Following the success of a coalition of public health organizations, government agencies and health experts in forcing the alcohol industry to remove caffeine from alcoholic beverages, a new public health threat is emerging: supersized alcopops.

These products come in 23.5 ounce, single-serving cans that look like soft drink containers, with up to 12 percent alcohol content—the equivalent of 4.7 standard drinks.

“These products are extremely dangerous because they’re cheap, taste like soda and provide young people with a big bang for their buck,” says Michele Simon, JD, MPH, president of the consulting firm Eat Drink Politics, and the former research and policy director of Alcohol Justice, an alcohol industry watchdog group. “We need to bring these drinks down to a single serving.” She helped Alcohol Justice write model state legislation that would accomplish this.

In early October, the Federal Trade Commission (FTC) forced an agreement with the manufacturer of the alcopop Four Loko to change the labels of the cans to say the drinks contain as much alcohol as four to five cans of beer. The FTC says the manufacturer, Phusion Projects, falsely claimed that a 23.5-ounce can of Four Loko contains the same amount of alcohol as one or two regular 12-ounce beers. Drinking a single can of Four Loko in one sitting constitutes binge drinking, according to federal guidelines.

Phusion Projects also will be required to use only resealable containers for flavored malt beverages that have more alcohol than the equivalent of two and a half regular beers. The company has not admitted to any wrongdoing, but says it will relabel the drinks to better inform its customers.

Simply putting a new label and resealable cap on the can is not enough, Simon argues. “This is really a win for the companies making these products,” she says. “We have no evidence that putting a label on the can to essentially advertise how much alcohol it contains is a deterrent, or that a resealable container will discourage people from drinking the entire contents at one time.”

A major concern with the FTC agreement is manufacturers may use it to dissuade states who want to go further in regulating alcopops. “Companies can just point to the FTC agreement as a stamp of approval and claim nothing else is needed,” Simon notes.

The campaign that eliminated caffeine from alcoholic drinks was built on a number of factors, including research showing the detrimental health effects of mixing caffeine and alcohol. One study showed this combination makes a person feel less drunk but does not lessen the effects of alcohol. Another showed a higher risk of injury from mixing alcohol with energy drinks than from alcohol alone.

State attorneys general became involved, negotiating agreements with several alcohol manufacturers to stop producing various caffeinated alcopops. In addition, a number of states introduced legislation to ban caffeine in alcohol, although all of the bills were defeated. Several states then successfully passed legislation regulating where alcopops were sold. In November 2010, the FTC and the Food and Drug Administration notified four companies, including Phusion Projects, that their products were unsafe, unapproved and deceptively marketed.

This November, attorneys general in 35 states and the San Francisco City Attorney asked the FTC to limit the amount of alcohol sold in a single-serving can to two servings.

The campaign to remove caffeine from alcopops demonstrates how important advocacy on the state level is in building momentum that drives federal action, Simon says. “The industry doesn’t want to deal with 50 state policies, and is at times willing to consider one uniform federal policy,” she says. “But this solution is unacceptable.”

Until the federal government takes steps to rid the market of supersized alcoholic drinks, advocates recommend that states pass laws against them. “From a legal perspective, no matter what the federal government does, states still retain the authority to go further,” she adds.

Concerned citizens who want to do away with supersized alcopops in their communities have several options, according to Simon. “Contact your state legislator about introducing a bill that would require these products to be sold in single-serving containers,” she says. She also advises getting in contact with your state alcohol beverage control agency and state attorney general’s office to encourage them to work on the issue.

Simon also recommends that community groups put pressure on local retailers and wholesalers to stop carrying supersized alcoholic drinks. “It’s important to hold every sector of the market chain—from manufacturers to distributors to retailers—accountable for flooding our communities with these dangerous products and helping to put them in the hands of young people.”