Guest Author – April 2023

Photo by Spencer Platt/Getty Images.

Traffic Safety Initiatives: In-Custody Death
How DREs Can Help With Prevention
Jim Maisano, Deputy Chief (Ret.), Norman Police Department, Oklahoma, Project Manager, IACP

Traffic enforcement and the investigation of motor vehicle collisions are essential parts of the daily activities performed by most state, county, and local law enforcement agencies.

In 2020, there were 11,654 fatal motor vehicle crashes in which at least one driver was alcohol impaired. But when initially thinking about alcohol-impaired drivers, it is common to automatically think of those offenses as being nighttime incidents. It is true that the rate of alcohol impairment among drivers involved in fatal crashes was 3.1 times higher at night than during the day; however, that does not mean there are no alcohol-impaired drivers during the daytime. Data from the Fatal Analysis and Reporting System 2020 annual report show that 10 percent of the drivers involved in fatal crashes during the period between 6 a.m. and 5:59 p.m. were alcohol impaired. This is an increase of 2 percent from 2019 (8 percent).

According to the FBI Uniform Crime Report data for 2019, there were 1,024,508 arrests for the offense of driving under the influence (DUI). That is more arrests than murder, rape, aggravated assault, and burglary combined. There is no doubt that driving under the influence is more common than it should be. As a result, there is a high probability of a law enforcement agency arresting a person who is driving under the influence.

The Role of a DRE

Every police executive dreads the 4:00 a.m. phone call from the night shift commander saying that an inmate in the agency’s custody was found unresponsive in the cell and declared deceased after being transported to the area hospital. After taking a moment to clear the sleep fog from his or her mind and organize thoughts, the executive starts asking for relevant facts about the incident. “Why was the person in custody?” The commander explains the person had been arrested on a charge of driving under the influence. The executive responds by asking if the subject had taken a breath test and, if so, how high the person’s breath alcohol concentration (BAC) results were. The results of the state’s breath test showed only a 0.03 BAC, which is well below the state’s DUI “per se” limit. A major thought immediately comes to mind: “Then how did this happen?”

Law enforcement executives trust that the officers made valid arrests based on the indicators of impairment they observed in the field since the person’s BAC was so low. With a BAC well below the state’s alcohol per se limit, this is a good indication that drugs may have been involved also. A common question asked is if there were any drugs found; in this event, the answer is that no drugs were found on the person or in the vehicle during the arrest. A state’s blood test was drawn for the DUI charge, but the result of that testing is not readily available to the arresting officer or the jail staff.

Many documented medical conditions may mimic intoxication from alcohol or drugs.

However, one must consider another factor when a person is arrested for the offense of DUI and exhibits an impairment level that is inconsistent with the breath alcohol test results—medical conditions the person may have. Many documented medical conditions may mimic intoxication from alcohol or drugs. In these incidents, a drug recognition expert (DRE) program in an agency can play a vital role during the arrest and booking process. Certified DREs are extremely valuable tools for combating the adverse impact of drugs on the communities served. Although the focus of a DRE is to identify drug-impaired drivers, DREs are frequently called upon to use their training to differentiate between drug influence, medical concerns, or mental disorders.

A documented drug influence evaluation performed on an arrested individual in Pennsylvania reflects a positive interaction with a suspected impaired driver and the prevention of a medical crisis. Around 8:00 a.m., the arresting officer had responded to a single-vehicle collision. The arresting officer noticed the driver was drowsy and had a hard time responding to questions. The driver’s speech was metered and slow as he indicated he must have fallen asleep while driving. There were several prescription bottles in a duffle bag in the front seat of the car. The officer had the driver perform the standardized field sobriety tests and multiple indicators of impairment were observed. The officer arrested the driver for driving under the influence, and, at the jail, the driver submitted to a breath alcohol test with a result of 0.00 BAC.

Because of the negative BAC results, a DRE was requested to perform a drug influence evaluation on the subject. Upon his initial contact with the suspect, the individual was agitated and uncooperative. As the DRE began his evaluation of the suspect, he noticed a small clear tube extruding from the left side of the suspect’s shirt. He questioned the suspect about the tube and verified it was for an insulin pump. The DRE asked the suspect to take a blood sugar test, but he initially refused. After gently coaxing, he finally agreed to allow the paramedics to check his blood sugar level. It was found that his blood sugar level was at 53 mg/dL, which is a dangerously low level. The jail’s registered nurse was on site and acknowledged that they should start administering medications when an inmate’s blood sugar level drops below 60 mg/dL.

At this time, the suspect indicated he was going to leave and became combative. A brief struggle ensued, including the use of a drive stun with a taser. Instead of taking the aggressive suspect straight to a jail cell, however, based on the facts the DRE had discovered, the officers were able to control the suspect and get him to take a glucose gel. After gaining compliance, in the following 10 minutes, the suspect’s behavior changed noticeably. His speech returned to a normal tone and speed, and he became fully cooperative. He, then, began answering questions quickly and fully. He began to speak to the personnel in a respectful manner. His blood sugar level was rechecked, and the test showed 82 mg/dL—within the normal range.

The drug evaluation process was explained to the suspect, and he agreed to participate in the evaluation to rule out the use of any other drugs. The DRE was able to complete the evaluation with no indications of the use of any other drugs. His opinion as a credentialed DRE was that the suspect was not under the influence of drugs or medication but was impaired due to a medical event. Had this suspected DUI driver simply been placed into a jail cell after the initial testing, his dropping blood sugar level could have caused a life-threatening emergency. The arresting officer had not noticed the catheter for the insulin pump, and without a DRE program within the agency, this incident could have had a much different (and tragic) outcome.

In another notable event in Kansas, a DRE was called to perform a drug evaluation. He quickly realized that something was not right, and this was not just an intoxicated person. He sought medical assistance, and it was discovered that the subject had a brain aneurism. Had the subject’s condition been untreated, the person could have died if he had not been evaluated and simply been placed in jail for suspected intoxication.

The presence of a DRE to have more in-depth interactions with the subjects in these two examples and to recognize signs of medical impairment was a major factor in the positive outcome of these events. Many times, the difference in the signs between intoxication and a medical event is very slight. In these two events and others like them, lives can be saved due to a DRE’s intervention and observations.


A DRE can be a tremendous asset to an agency of any size or jurisdiction. For more information about the program, visit the International Drug Evaluation & Classification Program website ( This website also lists contact information for the DRE state coordinator in each state.

  Reprinted with permission from the IACP Police Chief Magazine, March 2023 Issue. Copyright held by the International Association of Chiefs of Police, Inc., 44 Canal Center Plaza, Suite 200, Alexandria, VA 22314.  Further reproduction without express permission from the IACP is strictly prohibited.


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