Mr. Chairman, I would like to thank you and the members of the committee for giving me the opportunity today to share my views and concerns on the topic of premixed drinks combining alcohol, caffeine, and sugar.
I'd like to introduce myself. I am an Emergency Physician and Medical Toxicologist. I work at McGill University Health Centre in Montreal. I'm an assistant professor of medicine at McGill University. I'm a consultant in medical toxicology for the Quebec Poison Control Centre. I'm also a consultant at the coroner's office for the Province of Quebec. I'm the past president of the Canadian Association of Poison Control Centres. I appear today as an individual. The opinions expressed are personal.
The Government of Canada should be commended for addressing the health risks associated with the use of premixed drinks combining high alcohol, caffeine, and sugar. These drinks are associated with an unacceptable risk of toxicity when used by young people. The topic of alcohol abuse in Canada—more specifically, alcohol abuse in teenagers and young adults—is both complex and concerning.
The negative consequences of alcohol abuse in teenagers and young adults are very well documented. Impaired driving, risky behaviour, physical violence, and injuries from falls and motor vehicle accidents are just a few examples. Alcohol abuse has a long and unfortunate track record of leaving behind broken relationships, broken families, and broken lives. Every emergency physician I know across this country can testify to the negative consequences of alcohol abuse. We are in front-row seats to witness their occurrence.
Alcohol is everywhere in our lives. Wine is served at family reunions. Beer is available at sports events. Cocktails are enjoyed at social gatherings. Champagne is the symbol for celebration. As a result, inevitably, teenagers and young adults will sooner or later be exposed to alcohol, with a majority of teenagers experimenting with alcohol long before reaching the legal age for drinking. The question isn't whether or not teenagers will use alcohol; the real question is when and how they will. We must collectively take appropriate action to delay drinking in teenagers for as long as possible. We must also educate young people on drinking responsibly, with moderation.
Mixed drinks with high alcohol content are very unlikely to help us achieve these goals. Many emergency physicians, including me, feel that the growing popularity of mixed drinks with high alcohol content represents a significant public health problem, and their increasing prevalence on the Canadian market should be a cause for concern. Every year, thousands of teenagers and young adults are admitted for alcohol intoxication in emergency departments across the country. As you have heard, in 2017 alone more than 2,300 were admitted in the province of Quebec only, with one-fifth of them less than 18 years old. Although it is currently not possible to precisely evaluate the proportion of the emergency department visits that are related to the use of mixed drinks with high alcohol content, it is very likely significant.
The problems associated with mixed drinks combining alcohol, caffeine, and sugar have already been well identified by many experts here today. Let me summarize them again in six points, using plain language, describing the typical container: one, the can is too big; two, there's way too much alcohol in the can; three, the high sugar content masks the taste of alcohol; four, the can is too cheap; five, packaging and labelling is appealing to teenagers; and six, marketing strategies target young people.
The combination of large volume and high alcohol concentration means that the total amount of alcohol in each container is excessive. The amount of alcohol in one container can be equivalent to four standard drinks. That's enough alcohol to induce inebriation in an inexperienced drinker. The ingestion of two or three containers will send a teenager to the emergency department. The high sugar content and flavouring additives are appealing to young people and will mask the taste of alcohol. The sweet taste will exacerbate the tendency of rapid and uncontrolled drinking by young people with no drinking experience.
These drinks are inexpensive and widely available. They can usually be bought for less than $5.00 per container, allowing easy and affordable access to alcohol for young people. Containers are made colourful. They are designed and labelled to maximize the effect on young people, using high-impact and provocative language. Marketing strategies targeting a young crowd were set up by the industry with few ethical considerations. The use of social media and the Internet, as well as advertisement on university campuses, are just a few examples.
Mr. Chairman, last October I was asked by CBC in Montreal to do an interview on the dangers of combining drinks with high alcohol content, and energy drinks with caffeine. I wanted to see for myself if these products were available and easy to buy, so I took a walk from my house to the convenience store in my neighbourhood. There, I bought a can of approximately 600 millilitres of a mixed drink containing 11.9% alcohol, and I paid $3.99. That store is located approximately 200 metres away from my 11-year-old daughter's school.
These drinks present a high risk for the young population, and the negative consequences are highly predictable. I would go as far as saying that the risks they present are unacceptable.
With regard to caffeine, we know that mixing caffeine with alcohol should be prohibited, and promoting their simultaneous use should be strongly discouraged. When mixed with alcohol, caffeine will energize the drinker. It will increase the desire to drink, increase the pace of drinking, and it will make the drinking experience more pleasurable. As a result, more alcohol will be ingested when used with caffeine, and the risk for harm will be increased.
While it is already illegal under the Food and Drugs Act to add caffeine in its chemical form directly to alcoholic beverages, the use of natural sources of caffeine such as extracts from the guarana plant are permitted and largely unregulated. It should be reminded that all plant extracts cannot be assumed to be safe just because they are natural.
I would like to propose the following amendments to the food and drug regulations.
One, the volume of a non-resealable container and its alcohol content should be limited to the equivalent of one standard drink.
Two, a minimum selling price for drinks containing alcohol should be established, with the objective of limiting access to teenagers.
Three, packaging and labelling of drinks containing alcohol should be regulated, with the objective of promoting responsible drinking.
Four, publicity and marketing activities for drinks containing alcohol aimed at teenagers should be prohibited.
Five, the amount of caffeine from natural extracts in drinks with alcohol should be regulated and monitored as well.
If you would allow me, I would like to take a few minutes towards the end of my intervention to talk to you about kind of my baby project, to a certain extent, when I was president of the CAPCC, a project called the Canadian surveillance system for poison information. As I stated previously, I was past president of the Canadian Association of Poison Control Centres.
My years at the head of the organization taught me the importance of product safety as well as post-marketing surveillance. Consumer products should be designed with safety in mind, and once they are put on the market, every effort should be made to collect information looking for possible risks for human health or safety.
Although not considered consumer products under the Canada Consumer Product Safety Act, the same principles of safety and surveillance should also apply to mixed drinks with high alcohol content. An effective post-marketing surveillance strategy must be built on access to reliable information from different sources. That is not currently the case.
It's currently not possible to precisely evaluate the number of calls to Canadian poison centres or emergency department visits across the country that are related to the use of mixed drinks with high alcohol content. This information is just not currently collected.
Data collected by Canadian poison centres can be a valuable source of information. Poison centres have an important role in detecting and responding to major time-sensitive public health problems. Surveillance systems are required for post-marketing surveillance of consumer products like the one we are discussing today, as well as a very long list of others, including pharmaceutical and health products, controlled substances, industrial chemicals, as well as agents of concern for criminal acts and terrorism. Poison centre data is not currently aggregated, analyzed, and interpreted at a pan-Canadian level.
In fact Canada is the only G7 country that does not have an a national poison centre surveillance system that can provide evidence-based data to inform prevention, treatment, and harm reduction. Let me reassure you that help is on the way. The Canadian surveillance system for poison information initiative was established in 2014 through collaboration between Health Canada, the Public Health Agency of Canada, and the Canadian Association of Poison Control Centres. The surveillance system is currently being developed and will eventually offer the possibility of generating data in real time to better protect Canadians.
I would respectfully ask the members of the committee to take action in order to ensure that the Canadian surveillance system for poison information initiative is appropriately funded and sustained over time.
Once again, in conclusion, I would like to say that the Government of Canada should be commended for addressing the health risk associated with the use of mixed drinks with high alcohol content. I'm actually quite confident that your committee will have the leadership to take all the appropriate actions to better protect young Canadians.
Thank you very much for your attention.
I am ready for your comments and questions.
Thank you.