drinks identifying caffeine as an ‘unsafe food additive’ and
stated that their sale violated federal law. There are also
restrictions on the production and sale of caffeinated alcohol
beverages in some countries, including Canada, where caffeine
can only be mixed with alcohol if it comes from a
natural source (e.g. guarana) and Mexico where caffeinated
alcohol beverage sales are prohibited in bar rooms and night
clubs. In the UK, alcohol-related harms and binge drinking
are high on the political agenda and there have been calls for
a legal restriction on the amount of caffeine that can be
added to alcohol products, which would effectively ban
many of the commercially available combination drinks that
contain relatively high levels of caffeine. However, the
debate over-caffeinated alcohol beverages is somewhat
undermined by the fact that caffeinated energy drinks are
widely available. Although they have been banned in various
countries in the past (e.g. France, Denmark, Norway), many
of these bans have since been revoked. And individuals are
still free to mix their own caffeine/alcohol beverages. In fact,
some UK-licensed alcohol chains offer ‘energy cocktails’ as
part of their cocktail list that contain energy drink mixers,
and many bars and clubs stock lower quantity versions of
energy drinks that are ideally suited as mixers for alcoholic
spirits.
In conclusion, public health concern over caffeinated
alcohol drinks is justified, although the nature of the caffeine/
alcohol relationship is yet to be fully elucidated. For
example, the extent to which combined effects are due to an
additive or synergistic pharmacological relationship, and
whether they are mediated by expectancy effects, are unclear.
So what now for legislation and policy? While there have
been significant moves to control the production and sales of
pre-mixed caffeine/alcohol drinks, these are somewhat undermined
by the ability to ‘mix your own’ at home or in social
settings. One strategic option may be to restrict the sale of
energy drinks in licensed alcohol premises, although such
policies are often met with resistance and branded as signs
of the ‘nanny-state’. However, education should be
improved. Positive effects of energy drinks and caffeine/
alcohol combination drinks are readily and aggressively
relayed in marketing campaigns but negative effects, if
relayed at all, appear as ‘small print’ on labels that consumers
often fail to read. This balance needs to be addressed.
Current European legislation (European Directive 2002/67/
EC on the labeling of foodstuffs containing quinine and caffeine)
rules that beverages containing upward of 150 mg/l
(other than tea or coffee) must be marked as ‘high caffeine
content’ and that this statement should be in the same field