October 26, 2010
Caffeine and Alcohol Drink Is Potent Mix for Young
By ABBY GOODNOUGH

Mixing alcohol and caffeine is hardly a new concept, but a rash of cases involving students and others who landed at hospitals after drinking beverages that combine the two in a single large can has alarmed college and health officials around the country.

The drinks are dangerous, doctors say, because the caffeine masks the effects of the alcohol, keeping consumers from realizing just how intoxicated they are.

A brand called Four Loko — a fruit-flavored malt beverage that has an alcohol content of 12 percent and as much caffeine as a cup of coffee — has come under particular scrutiny after students who drank it this fall at Ramapo College in New Jersey and Central Washington University in Ellensburg, Wash., ended up in emergency rooms, some with high levels of alcohol poisoning.

“This is one of the most dangerous new alcohol concoctions I have ever seen,” said Dr. Michael Reihart, an emergency room doctor at Lancaster General Hospital in Lancaster, Pa., who said he had treated more than a dozen teenagers and adults over the last three months who had been brought there after drinking Four Loko. “It’s a recipe for disaster because your body’s natural defense is to get sleepy and not want to drink, but in this case you’re tricking the body with the caffeine.”

At the urging of 18 attorneys general, the Food and Drug Administration, which has never approved adding caffeine to alcohol, is reviewing whether the drinks are safe. And in July, Senator Charles E. Schumer of New York asked the Federal Trade Commission to investigate whether the drinks, with colorful packaging and flavors like watermelon, blue raspberry and lemon-lime, are “explicitly designed to attract under-age drinkers.”

Lawmakers in several states, including New York, have sought to ban the drinks, though no legislation has passed yet.

Peter Mercer, the president of Ramapo College in Mahwah, N.J., went so far as to ban energy drinks that combine caffeine and alcohol this month after six students were taken to the hospital after drinking Four Loko. One, he said, “admitted to drinking three cans of Four Loko and several shots of tequila in just over an hour.”

That student had a blood alcohol level of .40 afterward, Dr. Mercer said.

“I do not see any socially redeeming purpose being served by these beverages,” he said. “At the end of the day, they’re aimed at a young, inexperienced market for the purpose of enabling them to become rapidly intoxicated.”

Chris Hunter, a co-founder and managing partner of Phusion Projects, the five-year-old Chicago company that owns Four Loko, said Tuesday that the drink, introduced in August 2008, was being unfairly singled out. The company takes steps to prevent its products from getting into the hands of minors, he said.

“Alcohol misuse and abuse and under-age drinking are issues the industry faces and all of us would like to address,” Mr. Hunter said. “The singling out or banning of one product or category is not going to solve that. Consumer education is what’s going to do it.”

In a separate statement published on its Web site, Phusion Projects questioned why a police investigation into the Central Washington University incident had focused on Four Loko when, according to the police report, a number of other alcoholic beverages, including beer, vodka and rum, were also found at the off-campus party where students got sick.

Rob McKenna, the attorney general in Washington, said that while many students at the party had mixed alcohols, some of those who were hospitalized had drunk only Four Loko.

“You have a product where people don’t appreciate how much alcohol they’re consuming,” Mr. McKenna said.

Students at several universities around the country said Tuesday that Four Loko and similar drinks were catching on among their peers because they were cheap and potent yet did not taste like alcohol.

“You can get drunk for $5 all night,” said Christine Binko, a junior at Boston University who said she had noticed Four Loko cans littering streets near campus on weekends. “But I definitely think it brings out the aggression in people.”

Ms. Binko and most others interviewed expressed wariness about the drinks.

At Xavier University in Cincinnati, Adam Stowe, a sophomore, said that Four Loko was showing up much more at parties, but that most people only drank one to start their night with a powerful drink and then switched to beer. “I just tasted it once and said, ‘That’s gross,’ ” he said.

Also under scrutiny is Joose, a caffeinated alcoholic beverage made by United Brands, a San Diego company. It comes in the same 23.5-ounce can as Four Loko but has a lower alcohol content, 9.9 percent, and, according to Michael Michail, the company president, less caffeine. Mr. Michail said a can of Joose contained 54 milligrams of caffeine; Mr. Hunter said a can of Four Loko contained 135 milligrams.

“It is ludicrous for someone to come out and say we are targeting under-age drinkers,” Mr. Michail said. “We understand what the laws of the land are, and we stick with it.”

Both Mr. Michail and Mr. Hunter said their beverages came in 23.5-ounce cans because when they started out, that was the standard for malt liquor drinks. Mr. Michail said he was considering a smaller can; Mr. Hunter said Four Loko drinkers could already choose between the version with 12 percent alcohol and another with 6 percent alcohol, though the former is far more popular.

Both Four Loko and Joose are sold in 47 states; Mr. Hunter said his company had added 10 states in the last three months alone.

“We have seven spots on our labels that identify it’s an alcoholic product,” he said. “We go above and beyond industry standards.”

Critics, though, say that the brightly colored cans Four Loko comes in look like iced tea, soda or energy drink containers, and that it is easy to mistake the product for nonalcoholic drinks.

“I’ve talked to parents who were shocked because the can was in their refrigerator and they didn’t realize it was an alcoholic beverage,” Dr. Reihart said. “It looks like every other energy drink out there.”

Katie Zezima, Bob Driehaus and Staci Semrad contributed reporting.