be a useful source of reliable information, it can also provide false and biased information that may be harmful. In addition, social media may provide easy access to information about the sources, availability and access to substances and drugs that might be abused.
KO: What is the relationship of the lack of healthcare access and substance abuse rates
AP: Limited access to healthcare can lead to higher substance abuse rates due to untreated mental health issues. Individuals may turn to substances for relief. There may also be a lack of preventive services including absence of education and early intervention.
KO: What are long-term risks of prolonged self-medication including abusive and other substances
AP: In general, various forms of self-medication may result in drug resistance, especially with antibiotics.
They may cause organ damage inadvertently or deliberately consumed medications such as acetaminophen like Crocin and NSAIDS like ibuprofen (Brufen).
They may also lead to dependency, leading to addiction and serious health complications. A single episode, especially involving higher dose, mixed substances including alcohol may result in respiratory arrest and death.
KO: What are the avenues to reduce risks of self-medication
AP: To minimize risks, patients should consult healthcare professionals before taking any medication. They should follow prescription instructions and adhere to prescribed dosages and durations. They also need to avoid sharing medications with others. In addition, we need to avoid mixing prescription medications with unknown herbs, other substances and alcohol.
KO: What would be the educational resources and campaigns that may help reduce the extent of abuse and limit morbidity and mortality:
AP: Effective measures are varied and include public awareness campaigns that highlight the dangers of substance abuse. We also need school programs that educate youth about drug risks. Community workshops will help provide information and support. In addition, mental health support programs would be an essential part and a cornerstone in many situations.
KO: What kind of Support can healthcare systems and organizations offer?
AP: To combat substance abuse, healthcare systems should offer accessible treatment and counseling services. Pharmacies should monitor prescription drug use and provide patient education. In many developed countries, they also have to put each patient’s prescription information into a database that is available to healthcare providers also.
NGOs may run education, rehabilitation programs and support groups.
Governments can implement policies to control drug distribution and fund prevention programs. For example, a Prescription Drug Monitoring Program (PMP or PDMP) is embedded in the system in many developed countries including in the United States.
Before a prescription for a scheduled medication is prescribed, the patient’s full prescription history has to be reviewed.
Media plays a role in spreading awareness and accurate information. For example, they need to play a role by producing and showing documentaries and feature movies that highlight these serious issues.
Addressing substance abuse requires a multifaceted approach involving education, healthcare access, legalization and community support.
Human lives are precious, and we should do everything we can to protect and preserve them.
KO: How does your work in the United States help you understand better the crisis of addiction and healthcare challenges in Kashmir?
AP: My experience in the U.S. has profoundly shaped my understanding of addiction as a multifaceted issue involving biological, psychological and social factors.
Addiction is not a moral failing but a chronic disease that requires a multidisciplinary approach, combining medical care, psychological support, and community involvement.
In Kashmir, the situation is compounded by conflict and instability, which intensify stress and trauma. Many turn to substances as a coping mechanism. My work underscores the importance of early intervention, community education, and reducing stigma. Moreover, even now with the support of the private and public sector, the healthcare infrastructure in Kashmir faces significant challenges, such as limited resources and lack of access to specialized care especially in remote areas. Collaborating with local organizations to integrate mental health and addiction services into primary care could be transformative.
KO: What substances are commonly abused in Kashmir, and how do these trends compare to those in the United States?
AP: The substances abused in the two regions differ significantly. In the U.S., opioids, alcohol, and stimulants like methamphetamine dominate, driven by factors such as over prescription, accessibility, and synthetic drug markets. In Kashmir, the problem largely revolves around heroin, prescription drug misuse, and cannabis, with the region’s proximity to drug trafficking routes possibly playing a significant role.
Societal attitudes also vary. In the U.S., addiction is increasingly viewed through a medical lens, with significant efforts toward harm reduction strategies like medication-assisted treatment (MAT) and needle exchange programs. Conversely, in Kashmir, addiction still remains highly stigmatized, which discourages individuals from seeking help. Addressing this stigma through public education and community involvement is vital.
KO: What role can technology play in addressing addiction in Kashmir?
AP: Technology, particularly telemedicine, has immense potential to transform addiction care in Kashmir. Telemedicine platforms can connect patients with specialists for counseling, therapy, and medication management without requiring physical travel, which is often challenging in Kashmir due to its terrain and political instability.
Mobile health applications can also provide educational resources, self-help tools, and virtual support groups. Additionally, telemedicine can facilitate the training of local healthcare providers in evidence-based practices, strengthening the regional capacity to combat addiction. With proper investment and infrastructure, technology can ensure care reaches even the most remote areas.
KO: What policies or frameworks could significantly improve addiction treatment in regions like Kashmir?
AP: Effective addiction treatment policies should emphasize both prevention and recovery. Integrating addiction services into primary healthcare is a critical step. Training primary care providers to screen and treat addiction can make these services more accessible and reduce stigma.
Community-based rehabilitation centers offering counseling, vocational training, and social reintegration programs are also essential. Moreover, trauma-informed care should be prioritized. Public-private partnerships and international collaborations can provide the funding and expertise needed to address these challenges. Robust data collection to monitor trends and outcomes is crucial for evidence-based policymaking.
KO: What lessons can Kashmir learn from countries with advanced addiction treatment systems, such as the U.S.?
AP: Harm reduction strategies, such as naloxone distribution and syringe exchange programs, have proven to save lives in the U.S. These measures, along with MAT, which combines medication with therapy, can be adapted to Kashmir’s needs.
Public education campaigns to de-stigmatize addiction, along with community support networks like Narcotics Anonymous, can help foster recovery. Finally, building specialized treatment centers and training healthcare professionals are critical steps toward creating a sustainable system for managing addiction.
- Dr. Akhtar Purvez is an accomplished Kashmir-born physician- scientist and an addiction specialist who is a Clinical Adjunct Professor at Lincoln Memorial University in the United States of America, He is a healthcare policy advocate, researcher and author of two best-selling books ‘Managing Chronic Pain in An Age of Addiction’ and ‘The Brain behind Pain’.
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