Mixing sports drinks with alcohol dangerous — Ofoefule

The Head of Department, Pharmaceutical Technology and Industrial Pharmacy, University of Nigeria, Nsukka, and member of New York Academy of Sciences, Prof. Sabinus Ofoefule, discusses stimulants in this interview with MOTUNRAYO JOEL

What are stimulants?

Stimulants are drugs that increase immediate energy and alertness.  They are substances that act directly on the central nervous system (brain) to speed up parts of the brain and body.  When taken, they provide a steady supply of the chemicals (for example a chemical called dopamine) that allows one to pay attention.  Stimulants work directly by changing the way the brain works, allowing the person who ingested them to be more productive at work and at school.  When stimulants are taken properly – under medical supervision, they change brain function enabling one to be more organised, follow instructions and have more positive interactions with others.  This will allow the person to function better in social and professional settings.  A chemical substance called adrenaline is an example of naturally occurring stimulant in the body.

What are the other types of stimulants?

Others include nicotine (which is abundant in kola nut, cigarettes and tobacco), caffeine (found in coffee), prescription stimulants such as amphetamines and methylphenidate (marketed as Ritalin), methamphetamine (popularly known as meth), cocaine, 3, 4-Methylenedioxymethamphetamine (known as ecstasy) are other examples. Cocaine and amphetamine are commonly used street drugs. Some cold remedies often contain stimulants such as ephedrine, pseudoephedrine hydrochloride and phenylpropanolamine. Historically, many of the stimulants were used to treat asthma and other respiratory problems, obesity, neurological disorders and a variety of other ailments.  Prescription stimulants come in the form of tablets, or capsules.  When abused, they are swallowed, injected or crushed and snorted.

Can you explain the health benefits of stimulants?

Stimulants increase the levels of brain chemicals called catecholamines. These chemicals cause temporary increase in people’s energy and alertness. The effects vary according to the specific stimulant, the amount ingested and how it is taken.  For instance, stimulants that are snorted or injected have more immediate effects than the ones that are swallowed. Stimulants are often prescribed to treat individuals with Attention-Deficit/Hyperactivity Disorder.  When used according to a doctor’s directive, prescription stimulants such as amphetamine and ritalin can help a person with ADHD to be focused.  The stimulant, nicotine, in the form of a patch or gum, is used to help people stop smoking cigarettes and other tobacco products. Nicotine helps reduce the person’s withdrawal syndrome. The increased endurance and energy is what makes stimulants popular.

How should stimulants be taken?

In June 2005, the United States Food and Drug Administration issued a series of public health advisories warning that high intake and abuse of some stimulants cause visual hallucinations, suicidal thoughts and psychotic behaviour, as well as aggression or violent behaviour.  Users of ritalin and related stimulants develop symptoms of obsessive – compulsive behaviour within one year.  Stimulants should therefore be taken under strict medical supervision.  Stimulants such as ritalin come in small pills about the size and shape of aspirin tablets.  The 5mg tablets are pale yellow, 10mg tablets one pale green and the 20mg tablets are both white and pale yellow.  Abusers of this drug grind the tablets into a powder and snort it.  It is water soluble – making it easy for abusers to convert it to liquid which they now inject into their body.

What groups of people do you advise not to take stimulants?

People who have Tourette’s syndrome – a condition characterised by multiple vocal and muscular tics that appears in childhood and often lasts for the rest of an individual’s life – and persons with active heart disease and high blood pressure.  Stimulants cause increase in heart rate, blood pressure, body temperature and trigger heart attack on a large scale. People with glaucoma should avoid stimulant medication because of the associated increase in blood pressure can worsen related symptoms. Also, people experiencing active psychotic symptoms (such as hallucinations and delusions), people with liver disease and people who are allergic to any particular stimulant, should not take medications containing stimulants.

Can stimulants lead to sudden death?

Recent study published in the American Journal of Psychiatry stated that the stimulant used to treat children – the so called ADHD – can cause sudden cardiac arrest and death.  Other studies presented conflicting results.  However, the adverse effect of stimulants on the heart, blood pressure and on body temperature should be of particular concern to athletes and sports persons who use these stimulants to enhance their performance.  Any substance that can affect the smooth functioning of the heart and the circulatory system can lead to cardiac arrest and sudden death.  Amphetamine overdose has been implicated in sudden death.  It was reported that cardiac arrest must have caused the death of Len Bias, the All-American basketball star at the University of Maryland who died from cocaine in 1986.

What are the effects of taking sports drinks containing stimulants?

Sports drinks are also known as energy drinks.  There is no standard definition of a sports or energy drink.  It is, however taken to mean a non-alcoholic drink that contains caffeine, taurine (an amino acid) and vitamins, in addition to other ingredients. They are marketed for their perceived or actual benefits as stimulants. Potential risks associated with energy drink consumption include caffeine overdose which can lead a number of health problems – palpitation (irregular beating of the heart), high blood pressure, nausea and vomiting, convulsion and in some cases, even death. Type 2 diabetes may result from high consumption of caffeine contained in sports or energy drinks.  People who habitually take sports drinks are at the risk of the above health complications. Popular energy drinks that we all know contain high levels of caffeine.  Thus, the risk associated with sports drink consumption are primarily related to their caffeine contents.  The risk of health complications increases when such drinks are mixed with alcohol.  In addition, sports drink can cause late miscarriages, low birth weight and still births in pregnant women.  It may lead to use and dependency on other harmful substances.  It may also lead to poor dental health.

What then is your advice to consumers of energy drinks?

There is an increasing practice of mixing sports drinks with alcohol.  The consumption of high amounts of caffeine (as found in energy drinks) reduces drowsiness without diminishing the effects of alcohol, resulting in what is known as wide awake drunkenness. There is the high risk that people taking sports drink would mix it with alcohol and possibility of such people engaging in risky and dangerous behaviour such as violent or unprotected sex is high.  A mixture of alcohol and caffeine can lead to loss of inhibition.  Furthermore, sports men and women who take energy drink run the risk of suffering cardiac arrest on the sports field.  It is therefore my candid view that excessive ingestion of sports drinks should be discouraged because of their high caffeine content, which is a stimulant.

What are legal and illegal stimulants?

Stimulants that are contents of fruit/nuts (such as kola nuts) and beverages are considered legal stimulants. There are several legally available stimulants, though laws change from country to country. There are two main kinds of legal stimulants: over-the-counter stimulants and natural stimulants. Over-the-counter stimulants come in the form of diet pills. Natural legal stimulants include betel leaves, betel nuts, cocoa powder, coffee (caffeine) and kola nut (nicotine). Prescription medications such as Ritalin and adderall are considered legal stimulants. Stimulants such as cocaine, amphetamine and other related narcotics are referred to as controlled drugs.  Such stimulants are given under strict medical supervision.  Anything short of this constitutes illegal use of the stimulant.  Even stimulants contained in cold remedies fall under controlled substances.

What type of stimulants are people addicted to?

Majority of stimulants have additive effect.  Substances such as methylphenidate (ritalin) classified by the drug enforcement administration as ‘schedule II narcotic’ together with cocaine, morphine and amphetamines are abused by teenagers for its stimulant effects.  Students usually rely on coffee (which contains caffeine) drink to keep awake.  Recent studies have shown that Ritalin is abused by students in this regard.  Street names for these stimulants include r-bull, Skippy, vitamin R, JIF, truck driver, black beauties, crosses and uppers.  Parents should be on the watch.  Once you observe your child using any of these street names with his/her friends and peers, know that your child is on any of the stimulants mentioned above.  Societal deviants and miscreants abuse cocaine and amphetamines and are easily addicted to tobacco (nicotine).

What are the long-term side effects of stimulants?

The long-term side effect of stimulant is addiction.  Chronic high blood pressure, high body temperature and irregular heart beat may also result.  A person addicted to stimulants such as cocaine and amphetamines may develop psychotic problems which will make him a nuisance to the society at large.