The study found that sustained energy drink (ED) consumption in young adulthood might increase the risk of cocaine use, nonmedical use of prescription stimulants (NPS), and alcohol use disorder (AUD).
“Because of the longitudinal design of this study, and the fact that we were able to take into account other factors that would be related to risk for substance use,” said Dr Amelia Arria, lead author and associate professor with the Department of Behavioral and Community Health at the University Of Maryland School Of Public Health.
“This study provides evidence of a specific contribution of energy drink consumption to subsequent substance use.”
The rapid growth in ED popularity has taken caffeine use in a new direction.
They differ from traditional caffeinated beverages by typically containing higher doses and concentrations of added caffeine in the form of sweet, flavoured beverages or shots designed to be ingested quickly.
Marketed primarily to youth, some branding has adopted imagery or slogans that denote risky or aggressive behaviours (e.g., Monster Energy, Red Bull).
According to Mintel Global New Products Database (GNPD), Germany has overtaken the US as the top energy drink innovator with the highest rates of new product development (NPD) in 2015.
German product launches in this year accounted for 9% of global energy drink launches compared to 8% in the US.
Dr Arria and colleagues began by recruiting just under 1100 first-year college students with an average age of 18.
These students were surveyed at regular intervals between the ages of 21-25 in order to track changes in various health and risk-taking behaviours, including energy drink consumption and drug use.
While the prevalence of ED use fell significantly during ages 21–25 (63% down to 49%), half (51%) of those sampled fell into the group with a "persistent trajectory," meaning that they sustained their energy drink consumption over time.
Members of this group were at an increased risk for AUD at age 25 along with the abuse of stimulant drugs such as cocaine and NPS.
Those in the "intermediate trajectory" group (17.4%) were also at increased risk for using cocaine and NPS relative to those in the "non-use trajectory" who never consumed energy drinks (20.6%).
Additional findings by the team found those in the "desisting trajectory" group (those whose consumption declined steadily over time) and the non-use group were not at higher risk for cocaine abuse, NPS and AUD.
“These findings suggest that ED consumption might be a novel catalyst for AUD and certain types of subsequent substance use—namely, NPS and cocaine use,” the study observed.
“Because other caffeine consumption was included in the model, it is intriguing that the relationship with substance use outcomes appears to be specific to ED consumption and not to other forms of caffeine.”
The authors hypothesized that ED consumption might have a unique contributory role for the development and escalation of NPS and cocaine use among young adults.
EFSA and energy drinks
While Dr Arria has called for the US Food and Drug Administration (FDA) to regulate energy drinks, here in Europe there is no sign of caffeine health claim approvals in energy drinks.
The European Food Safety Authority (EFSA) has issued several scientific opinions related to ingredients contained in energy drinks.
Its most recent one back in 2015, ruled that acute caffeine intakes by adults of 3 milligrams per kilogram body weight per day (mg/kg bw per day) (about 200mg) do not give rise to safety concerns.
“Other constituents of “energy drinks” at typical concentrations in such beverages (about 300–320, 4 000 and 2 400 milligrams per litre (mg/L) of caffeine, taurine and d-glucurono-γ-lactone, respectively), as well as alcohol at doses up to about 0.65 grams per kilogram body weight (g/kg bw), would not affect the safety of single doses of caffeine up to 200 mg.”
Last year, Danish Socialist Member of European Parliament (MEP) Christel Schaldemose raised concerns about high consumption of these drinks among young people and children.
“We just don’t want to give them [energy drink manufacturers] this additional thing so they can earn a lot of money on a health claim that we think is not suited for young kids,” she said in an interview with EuroparlTV.
Her comments came as MEPs voted to veto four caffeine health claims for energy drinks. MEPs had raised concerns as to how a 250 millilitre (ml) can of energy drink can contain up to 27g of sugar and 80mg of caffeine.
The World Health Organisation (WHO) recommends that adults and children should get no more than 10% of their daily energy intake from free sugars, and that a further reduction to below 5% (about 25g per day) would provide additional health benefits.
Source: Drug and Alcohol Dependence
Published online ahead of print: doi.org/10.1016/j.drugalcdep.2017.06.008
“Trajectories of energy drink consumption and subsequent drug use during young adulthood.”
Authors: Amelia Arria et al.