Caffeinated Energy Drinks -- A Growing Problem Chad J. Reissig a , Eric C. Strain a , and Roland R. Griffiths b a Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224 b Department of Psychiatry and Behavioral Sciences, and Department of Neuroscience, The Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224 Abstract Since the introduction of Red Bull in Austria in 1987 and in the United States in 1997, the energy drink market has grown exponentially. Hundreds of different brands are now marketed, with caffeine content ranging from a modest 50 mg to an alarming 505 mg per can or bottle. Regulation of energy drinks, including content labeling and health warnings differs across countries, with some of the most lax regulatory requirements in the U.S. The absence of regulatory oversight has resulted in aggressive marketing of energy drinks, targeted primarily toward young males, for psychoactive, performance- enhancing and stimulant drug effects. There are increasing reports of caffeine intoxication from energy drinks, and it seems likely that problems with caffeine dependence and withdrawal will also increase. In children and adolescents who are not habitual caffeine users, vulnerability to caffeine intoxication may be markedly increased due to an absence of pharmacological tolerance. Genetic factors may also contribute to an individual’s vulnerability to caffeine related disorders including caffeine intoxication, dependence, and withdrawal. The combined use of caffeine and alcohol is increasing sharply, and studies suggest that such combined use may increase the rate of alcohol- related injury. Several studies suggest that energy drinks may serve as a gateway to other forms of drug dependence. Regulatory implications concerning labeling and advertising, and the clinical implications for children and adolescents are discussed. Keywords caffeine; energy drink; adolescents; overdose; withdrawal; dependence; alcohol; gateway drug 1. Introduction In 2006, annual worldwide energy drink consumption increased 17% from the previous year to 906 million gallons, with Thailand leading the world in energy drink consumption per person, but the U.S. leading the world in total volume sales (Zenith International, 2007). Although “energy drinks” first appeared in Europe and Asia in the 1960s, the introduction of “Red Bull” in Austria in 1987 and in the U.S. in 1997 sparked the more recent trend toward aggressive marketing of high caffeine content “energy drinks.” Since its inception, the energy drink market has grown exponentially, with nearly 500 new brands launched worldwide in Corresponding Author: Roland Griffiths, PhD, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224; USA, e-mail, rgriff@jhm.du, Phone: (410) 550-0034, Fax: (410) 550-0030. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author Manuscript Drug Alcohol Depend. Author manuscript; available in PMC 2010 January 1. Published in final edited form as: Drug Alcohol Depend. 2009 January 1; 99(1-3): 1–10. doi:10.1016/j.drugalcdep.2008.08.001. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript