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There’s been a recent flurry of news stories regarding how establishing a regulated cannabis program impacts the sale and use of alcohol. And there’s also a number of stories about how alcohol abuse is on the rise in some sectors, while on the decline in others.

Let’s start with a look at how having an entire country legalize cannabis impacts alcohol sales.

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OH CANADA: Now that people can buy cannabis from sea to shining sea in Canada, alcohol sales are on the decline. Specifically, beer sales. Per Merry Jane, the sales of Strange Brew were on the decline between 2014 to 2018 by a barely noticeable .3 percent. But in the first full year of cannabis legalization, sales dropped a full 3 percent.

A spokesperson for the aptly named trade association Beer Canada explained to Bloomberg News that from November 2017 to November 2019, “domestic beer volumes fell 3.9 percent” and yet “imported beer volumes grew 1.4 percent.” The analyst added that she “expects Canada’s launch of newly legal pot products like vapes, edibles, and cannabis beverages to “perpetuate this trend” of declining beer volumes.”

Shed no tears for the brewers, however—as Bloomberg mentions, “Based on recent monthly data, it is predicted that the Canadian pot industry will reach C$1.5 billion in annual sales. This pales in comparison to beer sales, which is expected to reach C$9.2 billion annually, while overall alcohol sales is estimated to reach C$23 billion.”

In the United States, there are mixed trends, and some are troubling.

A recent study performed by researchers at Oregon State University show that at colleges and universities in states with a recreational cannabis program, students are decreasing their binge drinking with cannabis. Binge drinking—defined as five or more drinks in one sitting within the past two weeks, aka any given night in Pacific Northwest during the winter months—has thankfully been on the decline nationwide at colleges overall.

Published in the magazine I can’t stop reading, Addiction, researchers Harold Bae and David Kerr shared with KTVZ TV that after analyzing data from seven states and 135 colleges where cannabis was legalized by 2018, and from 41 states and 454 colleges where recreational use was not legal, they found “that after legalization, students ages 21 and older showed a greater drop in binge drinking than their peers in states where marijuana was not legal.”

From KTVZ: “We saw changes after legalization that really differed by substance... for marijuana we saw state-specific increases that went beyond the nationwide increases, whereas binge drinking was the opposite: a greater decrease in the context of nationwide decreases.” The magnitude of effect was much larger with marijuana than with any of the other substances, Bae added. “So the changes following recreational marijuana legalization were quite specific to cannabis use.”

Binge drinking may be on a downward trend, but alcohol use and its effects are not. In a recent study by the National Institute on Alcohol Abuse and Alcoholism, part of the National Institute of Health, researchers told NPR they found an increase in deaths by, and abuse of, alcohol.

In the past 20 years, they found deaths by alcohol more than doubled. Per NPR, “Death certificates spanning 2017 indicate nearly 73,000 people died in the US because of liver disease and other alcohol-related illnesses. That is up from just under 36,000 deaths in 1999.” (That surpasses deaths from all opioids and illicit drugs of 70,000 that same year.)

The study noted that “there was a 10.1 percent increase in the prevalence of drinking and a 23.3 percent increase in binge drinking among women” and that “when analyzing annual increases in deaths, the largest increase was among white women.”

"With the increases in alcohol use among women, there's been increases in harms for women including ER visits, hospitalizations and deaths," said the study’s author.

So what happens when a state enacts a regulated program providing greater access to cannabis? It depends on who’s providing the answer to that question.

Last year, a widely reported study by the Distilled Spirits Council found virtually no change in the sales of booze in three states with recreational cannabis programs.

As CNBC explained, “The council analyzed per-capita alcohol sales in the three states for the two years prior to marijuana being legalized and up to four years after using state-level alcohol tax receipts and shipment data. Sales of spirits increased in all three states, from 3.6 percent in Oregon to 7.6 percent in Colorado.” And that “overall sales of spirits, wine and beer were roughly flat. Colorado was up 1.7 percent, while Washington state and Oregon were both down 0.2 percent and 0.5 percent, respectively.”

But hold up. Other research shows that alcohol sales do take a hit when consumers have the choice of cannabis.

Per Forbes:

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[A 10 year joint study found published in 2018] made use of available Nielsen Retail Scanner alcohol sales data from 90 alcohol chain stores—grocery, convenience, drug, and mass distribution stores—from 2006-2015." They did it this way because they believed asking consumers does not provide reliable information, as many people simply don’t tell the absolute truth about their alcohol consumption habits.

Using the 90-chain data, the study compared alcohol sales of states that do not have medical marijuana laws and states with medical marijuana laws (before and after the laws were implemented). The researchers also included demographics (age, race) as well as economics (income) for the study because those areas make a measurable impact on alcohol consumption. Over the ten years studied, counties located in medical marijuana states showed almost a 15 percent reduction in monthly alcohol sales.