A 0.05 BAC limit in the United States: an important challenge for policy, health and safety.

Abstract

This is an important paper systematically addressing many issues in the debate regarding the lowering of the blood alcohol concentration (BAC) level to 0.05 in the United States 1. Both authors have established careers in the area of alcohol, drugs and traffic safety and have made important research contributions leading to major policy changes. The failure of the United States to follow world best practice by reducing the BAC level to 0.05 as a policy of harm minimization and safety promotion has been difficult for planners and researchers outside the political climate of the States to understand. This paper comprehensively reviews the questions that have been raised in debate and they provide sound and well-established evidence to refute the failure to change. The increased risk of driving with the higher (0.08) BAC has been established through numerous epidemiological studies over many decades and research has moved on, as can be deduced from the dates of the core papers provided. For example, the World Health Organization (WHO) 2, in its 2010 international recommendations to increase global health, indicates that it is an evaluated effective policy that should be introduced. The message is reiterated in the more recent (2012) European action plan to reduce the harmful use of alcohol during 2012–20 3. Another important issue is that international research has moved on, and current core research and policy engagements are associated with the impact of lowering the BAC to 0.02, or effectively zero. There is a case to be made that if highly experienced professional drivers are required to use the lower level for community safety, the general driver population should also take this step. The authors note that the lower level has been introduced in the Scandinavian countries and also recently in Japan, with reductions in fatalities. A key issue they note may be the resistance by the US alcohol industry to such a change. It is the case that the WHO recommendation relates not only to the associated reduction in road crash injuries and fatalities, but also to its role in reducing high levels of alcohol consumption. There are some points that should be clarified for readers unfamiliar with the field. Almost all countries that have successfully introduced the change have already had or have established programmes of police random checking. This is similar to, but not the same as, the current vehicle-stopping programme used in the United States. There is also difference regarding the definition of an alcoholic drink. In Australia, for example, fewer drinks are estimated to place the person above the 0.05 limit than is noted in this paper. The difference relates to the quantifiable amount of alcohol in the definition of a standard drink. Overall, this is an important paper and relevant to Addiction. The pressures and resistance discussed have meant that in this key safety issue the United States is behind most comparable countries. None.