Does Lowering BAC Limit To 0.05% Actually Save Lives? (Part Deux)

TL;DR version:  It depends.

We at Twenty-One Debunked have long supported (and still support) lowering the legal BAC limit for DUI/DWI to 0.05%, with nuance and graduated penalties, based on what we thought was rock-solid research supporting such a move from the current 0.08% limit in most of the USA.  Indeed, most countries that have a limit (all but USA, England, Wales, Northern Ireland, and the Cayman Islands) currently set the limit at 0.05%, and some even lower.

However, last year we also noted that a pair of more recent British studies cast serious doubt on whether such a move will actually save any lives at all by itself.  Those studies found that Scotland lowering their BAC limit from 0.08% to 0.05% in 2014 did not appear to show any net reduction in traffic crashes or fatalities relative to England and Wales (who kept their BAC limit at 0.08%), and in fact Scotland showed a small but significant net increase.  Whoops!  The lack of any detectable lifesaving effect (and perhaps even a perverse effect) in Scotland was of course chalked up to weak enforcement and insufficient alternatives for transportation, and that may very well be true.  But hey, at least they didn't show any significant negative economic impacts (e.g. on the hospitality industry) as some had predicted.

Contrast this with Utah's experience, being the only US state so far to lower their per se BAC limit from 0.08% to to 0.05%.  When they lowered their limit in 2018, they saw a 19.8% drop in their fatal crash rate and an 18.3% drop in their fatality rate by 2019, which was significantly greater than for neighboring states or the nation as a whole.  More people apparently chose to plan ahead when going out drinking.  And yet like Scotland, they did not see any negative economic impacts either.

So why such a difference between Utah and Scotland?  Well, to ask the question is to answer it:  it's pretty clear which of the two has the bigger and more legendary drinking problem overall.  And combine that with relatively weak enforcement and poor alternatives for transportation, and it really doesn't take a rocket scientist to see why.

And the difference is notably NOT due to Utahns under 21 either, as drivers under that age were already long covered by their strict zero tolerance law, which has no equivalent in the UK where not only is the drinking age 18, but also their BAC limit applies equally to all drivers regardless of age or license duration.  So in Utah, the change effectively only applied to drivers over 21, while in Scotland, it applied to all drivers.  Thus, Scotland should have seen a larger effect than Utah, but they did not.

We clearly need to see the forest for the trees.  While 0.05-0.08% does indeed significantly increase the risk of crashing for most people, the vast majority of alcohol-impaired driving casualties are nonetheless from drivers with much, much higher BACs.

Recall, as Darren Grant noted in his famous study debunking the effectiveness of zero tolerance BAC laws for people under 21, it should really come as no surprise to an economist, who is used to thinking on the margin.  While driving impairment indeed begins long before reaching 0.08% or even 0.05%, it rises exponentially with each drink.  Thus, higher BACs are exponentially more dangerous than lower ones.  And the decision to have one's next drink based on trying to stay within the legal limit, even if a lower limit had the same deterrent effect at that limit, would have exponentially less effect that the decision not to cross a higher threshold.  (If anything, it's even MORE exponential for younger drivers, not less.)  And apparently once when the limit goes down to below 0.05%, any additional lifesaving effect over and above lowering the limit to 0.08% or 0.05% simply gets lost in the statistical noise.  That is especially true if the penalty is the same for crossing a lower threshold, since there is literally no marginal deterrence effect against each additional drink beyond that threshold.

(Grant also did a sort of sequel to that study in 2016, again drawing similar conclusions.)

We already know that the vast, vast majority of DUI casualties are concentrated among extremely high BAC drivers, usually 0.15%+ (average 0.16%) and often ones who do so repeatedly and frequently.  These drunk drivers are sometimes called "hardcore" drunk drivers, and are the most resistant to changing their behavior.  And most of those are in fact alcoholics to one degree or another.  They would, of course, laugh at the idea of a BAC limit being lowered to 0.05%, or at the very least, wouldn't exactly agonize over it.  This is all common knowledge, and not at all controversial, except of course among MADD and similar zealots.

Thus, if we as a society decide to set the BAC limit at 0.05%, or indeed any number below 0.08%, there should be steeply graduated penalties, with 0.05% (or 0.02% for young or novice drivers) being a mere traffic violation with a modest fine and short-term license suspension, and no criminal record, 0.08-0.10% being a misdemeanor with a steeper fine and longer license suspension or revocation, 0.10-0.15% being misdemeanor with an even steeper fine and even longer license revocation and mandatory jail time, and 0.15%+ being a felony with permanent or semi-permanent license revocation, very steep fines, vehicle forfeiture, and a stiff prison sentence.  Repeat offenses of 0.08% or higher would carry the same penalties as a 0.15%+ BAC, as would driving above 0.08% with a child under 16 in the vehicle.

Denmark, one of the most liberal drinking cultures in the world, has the BAC limit at 0.05% in general, but zero if not driving safely.  Penalties are at least largely graduated as well.  And that is for all drivers.

We also know that swiftness and certainty of punishment, or the perception of such, is a far greater deterrent than severity.  Thus, automatic administrative penalties, separate from any criminal penalties, are found to be more effective that any criminal laws on the books, most notably in the Canadian provinces of British Columbia and Alberta.

Of course, we would be remiss if we did not discuss the stunning success of special DUI/DWI courts.  These are diversion programs that allow DUI offenders to plead guilty and complete coerced treatment and enforced abstinence from alcohol instead of jail or other penalties.  And they work quite well, with far lower recidivism rates than for those who do not enter such programs.  There are two types of DUI offenders these days:  1) relative normies who simply make dumb decisions and can be "scared straight", and 2) hardcore drunk drivers.  And DUI courts actually get to the root of the problem for the latter.

But first, we need to get these ticking time bombs off of the roads before they kill or maim innocent people.  Australian-style random breath testing (RBT) is one blunt way to do it, but that would not likely pass constitutional muster in the USA. And even then, the long-run effects of Australia's RBT were not very different than those of American-style sobriety checkpoints when studied in the 1980s.  Tougher and sustained enforcement in general really seems to be the key.  And that can of course be done more effectively and cost-effectively with roving and saturation patrols, that look for signs of actually impaired drivers on the roads.  Especially in the many states that do not allow sobriety checkpoints to take place, they HAVE to rely on DUI patrols instead.

(Twenty-One Debunked recently came up with an ingenious idea to turn roving and saturation police patrols against DUI into a COPS-like reality TV show called "Operation Rovin' Eyes", complete with ride-alongs for community members as well.)

Seasoned drunk drivers know how to avoid the checkpoints with ease.  But with roving and saturation patrols, they will soon learn (either the easy way, or the hard way) that you can run, but you can't hide.  "Roving eyes...are watching YOU!" would be a good slogan to publicize the program.  The "fish in a barrel" method, that is, parking a police car outside bars, clubs, or parties and catching would-be drunk drivers before they get on the road, would also be a great complement to such patrols as well.

And while we're at it, let's get all of the garden-variety reckless, negligent, and distracted drivers off the road as well.  The same patrols will of course get them too.

It's time to stop tilting at proverbial windmills, and finish the job for good.  So what are we waiting for?

Boris Johnson Talks Some Sense For Once

Here's a good one from across the pond: 

Former Prime Minister of the UK, Boris Johnson, recently wrote an good article in the Daily Mail in which he actually talks sense for once.  Or at least, for the very first time since before that fateful day on March 22, 2020.  In his article, he strongly and very rightly criticizes the government's proposal to implement a New Zealand style generational smoking ban (that is, a lifetime smoking ban on anyone born after some arbitrary point in time).  He goes right to the heart of just how ridiculous the whole thing is.  And of course, we at Twenty-One Debunked also strongly oppose such an idea, not least because it is essentially the most extreme version of the very sort of fundamentally ageist policies that we despise.  

It basically raises the age limit (currently 18 in the UK) by a year every year, and of course we oppose 100% any attempt to set the age limit higher than 18.  While Twenty-One Debunked does not recommend that anyone of any age take up smoking or otherwise using tobacco, as it is a very foolish and dangerous habit with practically no objective benefits, we still believe that legal adults should have the right to do what they will with their own bodies and minds.

Of course, the proposed ban's defenders would likely claim that Johnson is being hyperbolic in his criticism.  Truly, no one is calling for the newly disenfranchised smokers themselves to be arrested or otherwise punished for smoking, right?  It's only the sellers of tobacco to people born after that arbitrary date who will actually be on the hook, right?  Well, as history has infamously shown with less extreme age limits for other substances and/or in other places, there is absolutely no guarantee of that, especially when the measure isn't nearly as quick or effective as initially hoped for, and the zealots inevitably begin to get impatient.  And even if penalties are limited to sellers, it's still utterly ridiculous at best, and an unjust infringement of civil rights at worst.

Perhaps old Alexander Boris de Pfeffel Johnson is at least somewhat redeemable after all?

Stop The STOP POT Act

While there are several bills in Congress to legalize cannabis at the federal level, there is also a Republican bill that seeks to do the opposite:  the STOP POT Act.  Modeled explicitly after the ageist and illiberal abomination that is the National Minimum Drinking Age Act that flies in the face of the Constitution but was upheld by SCOTUS anyway, this at least equally horrible bill would withhold 10% of highway funding from any state in which recreational cannabis is legal.  Hopefully it will be defeated. 

Hey ageists, how about telling us again how the federal 21 drinking age law that you supported was not a slippery slope?  Because now they are using the exact same specious and tortured logic to target a different, less dangerous substance that already has an age limit of 21 in every state that legalized it so far.

A Better Way To Tax Alcohol

We at Twenty-One Debunked have long supported hiking alcohol taxes as an alternative to illiberal (and highly inequitable) blunt-instrument policies like the ageist abomination that is the 21 drinking age.  And there is far more evidence in favor of tax and price hikes reducing alcohol-related problems than there is for the 21 drinking age.  But what is the best way to tax alcohol?

The answer is a single tax based on alcohol by volume (ABV), regardless of whether the beverage is beer, wine, cider, distilled spirits, alcopops, or whatever, similar to what the UK recently implemented.  Instead of having multiple, widely varying tax rates based on beverage type, it makes far more sense to simply tax all alcoholic beverages equally based on their actual alcohol content, period.  It can be either a flat rate or a graduated rate with multiple rate brackets (higher alcohol content brackets have higher tax rates), but either way, it is still a major improvement over the status quo in the USA and most other countries (or the status quo ante in the UK).

The UK's new alcohol duty system is more nuanced than that, of course, and one very important nuance is the Small Producer Relief (a reduced rate for the smallest brewers and such who produce beverages of 8.5% ABV or less) which we definitely support.  Purists may not like that, of course, but tough noodles for them.  Small businesses should not get unnecessarily kicked in the teeth just to appease the purists.

So what should the tax rate be in the USA?  Twenty-One Debunked has long supported raising and equalizing the federal tax on all alcoholic beverages to the 1991 inflation-adjusted value for distilled spirits.  In 2023 dollars, that would be $30.79 per proof-gallon (proportional to alcohol content).  One could have graduated rates, of course, but if we choose a flat rate that is the one that makes the most sense.  If graduated rates are chosen, the lowest bracket should be for beverages below 3.5% at less than half the above rate, while the highest bracket (wherever it is set) could in principle be significantly higher than the above rate (note that the 1951 distilled spirits tax would be a whopping $126.92 per proof-gallon in today's dollars).  So that's actually pretty tame in comparison, as it would translate to an extra dollar or two on a six-pack of beer or bottle of wine, or a few more dollars on a bottle of spirits.

Such substantial tax hikes can be phased in gradually over several steps to minimize any downsides that may come with large, sudden tax and price hikes, of course, but the weight of the evidence suggests that any such downsides would be fairly small overall in any case (and more than outweighed by the upsides).  Note that craft breweries are apparently thriving in high-tax Canada, and even Iceland, for example.

And for small producers, the relief could either be a reduced rate up front or a tax credit later.  Additionally, similar to the UK, we could perhaps also have another nuance, "Draught Relief", which is a reduced rate (or tax credit) specifically for on-premise draught (draft) beer and cider.  As long as overall rates on the cheapest beverages end up higher than they are now, such nuances would soften the blow but not actually detract from the benefits of the tax hike.

Twenty-One Debunked is well aware that alcohol tax hikes will likely be unpopular among a sizeable chunk of the population.  But as the saying goes, if the (relatively modest) price difference bothers you so much, perhaps you are drinking too much.

(Mic drop)

UPDATE:  Looks like at least some beverage makers in the UK are reducing their alcohol content somewhat in response to the tax change, especially for beer.  Alcohol giant Diageo predictably puts a negative spin on that, of course, but if that encourages moderation (and it almost certainly will), then it is a good thing on balance.  Keep in mind that, for most of recorded history, beer was on average significantly weaker in alcohol content than it has been in the past century or two, and wine was very frequently watered down as well.  So any marginal reductions in strength due to the tax would still put the product stronger than it was for most of recorded history. 

Lithuania Study Finds Raising Drinking Age Did Not Save Lives After All

Lest anyone speciously claim that Lithuania's raising of the their drinking age from 18 to 20 effective January 1, 2018 somehow saved lives, keep in mind that in 2017 they also greatly raised their alcohol taxes, banned alcohol advertising, and greatly cut trading hours for alcohol sales in 2018.  So once again, we see a great deal of confounding here.  

In fact, one recent study found that once such confounders were adjusted for, any supposed lifesaving effect of the drinking age hike itself on 18-19 year olds disappeared, implying that it was a spurious effect.  The study looked at all-cause deaths, which is probably the most bias-free measurement of the "final bill".  And the drop in deaths was actually larger in 20-21 year olds (who were already too old to have been affected at that time*) than for 18-19 year olds or 15-17 year olds. Relative to the former group, the effect was null, and interestingly no "trickle-down" effect was observed for 15-17 year olds either.  And controlling for alcohol taxes and GDP also rendered the net effect null as well.

Thus, raising the drinking age any higher than 18 is very unlikely to save lives on balance.  But raising alcohol taxes, etc. is very likely to do so, for all ages.

QED

*NOTE:  If many years of post-hike data were observed, it would probably have been better to use a slightly older age group (e.g. 22-23, 23-24, or 24-25 year olds) instead as the control group, since previous studies have found that mortality is often shifted to the age group just above the new drinking age.  However, since just one year of post-hike data was included, the choice of control group remains largely appropriate for such short-term effects, and in any case the relative results were in the "wrong" direction even if mortality were displaced as such.

About That Finland Study

This year, a new study came out in The Lancet that looked at the long-term differences in alcohol-related morbidity and mortality between birth cohorts in Finland that either were or were exposed to the lowering of their legal drinking age from 21 to 18 on January 1, 1969.  That is, based on how old they were when the drinking age was changed.  The study and its interpretation had a clear pro-21 bias. 

While the results did show that, exposed cohorts did have higher morbidity and mortality later in life relative to the unexposed cohorts, the results were ultimately inconclusive since several other changes happened at the same time. For example, the lowering of the drinking age occurred in tandem with other alcohol liberalization policies (in a previously very stringent policy regime with fairly low alcohol consumption) that greatly increased alcohol availability in general and thus consumption in a short period of time.  Urbanization also increased rapidly as well.  Culture changes (especially of the drinking culture) also inevitably occurred as well against a backdrop of increasing general alcohol consumption, and those who came of age during or right after the change would logically have been more affected than those who already came of age just before it, regardless of the legal age limit.  So teasing out the specific effects of the legal drinking age change is really practically impossible in this case.

A cursory reading of the Wikipedia article about Finnish drinking culture will tell you all you need to know about why the age limit is largely irrelevant.

Previous studies on the very long-term effects of the 21 drinking age in the USA and elsewhere have been very scarce and ultimately inconclusive at best as well.  (At least one Swedish study seems to suggest a null effect though.)  And this new Finland study, quite frankly, adds very little.  Causation can thus neither be confirmed nor ruled out, in other words.

Regardless, in any case, even if it were partly causal, using a study like this to justify the ageist abomination that is the 21 drinking age is mission creep at best, and grasping at straws at worst, given that the original justifications for it are either debunked, obsolete, or both.  The idea that some vague conception of "public health", especially theoretically in the distant future, somehow trumps civil rights (and selectively for only one demographic group, no less) is the very worst of utilitarianism and health fascism, and has no place in a free society.

And as long as we are on the subject of Finland, that same country has also since shown us what can be done to rapidly decrease alcohol-related mortality and morbidity at very little cost to society at large and without trampling civil rights:  raising the tax/price of alcohol.  Even the pro-21 crowd, including the authors of the aforementioned study, seem to be willing to concede that.  But apparently that doesn't satisfy the ageists' desire for power and control.  Their libido dominandi seems to know no bounds in that regard.

QED

UPDATE:  And while we are at it, lest anyone speciously claim that Lithuania's raising of the their drinking age from 18 to 20 effective January 1, 2018 somehow saved lives, keep in mind that in 2017 they also greatly raised their alcohol taxes, banned alcohol advertising, and greatly cut trading hours for alcohol sales in 2018.  So once again, we see confounding.  In fact, one study found that once such confounders were adjusted for, any supposed lifesaving effect of the drinking age hike on 18-19 year olds disappeared, implying that it was a spurious effect.

What Reactionaries Get Wrong About Drugs, Decriminalization, And Homelessness

Twenty-One Debunked does not take an official position on hard drugs (i.e. illicit drugs other than cannabis and some psychedelics) or the question of their legalization, but we generally lean more towards the decriminalization and harm reduction side of the spectrum as opposed to the War on (people who use a few particular) Drugs.  There is a lot of nuance that tends to get glossed over in debates that are, more often than not, typically dominated by hysterics.

Reactionaries have lately been giving some red-hot takes about the supposed perils of decriminalization and harm reduction, and often pointing fingers at Oregon for their decriminalization policy causing or exacerbating homelessness, crime, and overdose deaths.  However, such hot takes are typically completely devoid of nuance, and thus conflate correlation with causation.  Such nuances include the role of super-deadly fentanyl and its variation over time and geography, the role of the pandemic and lockdowns and their aftermath, the still-growing housing crisis, the inherent pitfalls of forced treatment, and so on.  Better articles about such nuances can be found here and here, for starters.

Those who have the GALL to oppose basic and increasingly necessary lifesaving harm reduction measures like making naloxone (Narcan) and fentanyl test strips readily available are, to put it mildly, murderously stupid.  Fentanyl often gets mixed into other drugs and can make the drug supply much deadlier than it would otherwise be.  While treatment and recovery are no doubt important goals, we also still need to meet people where they are as well.

Of course, the reactionaries do get one thing partially right, as a stopped clock always does twice a day.  There has been a general breakdown of law and order in most major North American cities in recent years due to a combination of general policy changes, anti-police sentiment, catch and release, political ideology, political correctness, and perhaps even deliberate chaos manufacture by various agents provocateur.  Of course, they should shut down and clear out the sprawling homeless encampments on the city streets and sidewalks and the open-air drug scenes that all too often go along with them.  End catch and release.  Re-criminalize theft.  Crack down on violence of all kinds.  Bring back "focused deterrence" policing, and take the classic "broken windows" theory literally.  All of these things are really just common sense, and none of them require ending harm reduction or reversing Oregon's decriminalization of simple possession of small amounts of illicit drugs.

In other words, simply enforce existing laws, and repeal bad or counterproductive ones.  But please, do it ethically, and don't let it be a springboard for an illiberal reactionary agenda.  If you feel the urge to show "tough love", look to Portugal or Alberta, not the current or historical drug warrior nations.

That said, we should always keep in mind that hard drugs called "hard" for a reason, as they are a different beast from alcohol, tobacco, and cannabis.  They may not be quite a million miles away from the latter ones, but they clearly don't belong in the same category either.  While illiberal drug policy clearly makes them much more dangerous than they have to be, they are also pretty inherently dangerous, deadly, and highly addictive in their own right as well regardless.  This is especially true for opioids in particular, as there is really no such thing as a truly safe opioid.  And we have also long known that "speed kills" and "meth is death".  And yet, unfortunately these things are still not going anywhere either.  Policymakers need to handle these things with great care as they should with any wicked problem.  And consumers would be wise to avoid these substances like the plague, especially in the age of fentanyl. 

As for the perennial wicked problem of homelessness, the housing crisis still needs to be solved before there is any hope of ending it for good.  Artificial scarcity of housing needs to end, yesterday.  And a recent study found that some form of UBI can also play a net positive role in the solution as well.  Contrary to popular opinion, spending on "temptation goods" did not actually increase for such recipients.  But good luck convincing the reactionaries of that!

Yet Another Myth Bites The Dust

Last month, another study came out that debunks yet another cannabis prohibitionist myth.  The study found that cannabis use during off-hours does NOT result in an increased risk of workplace accidents.  Therefore, there is no good reason to test workers for cannabis any more than there is a reason to test for alcohol, and no good reason to punish employees for their off-hours cannabis use any more so than for off-hours alcohol use.  Which is to say, there is no good reason, period.  Anything else is serfdom. 

Twenty-One Debunked has always opposed the use of drug testing for cannabis except to determine actual impairment at the time, and even then only when truly necessary.  Urine and hair testing only detect past use (days or even weeks ago), not actual impairment at the time, and thus serve no useful purpose whatsoever.  The only chemical test for cannabis (and most other substances) that could possibly serve as a "fitness for duty" test would be saliva (oral fluid) testing, which despite its flaws we grudgingly support for "safety sensitive" jobs, much like breathalyzers for alcohol.  And even better still would be non-chemical tests like the DRUID app and AlertMeter that detect any kind of impairment regardless of the cause.

The study was done in Canada where cannabis has been legal since 2018 for everyone over 18 at the federal level (18 in Alberta, 18 in Quebec until 2020 when it was raised to 21, and 19 in all other provinces and territories).  So this study also puts the lie to the tired, old canard that legalization itself will somehow make workplace accidents worse or more likely.

(Mic drop)

Remove Cannabis From The Federal Controlled Substances Act

With all the recent talk about removing cannabis from the most stringent Schedule I (the same category as heroin) of the federal Controlled Substances Act (CSA), we at Twenty-One Debunked believe that the best thing to do is to remove it from the Controlled Substances Act entirely (that is, "deschedule" it).  Merely reducing it to a lower schedule ("rescheduling") or creating a new schedule would not have nearly the same benefits as removing it from the CSA entirely and treating it no more stringently than alcohol and tobacco are currently treated.

As Ricardo Baca of Salon so elegantly and eloquently writes:

But rescheduling cannabis under the CSA, rather than descheduling it completely, doesn't address the underlying issue: The cannabis plant shouldn't be a controlled substance under federal law. Period. Alcohol isn't a controlled substance. Tobacco isn't a controlled substance. Not even caffeine is a controlled substance. Cannabis shouldn't be a controlled substance either. 

Indeed.  And to that we would add, there is also no good or rational reason to set a federal age limit any higher than 18 either.

(Mic drop)

Cannabis Legalization Does NOT Increase Tobacco Use

A recent study pours cold water on another prohibitionist fear, namely that legalizing cannabis for recreational use will lead to more tobacco use via a "reverse gateway" effect.  Well, the study found the opposite:  a slight decrease in tobacco use as well as e-cigarette use.  While the decrease did not quite reach statistical significance, it was lagged and perhaps builds over time.  And at the very least, it certainly puts the lie to the tired old "reverse gateway" theory.

Thus, another myth bites the dust.