North India's Heroin Epidemic

May 11, 2015 | Pulitzer Center

Sami Siva

The fence along the India and Pakistan border seen near Khalra border post in Tarn Tarn area of Punjab. Heroin is sent to Punjab from Pakistan through the gaps in the barbed wire using a 6-inch diameter PVC pipe and chains. Image by Sami Siva. India/Pakistan border, 2014.

Poster showing "hot spots"—places where heroin users shoot up in around Ajnala, Punjab—displayed at the Don Bosco Navjeevan Society, a local NGO in Punjab. Image by Sami Siva. India, 2014.

An IV drug user shows his veins at the counselling center run by Don Bosco Navjeevan Society in Ajnala. Image by Sami Siva. India,, 2014.

Landscape surrounding hot spots—the area where heroin users shoot up, seen outside of Ajnala. Image by Sami Siva. India, 2014.

An IV drug user takes water from a stream to mix the heroin, which comes in granular form, at a hot spot. Image by Sami Siva. India, 2014.

Used needles seen at a hot spot. Image by Sami Siva. India, 2014.

Rajesh Gill, 24, a village doctor, examines a woman with high fever at his clinic in Terri Village, just outside of Ajnala. Gill has been using heroin since 2012. Image by Sami Siva. India, 2014.

Rajesh Gill, 24, seen with his two-year-old son at their home in Terri Village, just outside of Ajnala. Gill is a village doctor and has been using heroin since just after his son was born. Image by Sami Siva. India, 2014.

Rajesh Gill, 24, a doctor from Terri, a small village near Ajnala, seen after shooting up heroin. Intravenous drug usage in Punjab has increased in the last few years as a large quantity of heroin has been smuggled from Pakistan to India along the porous borders of Punjab. Image by Sami Siva. India, 2014.

An IV drug user watches TV at the counseling center of Don Bosco Navjeevan Society in Ajnala. The users drop in to collect needles or just pass time at the center. Image by Sami Siva. India, 2014.

Counselors at the Don Bosco Navjeevan Society in Ajnala return to their office after the field visit, during which they distribute needles. Image by Sami Siva. India, 2014.

Landscape seen near the line of control in Uri, a town where army and police posts are located on the Indian side of the border. Image by Sami Siva. India, 2014.

Daily life in Uri, on the way to Peace Bridge, the bridge that links India and Pakistan in Kashmir. Image by Sami Siva. India, 2014.

Trade facilitation center in Salamabad in Uri. The trucks from Pakistan that cross the Peace Bridge and enter into the Indian side of Kashmir are stopped at the trade facilitation center for a customs check and the transfer of goods into trucks with Indian permits. Image by Sami Siva. India, 2014.

The Pakistani truck confiscated by the Jammu and Kashmir Police with 114 kg of heroin seen through a window in the district police station in Uri. Image by Sami Siva. India, 2014.

Bags containing heroin confiscated by the Jammu and Kashmir Police seen at the district police station in Uri. Image by Sami Siva. India, 2014.

A user demonstrates how brown sugar, a smokable form of heroin, is inhaled. Image by Sami Siva. India, 2014.

Youth poses for a photograph at the drug de-addiction center in Srinagar where he is currently undergoing treatment. Image by Sami Siva. India, 2014.

A recovering drug addict shows the Spasmo Provon (commonly known as SP) tablets, a widespread choice among drug users. This prescription drug is given to pregnant women to reduce the pain during labor; recreational users normally take about 20-30 pills to get high. Image by Sami Siva. Srinagar, India, 2014.

Men walk to a gathering place for drug users at a cemetery in the Nowhatta area of Srinagar. Image by Sami Siva. India, 2014.

An ex-user of heroin poses for a portrait at the spot where used to take the drug at a cemetery in the Nowhatta area of Srinagar. Image by Sami Siva. India, 2014.

Policemen and para-military forces set up a check post to verify ID cards on one of the main streets in Srinagar. Image by Sami Siva. India, 2014.

Dr. Arshad Ansari, assistant professor of psychiatry, sees patients at the government-run hospital in Srinagar where he also does extensive work on drug de-addiction. Image by Sami Siva. India, 2014.

Poster displaying information on drug de-addiction center in Srinagar. Image by Sami Siva. India, 2014.

The Indian border with Pakistan, specifically the northern most states of Punjab and Kashmir, has been ravaged by heroin addiction, and the situation is worsening. The bulk of the heroin has been flowing out of Afghanistan, mainly the result of instability following the American invasion of that country in 2001.

The threat to India is dire: As many as 70 percent of Punjabi males between the ages of 16 and 35 living in Amritsar are said to be addicted. In Kashmir, official numbers are not available, but it’s well known among residents that the issue is severe, and that the psychological pressures of living in a conflict zone often lead to self-medication through opiates.

The government of Punjab created a plan called Operation Clean that has initiated 100 drug arrests per day, but critics claim the plan is treating the symptoms instead of the cause—the persistent flow of heroin across borders. In Kashmir, little has been done outside of Islamic community organizations, and the rate of HIV/AIDS—a devastating side-effect of needle-sharing among addicts—is skyrocketing in both regions.