Hi, I am the medical director of the Centre antipoison du Quebec, one of the five poison centres in Canada. We receive calls, 24-7, from the public and from health care professionals regarding acute intoxication.
We were shocked by the death of Athéna Gervais, but unfortunately it's not an unusual situation for us. Just to remind you of the context, she was a teenager, a 14-year-old, who consumed more than one can of the drink FCKDUP. She was found dead the following day. She consumed it at lunchtime at school, so she had pretty easy access to the substance.
At the Quebec poison centre, we treated more than 48,000 cases in 2017. Among them, we had nearly 4,000 youth aged from 6 to 15, and approximately 16,000 people aged 16 to 45.
We have a grossly under-reported number of ethanol poisonings, just because the emergency physicians don't always call us. It the same thing for the public, because it's too frequent.
We have an under-reported number of cases of energy drink poisoning, because it's pretty easy or straightforward for an emergency physician to treat, so they don't always call us.
In 2017 in the province of Quebec, we had 2,560 cases related to ethanol consumption alone, including six deaths. The INSPQ reports many emergency department consultations, including by teens. These involve emergency consultations as well as ambulance transport and calls to 911, so they use a lot of health care resources.
We do actually have poisonings from energy drinks. In 2017, we had 96 cases of energy drink poisoning, two of which were in children under 12 years old. That's the main point. It's a very prevalent phenomenon, and unfortunately it's increasing.
I want to say a word on ethanol toxicity and caffeine toxicity, and why it is worse when you mix them.
Of course, ethanol poisoning is worse if you drink a lot very fast, if you're less tolerant, and if nobody is monitoring you reliably when you consume. For example, a young person who is not used to it, with friends rather than family, and drinking a lot very fast, is very likely to engage in risky behaviours, be traumatized, and get ethanol poisoning.
There are other risk factors that I won't go into. Of course, it affects their judgment, but it can also lead to a coma. Most people know what it looks like when you're drunk. However, caffeine poisoning is more and more prevalent as well. It causes excitement, yes, but also nausea, vomiting, cardiac arrhythmias, seizures, and coma. We have had cases of both being mixed together—for example, teenagers presenting with cardiac arrhythmias. We treat those patients.
Why does mixing make it worse? Because of the sugar concentration and because of the caffeine, people tend to drink more and drink faster. Again, this puts them at greater risk for ethanol poisoning. They adopt more risky behaviours as well, and tend to be less vigilant as to what they are actually doing. Maybe with Athéna Gervais there was a consumption problem but also a behaviour problem. Maybe she was with friends who were actually not monitoring her because they went back to school.
What we recommend is to consider natural caffeine as being caffeine, because we know that guarana, for example, which is not restricted, is still allowed with alcoholic beverages. Guarana is actually caffeine. It's just a different name. It has the exact same effect, so we think that we should consider natural sources of caffeine the same as synthetic caffeine.
We agree with the idea of fixing a minimum price as well. We think that we should avoid packaging that contains more than one serving. We also agree that we should have more control on the publicity, not only the regular way of doing it, but also on the web.
We think that those products should not be sold around schools or places that are frequented by teenagers, and we think that we should reinforce all campaigns to prevent alcohol consumption or consumption of energy drinks by teens during major events such as the beginning of the school, the end of school, and events like that.
In terms of intervention, because that's what we do at the poison centre, we think that Health Canada should encourage the development of a toxicovigilance system and that it should also be specific to some products. If it pops up, we can activate public health faster and intervene.
We think we should also encourage funding of the poison centre, but also toxicomanie dependence centres in order to help people who develop a dependence after starting those bad behaviours.
We think it's very important as well, for all those patients who start when they're teenagers and go to the emergency department, to encourage the implementation of a brief intervention to identify people at risk of developing dependence and intervene right away.
Finally, we think we should also look at the impact of media, not only on consumption but also on suicide attempts, because we tend to see more and more that when a product sells very well or is publicized, people tend to use it in attempting to die.
That's about it.