With so much focus on illicit drugs and overdose deaths, it might seem that opioids are the biggest addictions problem. Far from it.
Alcohol kills many more people each year (14,800 in 2014), results in more hospitalizations annually than heart attacks and is one of the most expensive and intractable health problems.
While cannabis was legalized a year ago and B.C.’s chief medical health officer is pushing hard for decriminalization and ultimately legalization of all illicit drugs, two Canadian addictions research centres want tougher regulations to mitigate the costs and harms of alcohol use and addiction.
The Victoria-based Canadian Institute for Substance Use Research and the Toronto-based Centre for Addiction and Mental Health want a minimum price of $3.50 for a standard drink in a bar or restaurant and $1.75 for off-premise sales. They also want a national minimum drinking age of 19, which is a year higher than national minimum for cannabis. Those are just two of the recommendations in reports they released last month that look at federal, provincial and territorial alcohol policies.
The reports also calling for stricter guidelines for advertising, restrictions on manufacturers’ and retailers’ promotions on digital and social media platforms, and a federal excise tax based on alcohol content that would replace the GST.
Over the past decades, the researchers found an erosion of effective policies and regulations.
“Overall, alcohol policy in Canada has been largely neglected relative to emerging initiatives addressing tobacco control, responses to the opioid overdose crisis, and restrictions imposed on the new legal cannabis market,” their report on the provinces and territories says. In several jurisdictions — Ontario is the worst example — “customer convenience and choice are being given priority over health and safety concerns … the responsibility of governments to warn citizens of potential risks is largely absent.”
British Columbia got a bare pass at 50 per cent based on its potential to reduce alcohol-related harm, which is not good. But it’s still better than the national average of 43 per cent.
Alcohol-related harm was estimated at $14.6 billion in 2014, according the Canadian Centre on Substance Use. Productivity loss due to illness and premature death accounts for $7.1 billion. Direct health care costs add another $3.3 billion and $3.1 billion is spent on enforcement costs for this legal drug.
Tobacco was second at $12 billion followed by opioids at $3.5 billion and cannabis at $2.8 billion. But the data predate the opioid overdose crisis and cannabis legalization.
Alcohol’s costs and harms reflect the fact that 80 per cent of Canadians drink. It’s not surprising. Culturally, we associate drinking with celebrations and good times. It’s We’re bombarded with images in movies, TV and ads of beautiful people drinking and having fun.
Scarcely a week goes by that there isn’t a “good news” story about research showing that a glass of red wine might be good for your heart or that yet another populist politician is campaigning on a promise to slash the price of beer.
Yet less was made of University of Washington’s Global Burden of Diseases Study last summer that found alcohol was the leading factor in 2.8 million premature deaths in 2016 and is so harmful that governments ought to be advising people to abstain completely.
One problem is that Canadian governments are addicted to the revenue from alcohol. Liquor sales and taxes provided $12.15 billion to federal and provincial governments in 2017/18 — $1.6 billion more than five years earlier, according to Statistics Canada.
Last year, liquor consumption rose in British Columbia, which already had the highest drinking rates in Canada. There were also record sales, which meant that in addition to tax revenue, the Liquor Distribution Branch provided $1.12 billion in earned revenue, up from $1.03 billion two years earlier.
Good for taxpayers? Not really. The reports by the substance-abuse centres recommends B.C. “reconsider the treatment of alcohol as an ordinary commodity: Alcohol should not be sold alongside food and other grocery items as this leads to greater harm.”
It’s based on research done last year by Tim Stockwell of the Canadian Institute for Substance Use Research. He and his researchers found that when access to alcohol is easier, more people die.
Between 2003 and 2008, “a conservative estimate is that the rates of alcohol-related deaths increased by 3.25 per cent for each 20 per cent increase in stores density.”
Estimates have to be conservative because alcoholics’ fatalities are mistakenly counted as death from one of more than 200 other kinds of alcohol-related fatalities including car accidents, suicide, liver diseases, cancers, tuberculosis and heart disease.
What’s surprising is that more than a century after legalization, there are no federal or provincial policies aimed specifically at mitigating alcohol’s harms and costs.
The opioid crisis has been the catalyst for governments to finally think about addictions and drug-use policies and, it’s now impossible to ignore the slower moving crisis caused by alcohol abuse and addiction.
In the coming months, the B.C. health officer also plans to release an alcohol addictions report. The B.C. Centre on Substance Use recently developed guidelines for best practices in treating alcohol addiction, but the provincial government has yet to approve or release those.
Prohibition proved a failure. Yet, legalization and regulation are not panaceas either. Because even with more than 100 years of experience, there is still no jurisdiction in Canada or anywhere else that seems to have got it right.