Item - 2017.HL18.2

The Board of Health recommends that:

1. City Council not permit the sale of Caffeinated Energy Drinks (CEDs), or allow marketing, promotion or sampling of Caffeinated Energy Drinks (CEDs) on any City property or facility that is occupied, leased or licensed by the City in its sole capacity consistent with the restrictions of the Municipal Alcohol Policy.

2. City Council forward the report (February 16, 2017) from the Acting Medical Officer of Health to the City's agencies and Toronto's four public funded school boards and request them not to permit the sale of Caffeinated Energy Drinks (CEDs), or allow marketing, promotion or sampling of Caffeinated Energy Drinks (CEDs) in any of their properties or facilities.

The Board of Health requested Health Canada and the Ontario Ministry of Health and Long-Term Care to establish age restrictions for the consumption of caffeinated energy drinks.

The Acting Medical Officer of Health gave a presentation to the Board of Health on Caffeinated Energy Drinks.

The Board of Health considered Items HL18.1 and HL18.2 together.

Energy drinks are a relatively new class of beverages that are popular among young people. Consumption of these drinks by young people has been identified as a public health concern because of the high levels of caffeine, added sugars and herbal stimulants, and youth-oriented marketing.1-5 Of particular concern is the use of energy drinks by children, during physical activity, or mixing them with alcohol.3,6-9 This report outlines the public health concerns and regulatory context for caffeinated energy drinks (CEDs) in Canada and provides information on the feasibility of various sales and marketing restrictions to youth in Toronto, as requested by the Board of Health (BOH) in November 2014.

Toronto Public Health reviewed the evidence and found no compelling reason to deviate from the current precautionary public health approach that encourages limits in CED consumption, discourages the consumption of CEDs for hydration purposes, and discourages the mixing of CEDs with alcohol, particularly among youth and young adults. Toronto Public Health also consulted Health Canada and received input from the City Manager's Office, City Solicitor, and Parks, Forestry and Recreation, and the Toronto Office of Partnerships.

Health Canada approves all CEDs that are sold or marketed in Canada and outlines requirements and conditions for their formulation, labelling, and marketing.10 Health Canada requires that: CED labels state that they are not recommended for children, that they should not be mixed with alcohol, that they shall not be marketed to children (12 years and under) or that they are not represented for the purpose of hydration and/or electrolyte replacement before, during or after physical activity.6,10

Policy options feasible for municipalities and local public health agencies to limit sales, marketing and consumption of energy drinks by children and youth include measures such as healthy vending machine policies, policies related to sponsorship, and education and awareness-raising to youth and young people. The City of Toronto has already implemented a number of the feasible options.11 A separate report to the BOH discusses a proposed amendment to the Toronto Municipal Alcohol Policy to increase awareness of Health Canada's precautionary advice not to mix CEDs and alcohol. Neither age restrictions on sales nor requiring health warning signs in retail settings are currently feasible for local authorities.

The Acting Medical Officer of Health recommends that City Council send this report to City agencies for their consideration in restricting sales of CEDs to children and youth.

Toronto Public Health will continue to monitor the developments related to CEDs and provide input as appropriate into the public consultations to be held by Health Canada for its final CED regulations.