Driving - Drinking and driving
September 2008
(This briefing paper applies to Great Britain)
The BMA calls on the Government to reduce the permitted blood alcohol concentration (BAC) level from 80mg/100ml (Reference 1) to 50mg and supports the introduction of random breath testing. These are life-saving measures.
Doctors have long been active campaigners on road safety concerns, whether seat belts or drink-driving, because they see and treat the tragic consequences of avoidable accidents. After a dramatic fall since the 1970s, the number of drink-drive fatalities remains high and from 2000 onwards has started to increase.
Although the only safe option for drivers must be "Don't drink then drive", having a 50mg limit is a simpler message for drinkers to understand. The current level is complex. It is difficult for people to work out what they can drink. This is dependent on body size, gender, age and whether food is consumed. One pub measure of alcohol (a 175ml glass of standard-strength wine or half a pint of strong beer) is all that would be allowed; compliance would increase as it would be easier to understand.
There is really no excuse for keeping the level at 80mg. Nearly every European country has a 50mg or lower limit and the UK needs to follow this lead. (Reference 2) Every death represents a family tragedy and every serious injury can be devastating for the person involved and their relatives.
Police officers are committed to breathalysing all drivers involved in accidents they attend. However, not all police forces have breathalysing equipment that displays the actual alcohol content in breath and instead use equipment which simply identifies whether alcohol in breath is present or absent. A Department of Transport study has been collecting and analysing alcohol levels taken from accident involved drivers, over a six month period, from police forces that have digital display breathalysers which provide accurate displays of alcohol in breath. This research is hoped to provide current estimates of alcohol usage below and above the drink drive limit. (Reference 3) The BMA will be interested to review the outcomes of this study.
The BMA supports a reduction in the drink drive limit because:
- There is clear evidence that this will reduce the number of deaths and serious injury caused by drink driving.
- Drivers’ reaction times and motoring skills deteriorate after even a small amount of alcohol - and get worse with increased alcohol consumption.
- The risk of involvement in a collision rises significantly once the blood alcohol level rises above 50mg per 100ml of blood.
- Evidence from other countries suggests that this lower limit saves lives.
Research has found that there is a marked deterioration in driving performance between a BAC of 50mg/100ml and 80mg/100ml. The relative crash risk of drivers with a BAC of 50mg/100ml is double that for a person with a zero BAC, and the risk rises to 10 times for a BAC of 80mg/100ml. (Reference 4)
Professor Richard Allsop, now Emeritus Professor at the Centre for Transport Studies at University College London in a 2005 Parliamentary Advisory Council for Transport Safety (PACTS) research briefing concluded that lowering the BAC level could be expected to lead to about 65 fewer deaths and 250 fewer serious injuries per year. This estimate is based on the 2003 road casualty figures. (Reference 5)
The Government's own estimate in 1998 was that reducing the limit to 50mg could save around 50 lives and 250 serious injuries a year. (Reference 6)
Statistics for 2007:
- It was estimated that 6 per cent of all road casualties occurred when someone was driving whilst over the legal alcohol limit.
- The number of people estimated to have been killed in drink drive accidents was 460 (16 per cent of all road fatalities).
- The provisional number of KSI (killed or seriously injured) casualties was 2,220.
- Provisional figures for the number of slight casualties in 2007 show a rise of 3.5 per cent since 2006, from 11,840 to 12,260.
- Provisional figures in 2007 show there were 9,620 accidents involving at least one driver/rider over the legal alcohol limit, of which 410 were fatal accidents. This represents a 2 per cent increase on all drink drive accidents since 2006, but a 16 per cent decrease on fatal accidents. Serious accidents fell to a low of 1,400, whilst slight accidents rose to 7,810.
- There were 14,480 casualties resulting from drink drive accidents, a 1 per cent increase since 2006.
- Slight casualties rose 3.5 per cent from 2006, from 11,840 to 12,260. (Reference 7 for all the above).
- The Association of Chief Police Officers (ACPO) reported that the total number of breath tests conducted during December 2007 was 155,216 (2006: 145,867). The total number of positive, refused or failed breath tests was 7,774 (2006: 9,658).(Reference 8).
Blood alcohol concentration level reduction
A new impetus is required to reduce the toll of injury and death. The law should be tightened to achieve the Government’s target for a 40 per cent reduction in the number of people killed or seriously injured (KSI) in road accidents by 2010. (Reference 9).
Recent research has shown that the KSI has fallen considerably from the baseline value and that by 2005 the reduction shown was greater than that required for the uniform progress towards the 2010 target. Researchers went on to conclude that following the KSI reductions in previous years, and taking account of possible scenarios for 2006 to 2010, the target is likely to be achieved or surpassed without the introduction of new measures. (Reference 10) These figures appear promising but are due largely to reductions in serious injuries rather than reductions in the number of fatalities. The Transport Research Laboratory (TRL) forecasts that if the fatality trend was to persist and no new measures were introduced then the number of fatalities would fall by just 11 per cent by 2010. (Reference 11)
A House of Lords Select Committee report in the late 1990s on blood alcohol levels for drivers recommended a reduction in the BAC level to 50mg. (Reference 12) The Government in 1998 (Reference 13) indicated that it was ‘minded’ to lower the drink-drive limit to 50mg. At the time, the Government had been looking to the European Commission to take action. Eleven countries of the European Union at that time already had a BAC level for driving of 50mg/100ml or less and as a result the European Commission adopted a recommendation in January 2001 which proposed harmonisation of the BAC level at 50mg or below. This recommendation however was not binding on member states and the Government announced in 2002 that it had no plans to make a change to the drink drive limit. (Reference 14).
There is widespread support among the public for lower limits. In response to the consultation paper Combating Drink Driving: Next Steps, of those who responded 79 per cent were in favour of a lower limit, 14 per cent were against and the remainder had no clear view. (Reference 15)
In the Second Review of Road Safety Strategy, published in February 2007, the Government stated that it would keep under review the case for a reduction in the BAC but that its main priority was to improve the enforcement of the current limit. (Reference 16)
Why not go for a zero level?
The BMA is not suggesting a zero limit because there will be cases where an individual would register slightly above zero even when they had not been drinking; diabetes and the use of mouthwash can both cause an above-zero level. The BMA doubts whether an absolute zero would be enforceable and acceptable to the public but argues that a 50mg level, which would bring the UK in line with most other European countries, would be effective and beneficial.
Experience in other countries
The 23 European Union countries with a 50mg or less BAC are:
Austria (50mg), Belgium (50mg), Bulgaria (50mg), Cyprus (to change from 90mg to 50mg), Czech Republic (0mg), Denmark (50mg), Estonia (20mg), Finland (50mg), France (50mg), Germany (50mg), Greece (50mg), Hungary (0mg), Italy (50mg), Latvia (50mg), Lithuania (40mg), Netherlands (50mg), Poland (20mg), Portugal (50mg), Romania (0mg), Slovakia (0mg), Slovenia (50mg), Spain (50mg), and Sweden (20mg).
Only UK, Ireland, Luxembourg, and Malta have an 80mg limit. (Reference 17)
Studies in Sweden, Australia and the USA have consistently found lowering legal blood alcohol limits to produce reductions in the incidence of drink-driving and related crashes. (Reference 18)
Newly qualified drivers
Newly qualified drivers are felt to be particularly at risk of alcohol-related road crashes as a result of their limited driving experience. The highest rates of drink-drive accidents per 100,000 licence holders occur in the 17 to 19 age group, followed by those in the 20 to 24 age group. (Reference 19 )
Evaluation of the introduction of lower BAC limits as part of new driver licensing systems have shown them to be effective in reducing collisions among young drivers and novice drivers.(Reference 20)
Repeat offenders
Special action is needed to detect drivers with an alcohol dependency problem. Those who are alcohol dependent represent a significant danger to themselves and others when driving. Recent research investigating drink-driving suggests that there is a two -fold increased risk associated with an alcohol-related motor vehicle crash and future alcohol-related hospital admissions. (Reference 21) Some commentators have suggested that 90 per cent of repeat offenders have a severe drinking problem. Repeat drink-drive offenders appear to be particularly resistant to the messages contained within public information broadcasts. In order to further reduce the number of accidents involving drink drivers, it is necessary to consider all alternative approaches.
In Sweden, a lower limit and random road blocks have been very effective in targeting this group without apparently antagonising the public over infringements of liberty.
Another alternative is the use of the alcohol ignition lock (AII) which is a device installed in a vehicle requiring the driver to provide a breath sample every time an attempt is made to start the vehicle. If the driver has a breath alcohol concentration above a specified value the ignition is locked and the vehicle cannot be started. This system has been employed effectively in a number of states in the USA, in Australia and in Canada where they can be imposed by courts to drivers who have been convicted of drink-driving violations, In Europe, several pilot projects have been carried out and there are plans for a demonstration project. In the UK it has been decided that before considering their introduction more research into the practicalities and social aspects of ‘AII’ use is needed. (Reference 22).
The Road Traffic Act 1991 allowed certain ‘designated’ Courts to offer drink-drive offenders the opportunity of attending a rehabilitation course as a means of reducing the amount of time that they were suspended from driving. Since January 2000 this scheme has been made permanent and is now expanding to cover the whole of the UK. Research examining the efficacy of these rehabilitation courses has found that after 72 months non course offenders are nearly two and a half times more like to re-offend in comparison to course offenders and this rate is similar at three, four, five and six years after initial conviction. (Reference 23).
Random breath testing
Stricter enforcement is a vital element in deterring people from drinking and driving. Random breath testing or similar police powers have a powerful deterrent effect and may tackle the hard core group of offenders who drink over the limit and drive.
Police officers do not currently have the power to carry out random breath tests. A police officer can request a breath test only if they have reasonable cause to suspect that the person has consumed alcohol, or has committed a moving traffic offence, or has been involved in an accident. Case law has established that it is lawful for a police officer to stop a vehicle at random and form a suspicion of drinking on the basis of the subsequent interview with the driver. (Reference 24).
The Serious Organised Crime and Police Act 2005 allows breath samples taken by the police at the roadside to be used as evidence in court rather than requiring officers to take further samples back at the police station. However, until a suitable roadside testing device has been approved by the Home Office, this power cannot be used.
In the Second Review of the Road Safety Strategy, published February 2007, the Government announced that there will be a consultation in 2007 to 'explore ways that enforcement might be made easier for the police, including the possibility of allowing fully random breath testing. (Reference 25)
With the exception of Denmark and the UK, random breath testing is permitted throughout the EU.(Reference 26 )
Research in Australia has found that highly visible, random testing can have a sustained and significant effect in reducing levels of drink-driving, alcohol-related road traffic crashes and associated injuries and fatalities. (Reference 27 )
One study found random testing to be twice as effective as selective testing, with a reduction in fatal crashes of 35 per cent and 15 per cent respectively. (Reference 28)
The BMA urges the Government to amend the law to permit the police to stop vehicles at random for the purpose of conducting breath tests. The BMA would hope that high profile random breath tests would be carried out at locations where it is reasonable to assume an amount of drinking may have taken place. This would act as a deterrent for drivers not to drink and drive as it would send out a message that the chances of being stopped by the police had increased significantly.
For further information, please contact the parliamentary unit at parliamentaryunit@bma.org.uk.
References:
- 80 milligrams (mg) of alcohol for every 100 millilitres (ml) of blood in the body.
- Blood Alcohol Concentration Limits Worldwide, International Centre for Alcohol Policies, May 2002.
- Road Safety Part 1: Alcohol, Drugs and Fatigue, Department of Transport, Spring 2006.
5. PACTS Research Briefing, 11 January 2005.
6. Combating drink driving - next steps, Department for Transport, February 1998 and Tomorrow’s roads: safer for everyone, Department of Transport, March 2000, paragraph 4.19
7 Road casualties Great Britain 2007: Annual report (September 2008)
8. ACPO press release 17/1/08
9. Tomorrow's Roads - Safer for Everyone, March 2000
10. Monitoring Progress Towards the 2010 Casualty Reduction target - 2005 data, DfT, 2007.
11. Tomorrow's Roads - safer for Everyone, the first three year review, DfT, April 2004.
12. European Communities - Sixteenth Report, March 1998.
13. Combating Drink-Driving – next steps, DETR, February 1998
14. DTLR press release 20/3/02
15. Tomorrow's Roads - Safer for Everyone: The second three year review, DfT, February 2007.
16. Combating Drink Driving - next steps: public esponse, DfT, April 2000.
17. Blood Alcohol Concentration Limits Worldwide, International Centre for Alcohol Policies, May 2002.
18. Plant M, Single E & Stockwell T (1997) Alcohol: minimising the harm. What works? London: Free Association Books.
US Department of Health and Human Services (2000) 10th Special Report to the US Congress on alcohol and health. Washington: US Department of Health and Human Services.
Shults R, Elder R, Sleet D et al (2001) Reviews of evidence regarding interventions to reduce injuries to motor vehicle occupants. American Journal of Preventive Medicine 21: 23-30.
Jonah B, Mann R, Macdonald S et al (2000) The effects of lowering legal blood alcohol limits: a review. In: Proceedings of the 15th International Conference on Alcohol, Drugs and Traffic Safety. Stockholm, Sweden.
Kloeden CN & Mclean AJ (1994) Late night drinking in Adelaide two years after the introduction of the .05 limit. Adelaide: NHMRC Road Accident Research Unit.
Henstridge J, Homel R & Mackay P (1997) The long-term effects of random breath testing in four Australian states: a time series analysis. Canberra: Federal Office of Road Safety.
Norstrėm T (1997) Assessment of the impact of the 0.02% BAC-limit in Sweden. Studies on Crime and Crime Prevention 6: 245-58.
Mann RE, Macdonald S, Stoduto G et al (2001) The effects of introducing or lowering legal per se blood alcohol limits for driving: an international review. Accident Analysis and Prevention 33: 569-83.
19. Department for Transport, Scottish Executive & National Assembly for Wales (2007) Road casualties Great Britain 2006. London: The Stationery Office.
20. Simpson HM & Mayhew DR (1992) Reducing the risks for new drivers: a graduated licensing system for British Columbia. Ontario: Traffic Injury Research Foundation.
Mayhew DR, Simpson HM, Ferguson SA et al (1999) Graduated licensing in Ontario: a survey parents. Journal of Traffic Medicine 27: 71-80.
Boase P & Tasca L (1998) Graduate licensing system evaluation: interim report. Ontario: Safety Policy Branch, Ontario Ministry of Transportation.
Bouchard J, Dussault C & Simard R (2000) The Quebec graduated licensing system for novice drivers. A two-year evaluation of the 1997 reform. In: Proceedings of the 15th International Conference on Alcohol, Drugs, and Traffic Safety, T-2000. Stockholm, Sweden.
21. Blood Alcohol Concentration Limits Worldwide, International Centre for Alcohol Policies, May 2002.
22. Stevenson M., D'Alessandro P., Bourke J., Legge M. & Lee A H (2003). A cohort study of drink-driving motor vehicle crashes and alcohol-related diseases Australian and New Zealand Journal of Public Health 27 (3), 328-332.
23. Road Safety Research - Compendium of Research Projects 2005/2006, DfT, July 2006.
24. Reconvictions of Drink/Drive Course Attenders: a Six Year Follow Up, TRL Report TRL574, 2003.
25. Chief Constable of Gwent v Dash 1986.
26. Parliamentary Advisory Council for Transport Safety (2003) Random breath testing amendment to the Railways and Transport Safety Bill. London: Parliamentary Advisory Council for Transport Safety.
27. US Department of Health and Human Services (2000) 10th Special Report to the US Congress on alcohol and health. Washington: US Department of Health and Human Services.
Shults R, Elder R, Sleet D et al (2001) Reviews of evidence regarding interventions to reduce injuries to motor vehicle occupants. American Journal of Preventive Medicine 21: 23-30.
Henstridge J, Homel R & Mackay P (1997) The long-term effects of random breath testing in four Australian states: a time series analysis. Canberra: Federal Office of Road Safety.
28. Henstridge J, Homel R & Mackay P (1997) The long-term effects of random breath testing in four Australian states: a time series analysis. Canberra: Federal Office of Road Safety.