I spent the whole of last weekend at a long and tiring pre-hospital
trauma course. The medicine was relatively basic as we were mostly
taught what simple life-saving procedures to do if we were to find an emergency
as a passer-by, and there’s not much complicated stuff one can do without any
medical kit. The main lesson for me was to avoid trauma in the first place, the
presentations were crammed with excruciatingly graphic images and tragic
stories. If victims of traumatic road accidents survive, and they often do with
prompt emergency service attention and transfer to hospital, they are likely to
be left with life-changing disability including brain injuries, paralysis, or amputations.
Alcohol is commonly implicated in serious road accidents. It is a chemical close
to my heart, so I decided to spend some time organising my thoughts on drinking
and driving, and hypocritically lecture against alcohol use.
In my experience, it seems that medical students as a group
drink more alcohol than the average person. I briefly tried to find some data
to back up or refute this stereotype but I didn’t find any numbers. Perhaps
students are unlikely to admit actual alcohol consumption for articles or
studies, or perhaps this information is not interesting enough to be gathered
and published. This assumed culture of drinking at medical school might set the
scene for unhealthy alcohol usage after qualifying; the old joke goes, the
definition of an alcoholic is the patient who drinks more than his doctor. This
is unfortunately seen in the levels of addiction and liver disease seen in doctors when compared with the general population.
Now some fair disclosures before I begin preaching. I am a
medical student and (therefore?) I enjoy a drink from time to time. I have drunk
irresponsibly and excessively on occasions and have suffered some apocalyptic hangovers
that are oddly still insufficient to condition me to stop drinking. Sometimes I
drive after a pint, and worse, it seems likely that I have driven whilst over
the limit in my youth – ignorantly having driven the morning after the night
before. I should also make it clear that my fondness for alcohol is sometimes opposed by a
personal dislike for road traffic accidents. It is a dilemma faced by all
drinkers who also drive.
As of this morning (5th December 2014) the drink-drive limit in Scotland has become
stricter, the maximum permissible alcohol level in the blood is now 50mg/100ml,
down from 80, which remains the limit for the rest of the UK (the highest level in Europe, joint with Malta) . 50mg/100ml is a blood alcohol level of 0.05% and is the same as
most European countries. The intention
is to reduce the number of drink-driving related deaths (over 200/year in the
UK), not to mention the huge numbers of injured but surviving people,
psychological harms and healthcare costs – particularly at this boozy festive
time of year. A blood alcohol level between 0.05 and 0.08% is associated with a
six-fold increase in the likelihood of dying in a car crash compared with 0.00%
(and this doesn’t even take into account the harms to pedestrians unlucky enough to get
struck by drink-drivers).
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Graph from wikipedia
The blood alcohol numbers, while clearly stated and
scientific-sounding, are nonetheless not very helpful in deciding how much one
can drink before legally driving, which is what people actually care about. Frustratingly, there are no clear guidelines
on what is legal because individuals metabolise alcohol at varying rates, and
the blood alcohol level will also depend on your: weight, age, build, gender,
type of drink, time since drinking, amount drank, whether you’ve eaten recently
and current stress levels. Apparently,
and according to popular belief, all of this taken together means that usually
a man can legally drive after one pint of beer (2 units = 20ml or 16g pure alcohol) ,
and women can drink about half that. This should usually be ok under the stricter Scottish rules too.
Since the legal amount is so vague and variable in real
terms (i.e. number of drinks) the advice is always the same: avoid drinking if driving and avoid driving if
drinking. It is too risky to guess what is legal and in any case it is safest to
avoid alcohol completely. Which leads to an obvious and unpopular conclusion,
why have a legal limit at all? Shouldn’t the law be consistent with the advice
that no level of alcohol is acceptable? Driving with a blood alcohol between
0.02 and 0.05% is still associated with a 3x higher risk of dying.
Reaction speeds are undoubtedly slowed by alcohol consumption. It is sometimes argued that for some drivers the reduction in reaction speed from a pint, or two, will still result in “normal/legal” reaction speeds, i.e. possibly as fast or faster than distracted drivers, elderly drivers, over-tired drivers (junior doctor car insurance premiums are higher due to increased accidents following night shifts). This might well be true but misses the point that any impairment in driving ability is bad for all road users, especially avoidable impairment such as alcohol use.
The alcohol and pub lobby often claim that country pubs will
suffer if people cannot drive to them or if people cannot have a drink with a
meal. In my opinion if a pub is far enough away to warrant driving than it’s
probably not worth making the effort to have one pint there anyway. Walking, taxis,
and designated drivers seem like pretty reasonable solutions. It is also argued that
lowering the legal limit criminalises the group of responsible people that
drank alcohol the night before and have not completely cleared it by the time
they drive. This situation is already the case, and I think its important that people are made to consider
how long it takes alcohol to be metabolised (approximately one unit/hour). Further, the effect of alcohol on
safe driving may be exacerbated by tiredness following a late night.
So I stand alongside nearly 80% of the Scottish population in
supporting the reduction in the legal limit and would welcome the change being
followed in England and Wales too. I haven’t done all of the research but at
the moment I see some benefits of it being reduced further, say to 20mg/100ml. As a medical student I am broadly opposed to
unnecessary deaths, and there’s loads of evidence that control of
alcohol use in drivers reduces death.
http://www.nice.org.uk/media/default/About/what-we-do/NICE-guidance/NICE-guidelines/Public-health-guidelines/Additional-publications/Blood-alcohol-content-effectiveness-review.pdf
