From Suspicion to Science : Improving Police Response to Inhalant Intoxication!
Are We Misidentifying Intoxication? The Case for Inhalant Awareness in Law Enforcement
Umair Ashraf
When we see someone walking unsteadily, speaking unclearly or behaving oddly in public, most of us reach a conclusion almost instantly. We assume the person is drunk. Some people walk past without giving it another thought. Others laugh, record videos on their phones or dismiss the individual as “another drug addict.” In some situations, frustration quickly replaces concern. People become impatient, shout at the individual or try to control the situation before understanding what may actually be happening.
Police officers experience these situations far more often than anyone else. So do emergency medical technicians, community volunteers, teachers, security personnel and ordinary citizens who happen to be the first to come across someone who appears intoxicated. Within a matter of seconds, they must decide whether the person is a danger to themselves, to others, or simply someone under the influence of alcohol or drugs.
These judgments are understandable because they are based on what can be seen. Slurred speech, poor balance, delayed responses, confusion and unusual behaviour are signs that most people associate with alcohol intoxication. Depending on the circumstances, some may suspect cannabis, opioids or sedative drugs. Years of experience often reinforce these assumptions because, in many situations, they are correct.
But medicine has repeatedly taught us an important lesson.
People may look the same on the outside while something completely different is happening inside their bodies.
A person complaining of chest pain may be suffering from indigestion, anxiety or a heart attack. The symptom appears similar, but the biology is completely different. The same principle applies to intoxication. Two people may appear almost identical from the outside, yet the effects taking place inside their brain and heart may have nothing in common.
This distinction becomes especially important when the substance involved is not alcohol, heroin or cannabis, but volatile inhalants such as glue, correction fluid, paint thinner, petrol or aerosol sprays. These substances often produce behaviour that closely resembles alcohol intoxication. Yet beneath those familiar signs, they affect the body through a very different biological pathway, one that deserves far greater attention than it currently receives.
Recognising this difference is not only important for doctors and toxicologists. It matters to police officers deciding how to approach an intoxicated person, to paramedics deciding how urgently someone needs medical care, to teachers noticing sudden behavioural changes in students, to parents trying to understand what is happening to their child, and to members of the public who are often the first witnesses to these situations.
The behaviour may look familiar.
The biology is not.
The Ground Reality in Jammu and Kashmir
This discussion is particularly relevant in Jammu and Kashmir, where substance use has emerged as one of the region’s most pressing public health concerns. According to the Parliamentary Standing Committee on Social Justice and Empowerment, the Union Territory has an estimated 13.5 lakh substance users, including nearly 1.68 lakh children and adolescents. These figures are more than statistics. They represent thousands of young lives, distressed families and communities trying to cope with an addiction crisis that continues to evolve.
The growing burden is visible every day at the Institute of Mental Health and Neurosciences (IMHANS), Srinagar, where clinicians now see up to 150 patients with substance use disorders each day. Adolescents account for nearly 10 percent of these daily presentations. Public discussion understandably focuses on heroin and pharmaceutical opioids because of the devastating impact they have had across Kashmir. Yet another form of substance use quietly continues in the background, often escaping public attention until tragedy strikes.
For many adolescents, inhalants become the first substance they experiment with. Unlike heroin or other illicit drugs, inhalants are not obtained from organised drug networks. They are ordinary products found inside homes, garages, workshops and neighbourhood shops. Glue, paint thinner, correction fluid, petrol and aerosol sprays are inexpensive, legally available and easily accessible. Their everyday presence often creates a false sense of safety, particularly among young people who assume that products sold openly cannot be especially dangerous.
That assumption is one of the greatest challenges in preventing inhalant abuse.
Because these products are so common, their misuse often goes unnoticed until someone begins behaving strangely in public. By then, the first person to respond is rarely a psychiatrist or toxicologist. More often, it is a parent, a teacher, a neighbour, a shopkeeper, a police officer or simply a passer-by trying to understand what they are seeing.
What happens during those first few minutes often depends entirely on one thing.
How we interpret the behaviour standing in front of us.
Looking Beyond Behaviour
Human beings naturally judge situations by what they can observe. Behaviour becomes our first source of information. We notice the way a person walks, speaks, reacts and interacts with others. From these observations we try to understand what has happened.
This process is remarkably useful. It helps police officers identify suspicious behaviour, doctors recognise illness and ordinary people respond quickly during emergencies.But behaviour has limitations.It tells us what a person is doing.It does not always tell us why.
That distinction becomes critically important in substance use.
Someone intoxicated with alcohol may appear almost identical to someone who has inhaled paint thinner. Both may have slurred speech. Both may struggle to walk in a straight line. Both may appear confused or unusually relaxed. To everyone watching, they look the same.
Yet inside their bodies, completely different biological processes are taking place.
One person’s intoxication is largely the result of alcohol acting on the central nervous system.The other’s involves chemicals that not only affect the brain but also alter the electrical behaviour of the heart.Without understanding this difference, it is easy to assume that every intoxicated individual can be approached, managed and treated in exactly the same way.
Medicine tells us otherwise.
When the Brain Sees a Solvent Instead of a Drug
To understand why inhalants deserve special attention, we first need to understand how they behave inside the brain.
Most psychoactive drugs have fairly specific targets. Heroin primarily acts on opioid receptors. Cannabis acts mainly on cannabinoid receptors. Although these substances influence many different brain functions, they begin by attaching themselves to particular receptors, rather like a key fitting into a specific lock.
Volatile inhalants behave differently.
These chemicals are highly lipid soluble, meaning they dissolve easily in fat. After being inhaled through the lungs, they enter the bloodstream within seconds and rapidly cross the blood-brain barrier because the brain itself is rich in fatty tissue. Instead of attaching to one particular receptor, volatile solvents spread through the fatty membranes surrounding brain cells.
One way to imagine this is to think of pouring oil into the wiring of a complex electrical system. The oil does not target a single switch. Instead, it changes the environment in which every switch is trying to function. Something similar happens inside the brain.
As these solvents dissolve into neuronal membranes, they reduce activity at NMDA receptors, which normally help us remain alert, think clearly, learn and form memories. At the same time, they increase activity at GABA-A receptors, the brain’s major inhibitory system responsible for slowing down nerve activity.
The combined effect is easy to recognise.Thinking becomes slower.Judgement becomes impaired.Balance is lost.Speech becomes slurred.
Some people become unusually cheerful and uninhibited. Others appear withdrawn, confused or emotionally detached. Reactions slow down and awareness of the surroundings begins to fade.
To everyone watching, the person simply appears drunk.That is where the misunderstanding often begins.Because while the brain is becoming quieter, another organ is beginning to face a very different problem.
The heart.
When the Brain Slows Down, the Heart Faces a Different Problem
For many people, intoxication is thought of as something that affects only the brain. We associate it with poor judgement, slow reactions, impaired speech and loss of coordination. Inhalants certainly produce all of these effects, but their story does not end there.
While the brain is becoming quieter, another process is quietly unfolding inside the chest.
The myocardium, the middle muscular layer of the heart, is responsible for pumping blood throughout the body. Unlike any ordinary muscle, it depends on an extraordinarily precise electrical system. Every heartbeat begins with a tiny electrical impulse that travels through specialised pathways before spreading across millions of cardiac muscle cells. Sodium, potassium and calcium ions move in and out of these cells in a carefully coordinated sequence, allowing the heart to contract and relax in perfect rhythm.
For most of us, this happens more than one hundred thousand times every day without us ever noticing it.
Like the brain, however, the heart is also made of cells surrounded by lipid-rich membranes. When volatile inhalants enter the bloodstream, they do not stop at the brain. They dissolve into the membranes of cardiac muscle cells as well. In doing so, they interfere with the normal function of the ion channels that regulate the heart’s electrical activity.
The result is not simply a faster heartbeat.
The myocardium becomes electrically unstable, a condition toxicologists describe as myocardial sensitization to catecholamines.
Although the term sounds complex, the concept is straightforward. The heart becomes unusually sensitive to the body’s own stress hormones, particularly adrenaline and noradrenaline. The person may look outwardly calm or simply intoxicated, but beneath the surface the heart has become more vulnerable to disturbances in its electrical rhythm.
It is important to understand that this does not mean the heart is constantly beating dangerously fast. Many people with recent inhalant exposure may appear relatively stable. The danger lies in how the heart responds when the body is suddenly placed under physical or emotional stress.
When Fear Becomes Biology
Every human being experiences moments of fear, excitement, surprise, pain or intense physical effort. These emotions are not merely psychological experiences. They immediately activate the sympathetic nervous system, which signals the adrenal glands to release adrenaline (epinephrine) and noradrenaline (norepinephrine) into the bloodstream.
This is the body’s natural fight or flight response. It prepares us to react quickly to danger by increasing the heart rate, raising blood pressure and directing more blood towards the muscles.Under normal circumstances, this response is protective. It has helped human beings survive for thousands of years.
But biology changes when the myocardium has recently been exposed to volatile inhalants.Instead of responding in a smooth and coordinated manner, the electrically unstable heart may respond unpredictably to this surge of catecholamines. The carefully timed electrical impulses that normally keep the ventricles contracting together may become disorganised.
Adrenaline is not the problem by itself. In a healthy heart it simply makes the orchestra play with more energy. In a heart whose electrical system has already been disturbed by inhalants, however, the same adrenaline surge can disrupt the rhythm completely.
Instead of pumping blood effectively, the lower chambers of the heart may begin to contract rapidly. This abnormal rhythm is known as a ventricular arrhythmia. One of its most dangerous forms is ventricular fibrillation, where the ventricles no longer pump blood but merely quiver. Blood pressure falls rapidly, the brain is deprived of oxygen and, unless immediate resuscitation is available, sudden cardiac arrest may follow.
This rare but well-recognised toxicological emergency is known as Sudden Sniffing Death Syndrome.Although uncommon, it has been reported even in otherwise healthy young individuals, sometimes after the first episode of inhalant abuse.
Why Recognition Matters During Real World Encounters
Most people who encounter an intoxicated individual never know what substance has been used. They respond to behaviour because behaviour is all they can see.
Imagine two young men sitting by the roadside. Both have slurred speech. Both struggle to stand. Both seem confused. From a distance, they appear almost identical.
One has consumed alcohol.The other has repeatedly inhaled paint thinner.To the eye, there is very little difference.Inside their bodies, however, the situation is very different.
The first is experiencing intoxication largely confined to the central nervous system. The second may also have a heart that has become electrically vulnerable.
This distinction matters because the situations surrounding intoxication are often stressful. Family members may discover the individual unexpectedly. Friends may panic. Bystanders may begin shouting. Community volunteers may intervene. Police officers may approach to assess the situation. The individual may become frightened, embarrassed or attempt to run.
All of these responses are part of ordinary human behaviour.They are also situations capable of activating the body’s natural stress response.
This does not mean that approaching, questioning or restraining someone automatically causes a cardiac emergency. Most encounters end without such an outcome. However, in a person who has recently abused volatile inhalants, sudden fear, intense emotional stress or vigorous physical exertion may increase physiological stress at a time when the heart is already electrically vulnerable.
The goal is not to reduce vigilance.The goal is to ensure that vigilance is informed by science.
Because inhalant intoxication often resembles alcohol intoxication, the surroundings may provide important clues.
A strong smell of glue, petrol or industrial solvents on clothing or breath may raise suspicion. Empty adhesive tubes, correction fluid containers, paint thinner bottles, aerosol cans or solvent-soaked cloths nearby may provide additional evidence.
Equally important is the age of the individual. Inhalant misuse is particularly common among adolescents and young adults because these products are inexpensive, easily available and often incorrectly perceived as harmless.
Recognising these clues does not replace medical assessment.
It simply encourages responders to consider that what appears to be alcohol intoxication may in fact represent a different toxicological emergency requiring closer observation and appropriate medical evaluation.
Science Should Strengthen Judgement
Substance abuse is often discussed in terms of crime, addiction or law enforcement. Those issues are undeniably important. Yet before any legal process begins, there is usually a human being standing in front of someone else.
A parent trying to understand their child.A teacher worried about a student.A neighbour attempting to help.A police officer responding to a call.An emergency medical technician deciding what to do next.All of them begin with exactly the same information.
Behaviour is important.
But behaviour alone is not biology.
By bringing basic toxicology into law enforcement training, first responder education and community awareness, we improve our ability to recognise situations where familiar symptoms may conceal a very different medical reality. Such knowledge does not weaken policing. It strengthens decision making. It allows officers, healthcare workers and ordinary citizens to respond with greater understanding while ensuring that appropriate medical care is sought when needed.
The future of public safety will depend not only on recognising suspicious behaviour but also on understanding the biology behind it.
Because not every intoxicated person is intoxicated in the same way.
Sometimes, the difference between a routine encounter and a medical emergency is not what we see.
It is what we fail to recognise.
(STRAIGHT TALK COMMUNICATIONS EXCLUSIVE. The author is a Councellor, Member of ISSUP. Aims to bridge psychology with advanced biology & neuroscience towards public welfare.)
