Drink and drug driving law - Transport Committee Contents


Written evidence from the British Medical Association (BMA) (DDD 32)

  The British Medical Association (BMA) welcomes the opportunity to submit evidence to the Committee's inquiry into drink and drug driving law. As doctors, we witness first hand the catastrophic impact of road traffic crashes. While considerable progress has been made in reducing the number of deaths and serious injuries on Britain's roads, the BMA believes that further measures are necessary to reduce the levels of drink and drug driving.

  The BMA's submission to the North Review of Drink and Drug Driving Law has been used to inform our responses to this inquiry and we welcome the opportunity to expand further on our attached submission.

EXECUTIVE SUMMARY

    — The BMA believes that lowering the prescribed alcohol limit for driving should be given a high priority. There is considerable evidence that driving impairment and crash risk increase exponentially with increasing blood alcohol content (BAC) levels, and that lowering the prescribed limit changes driver behaviour and results in fewer serious and fatal crashes. A reduction in the BAC limit to 50mg/100ml would bring the UK 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. The use of a fixed penalty (namely 12 months mandatory disqualification) at a BAC limit of 50/mg/100ml is appropriate.

    — There are very limited scientific data on the levels of drug driving. Front line experience of BMA members attending patients indicates that it is an increasing problem difficult to quantify because of the lack of simple reliable quantitative field testing equipment. Enforcing the current legislation on drug driving is complicated by the lack of distinction between drink and drug driving in the Road Traffic Act 1988, and the difficulty in detecting impairment resulting from drug use. In addressing the problem of drug driving, as recommended in the North Review, in the short-term, there should be a focus on developing preliminary drug screening tests for use in police stations, capable of detecting controlled drugs which are known to be commonly used by drivers. In the longer term, a new offence should be introduced making it unlawful to drive under the influence of specific drugs which are deemed to impair driving ability.

    — In relation to prescribed and over-the-counter medications, where these are included in any new offence, there are a number of important considerations. Individuals can respond differently to certain prescribed drugs and there would need to be a distinction between prescribed medications which may impair driving ability on their own and where impairment results from interactions with other drugs. The introduction of any new or amended legislation would also need to be accompanied by clear information for prescribers, pharmacists and patients on which drugs are proscribed for driving, and with a programme to raise awareness among the general public.

    — Lowering the BAC limit and the introduction of new measures to improve the process of detecting and deterring drug driving would reduce the number of drink and drug driving-related road traffic crashes, and associated mortality and morbidity. 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.

    — The BMA 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.

    — 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.

ABOUT THE BMA

  1.  The British Medical Association (BMA) is an independent trade union and voluntary professional association which represents doctors and medical students from all branches of medicine throughout the UK. With a membership of over 140,000 worldwide, we promote the medical and allied sciences, seek to maintain the honour and interests of the medical profession and promote the achievement of high quality healthcare.

  2.  The BMA welcomes the opportunity to contribute to this inquiry. As doctors, we witness first hand the catastrophic impact of road traffic crashes. While considerable progress has been made in reducing the number of deaths and serious injuries on Britain's roads, the BMA believes that further measures are necessary to reduce the levels of drink and drug driving.

  3.  The BMA's submission to the North Review of Drink and Drug Driving Law has been used to inform our responses to this inquiry, which are outlined below.

Should the permitted blood alcohol Limit be reduced as proposed?

  4.  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 1990. This was reaffirmed at the 2010 BMA Annual Representative Meeting (ARM) where members unanimously supported Sir Peter North's recommendation to lower the BAC limit to 50mg/100ml.

  5.  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.1,2 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.3,4,5

  6.  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% and injuries by 1% 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

  7.  A reduction in the BAC limit to 50mg/100ml would bring the UK 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.

  8.  There is widespread support from the public and key stakeholders to reduce the BAC limit to 50mg/100ml. In March 2008, the BMA Board of Science hosted a "stop drink-driving" stakeholder event with representatives from the Medical Royal Colleges, the police and the hospitality trade, and organisations such as Alcohol Concern and the Institute of Alcohol Studies. Following the event, letters of support from the various stakeholder organisations were forwarded to the Department for Transport (DfT) calling for the drink-drive limit to be lowered to 50mg/100ml.

  9.  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, and supports Sir Peter North's recommendation to review the impact of a new prescribed limit of 50mg/100ml on young and novice drivers over the five years following implementation and consider further reductions at that stage.

If so, is the mandatory one year driving ban appropriate for less severe offenders, at the new (lower) level?

  10.  Yes. The use of a fixed penalty (namely 12 months mandatory disqualification) at a BAC limit of 50/mg/100ml is 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.

How severe is the problem of drug driving and what should be done to address it?

  11.  There are very limited scientific data on the levels of drug driving. Front line experience of BMA members attending patients indicates that it is an increasing problem difficult to quantify because of the lack of simple reliable quantitative field testing equipment. Evidence indicates that drug use and the prevalence of drug driving have increased in recent years in the UK.9 In a survey of club-goers in Scotland, 69% had taken cannabis and 85% had at some time driven after using illegal drugs.10 The survey also identified common attitudes among drug users: many were not aware of drug driving legislation, ignored anti-drug campaigns, and did not believe that cannabis impairs driving ability.

  12.  The wider implications of this behaviour are beginning to emerge. Research from 2000 indicates an increasing incidence of road traffic crashes where individuals have tested positive for drugs, and where drugs may have been a contributory factor to the cause of the crash.11 A study by the Transport Research Laboratory (TRL) of fatal collisions between 1985 and 1987, and between 1996 and 1999 found that the incidence of medicinal drugs and alcohol in road collisions casualties remained stable over this period. Drug taking overall increased by a factor of three, and the proportion of those testing positive for multiple drugs increased dramatically, from 5% in 1985-87 to 26% in 1996-99. Further research into the levels of drug driving, the dual use of alcohol and drugs while driving, and the associated impact on road safety is essential.

  13.  Enforcing the current legislation on drug driving is complicated by the lack of distinction between drink and drug driving in the Road Traffic Act 1988, and the difficulty in detecting impairment resulting from drug use. Detection relies on demonstrating impairment through physical examination in a controlled environment, which can lead to delays in taking blood samples. The procedure for testing at the police station is still too variable, and is interpreted differently by individual forensic physicians. In particular, the identification of a condition that may be due to a drug is very broad-based and can lead to false positives and false negative results. Thus, in cases where both drugs and alcohol are suspected, it is therefore common practice not to pursue enquiries about driver impairment as a result of drug use. It is much simpler to prove the same offence with BAC evidence linked to alcohol use.

  14.  The BMA does not support Sir Peter North's recommendation to amend the Road Traffic Act 1988 to allow nurses to also take on the role currently fulfilled by the forensic physician in determining whether a drug driving suspect has a condition which might be due to a drug. Nurses do not have the relevant training, experience and expertise to undertake this role. Determining whether a suspect has a condition which might be due to a drug requires clinical judgement of an order only likely to be available to someone trained from first principles in pathophysiology and pharmacology, and who has an understanding of neurology and psychiatry.

  15.  In addressing the problem of drug driving, as recommended in the North Review, in the short-term, there should be a focus on developing preliminary drug screening tests for use in police stations, capable of detecting controlled drugs which are known to be commonly used by drivers. This would remove the need for a forensic physician to investigate whether the suspect has a condition which might be due to drug use. In the longer term, a new offence should be introduced making it unlawful to drive under the influence of specific drugs which are deemed to impair driving ability. This requires research, and agreement upon, levels at which controlled drugs which are prevalent among drivers could be deemed to be impairing, and the establishment of a list of which drugs, the presence of which was banned in drivers at or above the specified levels.

  16.  In relation to prescribed and over-the-counter medications, where these are included in any new offence, there are a number of important considerations. Individuals can respond differently to certain prescribed drugs and there would need to be a distinction between prescribed medications which may impair driving ability on their own and where impairment results from interactions with other drugs (eg opiate derived analgesics and sedative antihistamines). There are also conditions where drug testing will be inherently complex such as hypoglycaemic reactions that can be caused by prescribed drugs or other circumstances such as nutritional status. Consideration would need to be given to the fact that many currently prescribed medicines could become unusable for drivers, and the impact this may have on prescribing patterns and compliance with treatment regimes. In issuing penalties for driving under the influence of a prescribed drug, consideration would need to be given to ensuring any action is proportionate in relation to the driver's medical condition.

  17.  The introduction of any new or amended legislation would also need to be accompanied by clear information for prescribers, pharmacists and patients on which drugs are proscribed for driving, and with a programme to raise awareness among the general public.

  18.  The existing offence of driving while impaired by drugs in the Road Traffic Act 1988 should be maintained to cover those drugs (including prescribed and over-the-counter drugs) not listed in any new offence, as recommended in the North Review.

What wider costs and benefits are likely to result from changes to drink and drug driving law?

  19. Lowering the BAC limit and the introduction of new measures to improve the process of detecting and deterring drug driving would reduce the number of drink and drug 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.6 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).

What would be the implications of such changes for enforcement?

  20.  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. As the North Review highlights, 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 would not be expected to increase substantially if the BAC limit were lowered. The implementation of Sir Peter North's recommendations to increase the policing priority for drink and drug driving, as well as the development of roadside and evidential screening devices should improve the ability of the police to enforce the law and secure convictions in the longer term.

  21.  The following provides information on BMA policy in relation to a number of other areas considered in the North Review.

Random and selective breath testing

  22.  The BMA 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.

  23.  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.12

  24.  Under current regulations, enforcement is operated through selective breath testing that requires police to have judged that a motorist has consumed 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.13,14,15

  25.  With the exception of the UK, non-selective breath testing is permitted throughout the European Union (EU).16 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.17,18,19 One study found non-selective testing to be twice as effective as selective testing, with a reduction in fatal crashes of 35% and 15% respectively.19

Compulsory testing

  26.  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 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."

REFERENCES1  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 37:233-43.

2  Compton R P, Blomberg R D, 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.

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 R E (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.

9  European Monitoring Centre for Drugs and Drug Addiction (2000) United Kingdom drug situation 2000. London: European Monitoring Centre for Drugs and Drug Addiction and DrugScope.

10  Scottish Executive Central Research Unit (2000) Recreational drugs and driving: a qualitative study. Edinburgh: Scottish Executive Central Research Unit.

11  Tunbridge R J, Keigan M, James F J (2000) The Incidence of drugs and alcohol in road traffic accident fatalities. Berkshire: TRL Limited.

12  British Medical Association (2008) Alcohol misuse: tackling the UK epidemic. London: British Medical Association.

13  RAC (2007). RAC report on motoring 2007. Driving safely? Norwich: RAC.

14  Department of the Environment Northern Ireland (2008) Northern Ireland road safety monitor. Belfast: Department of the Environment Northern Ireland.

15  Scottish Executive Social Research (2008) Transport research series. Drinking and driving 2007: prevalence, decision making and attitudes. Edinburgh: Scottish Executive Social Research.

16  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.

17  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.

18  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.

19  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.

August 2010





 
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