"Speedballs" in a can

     Two college students on a train disguised their alcoholic beverages inside brown paper bags, while another didn't bother to cover up the fact that he was drinking a can of the caffeinated alcohol beverage, Sparks. To many observers, the undisguised can appeared to be a soda, recalls Michele Simon, research and policy director of alcohol industry watchdog, the Marin Institute, of the situation she witnessed on the train that day.

     On the other hand, anyone drinking "Cocaine" from a can might get a second look. The name of this popular energy drink is in the United States again, according to Redux Beverages LLC, after being known as "No Name" or "Insert Name Here" while the company was responding to an FDA letter warning about its marketing practices. Cocaine, the energy drink, is a legal and highly caffeinated (280 mg) energy drink (with no alcohol).

     The point is that energy drinks can be confusing and, as a result, adults today are often clueless. Simon, JD, MPH, points out there are few TV commercials for the top selling brand. (PepsiCo Inc. ran a commercial for AMP Energy during the Super Bowl.) Instead, the Internet and word of mouth ("viral marketing") are used to spread the word about alcoholic energy drinks, which typically contain 6 to 8 percent alcohol.

     Sorting out which energy drinks have alcohol can be tiring, but law enforcement officers need to be in the know. They need to know about energy drinks' alcoholic brothers — the AEDs or alcoholic energy drinks — and what happens when an energy drink is mixed with alcohol.

A dangerous mix

     Not many energy drinks have an alcoholic version. However, drinkers sometimes combine nonalcoholic energy drinks with alcohol to create their own AED. For example, Red Bull and vodka, known in some circles as a "speedball," is a popular combination.

     Premixed alcoholic energy drinks provide an inexpensive alternative to purchasing two beverages separately. In fact, Marin Institute research found that in some California convenience stores, alcoholic energy drinks were less expensive than nonalcoholic ones. Premixed alcoholic energy drinks can be the same size, shape and even have the same graphics as nonalcoholic versions, which can create confusion over whether or not the drinks contain alcohol.

     Cpl. Emmit Byrd, who is the underage drinking coordinator for the Mobile (Alabama) Police Department, agrees that energy drinks containing alcohol are packaged similarly to those that do not. However, he says, "the drinks containing alcohol are located in the section with other alcoholic beverages. If a person looks at the container, he can see that the drink contains alcohol and the percentage of alcohol in the drink."

     His department performs compliance checks targeting alcohol of all types (not only alcoholic energy drinks) to combat underage drinking. The first time an undercover police cadet tried to purchase alcoholic energy drinks was in December 2007. During this compliance check, the cadet, age 19, was able to buy alcoholic energy drinks in five out of 10 stores.

     Byrd encourages other law enforcement agencies to raise awareness of alcoholic energy drinks by including these beverages in overall compliance checks. The Mobile PD also educates the public through in-service classes for employees of businesses that hold alcohol licenses and through lectures at schools, churches and community groups.

     The combination of alcohol, energy drinks and youth is "a dangerous mix."

     Combining energy drinks with alcohol brings together two drugs that have the opposite effect, says Simon, who with James Mosher of the Pacific Institute for Research and Evaluation authored the report "Alcohol, Energy Drinks, and Youth: A Dangerous Mix."

     "A drug designed to keep you awake is combined with a drug that alters your motor skills and general judgment," Simon says. "Then, you throw into the mix young people, who are inclined to take risks, think they're invincible and consume energy drinks to stay awake longer or to get drunk faster and longer. And then, of course, they have the potential to harm themselves and others."

     After taking care of a badly intoxicated college student who had been up all night drinking alcohol mixed with energy drinks, Dr. Mary Claire O'Brien, a board-certified emergency physician, set out to determine the prevalence of mixing alcohol with energy drinks. An associate professor of emergency medicine and public health sciences at Wake Forest University School of Medicine, O'Brien also wanted to learn whether there were associations with high-risk drinking behaviors and connections with serious alcohol-related consequences.

     In fall 2006, Web-based surveys were administered to stratified random samples of 4,271 college students from 10 North Carolina universities. Students answered questions regarding alcohol use, its consequences and other risky behaviors. Results of the survey showed 24 percent, or roughly one in four students, reported drinking alcohol mixed with energy drinks.

     O'Brien then wondered if, as her patient suggested, students were mixing alcohol with energy drinks so that they could drink more without passing out. In other words, the survey sought to find out whether there was an association with high-risk drinking.

     The answer, according to the survey, is: Yes, there is an association with more drinks in a typical drinking episode, more days spent binge drinking, more days drunk in a typical week, and a greater number of drinks consumed in a single drinking episode when energy drinks are part of the equation. In fact, O'Brien says the survey found that students who mixed alcohol with energy drinks had twice as many episodes of weekly drunkenness.

     These high-risk drinking behaviors then led to serious alcohol-related consequences. According to the study, students who consumed alcohol mixed with energy drinks say they were twice as likely to:

  • Take advantage of someone else sexually as a result of their drinking.
  • Ride with a driver who was under the influence of alcohol.
  • Become hurt or injured.
  • Need medical treatment.

     And, students report they were nearly twice as likely to be taken advantage of sexually.

     O'Brien says students who drink alcohol mixed with energy drinks are at increased risk for alcohol-related consequences, even after adjusting for the amount of alcohol consumed.

Impairing the perception of impairment

     The dangers of mixing energy drinks with alcohol extend beyond youth, however.

     Brazilian researchers conducted the first controlled scientific study on the effects of combining alcohol with Red Bull. "Effects of Energy Drink Ingestion on Alcohol Intoxication" was published in Alcoholism: Clinical and Experimental Research 30 (4), 598-605. The results of this study released in 2006 include:

  • Drinking alcohol and Red Bull together significantly reduces the perception of headache, weakness, dry mouth and impairment of motor coordination.
  • Red Bull does not significantly reduce alcohol-related deficits on objective measures of motor coordination and visual reaction time.
  • People who combine alcohol with energy drinks may be at even greater risk for problems such as automobile accidents because they believe they are unimpaired.

     "Alcohol affects not only the motor coordination but the capacity of decision, because it affects one important area of the brain — the prefrontal cortex," explained an author of the study, Maria Lucia Oliveira de Souza Formigoni of the Federal University of Sao Paulo, Brazil, at the time the study was published. "Drunk drivers are dangerous not only because their reactions are delayed and motor coordination affected, but mainly because their capacity to evaluate the risks to which they will be exposed is also affected. People need to understand that the 'sensation' of well-being does not necessarily mean that they are unaffected by alcohol. Despite how good they may feel, they shouldn't drink and drive."

     In other words, people might not think they are drunk after consuming these supplement-laced energy drinks.

     "People who mix alcohol and energy drinks will walk out of bars thinking they're OK to drive because they don't pass out drunk," O'Brien says. "They have all this caffeine in their system but they're every bit as drunk as they would be if they didn't have caffeine in their system."

     O'Brien gives an example of a driver swerving down the road but when he gets out of his car, he's wide awake. When stopped by officers he says he's not drunk. At the stop, law enforcement officers need to consider whether he's mixed alcohol with energy drinks. "His motor skills are impaired but he doesn't think he's drunk, so you might not initially think he is either," she explains.

     In moderation, O'Brien says there's nothing wrong with an energy drink. However, she adds "I don't think they should be mixed with alcohol in any way — even once. I just think it's dangerous."

     James Wesley, M.S., a clinical toxicologist and forensic chemist, has been researching energy drinks since 2001. Among his concerns are people who consume alcoholic energy drinks while at work, and then drive home. When Wesley interviewed 20-somethings, they said alcoholic energy drinks make them feel both alert and relaxed at the same time. They reported that when they drank energy drinks without alcohol, they felt nervous by the end of the day. With alcoholic energy drinks, they said this nervous feeling was not a problem. Wesley likens alcoholic energy potions to prescription Desbutal from the 1960s, which contained methamphetamine and pentobarbital and was said to relieve tension and anxiety while producing a sense of well-being and increased energy.

Top cops call for change

     In addition to being aware of alcoholic energy drinks and the effects they have on a person's perception of impairment, Simon says law enforcement should make calls for national policy change, as well as a call for the alcohol industry to stop marketing these products. When he took an in-depth look at the alcohol industry's marketing practices promoting these power potions, Simon found the themes (risk-taking behaviors and sex) and strategies used on the Internet to target youth disturbing.

     "It really does take all of us (including law enforcement, parents, public health officials and advocacy groups) together to put pressure on the industry to stop marketing these products," she says.

     Last year, 29 state attorneys general wrote a letter asking the Alcohol and Tobacco Tax and Trade Bureau (TTB) to expand its efforts to prevent misleading health-related statements from being made in connection with the beverages. They also asked the TTB to investigate the formulation of these drinks to determine whether they are properly classified as malt beverages under federal law.

     In their letter, they wrote: "Adding caffeine and other stimulants to alcohol may increase risk to young consumers, because those additives tend to reduce the perception of intoxication and make greater quantities of alcohol palatable. Moreover, most alcoholic energy drinks are categorized as malt beverages even though their alcohol by volume is significantly greater than that of beer. This classification renders alcoholic energy drinks more readily available to young people, because malt beverages can be purchased in many more places, and at significantly lower prices, than distilled spirits."

     They listed a number of products and advertisements that "warrant investigation and possible enforcement action." Among the products named were: Miller Brewing Company's Sparks and Sparks Plus, Anheuser-Busch's Bud Extra, and Charge Beverage's Liquid Charge and Liquid Core. Earlier in 2007 after state attorneys general expressed their concern about the alcoholic energy drink Spykes in a letter to Anheuser-Bush, the company pulled it from the market.

     Commending the attorneys general, Simon says companies boast their products will enhance energy and alertness but fail to warn users of the potential for misjudging their own level of intoxication.

     "We know from common sense that combining caffeine with alcohol is not a good idea," she says. "We should really put the burden of proof on the alcohol industry to prove these products are safe — just as we do with prescription medication. Unfortunately with alcohol, we're not treating it as seriously. It's a drug. Now we're combining it with another drug."

     Local news media have done stories focusing on retailers and law enforcement to do a better job, but Simon says "We can't leave it all up to local law enforcement. The industry is basically making police officers' jobs more difficult by creating all these products and generating confusion in the market. We're looking for people to come together and put pressure on the alcohol industry to stop this practice and make parents' and law enforcement's jobs easier."

     Rebecca Kanable is a freelance writer based in Milton, Wisconsin, with more than 10 years of experience writing about public safety.

Police Fuel: a caffeinated boost for law enforcement

     Police work can be exhausting. Whether working late at night, working long hours or working on search and rescue missions, police officers can find themselves needing fuel — "Police Fuel," says Al Samson, who witnessed firsthand the dedication of law enforcement while working with rescue teams in New York City after 9/11.

     Police Fuel, a light citrus-tasting energy drink, available from the company Police Fuel since 2006, offers "an extra boost." "It keeps you going," he says.

     Americans have increasingly turned to energy drinks to get them through the day and stay awake late at night ever since Red Bull was introduced in the United States in 1997. Whether they're drinking Red Bull or Police Fuel, law enforcement officers can be among those who benefit from moderate consumption of energy drinks. (See "How much 'energy' is too much?" on Page 14.)

     Police Fuel, from the company that also makes Police Coffee, is designed specifically with the demands of law enforcement in mind. When officers are tired and need energy, Samson, founder of Police Fuel, says this power "punch" will replenish energy, improve concentration, enhance reaction speed, increase physical endurance, stimulate metabolism, assist in breaking down toxins and provide refreshment. The energy in Police Fuel comes from caffeine, carbohydrates, taurine, glucuronolactone and B vitamins. The caffeine in one 8-ounce serving is "roughly equivalent" to the amount of caffeine in one cup of coffee, says Samson.

     Police Fuel is available in resealable 20-ounce or 1-liter plastic bottles, and in concentrate form for fountain machines in police stations or convenience stores.

How much "energy" is too much?

     Typically the energy behind energy drinks comes from B vitamins, caffeine, carbohydrates (which sometimes include glucuronolactone) and taurine, says James Wesley, M.S. Wesley, a clinical toxicologist and forensic chemist, has been researching and speaking about the history and effects of power potables since 2001.

     Some of these ingredients, like taurine and glucuronolactone, have been raising eyebrows.

     Food sources provide 1 to 2 mg glucuronolactone per day, while a Red Bull contains 600 mg per 8.3-ounce can, says Wesley. In theory, he says glucuronolactone increases glucuronides, which should help remove toxins from the body.

     Given that most energy drinks have 1,000 grams of taurine per 8 ounce, and medical journals report 2 to 3 grams of taurine have been effective treating congestive heart failure, Wesley suggests energy drink users should consider limiting themselves to no more than 2000 mg of taurine. In 2001, when all energy drinks were the 8-ounce type, that wasn't much of a concern, but now, he says, 16-ounce energy drinks with 2000 mg of taurine represent 50 percent of the market, and three popular drinks are available in 24-ounce super size.

     "Taurine makes the heart beat harder, not faster, and it does not raise blood pressure," he says. "It acts in a unique way to increase blood flow and this results in improved alertness without nervous stimulation, but that's just the taurine effects."

     In Kentucky, Rep. Danny Ford introduced a bill on January 25, 2008, to prohibit the sale of any carbonated beverage that exceeds a caffeine content of 71 mg per 12-ounce serving and contains taurine and glucuronolactone, commonly referred to as "energy drinks," to anyone under 18 years of age.

     Although energy drinks seem to be morphing into "everyday soft drinks," Wesley cautions that these power potions should not be used as fluid replacements nor should they be consumed by children. When energy drinks were first introduced, they were 8.3 ounces (and some still are). Today 16 ounces is standard, and he predicts 24 ounces may become the next norm. Wesley says he's concerned that larger sizes encourage increased daily consumption. Exotic ingredients including yohimbine, bitter orange (synephrine) and others also should be avoided, he adds.

     The effects of caffeine consumption have long been debated. Some say adults can safely consume one to two cups of coffee daily, while others maintain up to three cups (less than 300 milligrams of caffeine) may be safely consumed.

     Energy drinks may have more — or less — caffeine than an 8-ounce, drip-brewed cup of coffee. The International Food Information Council reports coffee may have 65 to 120 milligrams of caffeine while an 8 1/3-ounce energy drink may have 50 to 200 mg of caffeine.

     Determining how much caffeine a person consumes per day requires factoring in daily servings of beverages, such as soft drinks, energy drinks, coffee and tea; foods like chocolate; and over-the-counter drugs. To help individuals figure out their consumption, The Caffeine Awareness Alliance offers a Caffeine Calculator at www.caffeineawareness.org/calcu.php.