# Impact of the LCBO strike on Ontario emergency department visits with an alcohol-related chief complaint: a natural experiment in alcohol policy

## TL;DR

A strike at Ontario's LCBO led to a 24% drop in emergency department visits related to alcohol, showing that limiting alcohol availability can reduce healthcare burdens.

## Contribution

This study uses a natural experiment to demonstrate the impact of reduced alcohol availability on alcohol-related ED visits.

## Key findings

- ED visits with alcohol-related complaints decreased by 24% during the LCBO strike.
- Visits increased by 32% when LCBOs reopened.
- ED visits during the 2024 closure were significantly lower than in 2023.

## Abstract

Alcohol is a leading preventable cause of death and disability in Canada. Alcohol-related emergency department (ED) visits place a substantial burden on the health system, with evidence that greater alcohol availability contributes to higher utilization and related harms. The July 2024 Liquor Control Board of Ontario (LCBO) strike provided a natural experiment to evaluate the impact of reduced alcohol availability on healthcare utilization.

An interrupted time series analysis was conducted to evaluate ED visits with an alcohol-related chief complaint, as captured in the Acute Care Enhanced Surveillance System for Ontario, across three time periods: before, during, and after the LCBO strike. Run charts were utilized to compare visit patterns with historical trends. Poisson regression models, both unadjusted and adjusted for weekly temporal patterns, were used to assess changes in visit rates.

ED visits with an alcohol-related chief complaint decreased by 24% during the LCBO closure (aRR: 0.76, 95% CI 0.66–0.88) and declined over the strike period (aRR: 0.98, 95% CI 0.97 – 1.00). They increased by 32% when LCBOs reopened (aRR: 1.32, 95% CI 1.02 – 1.70). Comparing 2024 7-day moving averages with 2023 values (± 1SD and ± 2SD) demonstrated that ED visits during the 2024 closure were significantly lower than in 2023.

Reduced alcohol availability during the LCBO strike was associated with a significant decline in ED visits with an alcohol-related complaint, underscoring the potential health system benefits of reducing alcohol availability. The findings may inform policymakers considering measures to reduce alcohol-related healthcare burdens.