Background In Mexico drinking and driving (DD) contributes to 19.5% of traffic-related deaths. Despite the fact that the control activities of DD have been operating for 20 years in Mexico City, the current breath alcohol concentration (BrAC) limit of 0.40 mg/L exceeds global recommendations for road safety.

Objective To estimate the prevalence of driving under the influence of alcohol in Mexico City.

Methods As part of the Bloomberg Initiative for Global Road Safety (BIGRS), an observational study of drink and driving was carried out between November 2022 and September 2023 in selected random sampling roads in collaboration with the local authorities. 16,985 drivers were observed, total and specific prevalence and 95% confidence intervals (95% CI) were estimated.

Results The prevalence of DD was 2.27% (95% CI 2.05–2.51), and 1.14% (0.99–1.31%) exceeded the legal limit. The prevalence was highest on Fridays, reaching 2.63% (2.18–3.14%), in SUVs with 2.60% (2.02–3.29%), and in women and young adults (18–24 years) 3.73% (2.87–4.74%) and 5.85% (3.75–8.65%) respectively. Only 26 motorcyclists were observed, of whom 15.4% exceeded the BrAC limit.

Conclusions 1 out of every 100 driver exceed the BrAC limit current in Mexico City legislation, posing a critical challenge for the effective implementation and evaluation of the General Mobility and Road Safety Law approved in 2022. The incorporation of global best practices, especially enforcing stricter BrAC limits for young, novice, commercial, and public transport drivers is imperative to contribute a comprehensive road safety strategy and prevent severe and fatal road traffic injuries.