The Trouble with the “Energy Drink Related ER Visits” Stat

So you want to talk about energy drinks sending people to the ER...

Hi. I’m Caffeine Scientist GreenEyedGuide. In this post, we’ll breakdown the statistic which gets mentioned all the time in energy drink-related news. It usually goes something like this, “energy drinks send thousands to the ER”, or “energy drink-related ER visits doubled in a 5 year period.”

This statistic does carry meaning, but it’s not the full story. Journalists aren’t experts in the science behind caffeine and energy drinks. But I am. And so, in this post, we’ll take a closer look at the source of this statistic.

  • First, we’ll look at real headlines.
  • Second, we’ll look at the source of this stat.
  • Finally, we’ll put it all together and identify what caffeine lovers can do.

Ready? Let’s Go!

You can read the blog post below or listen to it in podcast form. Just click the button to open the podcast on your platform-of-choice (e.g., Spotify, Apple Podcasts, etc.)

ONE - Where have we seen this stat on energy drink-related ER visits?

This statistic about energy drink-related ER visits is almost always used in articles about energy drinks. Here are a few examples:

You might have noticed some of these headlines are years old. In fact, this energy drink-related ER statistic comes from a report that came out nearly a decade ago! Nonetheless, this statistic is still used to this day in news articles about energy drinks. 

For example, it’s mentioned again in this article from February 2021:

"While many of the ingredients found in energy drinks are natural and may sound like a healthful choice, including them in your lifestyle comes with some risk. In fact, over a five-year span, the number of energy drink-related visits to emergency departments doubled, climbing from 10,068 to 20,783 cases."

To summarize, this article, and others like it, use this statistic about energy drink-related ER visits to emphasize energy drinks are dangerous. And they’re not wrong. But there’s more to the story, which brings me to the next point.

DAWN Report

TWO - What does the report on energy drink-related ER visits actually say?

Before I start listing my concerns with this statistic, let’s look more closely at where it comes from. Here are the 3 most important things you need to know about that report.

The DAWN Report

This statistic comes from the DAWN Report. Drug Abuse Warning Network. It was a federal study. The link has moved around a bit since the report has been published A DECADE AGO but I’ve found a link where you can read the whole report (only 3,0000 words – 10-minute read, max).

REFERENCE : Mattson, M. E. (2013). Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern. In The CBHSQ Report. (pp. 1–7). Substance Abuse and Mental Health Services Administration (US).

The numbers come from national estimates of Emergency Department (ED) visits involving energy drinks from 2005 to 2011. Again, that’s between 2005-2011.

What’s special about those years?

Hold that thought.

The Number of ER Visits

This report found, “The estimated number of ED visits involving energy drinks doubled from around 10,000 visits in 2007 to 20,000 visits in 2011.” Again, that’s an increase from 10-20 thousand.

Twenty THOUSAND sounds like a lot, right?

We’ll get to that.

Notable Details

Roughly 42% of the hospital visits had to do with combinations of energy drinks and alcohol or other drugs.

In other words, almost half of these energy drink-related ER visits had to do with energy drinks and bad decisions.

So let’s dive into what this all means.

THREE - We've got the news and the science. Now let's break that all down.

What's special about 2005-2011?

First of all, let’s talk about those years. From 2007-20011. 

Do you know the big event that happened in 2009-2010? Does anyone remember Four Loko? Also known as Black Out In a Can? 

That whole fiasco where Four Loko was sending people to the ER with potentially lethal alcohol poisoning all went down in 2009 and Four Loko reformulated in 2010.

Full disclosure, I’m married to a former frat brother, and he told me how his buddies stocked up on Four Loko when they knew it was going to be reformulated. This is the sh*t that gives me nightmares. 

For those of you who weren’t there and don’t know, Four Loko was 12% alcohol and 500 mg caffeine, all in one 23 oz can. This is 7 shots of Vodka and 5 Red Bulls! That’s too much alcohol and too much caffeine. Don’t mix your uppers and downers. It is not a good idea. 

Four Loko Played a Big Role in Those Energy Drink-Related Hospitalizations

This Four Loko saga all happened right during this critical data collection period of this report! This is a HUGE asterisk that gets completely glanced over when articles casually mention how energy drinks are sending more people to the ER. Furthermore, we’re not done talking about energy drinks and alcohol. But we’ll come back to that…

Is 20,000 energy drink-related ER visits a lot?

Second of all, we need to talk about the number of hospital visits. From 10,000 to 20,000. For context, there are more than 1 million drug-related hospital visits every year. That means, even at the peak, these energy drink-related visits accounted for only 2% of these drug-related hospital visits. 

The Role of Alcohol-Energy Drink Combinations

Finally, roughly 42% of those hospital visits had to do with people combining energy drinks and alcohol or other drugs. We’ve already talked about the fiasco that was Four Loko, but that’s just a portion of those visits.

The data suggests that 58% of those energy drink-related visits involved energy drinks only. But which energy drinks? And how much caffeine? And what other ingredients were in these drinks? We will never know because this level of detail is not collected. 

Before 2020 and COVID, I approached a few hospitals here in Milwaukee with a pilot study I wanted to do on energy drink-related hospitalizations. And all the nurses I talked to said, “When you come into the ER, we don’t care which energy drink you had. We’re just trying to save your life.”

The Bottom Line

In other words, no one is collecting the details about caffeine content, the energy drink brand, or the other ingredients during these energy drink-related ER visits. As a result, when articles say, “energy drinks double the rate of hospitalizations”, this line doesn’t help anyone make better choices.

If you’re a journalist, stop dropping this statistic. It’s irrelevant, outdated, and out of context. 

Instead, here’s what all energy drink articles SHOULD say:

  1. Don’t mix alcohol and energy drinks. This combination played a significant role in the number of energy drink-related hospitalizations.
  2. Know how much caffeine is too much. We can assume that a majority of these energy drink-related hospitalizations had to do with people who had too much caffeine. 
  3. Stop assuming all energy drinks are the same. Doing that ignores the role of the other ingredients in energy drinks. 

So what can you do, if you love energy drinks? Check out my Energy Drink Report Card. Whether you love the stereotypical energy drinks like Red Bull or the clean energy drinks like Marquis, I’ve got recommendations in there for you. Knowing how much caffeine is too much and knowing the difference between these energy drinks is key to avoiding a trip to the ER.

In conclusion, if you’re someone like a shift-worker, teacher, or first-responder, you probably rely on caffeine to get you through the day. So understanding the science behind claims like the ones in this news article can help you make better decisions. In other words, I want to make sure your caffeine choices are based on facts, not fear.

When Does Coffee Become an Energy Drink?

Science Behind Starbucks Doubleshot

3 Ways to Make Energy Drinks Safer – Live Chat with Food Safety Foundation

How Can We Make Energy Drinks Safer?

March is Caffeine Awareness Month, meaning it’s the perfect time to talk about energy drinks and safety. In this live chat with the Food Safety Foundation, Caffeine Scientist GreenEyedGuide shares 3 ways to make energy drinks safer. This live chat is full of tips every caffeine drinker needs to know.

Ready? Let’s go!

Continue reading

Energy Drinks and Hospitalizations Checklist: How to Ask The Right Questions

It’s happened again: someone was admitted to the hospital after consuming an energy drink. Reporters covering the story warn readers about the dangers of energy drinks…something is missing. In this post, I’ll review real headlines about energy drink to demonstrate how the omission of a few minor details hurts consumers, as well as the scientists who study energy drinks.

If you read a news story about someone being hospitalized because of a vegetable, you’d have some questions.

On the surface, the mere idea sounds ridiculous.

“Hospitalized…because of a VEGETABLE? People eat veggies all the time without dying, why would someone go to the hospital?”

In fact, leafy green vegetables were the number one source of foodborne illnesses from 1998-2008. Moreover, this hypothetical news story is a perfect example of how asking the right questions can save lives.

When someone is hospitalized because of a vegetable, scientists and doctors are able to piece together the clues and figure out whether or not to issue a recall, if so, what food and even what brand and lot numbers. The end result is information which saves people from eating something that could hurt them. If only we could do the same thing for energy drinks.
(Hint: we are not)

When it comes to energy drink-related hospitalizations, we are not asking the right questions. There are several examples of real energy drink news stories where small but critical details were omitted. Not only does this hurt consumers, but it also hurts scientists who desperately need this data to study the health effects of energy drinks.

The good news is these missing critical details can be summed up in just five questions.
Let me walk you through these five questions and why they matter so much, using real news stories about energy drink-related hospitalizations.

Read more

Open letter to Time regarding energy drink article in “The Answer Issue”

Greetings Ms. Nancy Gibbs and Time Staff,

Normally, I find Time Magazine articles engaging and insightful but the article “Energy drinks have doctors worried—but business is booming” by Ms. Alexandra Sifferlin was severely disappointing.

Did you know that the top-selling energy drink has less caffeine and less sugar per serving than a tall mocha from Starbucks? The Issue Contents page features the question, “Should your kid drink Red Bull”, but Original Red Bull has 80 mg caffeine, 27 g sugar in 8.46 fl oz can versus the 90 mg caffeine, 35 g sugar in tall (12 oz) cafe mocha. This is not to say Red Bull is without its hazards. In fact, the biggest hazard with Red Bull is the alarming frequency with which this drink is mixed with alcohol! Unfortunately, the dangerous combination of alcohol and energy drinks was completely omitted from this article. Read more