Energy drink
An energy drink is a type of beverage containing stimulant drugs, chiefly caffeine, which is marketed as providing mental and physical stimulation. They may or may not be carbonated and many also contain sugar or other sweeteners, herbal extracts and amino acids. They are a subset of the larger group of energy products, which includes bars and gels, and distinct from sports drinks, which are advertised to enhance sports performance. There are many brands and varieties of energy drinks.
Coffee, tea and other naturally caffeinated beverages are usually not considered energy drinks. Other soft drinks such as cola may contain caffeine, but are also not energy drinks. Some alcoholic beverages, such as Buckfast Tonic Wine, contain caffeine and other stimulants. According to the Mayo Clinic, it is safe for the typical healthy adult to consume a total of 400 mg of caffeine a day. This has been confirmend by a panel of the European Food Safety Authority (ESFA), which also concludes that a caffeine intake of up to 400 mg per day does not raise safety concerns for adults. According to the ESFA this is equivalent to 4 cups of coffee (90 mg each) or 5 standard cans (250 ml) of energy drink (80 mg each).[1][2][3]
Energy drinks have the effects caffeine and sugar provide, but there is little or no evidence that the wide variety of other ingredients have any effect.[4] Most of the effects of energy drinks on cognitive performance, such as increased attention and reaction speed, are primarily due to the presence of caffeine.[5] Other studies, however, ascribe those performance improvements to the effects of the combined ingredients.[6] Advertising for energy drinks usually features increased muscle strength and endurance, but there is still no scientific consensus to support these statements.[7] Energy drinks have been associated with health risks, such as an increased rate of alcohol-related injury,[8] and excessive or repeated consumption can lead to cardiac and psychiatric conditions.[9][10]
Uses
Energy drinks are marketed to provide the benefits among health effects of caffeine along with benefits from the other ingredients they contain.[11] Health experts agree that energy drinks which contain caffeine do provide the effects of caffeine.[11] The consumption of alcohol drinks combined with energy drinks is a common occurrence on many college campuses. The alcohol industry has recently been criticized for marketing cohesiveness of alcohol and energy drinks. The combination of the two in college students is correlated to students experiencing alcohol-related consequences, and several health risks.[12]
There is no good evidence that other ingredients in energy drinks provide further benefits, even though the drinks are frequently advertised in a way that suggests they have unique benefits.[11][13] The dietary supplements in energy drinks may be purported to provide detoxification, sustain mental process, protect heart health, and reduce muscle fatigue.[11][14] None of these claims are backed by good evidence, however, the ingredients alone, for example taurine or vitamin B, are scientifically proven to provide positive effects on the metabolism.[11][15][16] Various marketing organizations have described energy drinks by saying their beverage "gives you wings", is "scientifically formulated", or that it is a "killer energy brew".[11]
When mixed with alcohol, either as a prepackaged caffeinated alcoholic drink, a mixed drink, or just a beverage consumed around the same time as alcohol, energy drinks are often consumed in social settings.
Variants
Energy shots
Energy shots are a specialized kind of energy drink. Whereas most energy drinks are sold in cans or bottles, energy shots are usually sold in smaller 50ml bottles. Energy shots can contain the same total amount of caffeine, vitamins or other functional ingredients as their larger versions, and may be considered concentrated forms of energy drinks. The marketing of energy shots generally focuses on their convenience and availability as a low-calorie "instant" energy drink that can be taken in one swallow (or "shot"), as opposed to energy drinks that encourage users to drink an entire can, which may contain 250 calories or more.[17]
Caffeinated alcoholic drink
Energy drinks such as Red Bull are often used as mixers with alcoholic beverages, producing mixed drinks such as Vodka Red Bull which are similar to but stronger than rum and coke with respect to the amount of caffeine that they contain.[18] Sometimes this is configured as a bomb shot, such as the Jägerbomb or the F-Bomb — Fireball Cinnamon Whisky and Red Bull.[19]
Caffeinated alcoholic drinks are also sold in some countries in a wide variety of formulations. The American products Four Loko and Joose originally combined caffeine and alcohol before caffeinated alcoholic beverages were banned in the U.S. in 2010.[20][21][22]
Relaxation drinks
Several beverages have been marketed in the 2000s as "anti-energy", "chill out", or "relaxation" drinks, including Lava Cola, Slow Cow, Drank, Marley's Mellow Mood, Mary Jane's Relaxing Soda, Chill, Calm, Malava Kava, V.i.B., Relax by Rockstar and Jones Gaba.[23][24] They are growing in popularity, with sales doubling from 2008 to 2010, and expected to more than double again by 2014.[25] They contain ingredients such as theanine and melatonin.[26]
Effects
Excessive or repeated consumption of energy drinks can lead to cardiac problems, such as arrhythmias and heart attacks, and psychiatric conditions such as anxiety and phobias.[9][10] In Europe, energy drinks containing taurine and caffeine have been associated with the deaths of athletes.[27] In 2011 in the U.S., energy drinks were linked to 20,000 emergency room visits. In 42% of those cases, the patient had mixed energy drinks with another stimulant, and in the other 58% of cases the energy drink was the only thing that had been consumed.[28] Several studies suggest that energy drinks may be a gateway drug.[8]
Energy drinks have the effects caffeine and sugar provide, but there is little or no evidence that the wide variety of other ingredients have any effect.[4] Most of the effects of energy drinks on cognitive performance, such as increased attention and reaction speed, are primarily due to the presence of caffeine.[5] Advertising for energy drinks usually features increased muscle strength and endurance, but there is little evidence to support this in the scientific literature.[7]
A caffeine intake of 400 mg per day is considered as safe from the European Food Safety Authority (EFSA).[3] Adverse effects associated with caffeine consumption in amounts greater than 400 mg include nervousness, irritability, sleeplessness, increased urination, abnormal heart rhythms (arrhythmia), and dyspepsia. Consumption also has been known to cause pupil dilation when taken with certain antidepressants or SSRIs.[29] Caffeine dosage is not required to be on the product label for food in the United States, unlike drugs, but some advocates are urging the FDA to change this practice.[30]
Combined use of caffeine and alcohol may increase the rate of alcohol-related injury.[8] Energy drinks can mask the influence of alcohol, and a person may misinterpret their actual level of intoxication.[31] Since caffeine and alcohol are both diuretics, combined use increases the risk of dehydration, and the mixture of a stimulant (caffeine) and depressant (alcohol) sends contradictory messages to the nervous system and can lead to increased heart rate and palpitations.[31] Although people decide to drink energy drinks with alcohol with the intent of counteracting alcohol intoxication, another large majority do so to hide the taste of alcohol.[32] However, in the 2015, the EFSA concluded, that “Consumption of other constituents of energy drinks at concentrations commonly present in such beverages would not affect the safety of single doses of caffeine up to 200 mg.” Also the consumption of alcohol, leading to a blood alcohol content of about 0,08%, would, according to the EFSA, not affect the safety of single doses of caffeine up to 200 mg. Up to these levels of intake, caffeine is unlikely to mask the subjective perception of alcohol intoxication.[3]
Physical and chemical properties
Energy drinks generally contain methylxanthines (including caffeine), B vitamins, carbonated water, and high-fructose corn syrup (for non-diet versions). Other commonly used ingredients are guarana, yerba mate, açaí, and taurine, plus various forms of ginseng, maltodextrin, inositol, carnitine, creatine, glucuronolactone, sucralose and ginkgo biloba.[11]
Some energy drink manufacturers do not report how much caffeine their products contain.[33] One survey found that various energy drinks had from 6-242 milligrams (mg) of caffeine per serving.[33] In comparison, an 8 US fluid ounces (240 ml) cup of coffee contains 100 mg of caffeine and 12 US fluid ounces (350 ml) of Coca-Cola Classic contains 35 mg of caffeine.[33][34] Consumer Reports expected that the caffeine content of a beverage should be within 20% of what the label claims, but product testing on United States energy drinks found that the caffeine levels of some energy drinks vary beyond that range.[33] A major producer of energy drinks in the United States explained that they do not report caffeine levels because "there is no legal or commercial business requirement to do so, and also because our products are completely safe, and the actual numbers are not meaningful to most consumers."[33] Scientific groups and consumer organizations have requested more disclosure in ingredient lists.[33]
The sugar in non-diet energy drinks is food energy that can be utilized by the human body.[11]
Frequency of use
Globally, energy drinks are typically attractive to young people. Approximately 66 percent of consumers are between the ages of 13 and 35 years, with males being approximately 65 percent of the market.[35] A 2008 statewide Patient Poll conducted by the Pennsylvania Medical Society's Institute for Good Medicine found that: 20 percent of respondents aged between 21 and 30 had used energy drinks in high school or college to stay awake longer to study, or to write a paper; and 70 percent of respondents knew someone who had used an energy drink to stay awake longer to study or work.[36]
US research by Packaged Facts in 2012 showed that consumers aged between 18 and 34 years, men, Hispanics, Pacific region residents and adults with children in the household were the demographic groups that were using the highest amounts of energy drinks.[37]
History
Energy drinks were an active subset of the early soft drink industry; Pepsi, for instance, was originally marketed as an energy booster. Coca-Cola's name was derived from its two active ingredients, both known stimulants: coca leaves and kola nuts (a source of caffeine). Fresh coca leaves were replaced by "spent" ones in 1904 because of concerns over the use of cocaine in food products; the federal lawsuit United States v. Forty Barrels and Twenty Kegs of Coca-Cola pressured The Coca-Cola Company into reducing the amount of caffeine in its formula by 1916. These developments brought an end to the first wave of energy drinks.[38]
In the UK, Lucozade Energy was originally introduced in 1929 as a hospital drink for "aiding the recovery;" in the early 1980s, it was promoted as an energy drink for "replenishing lost energy." One of the first post-Forty Barrels energy drinks introduced in America was Dr. Enuf. Its origins date back to 1949, when a Chicago businessman named William Mark Swartz was urged by coworkers to formulate a soft drink fortified with vitamins as an alternative to sugar sodas full of empty calories. He developed an "energy booster" drink containing B vitamins, caffeine and cane sugar. After placing a notice in a trade magazine seeking a bottler, he formed a partnership with Charles Gordon of Tri-City Beverage to produce and distribute the soda.[39] Dr. Enuf is still being manufactured in Johnson City, Tennessee and sold sparsely throughout the nation.
In Japan, the energy drink dates at least as far back as the early 1960s, with the launch of the Lipovitan brand. However, in Japan, most of the products of this kind bear little resemblance to soft drinks, and are sold instead in small brown glass medicine bottles, or cans styled to resemble such containers. These "eiyō dorinku" (literally, "nutritional drinks") are marketed primarily to salarymen. Bacchus-F, a South Korean drink closely modeled after Lipovitan, also appeared in the early 1960s and targets a similar demographic.
In 1985, Jolt Cola was introduced in the United States. Its marketing strategy centered on the drink's caffeine content, billing it as a means to promote wakefulness. The drink's initial slogan read: "All the sugar and twice the caffeine."[40]
In 1995, PepsiCo launched Josta, the first energy drink introduced by a major US beverage company (one that had interests outside energy drinks), but Pepsi discontinued the product in 1999. Pepsi would later return to the energy drink market with the AMP brand.
In Europe, energy drinks were pioneered by the Lisa company and a product named "Power Horse", before Dietrich Mateschitz, an Austrian entrepreneur, introduced the Red Bull product, a worldwide bestseller in the 21st century. Mateschitz developed Red Bull based on the Thai drink Krating Daeng, itself based on Lipovitan. Red Bull became the dominant brand in the US after its introduction in 1997, with a market share of approximately 47% in 2005.[41]
In New Zealand and Australia, the leading energy drink product in those markets, V, was introduced by Frucor Beverages. The product now represents over 60% of market in New Zealand and Australia.[42]
UK supermarkets have launched their own brands of energy drinks, sold at lower prices than the major soft drink manufacturers, that are mostly produced by Canadian beverage maker Cott. Tesco supermarkets sell "Kx" (formerly known as "Kick"), Sainsbury's sell "Blue Bolt" and Asda sell "Blue Charge"—all three drinks are sold in 250-milliliter cans and 1-liter bottles—while Morrison's sell "Source" in 250-milliliter cans. Cott sells a variety of other branded energy drinks to independent retailers in various containers.
Since 2002, there has been a growing trend for packaging energy drinks in bigger cans. In many countries, including the US and Canada, there is a limitation on the maximum caffeine per serving in energy drinks, so manufacturers include a greater amount of caffeine by including multiple servings per container. Popular brands such as Red Bull, Hype Energy Drinks and Monster have increased the amount of ounces per can.
The energy shot product, an offshoot of the energy drink, was launched in the US with products such as "5-Hour Energy," which was first released onto the market in 2004. A consumer health analyst explained in a March 2014 media article: "Energy shots took off because of energy drinks. If you’re a white collar worker, you’re not necessarily willing to down a big Monster energy drink, but you may drink an energy shot."[43][44]
In 2007, energy drink powders and effervescent tablets were introduced, whereby either can be added to water to create an energy drink.
Energy drinks are also popular as drink mixers—Red Bull and vodka is a popular combination. In the US, a product called "Four Loko" formerly mixed beer with caffeine, while Kahlua is a coffee-flavored alcoholic beverage.[43]
On August 14, 2012, the word "energy drink" was listed for the first time in the Merriam-Webster's Collegiate Dictionary.[45]
Sales
Market research firm Euromonitor calculated that the global energy drink market was worth US$3.8 billion in 1999 and this value grew to US$27.5 billion in 2013.[43]
In 2000 the US energy drink market was worth US$350 million and data from the Packaged Facts company shows that the industry grew by 60 percent between 2008 and 2012 in the US—by 2012 total US sales were over US$12.5 Billion.[37] Red Bull and Monster were the two best-selling brands in 2012, accounting for nearly 80% of US energy drink sales, and the energy shot market is worth over US$1 billion in 2014.[43]
Regulation
The energy drink Red Bull did not get market approval in France after the death of an 18-year-old Irish athlete, Ross Cooney, who died within hours after playing a basketball game and consuming four cans of the product. This market approval was challenged in the European Court of Justice in 2004, and consequently lifted.[46] Norway did not allow Red Bull for a time, although this restriction has recently been relaxed. In May 2009 it became legal to sell in Norway. The Norwegian version has reduced B-vitamin B6.[47] The United Kingdom investigated the drink, but only issued a warning against its consumption by children and pregnant women.[46]
In 2009, Colombia, under the Ministry of Social Protection, prohibited the sale and commercialization of energy drinks to minors under the age of 14 under resolution 4150 of 2009.[48]
In November 2012, President Ramzan Kadyrov of Chechnya (Russian Federation) ordered his government to develop a bill banning the sale of energy drinks, arguing that as a form of "intoxicating drug", such drinks were "unacceptable in a Muslim society". Kadyrov cited reports of one death and 530 hospital admissions in 2012 due to "poisoning" from the consumption of such drinks. A similar view was expressed by Gennady Onishchenko, Chief Sanitary Inspector of Russia.[49]
In 2009, a school in Hove, England requested that local shops refrain from selling energy drinks to students. Headteacher Malvina Sanders added that "This was a preventative measure, as all research shows that consuming high-energy drinks can have a detrimental impact on the ability of young people to concentrate in class." The school negotiated for their local branch of the Tesco supermarket to display posters asking students not to purchase the products.[50] Similar measures were taken by a school in Oxted, England, which banned students from consuming drinks and sent letters to parents.
Some countries have certain restrictions on the sale and manufacture of energy drinks. In Australia and New Zealand, energy drinks are regulated under the Australia New Zealand Food Standards Code; limiting the caffeine content of 'formulated caffeinated beverages' (energy drinks) at 320 mg/L (9.46 mg/oz) and soft-drinks at 145 mg/L (4.29 mg/oz). Mandatory caffeine labeling is issued for all food products containing guarana in the country,[51] and Australian energy drink labels warn consumers to drink no more than two cans per day.[52]
On June 7, 2012, the parliament of Latvia approved changes in the legislation of sale of consumable goods, to prohibit sale of energy drinks to persons under the age of 18.[53]
As of 2013 in the United States some energy drinks, including Monster Energy and Rockstar Energy, were reported to be rebranding their products as beverages rather than as dietary supplements. As beverages they would be relieved of F.D.A. reporting requirements with respect to deaths and injuries and can be purchased with food stamps, but must list ingredients on the can.[54]
In May 2014 Lithuania became the first state in the world to explicitly ban selling energy drinks to minors below 18 years of age, effective November. An energy drink is described as any beverage containing at least 150 mg/L of caffeine.
Ban on caffeinated alcoholic beverages
Some places ban the sale of prepackaged caffeinated alcoholic beverages, which can be described as energy drinks containing alcohol. In response to these bans, the marketers can change the formula of their products.
See also
References
- ↑ "How much is too much?". mayoclinic.org. Mayo Clinic. Retrieved 5 November 2014.
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- 1 2 3 "Scientific Opinion on the safety of caffeine | Europäische Behörde für Lebensmittelsicherheit". www.efsa.europa.eu. Retrieved 2016-01-02.
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- ↑ "Scientific Opinion on the substantiation of health claims related to vitamin B12 and contribution to normal neurological and psychological functions (ID 95, 97, 98, 100, 102, 109), contribution to normal homocysteine metabolism (ID 96, 103, 106), maintenance of normal bone (ID 104), maintenance of normal teeth (ID 104), maintenance of normal hair (ID 104), maintenance of normal skin (ID 104), maintenance of normal nails (ID 104), reduction of tiredness and fatigue (ID 108), and cell division (ID 212) pursuant to Article 13(1) of Regulation (EC) No 1924/2006 | Europäische Behörde für Lebensmittelsicherheit". www.efsa.europa.eu. Retrieved 2016-01-02.
- ↑ M. Zhang, I. Izumi, S. Kagamimori, S. Sokejima, T. Yamagami, Z. Liu, B. Qi: Role of taurine supplementation to prevent exercise-induced oxidative stress in healthy young men. In: Amino acids. Band 26, Nummer 2, März 2004, S. 203–207, doi:10.1007/s00726-003-0002-3, PMID 15042451
- ↑ "Scientific Opinion on the substantiation of health claims related to vitamin B12 and contribution to normal neurological and psychological functions (ID 95, 97, 98, 100, 102, 109), contribution to normal homocysteine metabolism (ID 96, 103, 106), maintenance of normal bone (ID 104), maintenance of normal teeth (ID 104), maintenance of normal hair (ID 104), maintenance of normal skin (ID 104), maintenance of normal nails (ID 104), reduction of tiredness and fatigue (ID 108), and cell division (ID 212) pursuant to Article 13(1) of Regulation (EC) No 1924/2006 | Europäische Behörde für Lebensmittelsicherheit". www.efsa.europa.eu. Retrieved 2016-01-02.
- ↑ Klineman, Jeffrey (2008-04-30). ""Little competition: energy shots aim for big" profits". Bevnet.com. Retrieved 2013-05-24.
- ↑ Marczinski CA, Fillmore MT, Bardgett ME, Howard MA (2011). "Effects of energy drinks mixed with alcohol on behavioral control: Risks for college students consuming trendy cocktails". Alcoholism: Clinical and Experimental Research 35 (7): 1282–92. doi:10.1111/j.1530-0277.2011.01464.x. PMC 3117195. PMID 21676002.
- ↑ Hoare, Peter (January 9, 2014). "5 Awesome Drinks You Can Make With Fireball Cinnamon Whisky". Food & drinks. MTV. Retrieved June 17, 2014.
- ↑ FDA (11-03-2010). "List of Manufacturers of Caffeinated Alcoholic Beverages". U.S. Food and Drug Administration. Retrieved 11 November 2010. Check date values in:
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(help) - ↑ Zezima, Katie (October 26, 2010). "A Mix Attractive to Students and Partygoers". The New York Times. Retrieved November 11, 2010.
- ↑ Bruni, Frank (October 30, 2010). "Caffeine and Alcohol: Wham! Bam! Boozled.". The New York Times. Retrieved November 11, 2010.
- ↑ Morning Edition (2009-12-30). "What To Drink When You Want Less Energy". NPR. Retrieved 2010-03-22.
- ↑ Eric Wahlgren, Adios, Red Bull? Anti-energy drinks seek to soothe frazzled Americans, DailyFinance, October 7, 2009
- ↑ Eunju Lie (2011-07-19). "Relaxation drinks see energetic growth in U.S.". Reuters. Retrieved 2011-07-20.
- ↑ Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D. (2010-03-06). "Relaxation drinks: Does calm come in a can?". Mayo Clinic. Retrieved 2011-07-20.
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- ↑ United States Substance Abuse and Mental Health Services Administration (2013-01-10). "Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern" (PDF). Retrieved 2015-08-12.
- ↑ Winston AP (2005). "Neuropsychiatric effects of caffeine". Advances in Psychiatric Treatment 11 (6): 432–439. doi:10.1192/apt.11.6.432.
- ↑ Warning: Energy Drinks Contain Caffeine by Allison Aubrey. Morning Edition, National Public Radio, 24 September 2008.
- 1 2 Pennay A, Lubman DI, Miller P (2011). "Combining energy drinks and alcohol" (PDF). Retrieved 2015-08-12.
- ↑ O'Brien MC, McCoy TP, Rhodes SD, Wagoner A, Wolfson M (2008). "Caffeinated cocktails: Energy drink consumption, high-risk drinking, and alcohol-related consequences among college students". Academic Emergency Medicine 15 (5): 453–60. doi:10.1111/j.1553-2712.2008.00085.x. PMID 18439201.
- 1 2 3 4 5 6 Consumer Reports (December 2012). "Energy Drinks - Caffeine Levels". consumerreports.org. Retrieved 26 September 2014.
- ↑ Heckman, Melanie A.; Weil, Jorge; De Mejia, Elvira Gonzalez (2010). "Caffeine (1, 3, 7-trimethylxanthine) in Foods: A Comprehensive Review on Consumption, Functionality, Safety, and Regulatory Matters". Journal of Food Science 75 (3): R77–87. doi:10.1111/j.1750-3841.2010.01561.x. PMID 20492310.
- ↑ Mintel Energy Drink Report 2006, 07.05.06
- ↑ Pennsylvania Medical Society (19 September 2008). "Energy Drinks "" Busting Your Health for the Buzz". Newswise. Newswise, Inc. Retrieved 27 March 2014.
- 1 2 "Energy Drink Trends". ReportLinker. January 2013. Retrieved 27 March 2014.
- ↑ Ronald Hamowy (2007), Government and public health in America (illustrated ed.), Edward Elgar Publishing, pp. 140–141, ISBN 978-1-84542-911-9
- ↑ Fred W. Sauceman (1 March 2009). The Place Setting: Timeless Tastes of the Mountain South, from Bright Hope to Frog Level. Mercer University Press. pp. 89–. ISBN 978-0-88146-140-4.
- ↑ , Official Jolt website, 10 Nov 2011.
- ↑ Soda With Buzz, Forbes, Kerry A. Dolan, 03.28.05
- ↑ "Our brands - V". Frucor. Retrieved 2013-05-24.
- 1 2 3 4 Roberto A. Ferdman (26 March 2014). "The American energy drink craze in two highly caffeinated charts". Quartz. Retrieved 27 March 2014.
- ↑ Clare O'Connor (8 February 2012). "The Mystery Monk Making Billions With 5-Hour Energy". Forbes. Forbes LLC. Retrieved 27 March 2014.
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- 1 2 "French ban on Red Bull (drink) upheld by European Court". Medicalnewstoday.com. Retrieved 2009-05-07.
- ↑ http://www.nrk.no/nyheter/1.6576631
- ↑ https://www.invima.gov.co/images/Resolucion%204150%20de%202009%20Bebidas%20energizantes.pdf
- ↑ "Kadyrov Vows to Ban Energy Drinks". The Moscow Times. November 21, 2012. Retrieved November 24, 2012.
- ↑ "Pupils facing energy drink 'ban'". BBC News. 2009-10-07. Retrieved 2009-10-15.
- ↑ "Australia New Zealand Food Standards Code - Standard 2.6.4 - Formulated Caffeinated Beverages - F2009C00814". comlaw.gov.au. Department of Health and Ageing (Australia). 13 Aug 2009. Retrieved 3 November 2012.
- ↑ Pogson, Jenny (9 May 2012). "Energy drinks pack more punch than you might expect". ABC. Retrieved 3 September 2014.
- ↑ "Plenary agenda of the Latvian parliament, June 7, 2012".
- ↑ Barry Meier (March 19, 2013). "In a New Aisle, Energy Drinks Sidestep Some Rules". The New York Times. Retrieved March 20, 2013.
External links
Wikimedia Commons has media related to Energy drinks. |
- Sport and Energy drinks at DMOZ
- USA Today-Overuse of Energy drinks...
- Teens Who Consume Energy Drinks Are at Higher Risk for Drug Use
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