Here to stay? Policy changes in alcohol home delivery and “to-go” sales during and after COVID-19 in the United States

Abstract

During the early phase of the COVID-19 pandemic, legislative changes that expanded alcohol home delivery and options for “to-go” alcohol sales were introduced across the United States to provide economic relief to establishments and retailers. Using data from the Alcohol Policy Information System, we examined whether these changes have persisted beyond the peak phase of the COVID-19 emergency and explored the implications for public health. Illustration of state-level policy data reveals that the liberalisation of alcohol delivery and “to-go” alcohol sales has continued throughout a two-year period (2020 and 2021), with indications that many of these changes have or will become permanent after the pandemic. This raises concerns about inadequate regulation, particularly in preventing underage access to alcohol, and ensuing changes in drinking practices. In this commentary, we highlight the need for rigorous empirical evaluation of the public health impact of this changing policy landscape and underscore the potential risks associated with increased alcohol availability, including a corresponding increase in alcohol-attributable mortality and other alcohol-related harm such domestic violence. Policy makers should carefully consider public health consequences, whose costs may surpass short-term economic interests in the long term.

1 |. Introduction

According to the World Health Organization, regulating alcohol availability through measures such as limiting sales hours and the number of sales outlets is one of the most cost-effective ways to reduce the alcohol-attributable burden of disease [1]. In contrast, the COVID-19 pandemic has prompted a cohesive move towards increased availability of alcohol by loosening restrictions on alcohol home delivery and “to-go” alcohol sales across the United States [2]. Although many of these changes were initially enacted on a temporary basis to support restaurants, bars and liquor stores affected by pandemic-related closures, there have been deliberations from different perspectives regarding their permanence. While some welcome these new laws as a means of establishing a long-term revenue stream, health policy experts express concerns about the anticipated negative public health effects of increasing alcohol availability. Given the considerable increase in alcohol-attributable deaths between 2019 and 2020 [3], our objective was to investigate whether legislative changes permitting alcohol home delivery and “to-go” sales in various US states have persisted beyond the peak phase of the pandemic and to discuss their relevance to public health.

2 |. Policy landscape before and after COVID-19

Before the pandemic, off-premises retailers such as breweries, wineries and liquor stores were already allowed to deliver alcoholic beverages in some form in the majority of US states. However, in many cases, limitations existed such as restrictions on the type and amount of alcoholic beverages being delivered, hours of delivery or the requirement of special delivery privileges. For on-premises retailers such as bars and restaurants holding alcohol licenses, alcohol delivery or “to-go” alcohol sales in the form of take-out or curbside pick-up was entirely prohibited in 25 states before the onset of the COVID-19 pandemic [2]. Even in states where such sales were allowed, they were often restricted to beer and wine, only allowed in conjunction with a food order or a special delivery permit, or in some cases, limited to either delivery or take-out/curbside pick-up.

After the United States proclaimed that the COVID-19 outbreak constitutes a national emergency on 1 March 2020, and in response to subsequent economic impacts of lockdowns, new – initially often temporary as part of executive orders – legislation were introduced in several states allowing on-premises retailers to provide delivery and “to-go” purchasing of alcohol for the first time ever, relaxing delivery permit regulations, or expanding sales to spirits and mixed beverages. The Alcohol Policy Information System group systematically collected data on state-level changes in alcohol control policies from January 2020 to December 2021 [2]. We used their publicly available data to compare the policy landscape before and after the first two years of the COVID-19 pandemic (Figure 1a and 1b) as well as the timing of introducing these legislative changes throughout 2020 and 2021. When visualising these changes, it becomes apparent that the initial move towards liberalising alcohol home delivery and “to-go” sales in response to the economic constraints is not limited to the early and peak phase of the COVID-19 pandemic but continues throughout the full two years (Figure 1c).

Figure 1. Alcohol home delivery and “to-go” sales legislation in US States in 2020 and 2021.

On-premises establishments (A) refer to restaurants and bars that are licensed to sell alcoholic beverages. Off-premises establishments (B) refer to retailers that are licensed to sell alcohol beverages in the manufacturer’s original containers for consumption off the premises. Delivery or to-go sales are considered permitted if at least one type of alcohol, such as bottled beer, is allowed to be delivered or sold for takeout or curbside pickup. It is not specified whether delivery of alcoholic beverages to customers needs to be directly or can be through a third-party delivery service. In (C), a liberalising change refers to a legislative change from not allowing delivery or to-go sales to allowing delivery or to-go sales of at least one alcoholic beverage. A restricting change refers to a legislative change from allowing delivery or to-go sales of at least one alcohol beverage to not allowing any delivery or to-go sales. This may also constitute the reversal or expiration of a prior liberalising change. The authors created these figures using publicly available data from the Alcohol Policy Information System.

While the speed of legislative changes appears to have slowed down in the second half of 2020 and 2021, an unsystematic web search as of the writing of this article (May 2023) suggests that most of the observed changes will be permanent [4]. For example, in Arkansas, alcohol home delivery was first allowed under an emergency declaration in 2020 during the COVID-19 pandemic before being written into law in 2021 [5]. In early 2023, an attempt to repeal the delivery of alcoholic beverages proved unsuccessful [6]. Similarly, New York was the first state to temporarily authorise home delivery and “to-go” sales of alcoholic beverages in March 2020. This legislation expired when the state of emergency was lifted in June 2021, but in April 2022 a new bill was signed into effect that codifies “to-go” alcohol sales for off-premises consumption at least until 2025 [7]. In early 2022, California even expanded a 2021 law that originally permitted the sale and delivery of “to-go” cocktails as part of restaurant food orders by removing the requirement to purchase food and extending the privileges to bars [8]. Notably, states traditionally leaning towards more restrictive alcohol regulations such as South Carolina or Utah are in the midst of debating bills that would allow alcohol home delivery [9,10].

Having said this, some states have not extended pandemic-related legislative changes (illustrated in Figure 1c “restricting changes”), as seen in Maryland and Tennessee where “to-go” sales of alcoholic beverages were discontinued as of July 2023 [11]. Similarly, a policy initiative in Colorado aimed at enacting permanent laws permitting third-party alcohol delivery and “to-go” sales (in addition to direct home delivery from retailers) failed [12]. The rejection of these laws on the ballot came as a surprise to many, considering that today’s Colorado – once a restrictive state as an early adopter of Prohibition in 1916 [13] – is neither a control state nor does it have dry communities, and has not been associated with particularly restrictive alcohol regulations in recent times. Tellingly, the local opposition, whose campaign is at least partly credited with the voters’ rejection, was not led by public health experts but rather by established alcohol retailers who feared losing business to delivery services [14].

On the other hand, right-leaning policy groups have long labelled existing alcohol regulations as “crazy” relicts from the Prohibition era and its immediate aftermath [15]. Correspondingly, several publications now praise the opportunities opened up by the pandemic to liberalise alcohol regulations [16]. While it is certainly true that the Prohibition era has shaped present day’s diverse alcohol policy landscape, the ongoing expansion of alcohol home delivery and “to-go” sales deserve a more nuanced consideration from a public health perspective. This is particularly relevant given the broader context of arguably declining effective alcohol control policies in the United States for decades. When considering the World Health Organization’s “best buys” for reducing the harmful use of alcohol (namely, regulating availability, implementing pricing policies such as alcohol excise taxes, and restricting marketing) [17], notable shifts can be observed in the United States. For example, between 2000 and 2019 12 states lifted their Sunday alcohol sales bans (while none have been enacted) [18]. Similarly, the alcohol-specific excise tax experienced substantial inflation-adjusted declines between 1991 and 2015 in almost all states, with the average inflation-adjusted state excise tax rate declining by 30% for beer, 32% for distilled spirits and 27% for wine [19]. As part of the comprehensive privatisation of their liquor distribution and retailing system in 2012, Washington State also removed uniform pricing, bans on quantity discounts, and bans on spirits advertising in stores [20].

3 |. Potential consequences of liberalisation

A systematic review summarising international policies on online alcohol sale and delivery based on literature published until November 2020 concluded that while regulation varied widely across jurisdictions, it often does not meet the same standard as regulation for bricks-and-mortar establishments and may be insufficient to prevent youth access in particular [21]. For example, in a study conducted at the University of North Carolina at Chapel Hill in 2011, of 100 alcohol online orders placed by underage buyers, 45% were successfully received [22]. Newer data from the 2022 Rhode Island Young Adult Survey showed that 10.2% of the alcohol purchases through a home delivery or “to-go” purchases were completed by participants under the legal purchase age [23]. While the constantly evolving channels and techniques for digital marketing and online advertising of alcohol have already been identified as a topic that deserves attention by health policy experts, digital marketing is intrinsically linked to the online sale and delivery of alcohol, virtually enabling companies to sell alcohol directly into the home [24].

Reducing the space between advertising exposure and purchasing decisions to a minimum is likely to have a meaningful impact on drinking practices including the amount or type of alcohol consumed and the occasion and location of alcohol consumption. In a convenience sample from the United States surveyed during pandemic restrictions in spring 2020, alcohol home delivery was associated with heavier drinking compared to other purchasing methods, and participants who had alcohol delivered were nearly two times more likely to report engaging in binge drinking than those who purchased alcohol through other methods [25]. Additionally, the option for “to-go” purchasing of alcoholic drinks may ease the continued drinking beyond opening hours of restaurants and bars and it remains unclear, whether this merely “shifts” the time and location of total drinks being consumed or whether it will lead to an increase in alcohol consumption. In addition to effects on underage drinking, it is also important to consider potential variation by other group characteristics such as socioeconomic status which may be related to the affordability of home delivery services. Lastly, there may be unintended consequences of expanding alcohol home delivery and “to-go” sales such as effects on domestic violence, particularly against women and children, when restaurants or bars are replaced by private homes as the primary consumption site. To date, there are few, if any, studies that apply rigorous methods to evaluate potential causal relationships in these areas [26]. Public health researchers should not leave investigating the public health impact of alcohol regulations to non-peer-reviewed politically or economically motivated policy briefs [27], in particular when quasi-experimental study designs leveraging policy changes are conceivable.

4 |. Conclusion

In conclusion, the progressive deregulation of US alcohol control policies over the last 20 years culminated in the liberalisation of home deliveries and “to-go” alcohol sales during the COVID-19 pandemic. Concerningly, while there is yet the need for a deeper empirical evaluation of the related public health risks, many of the legislative changes observed during the early phase of the pandemic seem to be permanent and will inevitably lead to increased alcohol availability. This heightened availability will arguably contribute to a growing alcohol-attributable health burden and further exacerbate the current increase in mortality rates in the United States [3]. Thus, when pursuing changes in alcohol control policies, policymakers have to balance short-term economic interests against lives lost due to alcohol—the cost-of-illness is guaranteed to offset any additional revenue generated by alcohol sales.