The FDA Ban on Four Loko – Why The FDA Isn’t Going To Take Your Rum And Coke Away

November 23rd, 2010   2 Comments

It’s been exactly a week since my last article on Four Loko (“Wilmington Takes A Harder Look At Four Loko”) and in that time a lot has changed. In fact, Four Loko went from being a potential menace (especially if you drink more than one) and college party favorite to a banned drink. How exactly did this happen so fast?

Well, actually, it didn’t happen that fast. According to Discover Magazine (in 2009) the FDA requested proof that the caffeinated alcohol drinks were safe back in 2009. The list of companies notified to look into their products’ safety is here. State regulators did not wait for the FDA – Michigan, New York, and Utah among other states banned the sale of Four Loko in their state before the FDA sent their warning letter on November 17.

Four Loko can cause violent behavior in students due to its high powered blend of alcohol and caffeine.

Students that drink Four Loko are more likely to engage in dangerous behavior, according to Federal officials.

These facts, and other developments (hospitalizations of binge drinking students, a study that showed that caffeinated alcohol drinks cause more sexual violence and more dangerous behavior in general) led to a not so rosy outlook for Four Loko and its kind. In fact, on Nov. 16 Phusion Products, the makers of Four Loko, presumably anticipating the FDA’s letter, announced they were removing caffeine, guarana, and taurine from their drinks.

The reaction to this was somewhat predictable.  Philly Post writer Jeff Billman in his article “Leave Four Loko Alone” said:

“But: Do you really think that banning Four Loko, or anything else for that matter, is going to stop kids from figuring out that if they chug a Red Bull in between sessions of Coors Light or Jose Cuervo or whatever cheap vodka comes in plastic jugs and in bulk from the BJ’s across the state line in Delaware, they’ll be able to stay awake longer and, consequently, drink more? I had that figured out well before the advent of Four Loko, and I can assure you that, in this, the information age, the kids today are much better informed on these things than I was as a college frosh in 1997. If I want a particularly late-night bender—a rarer and rare occurrence these days—downing one of those five-hour energy shots does the trick. Oh, and those are totally legal. So is downing one, and following it with six shots of Jack Daniel’s.”

Er, yes, that is true.  But comparing a five-hour energy shot with Four Loko is unfair.  After all, a five-hour energy shot does not contain alcohol.  Nor is it packaged with alcohol, and my guess would be if the packaging expressed that it works well with six shots of Jack Daniel’s that they would be receiving a letter from the FDA as well.  Vague comparisons of dissimilar products aren’t going to get you very far.

Meanwhile, over at the Miami New Times, you could hear Kyle Munzenrieder make the “nanny state” argument:

“In a treacherous blow to the personal freedoms of Americans and Capitalism itself the FDA is expected to ban the sale of caffeinated alcohol drinks as soon as next week. Yes, alcohol and caffeine, two perfectly legal and widely available substances will not be allowed to be sold together in one can. The move comes after in the midst of the Four Loko craze.”

You may have a point when you make that argument (I wouldn’t say the ban is necessarily a good or bad thing) but it’s not really fair to make that argument in this manner:

“Researchers are concerned that caffeine counterbalances some of the effects of alcohol and may lead drinkers to believer they are less drunk then they are. That’s a valid point, yet the mixing of the two substances isn’t going away any time soon. While the pre-made mixtures will apparently now be banned, it’s unlikely Americans will stop drinking these find mixtures of caffeine and booze:

Rum and Coke
Vodka and Redbull
Irish Coffee
Espresso martinis
Shots followed by a Five Hour Energy chaser
Cafecito and Cisco”

Yes, Americans are still going to drink rum and coke, but no, that’s not really the same thing. Irish coffee has not been the scourge of college campuses lately. Nor have rum and cokes. Why is that? Because they contain vastly different quantities of caffeine and alcohol. Make a 6.5 oz rum and coke with 40% ABV rum and your drink will contain 0.6 oz of alcohol and 14.5 mg of caffeine. Make a version of it more generously sized and you are still nowhere near Four Loko. This recipe calls for 4 oz of Bacardi white rum (37.5% ABV) and 8 oz of Coca Cola (35 mg of caffeine in a 12 oz can). This drink will probably cost you more at the bar, and still only have 23.3 mg of caffeine and 1.5 oz of alcohol (4 oz x .375). This is compared to Four Loko, which has one serving size (23.5 oz) and contains 156 mg of caffeine and 2.82 oz of alcohol. Even two of those hefty rum and cokes wouldn’t have as much caffeine as a Four Loko. I don’t that anyone ever binges on Irish Coffees, but if you are drinking an average sized Irish Coffee (a 7.5 oz serving, plus cream on top) you’re only going to consume about 0.6 oz of alcohol and 90 mg of caffeine. Again, just not the same.

Four Loko does not stack up against other mixed drinks in terms of caffeine - it stacks over.

Four Loko, towering over the competition.

The other problem in Four Loko land (as we’ve pointed out before) is the serving size. It’s a carbonated beverage so once you crack open the can, you’re more or less forced to consume/get rid of it or have it go flat. Unlike vodka (which Arrested Development’s Lindsay Bluth memorably and mistakenly believed “goes bad once it’s opened”) Four Loko cannot really be consumed in moderation. Fortunately we can cap our whiskey, rum, and vodka bottles. In fact, that’s part of the design – if vodka was packaged to “go bad” within a few hours, you can bet it wouldn’t be on the market.

Was the ban the smartest thing ever? That seems to me to be another debate. It also seems to me that comparing a mixed drink like a rum and coke to Four Loko does not have a place in that debate. After all, Four Loko is a real product on a real shelf – nobody is selling rum and cokes in a can. The FDA’s job is to regulate real products. And again, if they did sell rum and coke in a can, that would probably have not caught the FDA’s attention – if the can was 12 oz instead of 23.5. Caffeine and alcohol together are not necessarily going to send you to the hospital or make you have a violent freak out, but moderation when consuming the two simultaneously is more even important than when consuming one or the other separately. Phusion Products ended up creating a product that fell a little far outside the lines of moderation. Four Loko is just oversized in almost every sense (except price, which Cord Jefferson thinks may’ve played a role in its being banned). My guess is that if Phusion Products had not tried to create the craziest thing on the market, their product would probably still be on the market.

Post by Robyn Schelenz. Have any thoughts, comments, or disagreements you wish to share? Send me an email over at robyn at homehealthtesting.com and I’ll get back to you as soon as I can.

Headline photo by Ted S. Warren/Associated Press.

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Wilmington Takes A Harder Look At Four Loko

November 16th, 2010   2 Comments

Four Loko, the high alcohol high energy drink, has received a lot of attention lately (including from us – see “Alcoholic Energy Drinks More Than Most Can Handle” for more).  There has been some new discussion locally as North Carolina contemplates doing what New York state recently did by banning the drink. At the moment Governor Perdue has asked manufacturers to voluntarily stop selling alcoholic energy drinks in the state.

The University of North Carolina Wilmington’s Substance Abuse and Prevention Office notes that most of the kids on campus caught drinking have been drinking Four Loko (WECT 6).  The students of the school interviewed for the article made clear that it is potent stuff.  It does, after all, have a 12% alcohol content and enough stimulants in it to mask normal feelings of drunkenness.  But does that warrant a ban?

Why Ban Four Loko?

There are a few arguments on this.  Some have accused Four Loko of intentionally marketing to younger people.  The design on the cans is bright and colorful and looks more or less like any other energy drink you would buy.  By virtue of this association it seems that kids underestimate the punch that each can packs. Which leads us to the second point – the can is almost 24 ounces, twice as large as a beer.  The alcohol content is about three times that of a light beer.  Basically, finish one can of Four Loko (which is only a few dollars – the price is one of its selling points) and you’ll have had the equivalent of a six pack, and jitters on top of that.  You will most likely be drunk, or very drunk. And not only will you have consumed a six pack, you will also have simultaneously consumed the equivalent of two Red Bulls. Why’s that? Because one 8.3 oz can of Red Bull only has 76 mg of caffeine in it…while Four Loko has 156 mg of caffeine.

Four Loko, the latest popular target for college partiers and alcohol testing alike.

Four Loko

Designed For Drinking

That Four Loko is packaged in such a manner is part of the problem.  It is not so much the eye-catching design, but the size of the can that presents the issue (in my mind anyway).  Once you open the can, you’re going to have to drink it or throw it out – it’s a carbonated beverage and will go flat like a soda does if left to sit.  You’re not purchasing a can of the drink to have as an apéritif over a few days.  You’re drinking the whole thing once it’s opened, and as pointed out above, that will definitely make you drunk.  It’s immoderation by design.

The Stimulants

Then you have the fact that the beverage contains a number of stimulants.  Those stimulants are caffeine, taurine, and guarana.  When they mix with alcohol (in this drink and in many others, including cocktails) they can have unexpected effects.  As our previous blog noted, people drinking an alcoholic energy drink believe their motor coordination is better than those who do not have those ingredients in their drink.  If you do not feel as drunk as you are, you may be inclined to continue drinking, and the signals from your body that say you’ve had enough may not be clearly perceived.  This is the aspect of alcoholic energy drinks that leads to hospitalization.  But there are other negative effects too.

One of the stimulants in Four Loko.

Guarana, one of the stimulants in Four Loko.

A study at Wake Forest University in 2006 found that those who mix energy drinks with alcohol are more likely to sexually assault or be sexually assaulted, more likely to get in a car with a drunk driver, and more likely to require medical treatment (see the Daily Collegian for more info).  In other words it’s much more likely that destructive and risk-taking behaviors will be pursued. Aimee Hourigan of the UNCW Substance Abuse and Prevention Office in an interview with WWAY3 noted that “You’re more likely to get into a fight and have other negative consequences related because your body’s just not equipped to handle that much alcohol and stimulant at the same time.”

An Experiment

The actual effect of drinking a Four Loko was measured recently by a local Raleigh woman. Drinking four ounces every half a hour (a pace probably considered slow by college standards), she measured her blood pressure and pulse through the process.  When she started out her blood pressure was 116 over 64; in 4 ounces’ time it went up to 192 over 36 and her heart was racing at 154 beats per minute.  The woman, a registered nurse, had her verdict.  Feeling sick after 8 ounces, she stopped, and told WALB10 news that “if you’re not careful, you could kill yourself with this.”

A Matter of Taste

Finally, in terms of taste, people will disagree, but it seems clear that the drink wasn’t made for delicate meal pairings.  In comes in a number of sugary, fruit like flavors that make it more appealing.  All these factors considered, it’s hard to see that it’s anything other than a product made for binge drinking.

A Question of Law

Does this mean that a ban is required?  It remains to be seen if this is so.  The makers of Four Loko, Phusion Projects, recently published an open letter addressing federal and state inquiry into their beverage.  They do sell a version of the drink that contains less alcohol; it’s foreseeable that they may soon only be allowed to sell that version.  The popularity of the drink on college campuses is a problem somewhat larger than themselves – college binge drinking is always a problem, especially as it often occurs in crowded situations with many inexperienced if not underage drinkers.  Four Loko may be a little too potent for that setting, but that doesn’t mean it couldn’t potentially be enjoyed elsewhere.

As Wilmington and North Carolina in general examine this issue, let us know what you think by leaving comments or sending us an email at cs at homehealthtesting.com.  We’d love to hear from you (and remember, it’s easy to keep tabs on your BAC with a disposable and portable alcohol test kit).

For more info, including info on the FDA’s inquiry into alcoholic energy drinks, check out Time’s Healthland.

Headline picture by Taggart, originally for the New York Daily News.

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A Country Thing? Rx Drug Abuse Most Common In Rural Areas

November 9th, 2010   Add Comment

Prescription drug abuse is a major point of focus for our blog, as it is a problem the scope of which is still not fully understood.  Florida has received a lot of attention for its pain clinics, but it seems the areas in which prescription drugs are mostly abused are rural (which should come as no surprise to the viewer of the OxyContin Express).

According to a new study that will appear in the Archives of Pediatrics & Adolescent Medicine (see Science Daily for the full article), rural teens are more likely to abuse prescription drugs.  With adjustments for other factors made, the study found that rural teens were 26 percent more likely than urban teens to admit to prescription drug abuse.

In general, 1 in 8 teens reported prescription drug abuse at some point in their lives, itself a rather alarming statistic.  The study suggests that the greater tendency toward prescription drug use in rural areas may be the result of a lack of availability of similar illegal drugs, such as heroin.

While a heroin shortage in rural communities may sound like a good thing, it doesn’t seem like, based on these statistics, the country life is simpler or free of drug use.  In fact, not only is prescription drug use a problem in rural communities, but treating it may be more difficult than it would be in an urban community.  Rural teens may be less likely or have a harder time finding places that will help them deal with a substance abuse problem.  It is possible that their communities do not have the same awareness level as do larger communities or have the same ability to deal with a local drug problem.

We have documented extensively in our blog that prescription drug abuse can have as many consequences as illegal drug abuse.  For parents and policymakers alike, it’s something to think about.

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Alcoholic Energy Drinks More Than Most Can Handle

October 19th, 2010   1 Comment

If you’re drinking in moderation, you may think to yourself that you are just having “a drink to relax.” Or having a drink with dinner. Either way, it’s doubtful you would reach over for any of the alcoholic energy drinks currently on the market, and as of this month banned at Ramapo College in New Jersey.

The cause of the ban? 23 alcohol related hospitalizations (as of October 1) since school started. A high number and out of the ordinary for Ramapo, they found that a few of the students were in the hospital as a result of an “energy alcohol drink” called Four Loko.

Four Loko is part of a trend of alcoholic drinks known in some spheres as alcopops (and that tells you something right there doesn’t it!). Among the first of the alcopops was Sparks, a drink produced by Miller Brewing Company. Sparks varied from between 6-8% alcohol content and aside from that contained a great deal of caffeine, taurine, ginseng and guarana along with syrupy, fruity flavors. Not exactly something that will be served to you by a sommelier, Sparks became popular among college students and young professionals as a way of staying alert while binge drinking. This got it branded as a health hazard, as it dulled the user’s awareness of their state (and increased dehydration) and eventually MillerCoors redeveloped it and removed the caffeine. These days Sparks is a shadow of its former self, and no longer retains the same stimulants (or popularity) that it once had.

This is not the case for Four Loko. As demonstrated by the AP, Four Loko is quite potent – the alcohol content is 12%, and it contains the staples of other non-alcoholic energy drinks: caffeine, taurine, and guarana. It has been called “liquid cocaine,” is extremely cheap, and can lead to blackouts unexpectedly quickly (see the Reading Eagle for more). It also doesn’t help that its twice the size of a can of beer at almost 24 ounces, and generally only 2 to 3 dollars.

If increased hospitalization rates and unexpected blackouts (as well as a Facebook group 67000 strong dedicated to this issue) have not yet convinced you this drink might be trouble, consider that drinking 1 can is equivalent to drinking 4 beers. That’s a lot of power in one can – and it’s masked by its deceptive size (all that in just one can?), taste (generally some fruity flavor) and caffeine. You’ll think you’re okay, but you’ll be much drunker than you think. A study in Alcoholism: Clinical and Experimental Research cited by Time found that people who drink energy alcohol drinks think their motor coordination is better than those who do not have energy supplements in their drinks, a combination that can obviously be dangerous. Perception versus reality has always been a problem with alcohol (that’s why we sell alcohol test kits !) but more so with these drinks. Let’s not forget caffeine is a drug too!

In sum, Four Loko and the like are not your average alcoholic beverages – cheaper, more sugary, and potentially more likely to provide a nasty hangover (or worse). Exercise caution and remember that a mixture of caffeine and alcohol is not a great combination.

Picture of Sparks (pre-reformulation) uncredited via Times Union Blog

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How Do Alcohol & Tobacco Interact?

August 10th, 2010   Add Comment

Anyone who has gone to parties and social gatherings will be aware of people who smoke only socially. Social smoking or smoking only atparties seems like a concept that is generally accepted by many. Research supports the fact that those who consume large amounts of alcohol are also likely to be those who smoke a lot too. It is probably not known that the combined effects of alcohol and tobacco can be relatively more devastating.

Almost all alcoholics (80 to 95 percent) smoke cigarettes. This is a rate that is three times higher than the normal population. Out of this about 70 percent of alcoholics are known to be heavy smokers as well. The proportion of heavy smokers in the overall population is ten percent.alcohol and nicotine effects
The concurrent use of alcohol and tobacco fall under what is called the rewarding affect or the aversive affect. In the first case consumption of the other adds to the rewarding effect of the first and in the aversive effect the negative effect of the first reduces.

The Risks Associated with Consuming Alcohol and Smoking

Smoking and consuming alcohol increase the risk of cardiovascular andlung diseases. The combined effect has also been known to cause somekind of cancers like mouth cancer, throat cancer and esophagus cancer. The risks posed are greater than the additive of the risks associated with smoking tobacco and drinking alcohol. The risk of developing a mouth cancer is 7 times higher among those who smoke and 6 times higher for those who consume alcohol than the general population. The same risk is amplified to 38 times more for those who smoke and consume alcohol at the same time. And for an alcohol test to work, you must put down your cigarette – 15 minutes should go by before you consume anything for the test to be administered correctly.
Tobacco and alcohol together also result in nutritional deficiencies too. This occurs due to the lack of proper absorption of the food. The combination is also notorious for resisting the proper action of antioxidants, elements that are able to otherwise fight cancer cells from  developing.

How does Simultaneous Tobacco and Alcohol Use Increase the Risk of Cancer?
There are more than 4000 toxic chemicals in a cigarette that are burnt when one is smoked. These are collectively known as tar and are converted into chemicals that can cause cancer (carcinogens). When one consumes alcohol, certain microsomal enzymes are produced that can increase the activity of these toxic chemicals, increasing the chances of smoking related cancers to a large extent. Some researchers also feel that the dehydrating effect of alcohol results in the ability of the tobacco chemicals to be absorbed in the mouth to a larger extent. This results in a much higher risk of mouth cancer than otherwise. Whether it is to show off to the opposite sex or generally increase camaraderie among friends, social smoking is something that should be avoided completely, lest it become a habit to smoke every time you drink. If you understand the amount of amplification that smoking and drinking together brings about, you should surely ensure that you avoid concurrent consumption.

Helping Michael Lohan Out: The Difference Between Adderall and Meth

August 2nd, 2010   2 Comments

“Adderall, which is a methamphetamine base…” – Michael Lohan

!!!

Recent reports in TMZ suggested that Lindsay Lohan is addicted to methamphetamine. Of course, it’s not true. When TMZ updated their report with the official response from Lindsay’s lawyer, TMZ also added that it is well known that Lindsay has an Adderall prescription and that rehab clinics would not consider them the same drug.

This is true. So, what are the differences between amphetamine and methamphetamine?

Meth pills

A variety of different methamphetamine pills

Well, first of all, if you are in a random drug testing program (as Lindsay is) and are going through rehab, people will be able to tell whether or not you are on meth or a prescription amphetamine like Adderall. This is in terms of their effects on the user and how easily they can be tested for.

Methamphetamine actually exists in a few different forms. There’s l-methamphetamine (levo-methamphetamine) which is the active ingredient in Vicks Vapor Inhaler. This version doesn’t do much to the central nervous system so it won’t make you high. It can show up as positive for meth on a drug test though. Then there’s dl-methamphetamine, which was more popular in the 60s and 70s than it is today. This type of meth is less potent and more toxic and made with different ingredients than the now popular form of meth, d-methamphetamine.

All very interesting. But you say, I know Adderall is a stimulant too, and chemically, they basically look the same. So what gives?

The main difference is the addition of the methyl group that gives methamphetamine its name. The methyl group is like a VIP pass to the brain; it allows the meth to travel faster than amphetamine across the blood-brain barrier and thus makes meth more potent than amphetamines. The methyl group also makes meth more stable than amphetamine.

So while meth and amphetamine may have a lot in common (heck, meth even breaks down into amphetamine in the body) they are still different in chemistry, effect, legal status, and potential for addiction. And they can be tested for separately as well – even something as simple as a home drug test can differentiate between amphetamine and methamphetamine easily. AND, although Adderall does have potential for abuse, it is not as dangerous as methamphetamine – Desoxyn, the prescription name for methamphetamine, is FDA Approved, and at times prescribed for ADHD and obesity, but due to the high risk for abuse it is prescribed quite rarely.

So yes, in the case of this TMZ article, the “experts” were more reliable than the “sources.” Someone should probably let Michael Lohan know though.

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