Caffeinated energy drinks--a growing problem

Abstract

Since the introduction of Red Bull in Austria in 1987 and in the United States in 1997, the energy drink market has grown exponentially. Hundreds of different brands are now marketed, with caffeine content ranging from a modest 50 mg to an alarming 505 mg per can or bottle. Regulation of energy drinks, including content labeling and health warnings differs across countries, with some of the most lax regulatory requirements in the U.S. The absence of regulatory oversight has resulted in aggressive marketing of energy drinks, targeted primarily toward young males, for psychoactive, performance-enhancing and stimulant drug effects. There are increasing reports of caffeine intoxication from energy drinks, and it seems likely that problems with caffeine dependence and withdrawal will also increase. In children and adolescents who are not habitual caffeine users, vulnerability to caffeine intoxication may be markedly increased due to an absence of pharmacological tolerance. Genetic factors may also contribute to an individual's vulnerability to caffeine-related disorders including caffeine intoxication, dependence, and withdrawal. The combined use of caffeine and alcohol is increasing sharply, and studies suggest that such combined use may increase the rate of alcohol-related injury. Several studies suggest that energy drinks may serve as a gateway to other forms of drug dependence. Regulatory implications concerning labeling and advertising, and the clinical implications for children and adolescents are discussed.

Figure 1

Energy drink sales in millions of dollars in the United States from 2002–2006. Data are based on scanner data from over 32,000 stores such as supermarkets, drug stores, and discount merchandisers other than Wal-Mart. Data are from retailers with $2 million or more in annual sales but exclude: clubstores/warehouse clubs, convenience stores, dollar/variety stores, foodservice, vending, concession sales and specialty channels/retailers of all types (e.g., gourmet/specialty food stores, hardware/home improvements stores, military exchanges) (Packaged Facts, 2007 used with permission).