Wednesday, November 03, 2010

Contemplating the caffeine overdose death of a 23-year old man in Britain.

In my speeches about drugs, for many years, I have often started by asking the audience about caffeine as a drug. Show of hands -- how many of you have ever had a caffeine overdose? I'll ask. I'll note the symptoms: grinding teeth, nausea, and rapidly beating heart. I suggest we call the ceramic or disposable "coffee cups" that many audience members are using a type of drug paraphernalia.

I try to build self-awareness around our near-universal intention to use coffee for three typical drug-use motives: (1) for chemical stimulation before a demanding task; (2) to revive ourselves from morning sleepiness or later-in-the-day drowsiness; and (3) to avoid the common withdrawal symptom of intense headache by all of us who are genuinely addicted to caffeine. (I usually leave out the common drug effect of stimulating the bowels.)

I usually mention that psychotic episodes can be experienced by those susceptible to large doses of caffeine to illustrate that even compounds that are benign as widely used can be "dangerous" under some circumstances.

The premise I am trying to establish is that in the law-abiding, hard-working, straight society most of us are part of, we are (1) routinely exposed to potentially risky drugs, (2) familiar with those risks, having learned about them through personal experience, and (3) addicted to the drug. The conclusion I want to draw is that as a society we manage those risks through cultural norms. We typically drink caffeine deliberately for stimulation, and many of us consciously stop later in the day in order to avoid interfering with sleep. Until recently, we consumed coffee and tea in fairly standardized dosage vessels, and colas in 12 oz. bottles or cans. (The coffee and espresso craze has thrown that out.) And even though caffeine content is not stated on beverage labels, we operate on our experience and hope that the caffeine concentration is standardized in coffee, tea or soft drinks.

Nevertheless, even though our behavior in the use of caffeine reflects an understanding of it as a drug, we are not often conscious or aware that we are using it as a "drug" because the concept of "drug" is so stigmatized and caffeine use is so normal.

While considering these risks over the years, I don't think I ever thought of caffeine as potentially lethal in the overdose sense. I had never read of such a case . . . until now.

ABCNEWS.com reports on the death in Britain of Michael Lee Bedford who swallowed two teaspoons of pure caffeine with an energy drink. They report a toxicology estimate that this quantity of caffeine was equivalent to the amount of caffeine in 70 Red Bulls!

Of course this is a tragedy, and a preventable tragedy.

ABCNEWS also reports that there is actually little research on the effects of this compound. That should be corrected. Caffeine is not only ubiquitous in our diet -- in coffee and tea, of course, colas, but Mountain Dew(R) and other "soft drinks" -- but it is routinely offered to children.

Not surprisingly Michael's grandmother is quoted as proposing a ban! (But she may have been asked a leading question by a reporter.) Being somewhat cynical, I can imagine she may be thinking about whether she should start a foundation to ban it so that her grandson's tragic death "won't be in vain."

The old mantra is "If only one life can be saved if we ban it, it is worth it." Right? This is a little like the campaign of the Delaware family to ban Salvia because their son committed suicide after using Salvia and had no one to talk with about the intense experience he had.

In some sense this desire to ban is like the current cry to ban "Spice," "K2" or other "synthetic marijuana." We don't have any real research about its effects or dangers -- long-term or short-term; we know that "drug users" use it and that it is not detected by cheap drug tests. What happens is that some people, who may lack good advice (or lack good judgment) use it wrongly, or use something that they were told was Spice or K2, have a bad reaction to whatever they used, and call the poison control center to report that they were poisoned by "spice." No one knows if they actually used "spice" or catnip and PCP sold as "spice." But those anecdotes become, in the hands of ambitious legislators and their law enforcement allies, "evidence of the drug's harmfulness," and the flimsy justification for banning it. This abridgment of liberty, without evidence, is called foresight. If just one life is saved...

Well, perhaps Michael's grandmother or someone can parlay his death into a run for Parliament. "Ban it!" -- such a typical, knee-jerk over-reaction.

Before we decide to heed the cry to ban caffeine powder, or even "regulate caffeine," we should more fully research its effects.

We need better education about about effects, dosage, etc. but it seems that we lack the actual scientific basis for such education.

To be constructive, Michael's grandmother could push for government-funded research, or campaign to get the caffeine industry to research the effects of their products. She could push for expanded education about caffeine use.

In the interim, we could have some labeling with some kind of warning. The education doesn't have to be in school. It could be a cartoon or a rap or a video.

"Don't be a guinea pig! Medical science has not yet determined that how much caffeine you need to take to hurt yourself. Does the idea of taking at once dozens of doses of a powerful drug make sense? BTW, some research shows that taking too much caffeine doesn't lead to more alertness, but to drowsiness, so maybe you shouldn't take a lot anyway!"

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1 comment:

Thinking CAP said...

Here's another use for your list. Caffeine is used by athletes (and others) because it somehow signals the body to decrease reliance on sugars for energy and to turn to burning fats. This is why caffeine has been used in diet products.

I think the Mormons have a caffeine prohibition, although it comes down to them as a prohibition on "hot drinks," which many take to mean a prohibition on tea and coffee because they have caffeine in them. Of course this leads to "rule breaking" since many of them drink soda and see nothing wrong with that since it's not a hot drink. But there is internal debate about it, and some people don't drink sodas for that reason.

In the interim, we could have some labeling with some kind of warning. The education doesn't have to be in school. It could be a cartoon or a rap or a video.
This reminds me of the fact that in many countries where citizens can't read or write, new concepts and education are transmitted through songs and plays.

Now I am reminded of a striking irony. If it was up to the DARE and Drug Free types to write such plays, they'd be about perfect "Gallant" guy who always does right and "Goofus" the doofus guy who always does wrong. Groan. The irony is that I'm sure significant percentages of the DARE crusaders and the Drug Free daydreamers consider themselves Bible-believing Christians. And WHERE IN THE BIBLE is there a perfect character besides Jesus?!

Before Jesus came along every "hero" in the Bible — and all the Bible stories — contained real people, not God's perfect word incarnate. Real people who tried to do their best, but also had real flaws and weaknesses. But somehow there's been a serious revival of the worst aspects of old time religion, namely the self-righteous Pharisees, and it has spread like a cancer via Zero Tolerance, prohibiting realistic sex education, etc…

By only portraying people as Gallant and Goofus, it drives a wedge between parents and children. Children who would otherwise ask for help, see themselves as failed and are too ashamed to ask for help. Young kids already see the world as black and white. What's needed as they mature is to see that all of us make mistakes, and to learn to differentiate the gray areas.