CISUR – Page 35 – Matters of Substance

It is now timely to consider how liquor laws can promote the health and safety of all British Columbians as BC has decided to review its liquor policies for the first time since 1999. Drinking patterns change over time and often new products emerge. One such emerging issue is the growing practice of mixing energy drinks with alcohol.

The consumption of energy drinks has gained in popularity and the practice of mixing them with alcohol has become commonly adopted by young adults in Canada. Energy drinks are widely available in liquor outlets and at drinking events where they are also often heavily promoted. When cocktails which mix energy drinks with alcohol are ordered at drinking establishments, sometimes a pre-mixed cocktail is served and sometimes the customer has to mix the cocktail themselves.

Despite the regular practice of mixing alcohol with energy drinks (which may occur for several reasons), the labels of energy drinks warn against their consumption with alcohol. Mixing them with alcohol is not approved by Health Canada and is advised against. As reported by the media and in scientific research, multiple hospitalizations, deaths, and other adverse consequences have been associated with the consumption of alcohol and energy drinks. Researchers have found that the consumption of alcohol and energy drinks, compared to alcohol use alone, is associated with an increased risk of heavy alcohol use, requiring medical treatment, being hurt or injured, drinking and driving, and engaging in high-risk sexual behaviours.

In response to more general concerns regarding the safety of energy drinks, Canadian policy makers have considered implementing regulations on energy drinks, although these regulations appear to have fallen short in terms of addressing the mixing of energy drinks with alcohol (see policy report for more details). Other countries (e.g., U.S.) have addressed safety issues with energy drinks and alcohol by banning the production and sale of high-risk alcoholic energy drinks (high alcohol content cocktails marketed as energy drinks). In Canada, some provinces have limited the amount of caffeine which can be permitted in an alcoholic beverage to 30mg/beverage. This regulation is a step forward in protecting the health and safety of Canadian consumers, although it fails to address the hand-mixing of alcohol and energy drinks which is more common. It also does not address the availability of energy drinks in establishments where alcohol is sold.

Although the research in this field has its limitations, risks associated with combining alcohol and energy drinks has been identified. In these circumstances, liquor laws need to be adapted. Should alcohol establishments be permitted to sell energy drinks mixed with alcohol? Should energy drinks be sold in drinking establishments? Should energy drinks be heavily marketed in these establishments? A transparent discussion of this emerging public health issue is surely warranted in the context of the current policy review.

Should a modern BC liquor policy include regulations on selling high caffeine content energy drinks in risky environments like bars and clubs?

Author: Kristina Brache

The chance of experiencing harm from alcohol consumption is related to how much alcohol we actually drink. So, naturally, to reduce our likelihood of experiencing harm from alcohol we need to decrease our consumption. But how much alcohol is too much? Is there a “safe” level of consumption?

In November 2011, the federal, provincial and territorial health ministers adopted national Low Risk Drinking Guidelines that were developed by a team of Canada’s alcohol experts. Drinking guidelines provide recommendations about specific upper limits of alcohol consumption, which can minimize your likelihood of experiencing alcohol-related harm. Unfortunately, many Canadian’s are unaware that these guidelines even exist! The current guidelines recommend that to reduce long-term health risks women should usually drink no more than 10 drinks per week and men usually no more than 15 drinks per week. To reduce short-term risks, such as injuries, women should drink no more than 3 drinks and men no more than 4 drinks on a single occasion. But what is a “drink”? If you drank two bottles of wine last week, how many drinks did you actually have?

Research shows that we considerably underestimate how much alcohol we consume. This is understandable given the large variety of alcoholic beverages in the market that vary not only in strength but also in container size. Canada’s drinking guidelines define a “drink” as 13.45 grams of ethanol. This is equal to 341ml of 5% beer or cooler, 142ml of 12% wine, or 43ml of 40% spirits. So, if one of us drank 2 bottles of wine last week, how many drinks was that? Still don’t know the answer? Without a calculator, we don’t either!

Some countries have introduced standard drink labeling on alcohol containers to inform consumers how many drinks are in each alcoholic beverage they purchase. In Australia for example, a typical 750ml bottle of 12% wine would have a label that says “Contains 7.1 standard drinks” (this would be equal to 5.3 Canadian standard drinks). In Canada, the alcohol in our stores is labeled with only alcohol concentration by volume (%ABV), not standard drinks – requiring consumers to “do the math”. Not surprisingly, a recent CARBC study showed that British Columbians are not very accurate in determining the number of drinks in a beverage when only provided with %ABV labels. Shockingly, some spirit drinkers thought that they were drinking up to 7 times less than they actually were! CARBC research has shown that adding standard drink labels (e.g. for a 40% strength bottle of spirits: “17.5 standard drinks”) overcomes this problem. Further, nearly 83% of British Columbians who participated in this study were in favor of standard drink labeling and believed that standard drink labels would help them to comply with Canada’s drinking guidelines. Given what you know now… if one of us drank 2 bottles of wine last week, how many drinks did we have? (5.3*2 = 10.6 standard drinks).

It’s estimated that if everyone in Canada were to follow the low-risk drinking guidelines the annual number of alcohol-related deaths would decrease by 4600 . We need to do a better job of sharing these guidelines with Canadians. Pamphlets with the guidelines could be placed in doctor’s offices, and posted in liquor outlets, bars and restaurants. But in order for the guidelines to be effective, we also have to better equip Canadians to follow them – without having to do the math.

Do you think standard drink labels would help consumers follow Canada’s low-risk drinking guidelines?

Authors, from left to right: Kara Thompson, Montana Osiowy

Author: CISUR

A “modern” drinking practice: Alcohol and energy drinks

Helping consumers help themselves? Demystifying Canada’s low-risk drinking guidelines