Pharmacists should dispense 'energy shots,' expert says

The miniature "energy shots" often on display at convenience stores and gas stations should be regulated as drugs and sold by pharmacists, says the chair of an expert panel on energy drinks that was convened by Health Canada several years ago to study the issue.

Noni MacDonald, a professor of paediatrics at Dalhousie University in Halifax, said regulating the beverages as "natural health products" – a category that includes vitamins and herbal remedies – is confusing for consumers.

"There isn't some magic [difference] out there between complementary, alternative medicine drugs and ordinary drugs," Dr. MacDonald said. "There's just a difference between how much information we have on them."

A spokeswoman from Health Canada said energy shots are categorized as natural health products because they contain naturally occurring substances used to "restore or maintain good health."

Health Canada confirmed earlier this week that it would cap the caffeine content in miniature "energy shots" at 200 mg per bottle – about the same amount that is found in a large Tim Hortons coffee. It is also asking some companies to add new cautions to their labels, including a note that the products are not recommended for children, pregnant or breastfeeding women and anyone who is sensitive to caffeine.

The new limit on energy shots does not go as far as that applied to the larger-sized energy drinks such as Red Bull and Monster. Those beverages, which are now regulated as foods, are subject to a 180 mg cap on caffeine for a single serving.

Dr. MacDonald was the chair of an expert panel convened by the government in the fall of 2010. At the time, the panel recommended that caffeine levels be capped at 80 mg per serving and that all of the beverages be referred to as "stimulant drug containing drinks," among other changes.

Health Canada is not alone in grappling with how best to regulate the sale of energy drinks and shots. The U.S. Food and Drug Administration is investigating the beverages amid news that 13 deaths had been reported as possibly linked to 5-Hour Energy, one of the energy shot brands. Another five deaths have been tentatively linked to the larger-sized Monster energy drinks.

Dr. MacDonald said the quantity of caffeine in the miniature shots is a particular concern because people often aren't aware of how much caffeine they are consuming. "It's not very easy to drink five large-volume drinks at the same time," she said. "The shots, you could still drink two or three in an hour, no problem."

Matthew Stanbrook, a deputy editor at the Canadian Medical Association Journal, said he also believes the beverages should be regulated as drugs because of the health claims their labels often make.

"If a product is going to be sold, and a marketing claim is made about it that is a health effect – and that applies to energy shots and drinks – then it's a drug. And it should be regulated as a drug," Dr. Stanbrook said.

Health Minister Leona Aglukkaq declined several interview requests about energy shots. In an e-mailed response to questions from The Globe and Mail earlier this week, she said Health Canada makes it clear that energy shots are not recommended for children and requires clear labels to help people make informed decisions.

John Finley, president of Doctors Nova Scotia, said the 200-mg limit is "probably not unreasonable" for adults because two of the shots would bring them to the daily maximum recommended by Health Canada. But "it does not solve the problem for children and youth," he said, whose lower body weight means that caffeine can have a more detrimental effect.

Doctors Nova Scotia is calling on the province to prohibit sales of energy drinks and shots to anyone less than 19 years of age.