Alcohol at corner stores is coming, is Ontario prepared for the health cost of convenience?

It’s where you go when you run out of milk or need a loaf of bread. You turn to its aisles of potato chips, chocolate bars and candy to satisfy a craving. Often, you can find an OK cup of coffee to go with a weekly splurge on lottery tickets.
And early next month, your neighbourhood convenience store will be able to sell you beer, wine and an assortment of ready-to-drink cocktails.
For many Ontarians, including perhaps yourself, the change coming on Sept. 5 will be little more than a convenience — making a routine purchase less of a hassle. But behind the scenes, health professionals and experts are watching with bated breath to see how Ontario’s push to allow booze in thousands of new stores will play out across the province. 
With emerging evidence linking alcohol to a growing list of costly outcomes, experts warn the biggest increase in alcohol availability in Ontario in nearly 100 years will lead to a cascade of health and social harms, including an increase in alcohol-related deaths.
The question is: Is Ontario prepared?
“Harm will increase in Ontario. That is straightforward,” said Dr. Daniel Myran, who has studied the costs of previous changes to alcohol sales, including Ontario’s last, when some grocery stores started selling beer and wine.
A chorus of experts is now calling on the province to have a plan: If we’re going to modernize alcohol sales to be more in line with our neighbours, it’s best to prepare ahead of time to help minimize the hangover.
“We need to have some safety measures put in place,” said Ian Culbert, executive director of the Canadian Public Health Association, “so that it’s not the wild, wild west when it comes to alcohol sales in this province.”
For decades, you may have heard that the occasional beer or glass of wine is harmless, even healthy for you. Shared so broadly, the notion has become widely accepted.
But recent research is proving this idea wrong.
One of the main messages in Canada’s Guidance on Alcohol and Health is that no amount of alcohol is good for your health.
The updated guidelines, released in 2023 by the Canadian Centre on Substance Use and Addiction, caught Canadians by surprise after drastically reducing the threshold for “low-risk” drinking.
Previous advice recommended no more than 10 drinks a week for women and 15 for men, with anything above that jeopardizing long-term health.
The new guidance, funded by Health Canada and based on emerging evidence on how alcohol harms health, set low-risk drinking at just one to two drinks per week; moderate risk is defined as three to six standard drinks a week, with each additional weekly drink increasing the alcohol-related consequences.
Adam Sherk, senior scientist and special policy adviser at the Canadian Centre on Substance Use and Addiction, said the aim of the 2023 advice is to make clear that “any reduction that we can do in our drinking will improve our health.”
Drinking less reduces the chance of injury but also lowers the risk of a host of health problems, such as heart disease and stroke, liver disease and at least seven types of cancer, including breast and colon cancer.
According to the updated guidelines, heavy drinking — defined as 3.5 drinks a day, or more — can double or even triple the risk of mouth and throat cancers, while those who consume 14 or more drinks a week face a 20 per cent increased risk of colorectal cancer.
And despite red wine’s long-held halo, the guidance states that all types of alcohol come with health costs.
It’s important to note that when experts discuss “harm,” they don’t mean that a typical low-to-moderate drinker can expect to face all of the most severe health consequences. People tend to connect alcohol consumption with dire outcomes, such as alcohol-use disorder, liver cirrhosis and impaired driving, said Myran, a family doctor and public health physician and Canada Research Chair in social accountability at the University of Ottawa.
But, he said, there needs to be a greater awareness that alcohol is linked to more than 200 different health conditions — and that it’s not just heavy drinkers who will see an impact on their health.
Research has shown that making alcohol easier to access leads to higher rates of consumption, which in turn leads to an increase in alcohol-related harms.
With Ontario expanding alcohol sales to an additional 8,500 stores — up from about 2,935 outlets — experts say they are bracing for these negative outcomes.
“People are going to drink more and there’s going to be more emergency room visits, deaths, chronic health conditions and acute health problems and social problems,” said Myran.
Already, alcohol leads to some 18,000 deaths a year in Canada. In Ontario alone, research shows that in 2020 alcohol was estimated to cause 6,201 deaths and led to about 47,500 hospital admissions and 258,700 emergency department visits.
And the burden on the health system comes with a stark economic cost, said Myran, an investigator at the Bruyère Research Institute at The Ottawa Hospital.
“For every standard drink — every bottle of beer, every glass of wine — that’s sold in Canada, it costs the taxpayer 34 cents, when you add up the health and social problems from it.”
He notes the 2015 move by the former Liberal government to allow grocery stores to sell beer — also billed as a way to deliver consumer choice and convenience — offers evidence of an increase in associated harms.
A 2019 study that he conducted found that in the two years following the policy change, emergency department visits due to alcohol increased by six per cent more in regions with grocery stores that sold beer and wine compared to regions that didn’t introduce alcohol in their grocery stores. 
While it’s not clear how much the levels of drinking in each province are the effects of more or less restrictive alcohol laws, Ontario has long bought less alcohol per person than the national average.
According to Statistics Canada’s most recent data from 2022, Ontario also had the lowest rate of self-reported heavy drinking of any province. And in 2023, the province also had by far the lowest police-reported rates of alcohol-impaired driving.
In the coming months, researchers will be watching to see how much these trends increase.
“I don’t think that we’re going to see a 20 per cent increase in how much people drink or a 20 per cent increase in health harms due to alcohol,” Myran said. “But we might see something on the order of a three, four or five per cent increase. And that is concerning because there is so much harm that already occurs from alcohol.”
As the days tick closer to booze being sold in corner stores, calls from federal and provincial health organizations have been growing stronger for Ontario to address the health and safety concerns from expanded alcohol sales.
In May, the Canadian Public Health Association (CPHA) “condemned” Ontario’s expansion of alcohol into convenience stores, more supermarkets and big-box stores, calling the move “alarming in light of the evidence” and urging the province to reconsider.
But with the change weeks away and the Ford government firm in its plans, Culbert of the CPHA said its priority now is to press for “guard rails” as alcohol is rolled out to thousands of stores in the province.
A coalition of 10 health organizations, including the Canadian Cancer Society, the Ontario Public Health Association and Toronto’s Centre for Addiction and Mental Health, have been pushing for Ontario to adopt a comprehensive alcohol strategy.
The group penned an open letter to Premier Doug Ford in May, pointing out that the province “does not have a co-ordinated action plan for reducing harms from alcohol use.” The letter also noted that “alcohol-related harms cost Ontario more than $7 billion annually, which is greater than the costs of harms from tobacco and opioids combined.”
Earlier this month, the coalition sent a followup letter to the Premier’s Office that laid out a 10-point plan. Among its recommendations are to: Allow municipalities to opt out of the expansion; Prohibit stores within 150 metres of a school or daycare from selling alcohol; Prohibit convenience stores at gas stations from selling alcohol; And prohibit convenience stores and supermarkets from cross-promoting alcohol with food or other products.
“We’re not asking for the moon,” said Culbert of the health care coalition, of which the CPHA is a member. “We’re asking for straightforward, logical, common-sense initiatives to help reduce the harms associated with the expansion of alcohol sales.”
In a statement to the Star, a spokesperson for Health Minister Sylvia Jones said the province continues “to believe that the people of Ontario should be treated like adults,” and that the government “has a clear mandate to give them the same choice and convenience that Canadians in every other province have when it comes to buying beer and wine.”
Alexandra Adamo said the government is investing an additional $10 million “to support social responsibility and public health efforts to ensure alcohol continues to be sold and consumed safely in the expanded marketplace.” She said that funding is in addition to the $396 million announced in this year’s budget for mental health and addiction services.
Warnings about alcohol’s growing harms have also come from inside the Ontario government.
In his 2023 Annual Report, Ontario’s Chief Medical Officer of Health Dr. Kieran Moore noted the COVID-19 pandemic led to “a significant increase in alcohol sales and alcohol toxicity deaths” — just one of the “disturbing trends” that also include “a growing number of youths in grades 7 to 12 who reported using alcohol, cannabis, and vaping products more frequently.”
Among other things — including a call for a comprehensive alcohol strategy — Moore recommended strengthening alcohol policies through pricing and taxation, limiting the number of retail outlets that sell alcohol and exploring the possibility of raising the drinking age from 19 to 21.
Dr. Leslie Buckley, Chief of Addictions at the Centre for Addiction and Mental Health (CAMH), noted that other jurisdictions, including Scotland, Lithuania  and the Nordic countries, are looking for ways to reduce alcohol availability in their countries to curb consumption. With Ontario pursuing a different course, Buckley said the province needs to have a greater focus on education, prevention and treatment to reduce alcohol-related harms. 
“There’s a lot of potential gain in providing better treatments, and getting treatment to people earlier.” 
Asked about Moore’s position, Adamo said while the Health Ministry appreciates his viewpoint, his position would “set Ontario apart from the rest of the country.”
Alcohol is a psychoactive substance that affects the way people think and behave. This means it shouldn’t be marketed and sold like most other consumer goods, said Sherk.
Because alcohol is potentially addicting and dependency-inducing, moves that lead to more drinking will have a “reinforcing effect or feedback loop,” he said. “Lower prices increase sales, which increases alcohol use that pulls more people into dependency, which further increases sales because people are dependent or addicted to alcohol itself.”
Sherk said it’s critical that Ontario maintain — or even modestly increase — the minimum price of alcohol in the province to offset the upcoming expansion in sales. The cheapest alcohol is the most harmful because it attracts new drinkers and continues to draw in those already addicted to alcohol, he explained.
“Those cheapest products fly off the shelves, and they cause a lot of harm. We know the more expensive we can make those cheapest products — that’s really important for public health.”
So far, the province has said it will continue to impose minimum price restrictions, though private retailers will be able to set their own prices — which the province says will benefit consumers.
Another key way to lower harms is to require warning labels on individual bottles and cans, said Erin Hobin, a senior scientist in the department of health promotion, chronic disease and injury prevention at Public Health Ontario.
She said a recent study — the most comprehensive review of its kind, of which she was the senior author — showed that such labels reduce alcohol consumption, in part because of their wide reach.
“They essentially reach everyone who handles the container, and they expose those who are handling the container repeatedly to key health information,” she said.
While Canada is a world leader in designing and mandating strong warning labels on cigarette packages, and most recently cannabis packages, alcohol containers are largely exempt from these labelling requirements, Hobin said.
Container labels can also help people learn about alcohol’s health risks, especially alcohol’s links to cancer, she said, adding this is important because evidence suggests that this makes people more likely to support stronger alcohol policies, including those that have to do with pricing.
For people who don’t have a problem with alcohol and aren’t one of the unlucky few who may experience the cancer risk, popping into a corner store to grab a bottle of wine for dinner may be nothing more than a time-saver.
But the impacts are much larger, and carry more weight, for those who already experience problems from alcohol — or importantly, people that will do so in the future — Sherk said, noting how booze will now be much more visible in their lives.
He noted that about one-quarter of all people who drink alcohol at any point will become dependent at some level in their lives.
“It’s not a benign product.”