Minimum unit pricing in Scotland prevented hundreds of deaths and hospital admissions despite "limited evidence" that it reduced consumption among the heaviest drinkers, according to a final evaluation of the policy.
Experts warned that "any beneficial impacts will only continue" if the cost increases in line with other prices and incomes from its current threshold of 50 pence per unit, but cautioned that this also comes with a risk that its "harmful effects might also increase".
They said this must be counterbalanced by access to alcohol support and rehabilitation services amid evidence that poorer drinkers with alcohol dependency cut back on food as alcohol costs rose.
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The report by Public Health Scotland (PHS) is based on an analysis of around 40 research papers carried out since Scotland's landmark MUP policy took effect in May 2018.
Under the terms of a 'sunset clause' built into the legislation, MUP would automatically expire from May 2024 unless MSPs vote to extend it.
This is likely given the findings and majority support for it in parliament, but the tougher challenge will be whether to reset it at a higher level and, if so, how much higher.
ANALYSIS: If the heaviest drinkers didn't cut down, then how can MUP have 'saved lives'?
Campaigners including the Scottish Health Action on Alcohol Problems (SHAAP) - an umbrella body of clinicians - are calling for a 65 pence rate.
SHAAP chair, Dr Alastair MacGilchrist, said: "The effectiveness of MUP is being eroded year on year by the effect of inflation.
"The current level of 50p was proposed when the legislation was first passed by the Scottish Parliament in 2012, over a decade ago, and it is essential to maintain and increase MUP’s effectiveness for the 50p level to be increased.
“MSPs must now act on the evidence and vote to keep MUP on our statute books and to uprate the level to at least 65p.”
READ MORE: Minimum pricing - how do you count deaths that never happened?
According to PHS, the current minimum unit policy has prevented roughly 150 deaths and 400 hospital admissions per year on average from alcohol.
The figure is based on gauging pre-MUP trends in Scotland and comparing outcomes in Scotland over the past five years against England as a control population without MUP.
In reality, the number of alcohol-specific deaths in Scotland rose from 1,120 in 2017 - the year before MUP - to 13-year high of 1,245 in 2021, the most recent year for which data is available.
The mortality rate also climbed by 9% over the same period, from 20.5 to 22.3 deaths per 100,000.
Nonetheless, the message from researchers is that the picture in Scotland would have been even worse without MUP.
The effect is estimated to have been most significant for men, drinkers aged 65 years or older, and people living in the 40% most deprived areas in Scotland, which is hailed as evidence that MUP has helped to narrow the "inequalities in alcohol-attributable health harms".
The policy has been associated with a 3% reduction in alcohol consumption at a population level based on retail sales, but the final report also notes that there is "limited evidence to suggest that MUP was effective in reducing consumption for those people with alcohol dependence".
It warns that some alcoholics on low incomes "may have experienced harm, such as withdrawal, reduced expenditure on food or increased intoxication possibly from switching to spirits as a consequence of MUP" and require "timely and evidence-based treatment and wider support that addresses the root cause of their dependence".
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Dr Sandesh Gulhane, a GP and the Scottish Conservative health spokesman, said MUP had been a “blunt instrument to tackle a complex problem" which had "made the lives of some of the most vulnerable even worse".
He urged ministers to "reflect carefully" on the findings.
Dr Nick Phin, medical director for PHS, said: "We're not saying that minimum unit pricing is the panacea, the answer to everything, it's only one element of a tackling this issue.
"Other elements include looking at the services that are there are available to people who are using alcohol in this way."
READ MORE: Could moderate drinking be good for you? It's a bit more complicated than that
Alison Douglas, chief executive of Alcohol Focus Scotland, said: “Now we know that minimum unit pricing is truly life-saving, the policy must be continued, and the price increased.
"To scrap it now or leave it at a level that will quickly lose its effect would condemn hundreds of people to unnecessary suffering."
Drugs and alcohol policy minister, Elena Whitham, welcomed the findings, adding that the Scottish Government had made £106.8 million to Alcohol and Drugs Partnerships last year.
She said: "We will now carefully consider this research as part of ongoing work on reviewing MUP."
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