A panel of the America's top public health experts is pushing for a sweeping set of policy changes and laws aimed at accomplishing an audacious goal - an end to deaths caused by drunk driving. But the recommendation touted as having the largest potential impact on deaths might also be the hardest to sell: lowering the amount of alcohol you need to drink before you legally shouldn't get behind the wheel.
On Wednesday, the National Academies of Sciences, Engineering, and Medicine, a mostly government-funded, but independently run organisation that offers advice on national health policy, released a new consensus study report, billed as a "comprehensive approach" to the persistent problem of drunk driving.
The report is the work of a committee of 13 experts sourced from places like Yale University, UCLA, and Johns Hopkins, and summarises the existing evidence surrounding policies that attempt to reduce drunk driving deaths. It highlighted the overall success the US has had in lowering deaths caused by drunk driving since the 1980s - when laws like those that increased the legal drinking age to 21 were first implemented - but also found that the number has stayed stagnant in recent years. From 2009 to 2015, for instance, the annual reported toll has been around 10,000 deaths.
The only way to substantially lower drunk driving deaths in the near future (long before, say, smart cars are in every driveway), the report concluded, is through drastic steps like banning alcohol sales from gas stations or drive-through stores; an expansion of specialised courts that provide counseling and support to repeat offenders; and the wide-scale development and implementation of interlock technologies that prevent drunk people from starting a vehicle. But chief among the recommended changes is that all states should modify the laws that dictate when someone is too drunk to drive.
Currently, someone can be charged with drinking while intoxicated if they have a blood alcohol concentration (BAC) of .08 or higher (in many states, though, impaired drivers can still be charged with a lesser crime of driving under the influence at lower BAC levels). The report recommends the limit should be .05 instead. As most anyone well knows, lots of factors can influence someone's potential drunkenness, including weight, gender, and how much you've eaten before, but very roughly speaking, it can take anywhere from two to five drinks within a hour to reach a BAC of .08. For 0.5, it might take one to three.
"The plateauing fatality rates indicate that what has been done to decrease deaths from alcohol-impaired driving has been working but is no longer sufficient to reverse this growing public health problem," report author and committee chair Steven Teutsch, a researcher at UCLA's Fielding School of Public Health, said in a statement. "Our report offers a comprehensive blueprint to reinvigorate commitment and calls for systematic implementation of policies, programs, and systems changes to renew progress and save lives."
This isn't the first major push to lower the legal limit. Since 2013, the National Transportation Safety Board (NTSB) has routinely recommended a universal decrease to at least .05 BAC or even lower. And the .05 limit seems to be a wholly uncontroversial idea among experts in the field. "There is strong empirical evidence, both from the US and from other countries, that a lower BAC limit would contribute to a safer driving environment," Diane Silver, an associate professor of public health policy at NYU's College of Global Public Health, tells me over email. In countries that have embraced a .05 limit, like Australia, the results have been dramatic.
"A number of Australian states lowered their allowable BACs from 0.08 to 0.05 in the 1980s and studies consistently found reductions in crashes and fatalities of between 7 per cent and 13 per cent. This is supported by various studies from European countries that conducted similar policy changes from the 1970s onwards," explains Michael Livingston, a senior research fellow at the Center for Alcohol Policy Research in Melbourne, Australia. "There are few downsides to the 0.05 limits that I'm aware of - they're pretty unequivocally a life-saving measure."
Some places like Sweden have even gone with a .02 limit and seen further drops in car accidents and fatalities.
Politically, though, there's been pushback. In response to the NTSB's initial proposal in 2013, the founder of Mothers Against Drunk Driving (MADD), Candace Lightner, said it was an impractical, unrealistic idea. Lightner left the organisation in 1985 and was similarly unenthused about the idea of a .08 limit, which became the US standard in 2004. But the current iteration of MADD hasn't backed the idea either, even as they are supportive of the new report in general.
"MADD applauds this report's recommendations, which affirm the key components of MADD's Campaign to Eliminate Drunk Driving: the importance of law enforcement and sobriety checkpoints, all offender ignition interlock laws in every state, and the promise of advanced alcohol detection technologies like the Driver Alcohol System for Safety (DADSS) program," a spokesperson with the organisation's New York chapter said in an email. "Regarding lowering the legal threshold for impairment, MADD supports the current .08 BAC laws and always says the best choice is to never drink and drive, period. If you're going to drink, plan ahead for a designated driver, public transportation, taxis, or take an Uber."
Silver notes that other opponents have a vested interest of keeping the status quo. "Of course, efforts to lower the BAC limit have run into resistance from the hospitality industry (restaurants, hotels, bars), which contend that it will have a negative effect on their bottom line, and the alcohol industry," she said. Critics have also argued that a lower limit would only prevent an insignificant amount of deaths, especially without the sort of aggressive enforcement of drunk driving laws found in countries with a .05 limit. (A 2017 study found that a 0.5 limit here would save at least an extra 1,750 lives a year.)
As both the authors of the report and those I spoke to make clear, a lower limit in of itself wouldn't really change things dramatically - the culture has to change, too. In Australia, Livingston said, drivers have been cowed into compliance by the country's practice of allowing cops to issue random breathalyzer road tests, which the US and many countries don't do. Police in the US have traditionally only been allowed to pull people over and test them if they suspect drunk driving. Over the past few decades, though, some states have cleared the use of sobriety checkpoints where police can freely screen for drunk drivers. The report highlights the expansion of these programs as a less blunt and constitutionally safe way to encourage similar deterrence, along with approaches like making rideshare programs more accessible and affordable, especially in rural areas.
A .05 BAC limit might not be as unpopular as it would appear at first glance, though. An annual poll conducted by AAA of licensed drivers has consistently found that two-thirds of respondents support a lower limit. And in 2017, Utah became the first state to approve a hard .05 limit, which is expected to come into effect by December 30th, 2018. The new law, still facing opposition from the restaurant and alcohol industry, might be modified to resemble a model seen in Colorado. There, drivers found with a BAC level between .05 to .08 who are found to be driving while drunk are punished less severely than drivers with a .08 or higher BAC.
If Utah's natural experiment pans out, then .05 might indeed someday be the new number we keep in mind next time we head to the bar.