TRAVIS AIR FORCE BASE, CA — The Air Force had good timing for its survey of energy drink consumption within the service: The Substance Abuse and Mental Health Services Administration (SAMHSA) recently released a new report showing a doubling of energy drink-related emergency department (ED) visits between 2007 and 2011.1
The Air Force is not planning to limit or ban the drinks, said lead investigator Lt. Col. Nicholas Milazzo, chief of pharmacy research for the 60th Medical Group’s clinical investigation facility at Travis Air Force Base, CA. “We are just trying to gather information at this stage,” he said.
Understanding who consumes the beverages and how much they drink could have important health consequences.
According to the SAMHSA report, nearly 21,000 ED visits were related to energy drinks in 2011, more than twice the 10,068 in 2007. That’s on top of a more than tenfold increase in energy drink-related ED visits from 2005 to 2008, from 1,494 to 16,059.
“The main group in the general population that’s going to the ED with caffeine intoxication [is] age 18 to 39, which is the primary population age of our military members,” Milazzo pointed out.
While 18 to 39 year olds continue to have the highest rate of ED visits related to energy drinks, the latest SAMHSA report notes that ED visits by those over the age of 40, related to energy drink usage increased 279% from 2007 to 2011.
The Air Force survey went to 10 bases in the United States, as well as to Aviano Air Base in Italy and RAF Lakenheath in the United Kingdom. Responses were received from 9,661 servicemembers.
“We were very pleased with the response to the survey. Our goal was to get at least a 10% participation rate from each base, and we achieved that at almost every base and exceeded it overall,” noted Milazzo. Both active duty and civilian personnel participated in the survey.
First released in September, the survey closed at all bases on or before Dec. 31, 2012. “Now we’re in the analysis phase,” said Milazzo, who said he hopes to have the final results available for publication in late March.
Vast Majority Use Energy Drinks
About 75% of the respondents indicated they had consumed energy drinks in the past. The survey also asked participants about their work schedules, age, sex and rank as well as how often, for how long and why they drank the beverages. In addition, participants were asked whether they consumed more energy drinks during or following deployment, if any, and whether their use of the drinks had increased over time.
Participants also were asked whether they had experienced any negative side effects such as dizziness, irritability, rapid or abnormal heartbeat, chest pain or insomnia and whether they had seen a physician or gone to the ED as a result of side effects from the drinks.
“We believe that consumption has become prevalent enough to warrant investigation,” said Milazzo. “The Air Force physical health assessment asks whether patients use alcohol and tobacco and how frequently. Asking about energy drink consumption would be a decent question to add as a screening tool.”
At this time, however, the “Air Force does not and is not considering the screening of energy drinks in our airmen,” stated Jonathan Stock, chief of public affairs, Office of the Air Force Surgeon General.OTC Not Risk-Free
The easy availability and virtual ubiquity of the beverages might lull drinkers into thinking they pose no risk.
“People think that if something is available over the counter, [then] it’s safe. That’s not necessarily true,” said Milazzo. “Any product with caffeine will increase respiration and heart rate, and its diuretic effects can cause dehydration.”
More critically, “there is a potential link between energy drinks and deaths related to arrhythmias,” he added.
In November, the Food and Drug Administration (FDA) released data showing 18 deaths associated with Monster Energy and 5-hour Energy from 2004 to late 2012. The deaths were reported by healthcare providers and patient families, and the FDA noted that no causal relationship had been established.
Part of the problem, according to Milazzo, is that drinkers may inadvertently consume more caffeine than they intend.
“Many people think of the drinks as being more like a soda or flavored drink than a cup of coffee. They may actually be supplementing them with other caffeinated drinks such as coffee, tea and soda,” he said, noting that younger people might be particularly at risk.
“If they are caffeine naïve, their bodies don’t have a chance to slowly adjust, and it can be a shock to the system,” he explained.
According to a November letter from FDA Acting Associate Commissioner for Legislation Michele Mital to Sen. Richard “Dick” Durbin (D-IL), the agency is “looking at whether products that may be safe for most individuals under labeled-use conditions may pose significant risks, arising from direct toxic effects, when the products are consumed in excess or by vulnerable groups, including young people and those with pre-existing cardiac or other conditions. … Areas of particular focus would include such matters as the vulnerability of certain populations to stimulants and the consequences of excessive consumption of ‘energy drinks,’ especially by young people.” 2
In addition, the labeling on energy drinks and the smaller, more concentrated energy shots, can be confusing or provide little information, according to the letter released by Durbin’s office.
Energy drinks typically include herbal supplements such as guarana, ginkgo, or taurine, which allow them to be marketed as dietary supplements, rather than as conventional food or beverages, and exempt them from FDA regulation. Those marketed as dietary supplements, including Monster and 5-hour Energy, do not need to disclose the amount of caffeine in the products.
Mital’s letter noted that “within the bounds of our authority, FDA will consider taking appropriate action with respect to the labeling of these products, such as requiring disclosure of the amount of caffeine in food products, limitations on intended use or warnings about possible adverse effects.”
Energy drinks sold as beverages already disclose the amount of caffeine they contain, but a consumer might not be clear on the amount in each can they drink.
“If you flip the can around, it may say it contains two servings. But the amount of caffeine and other ingredients in the table applies to just one serving, so it looks like less than it is,” Milazzo said. “It’s a little alarming when you don’t know the amount you’re consuming in some of these products.”
- The DAWN Report. Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern. Substance Abuse and Mental Health Services Administration. Jan. 10, 2013.
With a long history of point of care testing at both of its predecessor organizations, the Walter Reed National Military Medical Center (WRNMMC) laboratory services staff were keenly aware of the advantages of using portable testing devices to obtain rapid patient assessments.
Since the launch of the Opioid Safety Initiative in 2012, the VA has implemented a number of steps designed to reduce the use of opioids and the risk of addiction and overdose among veterans.