REDUCING THE DRINK DRIVE LIMIT IN SCOTLAND CONSULTATION QUESTIONNAIRE

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1 REDUCING THE DRINK DRIVE LIMIT IN SCOTLAND CONSULTATION QUESTIONNAIRE 1. Do you agree that the drink drive limits should be reduced in Scotland? Yes. Lowering the prescribed alcohol limit for driving should be given a high priority. The BMA has a long history supporting a reduction in the legal alcohol limit for drivers from 80mg/100ml to 50mg/100ml, and first called for a lowering of the permitted blood alcohol content (BAC) level in This was reaffirmed at the 2010 BMA Annual Representative Meeting (ARM) where members unanimously supported lowering the BAC limit to 50mg/100ml. 1A. The Scottish Government is proposing: A reduction in the blood limit from 80mg of alcohol in every 100 ml of blood to 50 mg of alcohol in every 100 ml of blood; An (equivalent) reduction in the breath limit from 35 mcg of alcohol in 100 ml of breath to 22 mcg of alcohol in every 100 ml of breath; and An (equivalent) reduction in the urine limit from 107 mg of alcohol in 100 ml of urine to 67 mg of alcohol in every 100 ml of urine. Do you agree with the SG proposal to reduce the drink driving limits? Yes. (Optional question) 2. Do you have any evidence for what would be the main consequences of the SG proposals? There is considerable evidence that driving impairment and crash risk increase exponentially with increasing BAC levels, and that lowering the prescribed limit changes driver behaviour and results in fewer serious and fatal crashes. Driving performance deteriorates significantly between a BAC of 50mg and 80mg/100ml, and crash risk increases 12. The relative crash risk of drivers with a BAC of 50mg/100ml is double that for a person with a zero BAC; the risk rises to 10 times for a BAC of 80mg/100ml Fell JC, Voas RB (2006) The effectiveness of reducing illegal blood alcohol concentration (BAC) limits for driving: evidence for lowering the limit to.05 BAC. Journal of Safety Research 37: Compton RP, Blomberg RD, Moskowitz H et al (2002) Crash risk of alcohol-impaired driving. Proceedings of the 16th International Conference on Alcohol, Drugs and Traffic Safety, 4 9 August 2002, Montreal. 3 British Medical Association (2008) Alcohol misuse: tackling the UK epidemic. London: British Medical Association. 4 World Health Organisation Regional Office for Europe (2004) Transport, environment and health. Copenhagen: World Health Organisation Regional Office for Europe.

2 Modelling studies predict that lowering the BAC limit to 50mg/100ml would reduce serious and fatal crashes, and could expect to save 65 lives and prevent 250 serious injuries per year in the UK 6. A 2010 review by the National Institute for Health and Clinical Excellence (NICE) of effectiveness of drink driving legislation estimated that lowering the BAC limit to 50mg/100ml would reduce road fatalities by up to 13.8 per cent and injuries by 1.4 per cent within six years of implementation. This would prevent 70 to 144 fatal, 139 to 323 serious and 1,121 to 2,606 minor injuries in the first year of implementation, increasing to 158 to 303 fatal, 274 to 708 serious and 2,213 to 5,715 minor injuries prevented annually by the sixth year of implementation 7. A reduction in the BAC limit to 50mg/100ml would bring Scotland in line with most other European countries, and would be in agreement with the best available evidence on the effects of alcohol on driving impairment. (Optional question) 3. Do you have any evidence for what would be the financial impact of the SG proposals? Lowering the BAC limit would reduce the number of drink driving-related road traffic crashes, and associated mortality and morbidity. As noted previously, it has been estimated that reducing the BAC limit from 80 to 50mg/100ml would save 65 lives and prevent 250 serious injuries per year in the UK. This would in turn reduce the burden of drink-drive related mortality, morbidity and disability on public healthcare services, and productivity and profitability in the workplace (absenteeism and lost working days). The lowering of the BAC limit with a mandatory 12 months disqualification for driving at or above that level is likely to provide a strong deterrent effect, as has been found to occur at the higher BAC limit 8. It is unclear what effect this would have on the number of offenders and resource demands on the police services. International evidence indicates that drivers modify their drink driving behaviour in response to a change in the legal BAC limit, where the percentage of people driving at every BAC level, including in drivers who drink heavily, decreases following a change in legislation. With appropriate public awareness and communications, the number of drink driving convictions 5 Parliamentary Advisory Council for Transport Safety (2008) Behave yourself - road safety policy in the 21st century. London: Parliamentary Advisory Council for Transport Safety. 6 Allsop RE (2005) Some reasons for lowering the legal drink-drive limit in Britain. London: Centre for Transport Studies, University College London. 7 National Institutes of Health and Clinical Excellence (2010). Modelling methods to estimate the potential impact of lowering the blood alcohol concentration limit from 80 mg/100ml to 50 mg/100ml in England and Wales. London: Centre for Public Health Excellence NICE. 8 National Institutes of Health and Clinical Excellence (2010). Review of effectiveness of laws limiting blood alcohol concentration levels to reduce alcohol-related road injuries and deaths. London: Centre for Public Health Excellence NICE.

3 would not be expected to increase substantially if the BAC limit were lowered. 4. Do you have any comments to make on the ancillary matters related to the SG s proposal to reduce the drink drive limits? In relation to a lower limit for certain categories of driver, the BMA believes there should be consideration for further reductions below 50mg/100ml for all newly qualified drivers. The use of a fixed penalty (namely 12 months mandatory disqualification) at a BAC limit of 50mg/100ml is still appropriate. As noted in the North Review, it would be a retrograde step to lessen the deterrent effect of mandatory disqualification. The 2010 NICE review found that driving licence suspension or revocation is an effective deterrent for drink driving, influences driver behaviour and results in fewer alcohol-related road crashes 8. The introduction of a graduated scale of penalties may also lead to an increase in the acceptability of drink driving and create a mixed road safety message. The BMA also supports the recommendation in the North Review to provide a general and unrestricted power to require anyone who is driving a motor vehicle to cooperate with a preliminary breath test. 5. Are there any other measures that should be considered in order to tackle drink driving? Random and selective breath testing The BMA supports a general and unrestricted power to require anyone who is driving a motor vehicle to cooperate with a preliminary breath test. As highlighted in the 2008 BMA Board of Science report Alcohol misuse: tackling the UK epidemic, the BMA believes that the use of highly visible police enforcement and non-selective random roadside breath testing measures (without the need for prior suspicion of intoxification) are key components of effective enforcement of drink-drive legislation 9. Under current regulations, enforcement is operated through selective breath testing that requires police to have judged that a motorist has consumed 9 British Medical Association (2008) Alcohol misuse: tackling the UK epidemic. London: British Medical Association.

4 alcohol before implementing the test. Non-selective random roadside breath testing is an advantageous approach as motorists are unable to influence the likelihood of being tested and there will be a perceived increased risk of detection. Research from Northern Ireland, Scotland and England indicate public support for these policies With the exception of the UK, non-selective breath testing is permitted throughout the European Union (EU) 13. Research in Australia has found that highly visible, non-selective testing can have a sustained and significant effect in reducing levels of drink driving, alcohol-related road traffic crashes and associated injuries and fatalities One study found non-selective testing to be twice as effective as selective testing, with a reduction in fatal crashes of 35 per cent and 15 per cent respectively 16. Compulsory testing The BMA believes that forensic physicians should be legally empowered to take blood samples for testing for alcohol and drug levels without consent from a driver without capacity after a road traffic accident, and that testing should occur later only with the consent of the driver. Other than in the strict circumstances laid down in the legislation, the BMA is opposed to doctors (other than forensic physicians) being involved in non-consensual testing of drivers involved in crashes for evidential purposes. The BMA publication Medical Ethics Today provides the following guidance in relation to drivers who are temporarily incapacitated either because of the crash or because of the effects of drug or alcohol consumption: A blood specimen may be taken for future testing for alcohol or other drugs from a person who has been involved in an accident and is unable to give consent where: a police constable has assessed the person's capacity and found the person to be incapable of giving valid consent due to medical reasons; and the forensic physician taking the specimen is satisfied, at the time the sample is requested, that the person is not able to give valid consent (for whatever reason); and the person does not object to or resist the specimen being taken and has not refused consent to the sample being taken before losing 10 RAC (2007). RAC report on motoring Driving safely? Norwich: RAC. 11 Department of the Environment Northern Ireland (2008) Northern Ireland road safety monitor. Belfast: Department of the Environment Northern Ireland. 12 Scottish Executive Social Research (2008) Transport research series. Drinking and driving 2007: prevalence, decision making and attitudes. Edinburgh: Scottish Executive Social Research. 13 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. 14 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. 15 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: 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.

5 competence; and in the view of the doctor in immediate charge of the patient's care, taking the specimen would not be prejudicial to the proper care and treatment of the patient. The specimen is not tested until the person regains competence and gives valid consent for it to be tested. If doctors follow the advice in this summary they will fulfil both legal and ethical requirements. Please this response by 29 November 2012 to: Or you can post it to: Jim Wilson Room 2W Justice Directorate Scottish Government St Andrew s House Regent Road Edinburgh EH1 3DG

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