It was sometime past midnight when a young man was brought into the emergency room.
He could not have been more than twenty-two or twenty-three.
His clothes were untidy. His eyes looked exhausted. There were multiple old puncture marks over his forearm. His family stood a few feet away, frightened, embarrassed, helpless and angry—all at the same time.
One of them whispered,
“Sir, he has been taking drugs.”
That sentence is becoming increasingly familiar in our emergency rooms.
Sometimes the young person comes with altered consciousness.
Sometimes with overdose.
Sometimes with fever, severe weakness, abscesses over the injection sites, infective endocarditis, hepatitis, HIV, sepsis, or complications of repeated intravenous drug use.
And sometimes, unfortunately, the young person arrives too late.
As physicians, we stabilize the airway.
We check the breathing.
We support the circulation.
We investigate.
We treat infection.
We manage withdrawal.
We counsel the family.
We arrange psychiatric or de-addiction referral whenever possible.
But after the immediate crisis settles, another question often remains in my mind:
How did someone so young reach this point?
And perhaps an even more uncomfortable question:
Where did we fail before the needle ever entered the vein?
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The Needle Is Usually Not the Beginning
When society sees an intravenous drug user, it often sees only the final act.
The injection.
The syringe.
The intoxication.
The behavioural changes.
The stealing.
The family conflict.
The hospital admission.
But addiction rarely begins with a needle.
It usually begins much earlier.
Perhaps with curiosity.
Perhaps with a cigarette.
Perhaps with alcohol.
Perhaps with a tablet offered by a friend.
Perhaps with a substance tried “just once.”
Perhaps with loneliness.
Perhaps with depression.
Perhaps with academic failure.
Perhaps with unemployment.
Perhaps with heartbreak.
Perhaps with family conflict.
Perhaps simply with the desire to belong to a group.
The journey may initially look harmless.
“Everyone is doing it.”
“It is only once.”
“I can control it.”
“I will stop whenever I want.”
But addiction has a dangerous way of turning experimentation into habit, habit into dependence, and dependence into desperation.
And somewhere during that journey, the young person who once controlled the substance begins to be controlled by it.
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From Experimentation to Injection
The transition to intravenous drug use represents an especially dangerous stage.
Injecting a narcotic produces a rapid and intense effect.
That rapid effect can reinforce dependence very strongly.
With time, tolerance develops.
The person may require increasing amounts to achieve the same effect.
The intervals between doses become shorter.
Life gradually begins to revolve around obtaining and using the substance.
Education suffers.
Employment disappears.
Relationships deteriorate.
Money becomes scarce.
Family trust collapses.
Health is neglected.
And eventually the individual may begin sharing needles or using unsafe injecting practices.
At that point, the danger is no longer limited to addiction alone.
It becomes a major medical and public health problem.
---
One Syringe Can Carry More Than a Drug
Every shared needle carries risks that many young users do not fully appreciate.
It may transmit:
• HIV
• Hepatitis B
• Hepatitis C
• Bacterial infections
• Skin and soft-tissue infections
• Septicaemia
• Infective endocarditis
• Thrombophlebitis
• Deep abscesses
• Severe systemic infections
There is also the constant risk of overdose.
A young person may use a quantity that was previously tolerated, only to collapse because the potency of the drug is different, because another substance has been mixed with it, or because tolerance has changed after a period of abstinence.
Sometimes the first warning sign is unconsciousness.
Sometimes it is respiratory depression.
Sometimes cardiac arrest.
And sometimes there is no second opportunity.
---
But Where Is the Gap?
Whenever we discuss substance abuse, society looks for someone to blame.
The young generation.
The parents.
The schools.
The police.
The government.
Social media.
Bad company.
But addiction is rarely the result of a single failure.
It is usually the consequence of multiple gaps occurring simultaneously.
---
Gap 1: We Often Start Talking Too Late
Most families discuss drug abuse only after they suspect that their child is already using substances.
By then, the problem may have been developing for months or years.
Prevention must begin before exposure.
Young people need age-appropriate, honest conversations about addiction.
Not only:
“Drugs are bad.”
But also:
Why are they addictive?
How does dependence develop?
Why is injecting particularly dangerous?
How does peer pressure work?
What should someone do if a friend offers a drug?
Where can a young person seek help without being humiliated?
Fear alone does not always prevent experimentation.
Understanding sometimes does.
---
Gap 2: We Teach Achievement, But Not Coping
A child may be taught mathematics, science, examinations and competition.
But who teaches that child how to deal with:
• Failure
• Rejection
• Loneliness
• Anxiety
• Relationship problems
• Academic pressure
• Family conflict
• Unemployment
• Social comparison
• Emotional pain
A generation that is expected to perform constantly may not always know how to cope when life does not go according to plan.
Some escape into gaming.
Some into alcohol.
Some into gambling.
Some into substances.
A narcotic may initially appear to offer temporary relief from emotional pain.
But temporary relief can become permanent dependence.
---
Gap 3: Mental Health Problems Are Still Hidden
Many young people with substance dependence also suffer from underlying psychological distress.
Depression.
Anxiety.
Trauma.
Low self-esteem.
Personality difficulties.
Family problems.
Sometimes undiagnosed psychiatric illness.
Unfortunately, mental health care is still associated with stigma in many communities.
A young person may find it easier to say,
“I am just enjoying with friends,”
than to say,
“I am not okay.”
When emotional suffering has no language, substances sometimes become the language.
---
Gap 4: Families May Notice the Signs But Delay Acting
The warning signs are often visible.
Sudden change in friends.
Falling academic performance.
Unexplained demands for money.
Irritability.
Staying outside late.
Secretive behaviour.
Sleep disturbance.
Weight loss.
Repeated minor illnesses.
Needle marks.
Missing household valuables.
Yet families may hesitate.
“He will improve.”
“It is just a phase.”
“What will people say?”
“We do not want anyone to know.”
Unfortunately, addiction does not wait for social embarrassment to disappear.
Early intervention matters.
---
Gap 5: We Stigmatize the Person Instead of Treating the Disease
Words matter.
“Addict.”
“Druggy.”
“Bad boy.”
“Criminal.”
“Useless.”
Once society places such a label on a young person, the path back to normal life becomes even more difficult.
Substance dependence is a complex health disorder with psychological, social and biological components.
This does not mean that harmful behaviour should be ignored.
It means that treatment must address the illness while also encouraging responsibility and rehabilitation.
A person who feels permanently rejected by society has very little incentive to return to it.
---
Gap 6: Treatment Is Often Available Only After Crisis
Ideally, help should be easily available at the earliest stage.
Counselling.
Mental health assessment.
De-addiction services.
Opioid substitution therapy where indicated.
Harm-reduction programmes.
Screening for HIV and viral hepatitis.
Family counselling.
Rehabilitation.
Vocational support.
Community reintegration.
But in many places, the first contact with the healthcare system occurs only after overdose, severe infection or behavioural crisis.
We are often treating the complications of addiction rather than preventing addiction from reaching that stage.
---
The Family Suffers Too
Addiction rarely affects only one person.
Behind every dependent young adult there may be a mother who no longer sleeps properly.
A father who has exhausted his savings.
A sibling who feels ashamed to invite friends home.
A spouse who has lost trust.
Children who do not understand why their parent behaves differently.
Families alternate between anger and sympathy.
Punishment and forgiveness.
Hope and exhaustion.
They may pay debts repeatedly.
They may admit the person to rehabilitation centres multiple times.
They may watch recovery begin and relapse occur.
Addiction gradually becomes a family illness.
---
Relapse Does Not Always Mean Failure
One of the biggest misunderstandings surrounding addiction is the belief that treatment should produce immediate and permanent abstinence.
Recovery may not always be linear.
There may be improvement.
Then relapse.
Then another attempt.
Then another relapse.
Families often become discouraged.
Healthcare workers may become frustrated.
The patient may begin believing,
“I will never change.”
But relapse should trigger reassessment rather than abandonment.
What caused the relapse?
Peer group?
Stress?
Untreated depression?
Easy availability of substances?
Lack of employment?
Family conflict?
Incomplete rehabilitation?
Unless those factors are addressed, detoxification alone may not be enough.
---
What Is Happening to Our Young Generation?
Young people today live in a world that is more connected than ever before.
Yet many feel profoundly disconnected.
Thousands of online contacts may coexist with very few people with whom someone can speak honestly.
There is constant comparison.
Constant pressure.
Constant stimulation.
Constant expectation.
Success is displayed publicly.
Failure is often suffered privately.
Substances can become an artificial shortcut to pleasure, confidence, escape or belonging.
But every shortcut eventually sends a bill.
And addiction sends one of the most expensive bills of all.
It may cost education.
Career.
Relationships.
Physical health.
Mental health.
Dignity.
Freedom.
And sometimes life itself.
---
Where Are We Heading?
If increasing intravenous drug abuse among young people becomes normalized, the consequences will extend far beyond individual users.
We may see increasing burdens of:
• HIV and viral hepatitis
• Infective endocarditis
• Overdose deaths
• Mental health disorders
• Crime related to substance procurement
• Family breakdown
• School and college dropout
• Unemployment
• Premature death
• Healthcare expenditure
• Social instability
This is not merely a law-and-order problem.
It is not merely a medical problem.
It is not merely a family problem.
It is a societal problem.
And societal problems require societal responses.
---
What Must Change?
We need prevention before punishment.
Education before experimentation.
Counselling before crisis.
Treatment before complications.
Rehabilitation before rejection.
And perhaps most importantly, conversation before silence.
Schools and colleges should teach substance-abuse awareness as a practical life skill.
Families should create environments where young people can discuss mistakes without fearing complete rejection.
Healthcare systems should make addiction treatment accessible and confidential.
Mental health support should become normal rather than shameful.
Law enforcement should aggressively disrupt drug supply networks while healthcare services address the demand created by dependence.
Recovered individuals should be supported in returning to education, employment and society.
Because recovery does not end when someone stops using drugs.
Recovery ends when that person begins living again.
---
Back to the Emergency Room
The young man I mentioned earlier eventually opened his eyes.
For a few seconds, he looked around the emergency room without understanding where he was.
His mother moved closer.
He looked at her.
She did not scold him.
She did not ask where the money had gone.
She simply held his hand.
And I remember thinking how strange addiction is.
A few millilitres inside a syringe had become more powerful than education, family, ambition, fear and even survival.
But I also wondered:
What if someone had reached him earlier?
Before the first injection.
Before dependence.
Before the emergency room.
Before his mother learned to recognize the sound of an ambulance.
Perhaps that is the real battle.
Not merely saving young people from overdose.
But reaching them long before overdose becomes possible.
---
The Question We Must Ask
Whenever we see a young person injecting narcotics, perhaps the question should not only be:
“Why is this young person doing drugs?”
We should also ask:
“What happened before this?”
Where did communication fail?
Where did emotional support fail?
Where did prevention fail?
Where did treatment access fail?
Where did society notice but remain silent?
Because the needle may be in one person's hand.
But the circumstances that placed it there may have been created by many gaps around him.
And if we continue looking only at the syringe while ignoring those gaps, we may keep treating one young patient after another without changing the direction in which an entire generation is moving.
The question is no longer only:
“Why are our young people becoming addicted?”
The more important question may be:
“Are we reaching them early enough to prevent it?”
And perhaps the most uncomfortable question of all is:
Where are we heading?
---
Key Message
Drug dependence among young people, particularly intravenous narcotic use, should not be viewed only as an individual's bad choice.
It represents an interaction between substance availability, peer influence, emotional vulnerability, mental health, family environment, social pressures, lack of early intervention and gaps in rehabilitation.
The solution therefore cannot come from one institution alone.
Families, schools, healthcare systems, communities, law enforcement agencies and young people themselves must work together.
Because every young person who enters an emergency room with an overdose represents not only a medical emergency.
It also represents an opportunity we may have missed much earlier.
And the earlier we recognize that gap, the greater our chance of protecting the generation that comes next.