Do minimum unit pricing policies reduce alcohol harms? A review of new evidence.

Introduction: Minimum unit pricing (MUP) policies set a minimum cost per standard drink at which alcohol can be sold. They work to increase the price of low-cost and high alcohol content products in order to reduce affordability. We aimed to synthesise findings from empirical studies on the impact of MUP including new studies recently published from Scotland, Wales and Australia.

Method: We conducted a systematic review of the updated evidence focusing on the impact of MUP on alcohol consumption or alcohol-related health or social outcomes, including quantitative and qualitative studies. We searched five major databases. Studies published between 2010-2023 were included and modelling studies were excluded. We took a narrative synthesis approach due to heterogeneity of studies.

Results: We included 26 journal articles and 17 reports. Studies consistently found immediate reductions in alcohol following MUP implementation (3-9%). Studies found larger reductions in use of higher-strength, low-cost products such as cask wine and ciders. Studies from Canada and Australia provided evidence that minimum pricing policies contributed to decreases in alcohol attributable hospital admissions and ICU admissions. New studies suggest decrease in alcohol attributable deaths (13%), in line with previous studies from Canada, with larger decreases in areas of lower socioeconomic status. Studies did not find any effect of MUP on substitution of alcohol for non-beverage forms of alcohol, tobacco, illicit drugs or non-medical use of pharmaceutical drugs. Journal articles and reports showed mixed effects on crime outcomes such as assaults with Australian studies demonstrating reductions in overall rates of alcohol assaults and non-domestic assaults, but no impact on domestic violence (including alcohol-related). Studies from Scotland showed relatively stable rates of violence-related outcomes. There is mixed quantitative evidence on the impact of MUP on people with harmful or dependent use. Qualitative research with people accessing treatment services highlighted varying responses to MUP. Some maintained their level of spending on alcohol, thereby purchasing and using less alcohol overall. Some described challenges with affordability as being a nudge into treatment services, while others attempted to find ways to maintain their previous levels of alcohol use which could exacerbate financial strain. Studies found no increase in withdrawal symptoms for people with dependence. 

Discussions and Conclusions: There is a growing body of evidence to support MUP as a measure to reduce alcohol use and related harms including hospitalisations, deaths and some crime types.  Findings suggest additional support may be required for people experiencing alcohol dependence when MUP is introduced. To our knowledge, this is the first review to incorporate post-implementation data of MUP from real world contexts since their introduction in Scotland, Wales and Australia.