Heavy metals in unrecorded Albanian rakia: A pilot study on a potential public health risk

Unrecorded alcohol has been linked to illness above and beyond that caused by ethanol alone because of the presence of toxic contaminants. While it can be found in all countries, consumption is high in Albania, where it is frequently consumed as a fruit brandy known as rakia. Among the contaminants identified previously in such products, metals including lead have been detected at levels posing a risk to health but there is little information on their presence in rakia. To fill this gap, we measured the level of ethanol and 24 elements among them toxic metals in 30 Albanian rakia samples. We found that 63.3% of rakia samples had ethanol concentration above 40% v/v. We also showed that there was a significant difference between the measured [mean: 46.7% v/v, interquartile range (IQR): 43.4-52.1% v/v] and reported (mean: 18.9% v/v, IQR: 17.0-20.0% v/v) concentrations of ethanol in rakia. Among the metals detected, aluminium, copper, iron, manganese, lead, and zinc were present in rakia samples at concentrations ranging between 0.013 and 0.866 mg/l of pure alcohol (pa), 0.025-31.629 mg/l of pa, 0.004-1.173 mg/l of pa, 0.185-45.244 mg/l of pa, 0.044-1.337 mg/l of pa, and 0.004-10.156 mg/l of pa, respectively. Copper and lead were found to be the greatest concern posing a potential public health risk. Although the estimated daily intake of these heavy metals from unrecorded rakia was below their toxicological threshold, the concentrations of lead and copper exceeded their limit value of 0.2 and 2.0 mg/l of pa specified for spirits in 33% and 90% of samples, respectively. Therefore, the possibility of adverse health effects cannot be excluded completely. Our findings highlight the need for action by policymakers against the risks posed by these products in Albania.

Estimations of unrecorded alcohol consumption levels and trends in 14 European countries

Håkan Leifman: Estimations of unrecorded alcohol consumption levels and trends in 14 European countries

Aims:

To map the extent of unrecorded alcohol consumption in the countries within the EU, including point estimates of the quantity of unrecorded consumption and the development over time.

Data and method:

The countries under investigation are 13 EU countries (Greece and Luxembourg excluded) and Norway. The study makes use of data collected earlier – mainly survey data – and of a recently completed general population survey directed to random samples of the general population aged 18–64 in six EU member states. An indirect method was used to assess the development of unrecorded consumption over time in each country by estimating the discrepancy between the observed development of alcohol-related mortality and the development that would be expected from changes in recorded consumption only.

Findings:

The unrecorded consumption is highest in the northern European countries, and has increased from about 1 litre in the 1980s to 2 litres per adult in the second half of the 1990s. The UK, too, shows clear signs of increased unrecorded alcohol consumption as of the mid-1980s. In the remaining countries, the changes in unrecorded alcohol appear to have been more modest over time. The quantities of unrecorded consumption in the Mediterranean countries in the 1990s are roughly estimated at 1 litre pure alcohol per adult and show no signs of increases over time. The general population survey indicated low quantities of personal imports of alcohol in Southern Europe (France and Italy) – one decilitre in France, less than half a decilitre in Italy – compared to about 1 litre or more in Finland, Sweden and the UK.

Conclusions:

The downward trend in recorded consumption in the Mediterranean countries for the past 20–30 years is most likely a real decrease in alcohol consumption: the large drop in recorded alcohol consumption in these countries has not been accompanied by increases in unrecorded consumption. When the total consumption (recorded plus unrecorded) is taken into account, and not just the recorded alcohol, the higher unrecorded consumption in the “low-consuming” countries would appear slightly to narrow down the differences between the countries. However, despite differences in unrecorded alcohol, the relative position between the countries in their total consumption in the mid-1990s remains to a large extent unchanged.

Estimating Alcohol Consumption: Measurement and Policy Issues Related to Legal and Illegal Sources of Alcohol

There are several challenges to obtaining an accurate estimate of alcohol consumption and per capita consumption in a jurisdiction. There are difficulties in estimating the extent of illegal production and fraudulent transportation activities. In some jurisdictions there is extensive home production, which is difficult to estimate. There are challenges to estimating the amount of alcohol that is brought into a country or is taken out, primarily by individuals. This includes “slippage” between official and unofficial production and consumption. As drinking preferences change and stronger or weaker brands are marketed, the conventional conversion factors from beverage to absolute alcohol volumes need to be adjusted. Finally, in light of extensive international travel there are challenges in determining the appropriate denominators in calculating some rates of consumption or damage. The eight papers in this special issue of Contemporary Drug Problems address a number ofthe challenges related to measurement issues and to estimating “unrecorded” consumption, and they note the underlying social and political dynamics and the applications of estimates. They also point to the need forfurther research on the reasons for gaps between different estimation methods, consequences ofhigh rates ofsmuggling or use ofillegal alcohol, and impacts ofvarious interventions to curtail illegal consumption.

The Validity of Political Arguments in the Norwegian Alcohol Policy Debate: Associations between Availability of Liquor and Consumption of Illegal Spirits

Unrecorded alcohol consumption in Norway contributes to around 25% of total consumption, and a large part of this consists of moonshine and smuggled spirits. It has been argued that this is due to the restrictive price and availability measures in Norwegian alcohol policy. At the aggregate level, a significant increase in smuggled spirits has been found concurrent with an increase in liquor outlets. This paper presents individual level analyses based on five national surveys over a two-decade period, from 1973 to 1994, and assesses whether liquor outlet availability has an impact on consumption of and demand for illegal spirits in Norway. It is demonstrated that self-reported consumption of moonshine has decreased over the years, whereas purchase ofsmuggled spirits has increased significantly. Consumption ofmoonshine was more prevalent in municipalities without liquor outlets, where as purchase ofsmuggled spirits and willingness to purchase illegal spirits did not depend on liquor outlet availability.

A systematic review of the epidemiology of unrecorded alcohol consumption and the chemical composition of unrecorded alcohol

BACKGROUND AND AIMS

Unrecorded alcohol constitutes about 30% of all alcohol consumed globally. The aims of this systematic review were to determine the epidemiology (occurrence, types, prevalence) of unrecorded alcohol consumption in different countries/regions, analyse the chemical composition of unrecorded alcohol and examine health outcomes caused by the consumption of unrecorded alcohol, based on either epidemiology or toxicology.

METHODS

A systematic search for, and qualitative analysis of, papers with empirical results on the different categories of unrecorded alcohol, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Unrecorded alcohol was widespread in all regions of the world. Artisanal fermented beverages and spirits were the most common categories of unrecorded alcohol globally, and were available on all continents. In India, industrially produced spirits (country spirits) were most prevalent. In Russia and countries of the former Soviet Union, surrogate alcohols complemented artisanal spirits. Cross-border shopping was the most prevalent method of obtaining unrecorded alcohol in parts of Europe. Ethanol was the most harmful ingredient of unrecorded alcohol, and health consequences due to other ingredients found in unrecorded alcohol were scarce. However, as unrecorded alcohol is usually the least expensive form of alcohol available in many countries, it may contribute to higher rates of chronic and irregular heavy drinking.

CONCLUSIONS

Very large amounts of alcohol are produced globally that go unrecorded. The primary harm from this kind of alcohol arises from the fact that it is typically much cheaper than licit alcohol.

Unrecorded consumption, quality of alcohol and health consequences

ISSUES

This contribution aims to examine systematically the evidence on the impact of the quality of unrecorded alcohol products on health consequences.

APPROACH

Systematic computer assisted review of the literature.

KEY FINDINGS

There are a number of pathways related to alcohol quality that may lead to acute or chronic health problems. The following constituents and contaminants of alcoholic beverages were identified as likely contributors to these problems: (i) toxic metals (e.g. lead) from contaminated water sources or unsuitable distillation equipment; (ii) volatile constituents, such as acetaldehyde or higher alcohols, which may be produced in significant amounts due to faults in production technology or microbiological spoilage; (iii) ethyl carbamate (urethane), a carcinogenic contaminant with major occurrence in certain fruit and sugarcane spirits; (iv) biologically active flavour compounds (e.g. coumarin in cosmetics used as non-beverage alcohol); (v) toxic compounds used to denature alcohol (e.g. methanol or diethyl phthalate). In addition, the often higher ethanol content may have detrimental health effects. These pathways should not be assumed as present for all subcategories of unrecorded alcohol, but are more relevant to certain types and geographic regions.

IMPLICATIONS

A health impact of unrecorded alcohol over and above the effect of ethanol cannot be excluded. More research is urgently needed, especially with respect to liver disease and alcohol poisoning as endpoints.

CONCLUSION

A feasible approach for new research on the effects of unrecorded alcohol could be based on a representative sample from low socioeconomic regions with high prevalence of unrecorded consumption.

Weakening of one more alcohol control pillar: a review of the effects of the alcohol tax cuts in Finland in 2004

AIMS

To review the consequences of the changes in Finnish alcohol policy in 2004, when quotas for travellers' tax-free imports of alcoholic beverages from other European Union (EU) countries were abolished, Estonia joined the EU and excise duties on alcoholic beverages were reduced in Finland by one-third, on average.

DESIGN

A review of published research and routinely available data.

SETTING

Finland.

MEASUREMENTS

Prices of alcoholic beverages, recorded and unrecorded alcohol consumption, data on criminality and other police statistics, alcohol-related deaths and hospitalizations, service use.

FINDINGS

Alcohol consumption increased 10% in 2004, clearly more than in the early 2000s. With few exceptions, alcohol-related harms increased. Alcohol-induced liver disease deaths increased the most, by 46% in 2004-06 compared to 2001-03, which indicates a strong effect on pre-2004 heavy drinkers. Consumption and harms increased most among middle-aged and older segments of the population, and harms in the worst-off parts of the population in particular.

CONCLUSIONS

Alcohol taxation and alcohol prices affect consumption and related harms, and heavy drinkers are responsive to price. In Finland in 2004, the worst-off parts of the population paid the highest price in terms of health for cuts in alcohol prices. The removal of travellers' import quotas, which was an inherent part of creating the single European market, had serious public health consequences in Finland.

Differences in mortality by marital status in Finland from 1976 to 2000: Analyses of changes in marital-status distributions, socio-demographic and household composition, and cause of death

Being currently not married is more common today than 25 years ago. Over this period relative differences in mortality by marital status have increased in several countries, mainly as a result of a sharp decline in mortality among the married. Using Finnish census data linked with death certificates, we show that these increases are not explained by the non-married population becoming more marginalized in socio-economic status or household composition. However, the increases in marital-status differences in mortality from accidental, violent, and alcohol-related causes of death in the 30-64 age group indicate that changes in the health-related behaviour of the non-married population may play a role. The public-health burden associated with not being married has also grown. At the end of the 1990s about 15 per cent of all deaths above the age of 30 would not have occurred if the non-married population had had the same age-specific mortality rates as the married population.

Alcohol sales and fatal alcohol poisonings: a time-series analysis

AIMS

To discover whether the number of fatal alcohol peaks during festivities characterized by unrestrained drinking and relates to sales of alcoholic beverages.

DESIGN

Time-series and cross-sectional.

DATA

Fatal alcohol poisonings and retail alcohol sales in Finland in 1983-99.

FINDINGS

Fatal alcohol poisonings were found to peak during weekends and in the May Day, Midsummer Day and Christmas celebrations. Regression analysis of quarterly series lead to a model showing that 1% increase in the sales of spirits increases the number of fatal alcohol poisonings by 0.4%.

CONCLUSIONS

At the population level, increases in the sales of spirits and periods of hard drinking seem to increase deaths from alcohol poisoning. The findings could be of use in efforts to decrease hard drinking.