Scottish Government chiefs have been advised to raise the legal drinking age to 21 in an effort to tackle binge drinking.
The new limit – to apply in pubs, clubs, supermarkets and off-licences – has been recommended by NHS experts.
It would bring Scotland into line with countries such as the US, but could create a cross-Border divide if the drinking age remained at 18 in England.
First Minister Nicola Sturgeon and Health Secretary Shona Robison have both backed previous proposals to raise the legal drinking age in problem areas.
The SNP tried to ban sales to under-21s in some off-licences in 2010 but the move was rejected by opponents.
The new recommendation comes from experts at NHS Health Scotland, the Scottish Government’s health promotions agency, who produced a report entitled Best Preventative Investments For Scotland – What The Evidence And Experts Say.
Its author, NHS Health Scotland principal public health adviser Neil Craig, said: “In Scotland, hazardous alcohol consumption in young people is a continuing problem.
“For both males and females, the largest increase in hospitalisation rates for alcohol-related conditions since the early 1980s has been in the 15-24 year olds, and this was particularly marked for females.”
Since taking power, the SNP has made tackling alcohol abuse a top priority.
Although the Scottish Government says it has no current plans to press ahead with raising the legal drinking age, it would look to alternative measures if the Scotch Whisky Association succeeds with its court battle to block minimum pricing legislation.
A Scottish Government spokesman said: “We are committed to tackling alcohol misuse and have outlined a package of over 40 measures to do this. These focus on education, diversionary activity, support for families and communities and preventive public health measures such as alcohol brief interventions.
“Together with minimum unit pricing and regulatory measures on issues such as the irresponsible promotion of alcohol, we believe this wider package will help to create the cultural shift required to change our relationship with alcohol.
“While we have no plans to change the legal age for drinking alcohol, we remain open to the consideration of any evidence-based proposals.”