On a warm spring day in Louisville, Kentucky, recovering drug addict Tyler Wolz sits at a conference table at The Healing Place. His tone is matter-of-fact as he reflects on his dismal past as an opioid addict. “It was a two-year run — nonstop, every day, and the usage increased. I was using more and more heroin every day. It was chaos – always,” says the 23-year-old who abused prescription painkillers before turning to heroin.

Halfway across the world, 17-year-old Bangalore student Shahzad Ahmed rues a similar experience. “My mother tried to convince me to leave drugs for eight months,” he says, “I tried but couldn’t. I was so badly into it.”

Wolz and Ahmed&’s accounts highlight the global challenge of opioid abuse — a persistent scourge in the USA and an emerging problem in India. The US Centers for Disease Control and Prevention call prescription opioid abuse an American epidemic, reporting that nearly 100 people died from overdose every day in 2010. In India, a 2011 report by the UN Office on Drugs and Crime found that opiate use accounted for the highest proportion of illicit drug abuse in India, at 40 per cent.

In the USA, death and injury from prescription drug abuse is concentrated in largely rural states such as Kentucky and West Virginia, which are also two of the poorest in the nation, with economies that can ill afford the high price of rampant drug abuse. On the other hand, opioid addiction is a newer phenomenon in India, with Northeastern states in particular seeing rising rates of addiction to prescription painkillers and heroin. Problems are also surfacing in other states such as Punjab, Odisha, Haryana and Karnataka. Experts say addiction is a disease that knows no boundaries and places like Kentucky sound a note of caution — and a lesson in dealing with an entrenched scourge — to parts of the world just beginning to experience the devastation of opioid abuse.

Karyn Hascal, president of The Healing Place, has worked with addicts abroad and says, “Something I learnt is that a rose is a rose is a rose. Once the process is begun and you’ve crossed the threshold to loss of control, addiction is the same — no matter where you are and no matter whom you are. Addiction is truly the indiscriminate disease.” 

Kentucky, located in the southeastern region of the country, is among the American states hardest hit by an opioid epidemic centered on prescription painkillers. In 2011, the state&’s prescription drug monitoring programme recorded a startling 219 million doses of the opioid hydrocodone dispensed in Kentucky. “We are a state of 4.3 million people. That&’s 51 doses of hydrocodone for every man, woman and child in the state,” says Kentucky attorney general Jack Conway.

The eastern portion of Kentucky is part of the cultural region known as Appalachia, which spans the Appalachian Mountain range in eastern USA. Though endowed with an abundance of natural resources, Appalachia has long been associated with poverty. Five of the top 10 counties with the lowest median incomes in America are located in Appalachian Kentucky. The area&’s already downtrodden economy is further ravaged by addiction, as employers struggle to find and maintain a sober workforce. Bill Bissett, president of the Kentucky Coal Association, says upwards of 7,000 miners have been laid off since 2012 after failing drug tests.

“It&’s not hard to realise that Kentucky&’s issue with opioid addiction is also a jobs development issue,” says Conway, “We generally have a great workforce but in certain parts of the state there is a perception that it is too addicted and it&’s toxic. There are a lot of employers who are concerned that their workers can’t pass drug tests.”

After the passage of a 2012 state law, prescription painkiller abuse in eastern Kentucky finally began to recede but a recent rise in heroin abuse is raising fresh concerns across the rest of the state and nation. US federal health statistics show the death rate of heroin overdose doubled from 2010 through 2012 and the 2013 fatality report of the Kentucky Office of Drug Control Policy noted a 12.6 per cent increase in autopsied overdose deaths attributed to heroin.

“Heroin has really just substituted the pills,” says Conway. One big reason for this shift is the increased availability of heroin throughout the USA, which makes it a cheaper alternative for long-time prescription painkiller abusers to keep getting high. The population at The Healing Place reflects this shift. “One year ago, our admissions to men&’s detoxification were five per cent heroin addicts,” Hascal says. “Today, it&’s 95 per cent heroin addicts.”

Conway says heroin makes its way into urban areas throughout the USA via Mexican drug cartels. A distribution network in the upper Midwest then filters the drug into cities like Cincinnati and Louisville. While the drug so far seems to be generally contained in cities, there&’s growing concern about its spread to rural areas such as Appalachia – that would further tax an area with an outsized addiction problem and far too little drug treatment. “In Kentucky, for every 100 people who need treatment, 12 are able to get it,” says Hascal.

As the Mexican drug cartels funnel illicit narcotics to the USA, foreign drug traffickers also play a key role in India&’s developing addiction problem. Geographically, India is located in close proximity to both the Golden Triangle and Golden Crescent — two of Asia&’s primary areas of opium cultivation in Afghanistan, Pakistan, Myanmar, Laos and Thailand. As a result, border states such as Punjab in the North and Nagaland in the East serve as a gateway for opiates being smuggled into India.

Contrary to the situation in the USA, prescription opioids are less expensive than heroin in India, which the UN says is the fourth largest producer of pharmaceuticals globally. However, with the mass manufacture of opioid medications comes an increase in addiction and abuse. Limited data makes it difficult to know exactly how big the problem is, but experts agree that the illicit use of painkillers is an issue throughout the country. A 2006 report by the World Health Organisation estimated that 12 per cent of opiate addicts in India abused prescription painkillers such as dextropropoxyphene and buprenorphine.

Opioid abuse in any form is destructive, but it becomes especially dangerous when users inject their drugs; intravenous use is fuelling an epidemic of blood-borne illnesses throughout India&’s Northeastern states. A 2011 report by the UN Office on Drugs and Crime said injection drug use was primarily responsible for placing Nagaland and Manipur among the top five states in India in terms of HIV infection — which is hitting 15- to 30-year-olds hardest.

Drug addiction overall is skewed towards younger people in India in comparison with America. The yearly average of adolescents seeking treatment for addiction more than doubled from 2009 to 2014, as reported by the National Institute of Mental Health and Neurosciences’ deaddiction centre in Bangalore.

“The generation today is exposed to many substances. They start drugs right from school, from the age of 12 or 13. Opium is prevalent in the urban areas because there are people who can afford it. On the other hand, synthetic (drug) abuse is mostly found among people who are too poor to afford other drugs,” says Laxman S, an occupational therapist and research scholar at the Centre of Addiction Medicine, at the National Institute of Mental Health And Neuro Sciences.

Ahmed, who is almost finished with his treatment at the Bangalore facility, says he finally looks forward to living a healthy, drug-free life. But it&’s been a difficult road back. “I lived in a completely different world for the last two years. I missed out on a lot, it seems,” he says. “I would not blame my friends as I was equally responsible. I would want to continue college if given a chance. And also support my family in whatever way I can.”

But even as Ahmed recovers, countless other teens are being introduced to narcotics on a daily basis. Manjunath BS, vice-president of Chemical Addiction Treatment in Kengeri, says drugs remain abundantly available. “There are a lot of peddlers in the city who supply drugs to school and college children at an affordable price. They learn it from school itself and that is a big reason to worry.”

Preventing at-risk adolescents from resorting to drug abuse is a big priority for lawmakers in both the USA and India. Last December, Prime Minister Narendra Modi addressed the nation about fighting India&’s drug addiction problem, particularly among the youth. Modi called for a national campaign promoting a “drug-free India”, and said in a national broadcast, “For a long time, I have been concerned about the young generation.”

In the USA, the 2013 federal budget allocated $20 million for the Youth Drug Media Prevention Programme in the US Office of National Drug Control Policy, which aims at raising awareness about the dangers of abuse.

Conway agrees that educating teenagers is a crucial way of fighting addiction. “The statistics show that if you can get an adolescent or juvenile to get started down this path into treatment at an earlier age, you have a better chance of permanent success down the road,” he says. “We can’t incarcerate our way out of this problem.”

Hascal agrees, saying locking up addicts “doesn’t work unless you really have nothing but money to put into prisons”.

Wolz, who has struggled with addiction since he was 14, has found both sobriety and a sense of purpose since beginning treatment at The Healing Place. His daily schedule is filled with classes, chores and other activities that he completes alongside coresidents, who, he says, have now become some of his closest friends. “This programme has done wonders for me. I can talk to people about anything. We have fun yet we are sober,” says Wolz. “As long as we stick together, we will be all right.”

Hascal would like to see policymakers across the globe focus more on giving addicts access to treatment. “I think one of the universal truths is that it doesn’t matter what you’re addicted to, the process is the same and the process of recovery is basically the same as well,” he says. “There may be a lot of different avenues to recovery, but, ultimately, recovery means an improvement in your lifestyle.”

(Trans World Features)