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Figure 1.  National Alcohol Retail Sales 16 Months Prior to and During the First 16 Months of the COVID-19 Pandemic in Canada
National Alcohol Retail Sales 16 Months Prior to and During the First 16 Months of the COVID-19 Pandemic in Canada

A, Dark blue bars indicate prepandemic alcohol sales; light blue bars, intrapandemic alcohol sales; orange line, linear counterfactual trend. B, Circles indicate monthly sales; solid line, intrapandemic trend; dashed line, counterfactual trend; shaded area, COVID-19 period.

Figure 2.  National Cannabis Retail Sales 16 Months Prior to and During the First 16 Months of the COVID-19 Pandemic in Canada
National Cannabis Retail Sales 16 Months Prior to and During the First 16 Months of the COVID-19 Pandemic in Canada

A, Dark blue bars indicate prepandemic cannabis sales; light blue bars, intrapandemic cannabis sales; orange line, linear counterfactual trend. B, Circles indicate monthly sales; solid line, intrapandemic trend; dashed line, counterfactual trend; shaded area, COVID-19 period.

1.
Clay  JM, Parker  MO.  Alcohol use and misuse during the COVID-19 pandemic: a potential public health crisis?   Lancet Public Health. 2020;5(5):e259. doi:10.1016/S2468-2667(20)30088-8 PubMedGoogle Scholar
2.
Statistics Canada. Retail trade sales by industry (x1,000). Accessed August 23, 2021. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=2010000802
3.
Imtiaz  S, Wells  S, Rehm  J,  et al.  Cannabis use during the COVID-19 pandemic in Canada: a repeated cross-sectional study.   J Addict Med. Published online December 14, 2020. doi:10.1097/ADM.0000000000000798PubMedGoogle Scholar
4.
Minhas  M, Belisario  K, González-Roz  A, Halladay  J, Murphy  JG, MacKillop  J.  COVID-19 impacts on drinking and mental health in emerging adults: longitudinal changes and moderation by economic disruption and sex.   Alcohol Clin Exp Res. 2021;45(7):1448-1457. doi:10.1111/acer.14624 PubMedGoogle ScholarCrossref
5.
Ontario Cannabis Store. A year in review: April 1, 2020-March 31, 2021. Accessed June 12, 2021. https://cdn.shopify.com/s/files/1/2636/1928/files/OCS-InsightsReport_____2020-21.pdf?v=1625075546
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    1 Comment for this article
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    Method Choices Make Cannabis Results Less Accurate
    Michael Armstrong, PhD; Daniel Myran, MD, MPH | Brock University
    We thank MacKillop et al. for examining Canadian alcohol and cannabis sales during COVID-19. We wish to highlight several methodological choices we believe are relevant to the cannabis sales analysis.

    First, the study assumed the cannabis data were seasonally adjusted. However, Statistics Canada only provides unadjusted cannabis sales figures: see footnote #6 of its data files. If the study had adjusted those figures to reflect standardized 30-day months, its pre-pandemic growth estimate would have risen from (150.75 – 55.40)/15 = $6.36 to (155.94 – 55.40)/15 = $6.70 million/month.

    Second, the study used only the 1st and 16th
    data points for this estimate. It instead could have used the slope from regressing across all 16 pre-pandemic months of standardized data, raising the growth estimate to $7.73 million/month (95% CI: 6.89, 8.58).

    Third, the study fit linear models to nonlinear pre-pandemic data. Figure 2B displays the departure from linearity: the first 2 points are above the fitted line, the next 6 below, and the subsequent 7 above. This non-linearity resulted from nationwide dry cannabis product shortages between November 2018 and March 2019 [1]; sales grew only after those shortages faded. A regression using just the 12 post-shortage months from March 2019 to February 2020 raises the growth estimate to $8.58 million/month (95% CI: 7.60, 9.57).

    Together, the above-mentioned choices understated the pre-pandemic growth rate by 26% ($6.36 vs $8.58 million/month). This indirectly made the pandemic-period sales increase appear relatively much larger.

    Fourth, the study did not consider two alternative explanations for pandemic-period cannabis sales acceleration: increased retail store openings, especially after Ontario resumed licensing in early 2020; and the introduction of more legal product formats (e.g., vapes) from January 2020 onward. Our recently published paper explored these factors and found they better explained the pandemic-period sales increases than COVID-19 did [2].

    This difference in explanations has important policy implications, as it suggests reported increases in pandemic-period cannabis use [3] might likewise relate to legal market maturation rather than to COVID-19.

    1. Armstrong MJ, Cantor N, Smith,BT, Jesseman R, Hobin E, Myran D (2022) Interrupted time series analysis of Canadian legal cannabis sales during the COVID-19 pandemic, Drug and Alcohol Review, 13465. http://doi.org/10.1111/dar.13465

    2. Armstrong MJ (2021) Legal cannabis market shares during Canada’s first year of recreational legalization, International Journal of Drug Policy 88, Feb, 103028. https://doi.org/10.1016/j.drugpo.2020.103028

    3. Rotermann M (2021) Looking back from 2020, how cannabis use and related behaviours changed in Canada. Health Reports 32 #4: 3-14. https://doi.org/10.25318/82-003-x202100400001-eng
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Research Letter
    Psychiatry
    November 4, 2021

    National Retail Sales of Alcohol and Cannabis During the COVID-19 Pandemic in Canada

    Author Affiliations
    • 1Peter Boris Centre for Addictions Research, St Joseph's Healthcare Hamilton/McMaster University, Hamilton, Ontario, Canada
    • 2Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
    • 3Homewood Research Institute, Guelph, Ontario
    JAMA Netw Open. 2021;4(11):e2133076. doi:10.1001/jamanetworkopen.2021.33076
    Introduction

    There is concern that the societal consequences of the COVID-19 pandemic will be associated with increased substance use.1 Data to date have primarily been self-reported changes, but objective sales data may inform this question. Here, we examined national retail sales of alcohol and cannabis prior to and during the pandemic in Canada.

    Methods

    Where applicable, the report for this economic evaluation is consistent with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) reporting guideline. The Hamilton Integrated Research Ethics Board determined that ethical review board approval and informed consent were not needed because the data were publicly available sales metrics. The data were seasonally adjusted national monthly retail sales (ie, North American Industry Classification System codes 4453, for beer, wine, and liquor stores, and 453993, for cannabis stores) from November 2018 to June 2021 in Canadian dollars.2 The period was selected to provide a sizable prepandemic window and because of the timing of cannabis legalization (ie, mid-October 2018). Principal analyses were contrasts between intrapandemic sales and a counterfactual intrapandemic linear trend based on prepandemic sales. A subanalysis quantified stockpiling, operationalized as the proportionate change in March 2020, when states of emergency were declared, compared with the counterfactual estimate. Because the data were population level, null hypothesis significance testing was a secondary priority, but overall differences and intrapandemic trends in poststockpiling data were examined statistically using analysis of variance (ANOVA) and segmented regression, respectively. Significance tests used P < .05 and were 2-sided, and analyses were conducted from May to August 2021 using Excel version 2019 (Microsoft), SPSS statistical software version 26.0 (IBM), and R statistical software version 4.1.1 (R Project for Statistical Computing).

    Results

    Mean (SD) monthly prepandemic alcohol sales were $2.02 billion ($26.24 million), exhibiting a positive slope of $4.45 million/month (Figure 1). Putative stockpiling in March 2020 was an increase of $330 million (15.97%) from the counterfactual estimate of $2.06 billion. Intrapandemic poststockpiling alcohol national monthly sales were $2.09 billion in April 2020 and $2.29 billion in June 2021. Mean (SD) monthly intrapandemic alcohol sales during the intra–COVID-19 period were $2.214 billion ($87 million), which was an increase of $116 million (5.54%) vs the mean (SD) counterfactual estimate of $2.098 billion ($21 million), reflecting an increase of $1.86 billion over the 16-month period. Based on ANOVA, mean monthly prepandemic sales were statistically significantly lower than intrapandemic sales ($2.02 billion; 95% CI, $1.99-$2.06 billion vs $2.21 billion; 95% CI, $2.18-$2.25 billion; P < .001). In segmented regression, there was an increasing trend in the time × COVID-19 interaction (B = 7.78; standard error [SE] = 3.07; P = .02) (Figure 1).

    Monthly prepandemic cannabis sales exhibited an increase (Figure 2), from $55.40 million in November 2018 to $150.75 million in February 2020 (slope, $6.36 million/month), associated with the expanding legal marketplace. Stockpiling was estimated at an increase of $23.59 million (15.02%) greater than the counterfactual estimate of $157.10 million. Mean (SD) monthly intrapandemic cannabis sales were $255.51 million ($47.71 million), which was 24.78% greater than the mean (SD) counterfactual estimate of $204.78 million ($30.26 million) and reflected an increase of $811.74 million over the 16-month period. The difference in mean monthly prepandemic sales ($100.58 million [95% CI, $78.56-$122.61 million]) vs intrapandemic sales ($255.51 million [95% CI, $233.48-$277.54 million]) was significant (P < .001) but uninformative because of the steep postlegalization slope. In segmented regression, there was no statistically significant increasing trend (B = 1.82; SE = 1.43; P = .22) Figure 2).

    Discussion

    In this economic evaluation, mean monthly national retail sales of alcohol, with notable stockpiling, exhibited a monthly increase of 5.5% vs the counterfactual estimate during the intrapandemic period. For cannabis, although stockpiling was similar, the general intrapandemic increase in mean monthly sales vs the counterfactual estimate was substantially higher, approaching 25%. Interestingly, these results converge with a national study of self-reported pandemic-associated changes that found a similar dissociation between alcohol and cannabis.3

    The public health and clinical significance of these changes cannot be directly inferred. National retail sales cannot be directly converted into person-level expenditures, consumption behavior, or, more importantly, the extent to which individuals transition to higher-risk levels of use. Additionally, some subpopulations have reported decreases in alcohol involvement during the pandemic,4 and aggregate sales necessarily conflate increases, decreases, and stable patterns. A limitation of this study is that these macroeconomic indicators represent large proportions of the market but not its entirety (eg, illegal sales and alcohol sold through ferment-on-premises operations). This is particularly significant for cannabis, for which a large contraband market remains,5 and it is possible that the pandemic pushed consumers from illegal terrestrial purchasing to legal online purchasing.

    These results nonetheless offer one of the first national perspectives on changes in alcohol and cannabis use during the COVID-19 pandemic. Whether similar patterns are present in other nations is an open question, but these findings suggest the value of sales data as a strategy to characterize the pandemic’s associations with substance use.

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    Article Information

    Accepted for Publication: August 31, 2021.

    Published: November 4, 2021. doi:10.1001/jamanetworkopen.2021.33076

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 MacKillop J et al. JAMA Network Open.

    Corresponding Author: James MacKillop, PhD, Peter Boris Centre for Addictions Research, St Joseph’s Healthcare Hamilton/McMaster University, 100 W Fifth St, Hamilton, ON L8N 3K7, Canada (jmackill@mcmaster.ca).

    Author Contributions: Dr MacKillop and Ms Cooper had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: MacKillop.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: MacKillop, Cooper.

    Critical revision of the manuscript for important intellectual content: MacKillop, Costello.

    Statistical analysis: All authors.

    Administrative, technical, or material support: MacKillop.

    Supervision: MacKillop.

    Conflict of Interest Disclosures: Dr MacKillop reported serving as principal and senior scientist at Beam Diagnostics and receiving consulting fees from Clairvoyant Therapeutics outside the submitted work. No other disclosures were reported.

    Funding/Support: This work was supported by the Peter Boris Chair in Addictions Research and Homewood Research Institute, an independent charitable organization funded through a variety of sources, including Homewood Health, community stakeholders, corporations, and private foundations.

    Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Additional Contributions: Kyla Belisario, MA (Peter Boris Centre for Addictions Research, St Joseph's Healthcare Hamilton/McMaster University), provided insights on an earlier data set and was not compensated for this work.

    References
    1.
    Clay  JM, Parker  MO.  Alcohol use and misuse during the COVID-19 pandemic: a potential public health crisis?   Lancet Public Health. 2020;5(5):e259. doi:10.1016/S2468-2667(20)30088-8 PubMedGoogle Scholar
    2.
    Statistics Canada. Retail trade sales by industry (x1,000). Accessed August 23, 2021. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=2010000802
    3.
    Imtiaz  S, Wells  S, Rehm  J,  et al.  Cannabis use during the COVID-19 pandemic in Canada: a repeated cross-sectional study.   J Addict Med. Published online December 14, 2020. doi:10.1097/ADM.0000000000000798PubMedGoogle Scholar
    4.
    Minhas  M, Belisario  K, González-Roz  A, Halladay  J, Murphy  JG, MacKillop  J.  COVID-19 impacts on drinking and mental health in emerging adults: longitudinal changes and moderation by economic disruption and sex.   Alcohol Clin Exp Res. 2021;45(7):1448-1457. doi:10.1111/acer.14624 PubMedGoogle ScholarCrossref
    5.
    Ontario Cannabis Store. A year in review: April 1, 2020-March 31, 2021. Accessed June 12, 2021. https://cdn.shopify.com/s/files/1/2636/1928/files/OCS-InsightsReport_____2020-21.pdf?v=1625075546
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