In Tamil Nadu''s Kallakurichi, at least 34 people have died and around 100 others are in the hospital after drinking spurious liquor, also known as hooch. It''s possible that more people have died than reported, as some may have passed away before reaching medical help.

The Science of Creating Alcohol:

• Alcohol is produced using two basic processes: fermentation and distillation.
• Fermentation is a chemical reaction where yeast or bacteria react with the sugars (from grain, fruits, sugarcane, etc.) to produce ethanol (the alcohol in the drink).
• Liquor is differentiated by its alcohol content from the 5% by volume (beer) to the 12% (wine) to the 40% (distilled spirits).
• Distillation is important because with more of the sugar getting converted to alcohol, the conditions become toxic.
• Distillation is the process of physically separating the alcohol from the rest of the mixture using evaporation and condensation.

Adverse effect of Ethanol on Human Health:

• Ethanol (C₂H₅OH) is metabolised in the liver and the stomach by alcohol dehydrogenase (ADH) enzymes to acetaldehyde.
• Then aldehyde dehydrogenase (ALDH) enzymes transform the acetaldehyde into acetate.
• The adverse effects of alcohol consumption, from the hangover to cancer, are due to acetaldehyde.
• Contrary to popular belief, the World Health Organization (WHO) has found that “no level of alcohol consumption is safe for health”.

Hooch/Spurious Liquor

• About
• Hooch is a commonly used term for poor quality alcohol, derived from Hoochinoo, a native Alaskan tribe that was known to produce very strong liquor.
• Unlike branded liquor which is produced in factories with sophisticated equipment and rigorous quality control, hooch is made in more crude settings (in many cases homemade) without any quality checks.
• Process
• Like all alcohol, hooch is produced using two basic processes: fermentation and distillation.
• Hooch is produced using distillation of a fermented mixture, generally of locally available yeast, and sugar or fruit (often fruit waste).
• The fermented mixture which is to be distilled contains more than just consumable alcohol (ethanol).
• It also contains methanol (CH₃OH), a different form of alcohol which is highly toxic for human beings.
• During the distillation, both ethanol (boiling point of 78.37 °C) and methanol (boiling point of 64.7 °C) are concentrated.
• Thus, if done incorrectly, distillation can lead to an end product which contains high quantities of toxic methanol.
• The end product can have a high concentration of methanol (instead of harmless trace amounts), which is poisonous and can also cause cerebral edema (swelling of the brain), haemorrhage, and death.
• Importantly, it is near impossible to tell whether hooch is safe to consume before actual consumption.

Regulation of Methanol in India:

• Schedule I of the Manufacture, Storage and Import of Hazardous Chemical Rules 1989 includes methanol.
• The Food Safety and Standards (Alcoholic Beverages) Regulations 2018 stipulate the maximum permissible quantity of methanol in different liquors.
  • For example, these values span a wide range including “absent” in coconut fenny, 50 grams per 100 litres in country liquor, etc.
• The Indian Standard (IS 517) applies to how the quality of methanol is to be ascertained, and together with the Tamil Nadu Denatured Spirit, Methyl Alcohol, and Varnish (French Polish) Rules 1959, what signage, methanol packaging should carry

Methanol Poisoning

• The deadliness of spurious liquor arises from methanol.
• The human body contains infinitesimal quantities of methanol (4.5 ppm in the breath of healthy individuals, per a 2006 study) as a result of eating some fruits. But even for an adult, more than 0.1 ml of pure methanol per kilogram of body-weight can be devastating.
• Once ingested, ADH enzymes metabolise methanol in the liver to form formaldehyde (H-CHO). Then ALDH enzymes convert formaldehyde to formic acid (HCOOH). The accumulation of formic acid over time leads to a condition called metabolic acidosis, which can lead to acidaemia: when the blood’s pH drops below its normal value of 7.35, becoming increasingly acidic.
• The blood’s pH is normally maintained by a balance between an acid, like carbon dioxide (CO₂), and a base, like the bicarbonate ion (HCO₃^–). The ‘metabolic’ in ‘metabolic acidosis’ means the concentration of the bicarbonate ion is dropping, leading to the acid gaining the upper hand.
• Formic acid also interferes with an enzyme called cytochrome oxidase, disrupting cells’ ability to use oxygen and leading to the build-up of lactic acid and contributing to acidosis.
• According to a paper published by the journal Archives of Toxicology in January 2022, consuming methanol also leads to “methanol-induced optic neuropathy …, a serious condition that may result in long-term or irreversible visual impairment or even blindness [due to] damage and loss of function of the optic nerve and retina”.
• This consequence “shows a tendency to occur as mass poisonings around the world with a clear predilection for poor societies in developing countries,” it added.
• Methanol-poisoning can also cause cerebral edema, haemorrhage, and death.

Treating Methanol Poisoning

• Once methanol is ingested, the body takes some time to completely eliminate it. There are two immediate ways to treat methanol poisoning.
• One is to administer ethanol (of a pharmaceutical grade, by healthcare workers). Ethanol competes with methanol for the ADH enzymes. As a result, the methanol is kept from being metabolised to formaldehyde.
• The other option is to administer an antidote called fomepizole, which slows the action of the ADH enzymes, causing the body to produce formaldehyde at a rate that the body can quickly excrete, preventing the deadlier effects from kicking in.

Issues involved

• Inadequate Law Enforcement and Prohibition Measures: The Prohibition Enforcement Wing of the Tamil Nadu police is tasked with preventing the production and sale of illicit liquor. However, the recurrence of hooch tragedies, including the recent one in Kallakurichi and previous incidents in Marakkanam and Madhuranthakam, indicates a failure in effectively curbing the illegal trade of methanol-laced moonshine. Despite existing laws and amendments to control methanol supply, enforcement has been lax, allowing the illicit brewing industry to thrive.
• Economic Factors Driving Consumption of Illicit Liquor: The high cost of alcohol sold through the Tamil Nadu State Marketing Corporation Limited (TASMAC) outlets and irregular incomes of daily wage workers have driven many to seek cheaper alternatives. The aggressive price hikes in TASMAC shops have made legal alcohol unaffordable for many, pushing them towards dangerous, low-cost moonshine. This economic pressure is a significant factor contributing to the consumption of illicit liquor.
• Public Health Awareness and Education: There is a critical need for increased public health awareness regarding the dangers of consuming illicit liquor. Methanol, often added to moonshine to increase its potency, is a potent poison that can cause severe health issues, including liver failure, blindness, and death. The government needs to implement robust public health campaigns to educate the population about these risks and discourage the consumption of illicit alcohol.
• Regulatory and Policy Gaps: The Tamil Nadu Prohibition Act, 1937, and subsequent amendments were designed to control the manufacture, sale, and consumption of intoxicating substances. However, the persistent issue of methanol poisoning suggests gaps in the regulatory framework and its implementation. The government needs to review and strengthen these regulations to prevent the diversion of industrial methanol to the illicit liquor market.
• Post-Tragedy Response and Accountability: The state government’s response to the tragedy, including announcing financial compensation for the victims’ families and initiating a CB-CID investigation, is reactive rather than preventive. While these measures provide some relief, they do not address the root causes of the problem. There is a need for proactive measures to shut down the illicit brewing industry and hold accountable those responsible for the illegal production and distribution of methanol-laced liquor.

Road ahead

• Strengthening Regulatory Framework and Enforcement: Article 47 of the Indian Constitution directs the state to prohibit intoxicating drinks and drugs harmful to health. Seventh Schedule (Article 246) empowers states to legislate on alcohol, making it a state subject. Parthasarathy Committee Report (1992) recommended stringent laws to prevent the illegal possession and storage of methanol, including adding a bitter substance to make it undrinkable. The judiciary has often emphasized the need for strict enforcement of prohibition laws to prevent illicit liquor tragedies.
• Public Health Awareness and Education Campaigns: Initiate public education campaigns through advertisements, street plays, and community involvement to raise awareness about the dangers of consuming illicit liquor. Similar to the botulism prevention strategies in prisons, use handouts, fliers, and local media to educate the public about the risks of methanol-laced alcohol. Maharashtra has conducted public awareness campaigns to educate people about the dangers of illicit liquor and the importance of consuming only legally available alcohol.
• Economic Interventions and Subsidies: Provide low-cost legal alcohol through state-run outlets like TASMAC to reduce the demand for cheaper, illicit alternatives. Implement economic interventions such as job creation and subsidies for legal alcohol to lessen the financial burden on daily wage earners. Tamil Nadu (2002) introduced low-cost liquor through TASMAC, which helped control deaths due to hooch by providing an affordable legal alternative.
• Community Involvement and Vigilance: Form community-based vigilance committees to monitor and report illicit brewing activities. Engage local leaders and women’s groups in these efforts. Empower women-led community initiatives to combat the sale and consumption of illegal liquor, as they are often the most affected by alcohol-related issues. Despite challenges, Bihar’s prohibition policy has seen some success through community involvement and women’s groups advocating for the ban.
• Judicial and Administrative Reforms: Conduct thorough judicial inquiries into hooch tragedies and hold officials accountable for lapses in enforcement. Implement recommendations from such inquiries to prevent future incidents. Adopt a zero-tolerance policy towards illicit liquor trade, with strict penalties for those involved, including law enforcement officials found complicit. Despite being a dry state, Gujarat has implemented strict penalties, including the death penalty for those responsible for deaths due to toxic alcohol.

While the state government has taken post-facto measures, including disciplinary actions and financial compensation, these efforts are insufficient and overdue. The government must urgently dismantle the illicit brewing industry and enforce stringent controls on methanol supply. Additionally, increasing public health awareness about the dangers of consuming hooch is imperative to prevent future tragedies.