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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Wednesday 24th October 2012

‘The poison is in the dose’ is a central theme of much of what I write and say about poisons. Poor media coverage of both poisons and psychoactive substances is another. When the two came together, recently, it set me thinking about a potential side effect of an end to drug prohibition.

The substance of interest is one that most people do not think of as a concern, much less as a potentially lethal poison; caffeine. Billions of people consume caffeine every day and only a very few of them ever consider that this is an addictive substance with a well-defined fatal dose.

Since the introduction of high caffeine ‘energy drinks’ there have been stories, from time to time, of people suffering illness and death from caffeine overdose. The number of deaths is not large and most of them seem to have been due to the consumption of caffeine itself rather than a caffeine containing beverage.

What brings this topic back into the news was a report on 19th October1 that a family had filed a lawsuit against a manufacturer of an energy drink claiming that it failed to issue warnings about its very high caffeine level and the absence of such warnings resulted in their daughter’s death last December.

Anais Fournier was reported to have consumed two large cans of a high caffeine drink while watching a movie and suffered cardiac arrest. The theoretical toxicity of caffeine suggests that the amount consumed, 480mg, should not have been lethal but it certainly was very much higher than would be found in an ordinary soft drink. If the case comes to court, I’m sure the matter of dose will be fully explored.

As part of the collection of evidence, the family entered freedom of information (FOI) requests to the US Food and Drug Administration (FDA), and others, asking about cases of caffeine toxicity resulting from the drinks produced by this particular manufacturer (I will name the company later but the naming is a focal point of my theme).

The original story was picked up and has been re-reported but the re-reporting seems to have focussed on the FDA and gives the impression that the FDA is conducting an investigation at its own urging rather than that FOI legislation has brought this into the open. The FDA seems to have had material in its archive going back to 2004 on the subject of high caffeine drinks but, and this is central, these drinks are sold as dietary supplements and not, therefore, regulated by the FDA.

The National Poisons Data Service annual report for 20102 shows around 400 ‘single exposures’ reported to it concerning caffeine-containing energy drinks with 50 resulting in ‘moderate’ or ‘major’ outcomes but no deaths.

So, there is no doubt that high doses of caffeine can be harmful but the open question remains whether this young woman consumed a fatal amount.

The aspect of the media reporting that interested me was the way the New York Times dealt with it.3 Its headline ‘Monster Energy Drink Cited in Deaths’ clearly puts the company concerned ‘in the frame’ but the first sentence of the second paragraph backs away from that by saying;

‘The reports, like similar filings with the F.D.A. in cases involving drugs or medical devices, do not prove a link between Monster Energy and the deaths or other health problems.’

Now that is perfectly true and is being completely fair to the company. As I said above, based on published LD50 figures and the measured caffeine content of the drinks, it cannot be stated, with certainty that the drinks were responsible.

What interests me, though, is what the media (and I’m thinking more about the UK media rather than the NYT) would have said if the allegation were that some non-proprietary substance was implicated in a death. We don’t need to guess because we know that the media prints as fact that substances such as ecstasy, cannabis or mephedrone have caused deaths in the immediate aftermath of such a death and then are very reluctant to correct that information when toxicology studies prove that either the death was not due to the blamed substance or, even, that substance was not present.

Obviously, the NYT was being careful not to make a false statement about Monster Energy’s drinks to protect itself from litigation and that made me wonder whether one side effect in a post-prohibition world would be that the British media would realise the need to be more careful about reporting the truth. Though most reformers, in the UK at least, look for a non-commercial solution to the provision of currently banned substances those substances, in a regulated market, would be provided by someone and that someone would have a reputation that could be defamed by the sort of media reporting we currently see whenever there is even the most tenuous link to a psychoactive substance in a tragedy.

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