DRUG CONTROL 

POLICY

Information on Status of 

Federal Efforts and Key 

Issues for Preventing Illicit 

Drug Use 

Statement of Diana Maurer, 

Director, Homeland Security and Justice Issues

Testimony 

Before the Committee on Oversight and 

Government Reform, House of 

Representatives

For Release on Delivery 

Expected at 10:00 a.m. ET

Wednesday, July 26, 2017

GAO-17-766T

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-17-766T, a testimony 

before the Committee on Oversight and 

Government Reform, House of 

Representatives

July 26, 2017

DRUG CONTROL POLICY

Information on Status of Federal Efforts and Key 

Issues for Preventing Illicit Drug Use

What GAO Found

The federal government has made mixed progress toward achieving the goals 

articulated in the 2010 National Drug Control Strategy (Strategy). In the Strategy, 

the Office of National Drug Control Policy (ONDCP) established seven goals 

related to reducing illicit drug use and its consequences by 2015. In many 

instances, the data used to assess progress in 2015 have only recently become 

available. GAO’s review of this updated data indicates that, as of July 2017, the 

federal government made moderate progress toward achieving two goals, limited 

progress on two goals, and no progress on the other three goals. However, none 

of the overall goals in the Strategy were fully achieved. For example, progress 

had not been made on the goal to reduce drug-induced deaths by 15 percent. 

Drug-induced deaths instead increased from 2009 to 2015 by 41.5 percent. 

Although progress was made reducing the 30-day prevalence of drug use 

among 12- to 17-year-olds from the 10.1 percent reported in 2009, the goal of 

reducing prevalence to 8.6 percent by 2015 was not achieved. According to 

ONDCP, as of July 2017, work is currently underway to develop a new strategy. 

In June 2016, GAO convened a diverse panel of experts, including from ONDCP 

to advance the national dialogue on preventing illicit drug use. The panel 

focused on (1) common factors related to illicit drug use; (2) strategies in the 

education, health care, and law enforcement sectors to prevent illicit drug use; 

and (3) high priority areas for future action to prevent illicit drug use. According to 

forum participants, illicit drug use typically occurs for the first time in 

adolescence, involves marijuana, and increasingly, legal prescriptions for opioidbased pain relievers. Forum participants also discussed strategies available in 

the education, health care, and law enforcement sectors for preventing illicit drug 

use. For example, forum participants championed the use of school- orcommunity-based prevention programs that research has shown to be 

successful in preventing illicit drug use and other behaviors. They also identified 

several high priority areas for future actions to prevent illicit drug use, including: 

supporting community coalitions, consolidating federal funding streams for 

prevention programs, and reducing the number of opioid prescriptions. 

In February 2017, GAO issued a report on the Drug-Free Communities Support 

Program (DFC)—a program that ONDCP and the Substance Abuse and Mental 

Health Services Administration (SAMHSA) jointly manage. This program aims to

support drug abuse prevention efforts that engage schools, law enforcement, 

and other sectors of a community to target reductions in the use of alcohol, 

tobacco, marijuana, and the illicit use of prescription drugs. GAO reported that 

ONDCP and SAMHSA had strengthened their joint management of the program 

by employing leading collaboration practices; however, the agencies could 

enhance DFC grantee compliance and performance monitoring. For example, 

SAMHSA did not consistently confirm grantees had completed plans to achieve 

long-term goals after exiting the program. GAO recommended that SAMHSA 

develop an action plan to strengthen DFC grant monitoring and ensure it sends 

complete and accurate information to ONDCP. SAMHSA concurred with GAO’s

recommendations and reported in April 2017 that its actions to address them

should be completed by this fall.

View GAO-17-766T. For more information, 

contact Diana Maurer at (202) 512-8777 or 

maurerd@gao.gov.

Why GAO Did This Study

According to the National Institute on 

Drug Abuse, in 2015, the most recent 

year for which national data are 

available, over 52,000 Americans died 

from drug overdoses, or approximately 

144 people every day. Policymakers, 

criminal justice officials, health care 

providers, and the public at large are 

turning with renewed attention to the 

drug epidemic and its impact on our 

nation. To help reduce illicit drug use 

and its consequences, ONDCP 

oversees and coordinates the 

implementation of national drug control 

policy across the federal government. 

This statement addresses: (1) the 

federal government’s progress in 

achieving Strategy goals, (2) results 

from a Comptroller General’s Forum on 

preventing illicit drug use, and (3) the 

findings of GAO’s recent review of 

ONDCP’s DFC Support program. 

This statement is based on GAO’s prior 

work issued from May 2016 through 

February 2017, with selected status

updates as of July 2017, and updates 

from ONDCP’s National Drug Control 

Budget Funding Highlight reports

issued from fiscal year 2016 to fiscal 

year 2018. For the updates, GAO 

used publically available data sources 

that ONDCP uses to assess its 

progress on Strategy goals, and 

interviewed ONDCP officials.
Letter

Page 1 GAO-17-766T 

Chairman Gowdy, Ranking Member Cummings, and Members of the 

Committee:

I am pleased to be here today to discuss GAO’s recent work related to 

the Office of National Drug Control Policy (ONDCP). Though drug abuse 

in our nation is not a new phenomenon, the scale and impact of illicit drug 

use in this country has reached new heights. Policy makers, criminal 

justice officials, health care providers, and the public at large are turning 

with renewed attention to the drug epidemic and its impact on our nation. 

Deaths from drug overdoses have risen steadily over the past two 

decades and are the leading cause of death due to injuries in the United 

States. In fact, according to the Centers for Disease Control and 

Prevention (CDC), drug overdose deaths surpass the annual number of 

traffic crash fatalities, as well as deaths due to firearms, suicide, and 

homicide. In 2015, the most recent year for which national data are 

available from the National Institute on Drug Abuse (NIDA), over 52,000 

Americans died from drug overdoses, or approximately 144 people every 

day.

ONDCP is responsible for, among other things, overseeing and 

coordinating the implementation of national drug control policy across the 

federal government to address illicit drug use.1 In this role, the Director of 

ONDCP is required annually to develop a National Drug Control Strategy 

(the Strategy), which is to set forth a comprehensive plan to reduce illicit 

drug use through programs intended to prevent or treat drug use or 

reduce the availability of illegal drugs.2 According to ONDCP, work is 

currently underway to develop a new Strategy. ONDCP is also 

responsible for developing a National Drug Control Program Budget 

proposal for implementing the Strategy.3 For fiscal year (FY) 2018, a total 

of $27.8 billion was requested to support federal drug control efforts. As I 

 1

Illicit drug use includes the use of marijuana (including hashish), cocaine (including 

crack), heroin, hallucinogens, and inhalants, as well as the nonmedical use of prescription 

drugs, such as pain relievers and sedatives.

2

For the purposes of this statement we refer to the National Drug Control Strategy as ‘the 

Strategy’ mirroring the reference commonly used by ONDCP.

3

21 U.S.C. §§ 1703(b)-(c), 1705(a).

Letter
Page 2 GAO-17-766T 

will detail in my statement, this represents an increase of about $280 

million over the annualized Continuing Resolution (CR) level in FY 2017.4

Today, I will discuss (1) the federal government’s progress achieving the 

National Drug Control strategy goals, (2) results of a Comptroller General 

(CG) Forum on preventing illicit drug use, and (3) the findings of our 

recent review of ONDCP’s Drug-Free Communities (DFC) Support 

program.

This statement is based on our prior work issued from May 2016 through 

February 2017 with selected updates as of July 2017.5 In performing the 

work for our May 2016 testimony, we analyzed available data on progress 

toward achieving Strategy goals, as well as documents related to 

ONDCP’s monitoring mechanisms. For this statement we updated the 

information and data where appropriate from publically available data 

sources and ONDCP’s Fiscal Year 2016 through Fiscal Year 2018 

National Drug Control Budget Funding Highlights reports, and interviews

with ONDCP officials. For our November 2016 CG Forum, we convened 

and moderated a panel of education, health care, and law enforcement 

officials and summarized the viewpoints shared on common factors 

related to illicit drug use; strategies in the education, health care, and law 

enforcement sectors to prevent illicit drug use; and high priority areas for 

future action to prevent illicit drug use. For our February 2017 report on 

the DFC, we analyzed agency policies, interviewed agency officials, 

analyzed coordination efforts against relevant key practices GAO 

identified previously, reviewed files obtained from a non-generalizable 

random sample of grant recipients and interviewed a random subset of 

these grantees. More detail on our scope and methodologies can be 

found in each of these respective products.

 4

A continuing resolution (CR) is an appropriation act that provides budget authority for 

federal agencies, specific activities, or both to continue in operation when Congress and 

the President have not completed action on the regular appropriation acts by the 

beginning of the fiscal year.

5

See GAO, Office of National Drug Control Policy: Progress Toward Some National Drug 

Control Strategy Goals, but None Have Been Fully Achieved, GAO-16-660T (Washington, 

D.C.: May 17, 2016), GAO, Highlights of a Forum: Preventing Illicit Drug Use. 

GAO-17-146SP (Washington, D.C.: Nov. 14, 2016), and GAO, Drug-Free Communities 

Support Program: Agencies Have Strengthened Collaboration but Could Enhance 

Grantee Compliance and Performance Monitoring, GAO-17-120 (Washington, D.C.: Feb.

7, 2017). 
Page 3 GAO-17-766T 

We conducted the work on which this statement is based in accordance 

with generally accepted government auditing standards. Those standards 

require that we plan and perform the audit to obtain sufficient, appropriate 

evidence to provide a reasonable basis for our findings and conclusions 

based on our audit objectives. We believe that the evidence obtained 

provides a reasonable basis for our findings and conclusions based on 

our audit objectives.

ONDCP was established by the Anti-Drug Abuse Act of 1988 to, among 

other things, enhance national drug control planning and coordination and 

represent the drug policies of the executive branch before Congress.6 In 

this role, the office is responsible for (1) developing a national drug 

control policy, (2) developing and applying specific goals and 

performance measurements to evaluate the effectiveness of national drug 

control policy and National Drug Control Program agencies’ programs,7

(3) overseeing and coordinating the implementation of the national drug 

control policy, and (4) assessing and certifying the adequacy of the 

budget for National Drug Control Programs.8

ONDCP is required annually to develop the National Drug Control 

Strategy, which sets forth a plan to reduce illicit drug use through 

prevention, treatment, and law enforcement programs, and to develop a 

National Drug Control Program Budget for implementing the strategy. 

National Drug Control Program agencies follow a detailed process in 

developing their annual budget submissions for inclusion in the National 

Drug Control Program Budget, which provides information on the funding 

that the executive branch requested for drug control to implement the 

strategy.9 Agencies submit to ONDCP the portion of their annual budget 

 6

Pub. L. No. 100-690, 102 Stat. 4181 (1988).

7

In addition to ONDCP, these agencies are: the Departments of Agriculture, Defense, 

Education, Health and Human Services, Homeland Security, Housing and Urban 

Development, the Interior, Justice, Labor, State, Transportation, Treasury, and Veterans 

Affairs, as well as the Court Services and Offender Supervision Agency for the District of 

Columbia; and the Federal Judiciary.

8

21 U.S.C. § 1702(a).

9

21 U.S.C. § 1703(c). Under 21 U.S.C. § 1701(7), the term “National Drug Control 

Program agency” means any agency that is responsible for implementing any aspect of 

the National Drug Control Strategy, including any agency that receives federal funds to 

implement any aspect of the National Drug Control Strategy, subject to certain exceptions 

regarding intelligence agencies.

Background
Page 4 GAO-17-766T 

requests dedicated to drug control, which they prepare as part of their 

overall budget submission to the Office of Management and Budget for 

inclusion in the President’s annual budget request. ONDCP reviews the 

budget requests of the drug control agencies to determine if the agencies 

have acceptable methodologies for estimating their drug control budgets, 

and includes those that do in the Drug Control Budget.10 In FY 2016, the 

budget contained 38 federal agencies or programs.

There are five priorities for which resources are requested across 

agencies: substance abuse prevention and substance abuse treatment 

(which are considered demand-reduction areas), and domestic law 

enforcement, drug interdiction, and international partnerships (which are 

considered supply-reduction areas) as shown in figure 1. ONDCP 

manages and oversees two primary program accounts: the High Intensity 

Drug Trafficking Areas (HIDTA) Program and the Other Federal Drug 

Control Programs, such as the DFC Support Program. ONDCP previously 

managed the National Youth Anti-Drug Media Campaign which last 

received appropriations in fiscal year 2011. Also, from fiscal year 1991 to 

fiscal year 2011, ONDCP managed the Counterdrug Technology 

Assessment Center (CTAC).

 10 An acceptable methodology relies on availability of empirical data at the agencies for 

estimating their drug control budgets. These data include determining which portion of an 

agency’s funding is for drug control programs or activities versus non-drug control 

programs. See GAO, Office of National Drug Control Policy: Agencies View the Budget 

Process as Useful for Identifying Priorities, but Challenges Exist, GAO-11-261R 

(Washington, D.C.: May 2, 2011). Agencies may administer programs that include drug 

abuse prevention and treatment activities but do not meet ONDCP’s standards for having 

an acceptable budget estimation methodology. Such programs are not represented in the 

Drug Control Budget.
Page 5 GAO-17-766T 

Figure 1: Federal Drug Control Program Priority Areas

According to ONDCP, federal drug control spending increased from $21.7 

billion in FY 2007 to the approximately $27.5 billion that was allocated for 

drug control programs in FY 2017 as shown in figure 2.11 Spending on 

supply reduction programs, such as domestic law enforcement, 

interdiction, and international programs increased 16 percent from $13.3 

billion in FY 2007 to $15.4 billion in FY 2017. However, federal spending 

for demand programs—treatment and prevention— increased at a higher 

rate from FY 2007 through FY 2017. Spending in these two programs 

increased 44 percent from $8.4 billion in FY 2007 to $12.1 billion in FY 

2017. As a result, the proportion of funds spent on demand programs 

increased from 39 percent of total spending in FY 2007 to 44 percent in 

FY 2017.

 11 The fiscal year 2018 National Drug Control Budget Funding Highlights describes fiscal 

year 2017 allocations. ONDCP refers to these funds as “annualized Continuing Resolution 

levels” in the National Drug Control Budget, while we use the term allocated funding. All 

FY 2017 funding is considered allocated funding for purposes of this statement. Funds 

allocated at the beginning of a fiscal year may not reflect actual agency spending during 

the course of the fiscal year. For example, appropriations acts may allow agencies to 

reallocate unobligated funds from one program to another, or actual spending for 

mandatory funding programs such as Medicare and Medicaid may differ from projected 

spending levels. 
Page 6 GAO-17-766T 

Figure 2: Federal Drug Control Spending for Fiscal Years 2007 through 2017

According to ONDCP’s National Drug Control Budget Fiscal Year 2018 

Highlights, the proposed budget supports $1.3 billion in investments 

authorized by the Comprehensive Addiction and Recovery Act (CARA), 

the 21st Century Cures Act, and other opioid-specific programs to help 

address the opioid epidemic, including funding prevention and treatment 

efforts.12 Allocated funding for treatment increased in FY 2017 to 

approximately $10.6 billion, a 7.5 percent increase over FY 2016. 

Funding for prevention increased slightly in FY 2017 to about $1.5 billion, 

a 1.4 percent increase from FY 2016.

 12ONDCP, National Drug Control Budget Fiscal Year 2018 Funding Highlights, 

(Washington, D.C.: May 2017)
Page 7 GAO-17-766T 

According to its FY 2018 Budget Highlights document, ONDCP considers 

three main functions to address the drug supply: Domestic Law 

Enforcement, Interdiction, and International. For Domestic Law 

Enforcement, ONDCP noted that federal, state, local, and tribal law 

enforcement agencies play a key role in the Administration’s approach to 

reduce drug use and its associated consequences. ONDCP also stated 

that interagency drug task forces, such as the HIDTA program, are critical 

to leveraging limited resources among agencies. Allocated funding for 

domestic law enforcement in FY 2017 is approximately $9.3 billion, which 

is similar to its FY 2016 spending level.

According to ONDCP, the United States continues to face a serious 

challenge from the large-scale smuggling of drugs from abroad which are 

distributed to every region in the nation. Interdiction funds support 

collaborative activities between federal law enforcement agencies, the 

military, the intelligence community, and international allies to interdict or 

disrupt shipments of illegal drugs, their precursors, and their illicit 

proceeds. Allocated funding in support of Interdiction for FY 2017 is 

approximately $4.6 billion, a decrease of 3.5 percent from FY 2016.

International functions place focus on collaborative efforts between the 

U.S. government and its international partners around the globe. 

According to ONDCP, illicit drug production and trafficking generate huge 

profits and are responsible for the establishment of criminal networks that 

are powerful, corrosive forces that destroy the lives of individuals, tear at 

the social fabric, and weaken the rule of law in affected countries. In FY 

2017, approximately $1.5 billion was allocated to international functions, 

which is similar to its FY 2016 spending level.

As we previously have stated, the 2010 National Drug Control Strategy 

was the inaugural strategy guiding drug policy under the previous 

Administration. According to ONDCP officials, it sought a comprehensive 

approach to drug policy, including an emphasis on drug abuse prevention 

and treatment efforts and the use of evidence-based practices—

approaches to prevention or treatments that are based in theory and have 

undergone scientific evaluation. ONDCP established two overarching 

policy goals in the 2010 Strategy for (1) curtailing illicit drug consumption 

and (2) improving public health by reducing the consequences of drug 

abuse, and seven overall sub goals under them that delineate specific 

quantitative outcomes to be achieved by 2015, such as reducing druginduced deaths by 15 percent. To support the achievement of these two 

policy goals and seven sub goals (collectively referred to as overall 

The Federal 

Government Has 

Made Mixed Progress 

But Has Not Fully 

Achieved the Overall 

2010 Strategy Goals
Page 8 GAO-17-766T 

goals), the Strategy included seven strategic objectives and multiple 

action items under each objective, with lead and participating agencies 

designated for each action item. Strategy objectives include, for example, 

“Strengthen Efforts to Prevent Drug Use in Communities” and “Disrupt

Domestic Drug Trafficking and Production.” Subsequent annual 

Strategies provided updates on the implementation of action items, 

included new action items intended to help address emerging drugrelated problems, and highlighted initiatives and efforts that support the 

Strategy’s objectives.

In March 2013, we reported that ONDCP and the federal agencies lacked 

progress on achieving the Strategy goals and were in the process of 

implementing a new mechanism to monitor progress.13 As we reported in 

May 2016, ONDCP and the federal agencies had made moderate 

progress toward achieving one goal, limited progress on three goals, and 

no demonstrated progress on the remaining three goals.14 For example, 

we reported that the rate of drug use for young adults aged 18 to 25 had 

increased since 2009, moving in the opposite direction of the goal. 

However, we also reported that HIV infections attributable to drug use, 

one of the strategy’s sub-measures, had decreased from 2009 to 2014 

and had exceeded the strategy’s established target. In many instances, 

the data used to assess progress, while the most up to date at the time, 

were several years old. Based on the most recent data available, 

although some of the sub-measures, such as decreasing tobacco use by 

eighth graders, were achieved, none of the seven overall goals in the 

Strategy have been fully achieved as of July 2017. Table 1 shows the 

2010 Strategy goals and progress toward meeting them as of July 2017.

 13See GAO: Office of National Drug Control Policy: Office Could Better Identify 

Opportunities to Increase Program Coordination; GAO-13-333 (Washington, D.C.: March 

26, 2013).

14GAO-16-660T. Three of the Strategy’s goals have multiple sub-measures. Limited 

progress indicates that progress has been made toward goals on at least one of these 

measures but not all.
Page 9 GAO-17-766T 

Table 1: 2010 National Drug Control Strategy Goals and Progress toward Meeting Them, as of July 2017

2010 Strategy goals 2009 (baseline) 2015 (goal) Progress as of most 

recently available 

dataa

Curtail illicit drug consumption in America

1. Decrease the 30-day prevalence of drug use among 12-

to 17-year- olds by 15 percentb 10.1 percent 8.6 percent 8.8 percent (2015)

2. Decrease the lifetime prevalence of eighth graders who 

have used drugs, alcohol, or tobacco by 15 percentc

Illicit drugs 19.9 percent 16.9 percent 17.2 percent (2016)

Alcohol 36.6 percent 31.1 percent 22.8 percent (2016)

Tobacco 20.1 percent 17.1 percent 9.8 percent (2016)

3. Decrease the 30-day prevalence of drug use among 

young adults aged 18-25 by 10 percentd

21.4 percent 19.3 percent 22.3 percent (2015)

4. Reduce the number of chronic drug users by 15 

percente

Cocaine 2.7 million 2.3 million 2.5 million (2010)

Heroin 1.5 million 1.3 million 1.5 million (2010)

Marijuana 16.2 million 13.8 million 17.6 million (2010)

Methamphetamine 1.8 million 1.5 million 1.6 million (2010)

Improve the public health and public safety of the American people by reducing the consequences of drug abuse

5. Reduce drug-induced deaths by 15 percent 39,147 33,275 55,403

(2015)

6. Reduce drug-related morbidity by 15 percent

Emergency room visits for drug misuse and abusef 2,070,452 1,759,884 2,462,948 (2011)

HIV infections attributable to drug use 5,799 4,929 3,594 (2015)

7. Reduce the prevalence of drugged driving by 10 

percentg 16.3 percent (2007) 14.7 percent 20.0 percent (2013)

Source: GAO review of ONDCP’s 2015 Performance Reporting System report and data from (1) Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use 

and Health (NSDUH); (2) National Institute on Drug Abuse’s Monitoring the Future; (3) What America’s Users Spend on Illegal Drugs; (4) Centers for Disease Control and Prevention’s (CDC) National 

Vital Statistics System; (5) SAMHSA’s Drug Abuse Warning Network drug-related emergency room visits; (6) CDC’s HIV Surveillance Report‐Diagnoses of HIV Infection in the United States; and (7) 

National Highway Traffic Safety Administration’s National Roadside Survey. | GAO-17-766T

a

Year for which the most recent data were available is in parenthesis.

b

NSDUH is a statistical sample survey and these results from this survey are population estimates. 

According to the 2015 NSDUH, 7 percent of 12- to 17-year-olds reporting having used marijuana in 

the past month.

c

According to the 2016 Monitoring the Future survey, 12.8 percent of eighth graders reported having 

used marijuana in their lifetimes and 8.9 percent reported having used any illicit drug other than 

marijuana.

d

According to the 2015 NSDUH, 19.8 percent of 18- to 25-year-olds reported having used marijuana 

in the past month.

e

The data source for this measure is a report entitled What America’s Users Spend on Illegal Drugs, 

which is sponsored by ONDCP and prepared by RAND Corporation. As of July 2017, the most recent 

report had been released in February 2014 and provided data from 2000 through 2010.
Page 10 GAO-17-766T 

f

According to ONDCP’s 2015 Performance Reporting System report, the data source for this 

measure—the Drug Abuse Warning System—was discontinued by SAMHSA in 2011, and SAMHSA 

and CDC are currently working to implement a replacement system to provide data on drug‐related 

emergency department visits. SAMHSA’s Drug Abuse Warning Network was a statistical sample 

survey of hospital emergency rooms and the results from this survey were population estimates.

g

The primary data source for this measure is the National Roadside Survey conducted by the National 

Highway Traffic Safety Administration. The baseline survey was conducted in 2007. The NSDUH, 

which also measures the prevalence of drugged driving, serves as a secondary data source to the 

National Roadside Survey. ONDCP reported that the drugged driving goal was met when 2013 data 

from the NSDUH source is used.

Federal drug control agencies made mixed progress but did not fully 

achieve any of the four overall Strategy goals associated with curtailing 

illicit drug consumption. For example:

• Progress was made on the goal to decrease the 30-day prevalence of 

drug use among 12- to 17-year-olds by 15 percent. The data source 

for this measure— SAMHSA’s National Survey on Drug Use and 

Health (NSDUH)15— indicated that in 2015, 8.8 percent of 12- to 17-

year-olds reported having used illicit drugs in the past month.

• Progress was not made on the goal to decrease the 30-day 

prevalence of drug use among young adults aged 18 to 25 by 10 

percent. Specifically, the reported rate of drug use for young adults 

was 21.4 percent in 2009 and 22.3 percent in 2015, moving in the 

opposite direction of the goal. Marijuana remained the drug used by 

the highest percentage of young adults. According to the 2015 

NSDUH, 19.8 percent of young adults reported having used marijuana 

in the past month.16 The rates of reported marijuana use for this 

measure increased by 9 percent from 2009 to 2015.

Progress was also mixed on the remaining three overall Strategy goals 

associated with reducing the consequences of drug use. For example:

• Progress was not made on the goal to reduce drug-induced deaths by 

15 percent. According to the CDC’s National Vital Statistics System, 

which collects information on all deaths in the United States, 55,403 

deaths were from drug-induced causes in 2015, an increase of 41.5 

percent compared to 2009 and 66.5 percent more than the 2015 goal. 

The CDC’s December 30, 2016 Morbidity and Mortality Weekly 

 15NSDUH is a statistical sample survey.

16 Marijuana includes marijuana and hashish.
Page 11 GAO-17-766T 

Report stated that 52,404 of these deaths were from drug overdoses, 

the majority of which (63 percent) involved opioids.

• The goal to reduce drug-related morbidity by 15 percent has two submeasures, and progress had been made on one but not the other. 

Specifically, HIV infections attributable to drug use decreased by 29

percent from 2010 to 2015, exceeding the established target. 

However, the number of emergency room visits for substance use 

disorders increased by 19 percent from 2009 to 2011. The data 

source for this measure— SAMHSA’s Drug Abuse Warning 

Network17—indicated that pharmaceuticals alone were involved in 34 

percent of these visits and illicit drugs alone were involved in 27 

percent of them.18 According to the 2013 Drug Abuse Warning 

Network report, the increase in emergency room visits for drug misuse 

and abuse from 2009 to 2011 was largely driven by a 38 percent 

increase in visits involving illicit drugs only.

To advance the national dialogue on preventing illicit drug use, including 

preventing individuals from using illicit drugs for the first time, we 

convened and moderated a diverse panel of health care, education, and 

law enforcement experts, including from ONDCP, on June 22, 2016. The 

panel focused on (1) common factors related to illicit drug use; (2) 

strategies in the education, health care, and law enforcement sectors to 

prevent illicit drug use; and (3) high priority areas for future action to 

prevent illicit drug use, and our November 2016 report19 summarized the 

themes from the forum.

Forum participants identified a number of common factors related to illicit 

drug use. For example, the participants agreed that first time illicit drug 

use typically starts in adolescence and typically involves marijuana, 

however, prescription pain relievers are increasingly a pathway to illicit 

drug use. Other common factors include: a family history of substance 

abuse, conflict within the family, and the early onset of anxiety disorders 

or substance use, among others.

 17SAMHSA’s Drug Abuse Warning Network is a statistical sample survey of hospital 

emergency rooms.

18 These numbers do not include visits that involved a combination of illicit drugs, 

pharmaceuticals, and/or alcohol, which accounted for an estimated 35 percent of 

emergency room visits for substance use disorders.

19See GAO-17-146SP.

Themes from a 

Comptroller General 

Forum on Preventing 

Illicit Drug Use
Page 12 GAO-17-766T 

Forum participants also noted several strategies available in the 

education, health care, and law enforcement sectors for preventing illicit 

drug use:

• Education. Forum participants championed the use of school-or 

community-based prevention programs that research has shown to be 

successful in preventing illicit drug use and other behaviors. These 

programs include: Life Skills, Strengthening Families Program: For 

Parents and Youth 10-14, and Communities That Care. These 

programs focus generally on combatting a range of risky behaviors, 

giving participants skills to recognize and manage their emotions, and 

strengthening family and community ties. 

• Health care. Forum participants identified and discussed three 

principle health care strategies for preventing illicit drug use: (1) 

having providers adhere to the CDC’s guideline for prescribing opioids 

for chronic pain, (2) having providers use prescription drug monitoring 

programs (PDMP)—state-run electronic databases used to track the 

prescribing and dispensing of prescriptions for controlled 

substances—and (3) having primary care providers screen and 

intervene with patients at risk for illicit drug use.

• Law Enforcement. Forum participants identified four law enforcement

strategies for preventing illicit drug use: (1) enforcing laws prohibiting 

underage consumption of alcohol and tobacco, (2) building trust 

between law enforcement and local communities, (3) using peers to 

promote drug-free lifestyles, and (4) closing prescription drug “pill 

mills” — medical practices that prescribe controlled substances 

without a legitimate medical purpose—and other efforts to reduce the 

supply of illicit drugs.

Forum participants also identified several high priority areas for future 

action to help prevent illicit drug use, including the misuse of prescription 

drugs. Some examples include:

• supporting community coalitions comprising the health care, 

education, and law enforcement sectors that work in concert to 

prevent illicit drug use at the local level;

• consolidating federal funding streams for multiple prevention 

programs into a single fund used to address the risk factors for a 

range of unhealthy behaviors, including illicit drug use;

• increasing the use of prevention programs that research has shown to 

be effective, such as those that are well-designed and deliver 

persuasive drug prevention messages on a regular basis;
Page 13 GAO-17-766T 

• identifying and pursuing ways to change perceptions of substance 

abuse disorders and illicit drug use, such as emphasizing that a 

substance abuse disorder is a disease of the brain and can be treated 

like other diseases;

• supporting drug prevention efforts in primary care settings, such as 

exploring ways to reimburse providers for conducting preventative 

drug screenings; and

• reducing the number of prescriptions issued for opioids.

In February 2017, we issued a report on the Drug-Free Communities 

Support Program (DFC)—a program that ONDCP and SAMHSA jointly 

manage. This program aims to support drug abuse prevention efforts that 

engage schools, law enforcement, and other sectors of a community to 

target reductions in the use of alcohol, tobacco, marijuana, and the illicit 

use of prescription drugs.20 We examined the extent to which the two 

agencies (1) use leading processes to coordinate program administration 

and the types of activities funded, and (2) have operating procedures that 

ensure DFC grantee compliance and provide a basis for performance 

monitoring.

In 2008 we had previously reported that ONDCP and SAMHSA needed to 

establish stronger internal controls and had not fully defined each 

agency’s roles and responsibilities for the management of the DFC 

program.21 In our February 2017 report, we found that ONDCP and 

SAMHSA had improved their joint management of the program.

Specifically, we found that ONDCP and SAMHSA employed leading 

collaboration practices to administer the DFC program and fund a range 

of drug prevention activities. For example, ONDCP and SAMHSA had 

defined and agreed upon common outcomes, such as prioritizing efforts 

to increase participation from under-represented communities. The two 

agencies also had funded a range of DFC grantees’ activities and report 

on these activities in their annual evaluation reports. For example, 

ONDCP reported that from February through July 2014, grantees 

educated more than 156,000 youth on topics related to the consequences 

of substance abuse. Other examples of grantees’ efforts included those 

 20See GAO-17-120. 

21See GAO, Drug-Free Communities Support Program: Stronger Internal Controls and 

Other Actions Needed to Better Manage the Grant-Making Process, GAO-08-57 

(Washington, D.C.: July 31, 2008).

Agencies Have 

Strengthened 

Collaboration of DrugFree Communities 

Support Program but 

Could Enhance 

Grantee Compliance 

and Performance 

Monitoring
Page 14 GAO-17-766T 

that enhanced the skill sets of community members, including parents, to 

identify drug abuse or limit access to prescription drugs and those that 

reduced language barriers precluding non-English speakers from 

understanding drug prevention campaigns.

We also found that ONDCP and SAMHSA had operating procedures in 

place, but SAMHSA did not consistently follow documentation and 

reporting procedures to ensure grantees’ compliance and had not 

accurately reported to ONDCP on grantee compliance. Based on a file 

review we conducted, we found that SAMHSA followed all processes for 

ensuring that the grant applicants whose files we reviewed had submitted 

required documentation before SAMHSA awarded them initial grant 

funding. However, SAMHSA was less consistent in adhering to 

procedures for confirming documentation in later years of the program. 

We found that the majority of grantees whose files we reviewed were 

missing required paperwork to document how they planned to sustain 

their programs after grant funds expired. Prior to our review, ONDCP and 

SAMHSA officials were not aware of the missing data in the grant files. 

We concluded that without close adherence to existing procedures, and a 

mechanism to ensure that the documentation it reports to ONDCP is 

accurate and complete, SAMHSA’s performance monitoring capacity was 

limited. Moreover, SAMHSA could not be certain that grantees were 

engaging in intended activities and meeting their long-term program 

goals.

We made recommendations that SAMHSA develop an action plan to 

strengthen the agency’s grant monitoring process and ensure ONDCP 

gets complete and accurate information, among other things. SAMHSA 

concurred with our recommendations and reported to us in April 2017 that 

it is implementing actions to address our recommendations that should be 

completed by this fall.

Chairman Gowdy, Ranking Member Cummings, and Committee 

members, this concludes my prepared statement. I would be happy to 

respond to any questions you may have.
Page 15 GAO-17-766T 

For questions about this statement, please contact Diana Maurer at (202) 

512-8777 or maurerd@gao.gov. Contact points for our Offices of 

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of this statement. Individuals who made key contributions to this 

statement include Aditi Archer (Assistant Director), Joy Booth (Assistant 

Director), Julia Vieweg, Sylvia Bascope, Jane Eyre, Stephen Komadina, 

Mara McMillen, David Alexander, Billy Commons, and Eric Hauswirth. 

Staff who made key contributions to the reports cited in this statement are 

identified in the source product.

GAO Contact and 

Staff 

Acknowledgements

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