From the same small town brewery that conjured Rolling Rock from mountain spring water comes a brew that, depending on whom you talk to, is either as conventional as a rum and Coke or the beverage from hell.
Four Loko, a caffeinated malt beverage produced at City Brewing's Latrobe plant, offers a fruit-favored blend of 12 percent alcohol and about as much caffeine as a 12-ounce coffee -- all packed in a 23.5-ounce can that sells for about $2.50.
Like Joose and other caffeinated alcoholic beverages, Four Loko provides a ready-to-drink version of what its originators observed young drinkers doing on their own: combining energy drinks with alcohol.
"Mixing caffeine and alcohol has been around a long time. It's nothing new or novel," said Jaisen Freeman, a former Ohio State University hockey player who started Phusion Projects, the Chicago-based maker of Four Loko, with two other OSU grads.
But while Freeman views Four Loko as an extension of traditional mixes such as Irish coffee and Jack Daniels and cola, some doctors and behavioral scientists say caffeinated alcoholic beverages turn drinkers into wide-awake drunks who are more dangerous to themselves and those around them.
"I think the science is clear that consumption of alcohol with caffeine leads to risky behaviors," said Bruce Goldberger, director of toxicology at University of Florida College of Medicine.
Goldberger and former University of Florida College of Public Health professor Dennis Thombs published a study on alcoholic energy drinks this spring in Addictive Behaviors, a scientific journal.
Their findings: College-age adults who had consumed energy drinks mixed with alcohol left bars later and were more likely to leave intoxicated than those who drank just alcohol. They also were more inclined to think they were capable of driving than those who consumed just alcohol.
"When you mix caffeine with alcohol, you get problems," said Thombs, who is now with the University of North Texas Health Science Center.
He called caffeinated alcoholic beverages "a new, emerging drug problem."
Doctors and state attorneys general have taken their concerns to the U.S. Food and Drug Administration. In November, the agency sent letters to Phusion Projects and 26 other alcoholic energy drink makers, asking them to document why it is safe to mix caffeine with alcohol. The FDA has approved caffeine as an additive for soft drinks, but has never made a similar ruling with alcohol.
Nearly a year later, 19 of the 27 companies have responded, including some who asked for more time, FDA spokesman Michael Herndon said.
The agency will evaluate what the producers have to say as quickly as possible but "a decision regarding the use of caffeine in alcoholic beverages could take some time," Herndon said in an e-mail.
The delay angers Mary Claire O'Brien, who teaches emergency medicine at Wake Forest University.
"I'm mad as a hornet that they didn't do something in the first place, and I'm mad as a hornet that they haven't done anything yet," O'Brien said.
Research shows that those who use the beverages drink more often, binge drink more often and are more likely to engage in risky behavior, such as driving with a drunken driver, than those who drink just alcohol, O'Brien said.
"There is no general consensus among health professionals and the scientific community that the use of caffeine in alcoholic beverages has been demonstrated to be safe," O'Brien wrote in a September 2009 letter to the National Association of Attorneys General's committee on youth access to alcohol.
The letter also was signed by Goldberger and three other doctors. A few days later, the attorneys general group asked the FDA to immediately remove the drinks from the market. MillerCoors and Anheuser-Busch InBev agreed to stop making alcoholic energy drinks in 2008 following complaints from a group of state attorneys general.
Ramapo College in Mahwah, N.J., banned all caffeinated alcoholic drinks, including Four Loko, from campus this month after about two dozen students were hospitalized with alcohol-related problems this semester. Only a handful of those cases involved Four Loko, spokeswoman Anna Farneski said.
Freeman said Phusion Projects submitted its report this summer on why Four Loko is safe. The findings, which were based on a study conducted by scientific and food safety experts, are being reviewed by the FDA, he said.
Alcoholic energy drinks are a relatively new product. Freeman said Phusion Projects produced its first version in late 2005. The product will be available in all 50 states by the end of the year, he said. The market for the drinks is growing faster than the overall beer market, but not as fast as demand for craft beer, Freeman said.
"It's a relatively small part of the beer market, less than 1 percent," he said.
He declined to speculate how sales could be affected by the outcome of the FDA review.
City Brewing's D.J. O'Donnell, who is in charge of business development and scheduling for the LaCrosse, Wis., company, said Four Loko represented a good portion of production at the Latrobe brewery, which employs about 115.
He said it would be hard to speculate on how production might be affected by what, if anything, the FDA decides to do. Whatever the outcome, O'Donnell does not believe jobs in Latrobe would be affected.
Those who want the FDA to act concede that the regulations would apply to only ready-to-drink versions of the cocktail. They wouldn't stop drinkers from buying energy drinks and alcohol and mixing them on their own. The combination is appealing to young drinkers because "it's rapidly intoxicating," Goldberger said.
"It's consistent with that instant gratification that young people crave today," he said.
E-mail reporter Len Boselovic at lboselovic(at)post-gazette.com.