U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

1 

29–011 2013

113th Congress, 1st Session – – – – – – – – – – – – – House Document 113–20 

2013 NATIONAL DRUG CONTROL STRATEGY 

MESSAGE 

FROM

THE PRESIDENT OF THE UNITED STATES 

TRANSMITTING

THE ADMINISTRATION’S 2013 NATIONAL DRUG CONTROL 

STRATEGY, PURSUANT TO 21 U.S.C. 1504 

APRIL 24, 2013.—Message and accompanying papers referred to the Committees on Energy and Commerce, Education and the Workforce, Veterans’ Affairs, Armed Services, the Judiciary, Natural Resources, Financial Services, Homeland Security, Oversight and Government Reform, 

Ways and Means, Foreign Affairs, Transportation and Infrastructure, 

and Intelligence (Permanent Select) and ordered to be printed 


tjames on DSK6SPTVN1PROD with HEARINGE:\Seals\Congress.#13

tjames on DSK6SPTVN1PROD with HEARING
(1) 

To the Congress of the United States: 

I am pleased to transmit the 2013 National Drug Control Strategy, my Administration’s blueprint for reducing drug use and its 

consequences in the United States. As detailed in the pages that 

follow, my Administration remains committed to a balanced public 

health and public safety approach to drug policy. This approach is 

based on science, not ideology—and scientific research suggests 

that we have made real progress. 

The rate of current cocaine use in the United States has dropped 

by 50 percent since 2006, and methamphetamine use has declined 

by one-third. New data released this year suggest that we are turning a corner in our efforts to address the epidemic of prescription 

drug abuse, with the number of people abusing prescription drugs 

decreasing by nearly 13 percent—from 7 million in 2010 to 6.1 million in 2011. And the number of Americans reporting that they 

drove after using illicit drugs also dropped by 12 percent between 

2010 and 2011. 

While this progress is encouraging, we must sustain our commitment to preventing drug use before it starts—the most cost-effective way to address the drug problem. The importance of prevention is becoming ever more apparent. Despite positive trends in 

other areas, we continue to see elevated rates of marijuana use 

among young people, likely driven by declines in perceptions of 

risk. We must continue to get the facts out about the health risks 

of drug use and support the positive influences in young people’s 

lives that help them avoid risky behaviors. 

The Strategy that follows presents a sophisticated approach to a 

complicated problem, encompassing prevention, early intervention, 

treatment, recovery support, criminal justice reform, effective law 

enforcement, and international cooperation. 

I look forward to working with the Congress and stakeholders at 

all levels in advancing this 21st century approach to drug policy. 

BARACK OBAMA. 

THE WHITE HOUSE, April 24, 2013. 


tjames on DSK6SPTVN1PROD with HEARING
2 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 4 here HDOC20.001
3 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 5 here HDOC20.002

To the Congress ofthe United States . . . . . . . . . . . . . . . . . . . . . . . . . iii 

Preface from Director Kerlikowske . . . . . . . . . . . . . . . . . . . . . . . . . . v 

Introduction. . . . . . . . . . .......... 1 

Chapter 1. Strengthen Efforts to Prevent Drug Use in OUf Communities. . . . . . . . . . . . 5 

Chapter 2. Seek Early Intervention Opportunities in Health Care. . . . 13 

Chapter 3. Integrate Treatment for Substance Use Disorders into Health Care and Expand 

Support for Recovery . . . . . . . . . . . . . . . . . . . . . . . 19 

Chapter 4: Break the Cycle of Drug Use, Crime, Delinquency, and Incarceration. . . . . . . . 27 

Chapter 5. Disrupt Domestic Drug Trafficking and Production . . . . . 37 

Chapter 6: Strengthen International Partnerships . . . . . 49 

Chapter 7. Improve Information Systems for Analysis, Assessment, and Local Management. 61 

Policy Focus: Reducing Drugged Driving. . . . . . . . . . . . . . . . . . . . . . . 67 

Policy Focus: Preventing Prescription Drug Abuse . . . . . . • . . . . . . . . . . . . 71 

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 

List of Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 

Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 
4 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 6 here HDOC20.003

dmg use and its consequences in the United States. As detailed in the pages that follow, my Administration 

remains committed to a balanced public health and public safety approach to dmg policy. "!his approach is 

based on science, not {jcl,lnO"v----cmrl scientific research suggests that we have made real progress. 

The rate of current cocaine use in the United States has dropped by 50 percent since 2006, and methamphetamine use has declined by one-third. New data released this year suggest that we are turning a corner in our 

efforts to address the epidemic of prescription abuse, witb the number of people abusing prescription 

drugs decreasing by nearly 13 7 million in 2010 to 6.1 million in 2011. And the number 

of Americans reporting that they drove after using illicit (h11gS also dropped by 12 percent between 2010 

and 2011. 

While this progress is encouraging, we must sustain our commitment to preventing drug use hetore it 

starts-the most cost-effective way to address the dmg problem. 'The importance of prevention 

ever more apparent. Despite positive trends in other areas, we continue to see elevated rates of marijuana 

use among young people, likely driven hy declines in perceptions of risk. vVe must continue to get the facts 

out ahout the health risks of dmg use and support the positive influences in young people's lives that help 

them avoid rislqr behaviors. 

The a sophisticated approach to a complicated problem, encompassing prevention, early intervention, treatment, recovery support, criminal justice reform, eftective law enforcement, and 

international cooperation. 

I look fOlward to working with the Congress and stakeholders at alllevcls in advanciug this 21" century 

approach to dmg policy. 

"The White House 

iii 
5 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 7 here HDOC20.004

the Administration's vision for a modem, balanced drug 

policy, yet it also contains the voices of thousands of individuals committed to building a safer and healthier 

future, both across the country and around the world. Throughout 2012, these individuals submitted their 

ideas about how we can improve our efforts to reduce dmg use and reflects 

input from members of Congress and my colleagues in the Federal Govemment, whom I convened I()r a 

meeting at the VVhite House in July 2012 to discuss our progress and identifY priorities for the coming year. 

This process of consultation led to a number of enhancements in the 2013 Strategy. For example, our work 

to address prescription dmg abuse in the United States led us to collaborate with a wide range of researchers, 

advocates, and policymakers concerned with the impact this is having on the health of mothers 

and in£~nts. In August 2012, I hosted a national leadership meeting that focused on neonatal abstinence 

and evidencc-based treatment and prevention options for maternal addiction. The conclusions 

reached at this meeting are reflected in a renewed emphasis on maternal addiction and neonatal abstinence 

in the Strategy. 

'l11e 2013 includes an enhanced focus on overdose prevention and intervention as an important 

component in redncing drug-related deaths and connecting those in need with treatment and recovery 

services. In August 2012, I traveled to Wilkes County, North Carolina, and visited Project Lazarus, an 

organization helping to address the prescription drug abuse prohlem in a region hard hit epidemic. 

While there, I dedicated to reducing prescription dmg abuse-to include preventing drug-related deaths through the use of the life-saving 

overdose reversal drug naloxone. As a result, the 2013 a section on overdose and highlights 

a law enforcement professional who is pioneering the use of naloxone 

(hlincy, Massachusetts. 

officers in his hometown of 

experience has shown us 

make real and lasting change. I look 

fonvard to working with the Congress and the American people to efleet that change in the year ahead. 

R. Gil Kerlikowske 

Director of National Drug Control Policy 

v 
6 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 8 here HDOC20.005

The President's inaugural 20 1 a National Drug Control Strategy laid out a comprehensive, evidence-based 

approach to reducing drug use and its consequences in the United States. In doing so, the Administration 

charted a "third way" in drug policy, a path that rejects the opposing extremes of legalization or a law 

enforcement-only "war on drugs:'Rather, the Strategy pursues a 21st century approach to drug policy 

that balances public health programs, effective law enforcement, and international partnerships. This 

"third way" is rooted in the knowledge that drug addiction is a disease of the brain-one that can be 

treated, recovered from, and, most importantly, prevented. It represents the future of drug policy not 

just in the United States, but all over the world. 

In May 2012, the United States presented a document to the international community that sets forth the 

principles upon which the Administration's approach to drug policy is 

released at the 3rd World Forum Against Drugs, a gathering of international drug policy 

leaders and nongovernmental organizations hosted in Stockholm by the Government of Sweden. The 

Principles document represents a commitment-and an invitation to nations around the globe-to 

adopt modern approaches to address the world drug problem. It emphasizes the importance of recognizing that drug addiction is a chronic disease of the brain and that drug policies should be balanced, 

compassionate, and humane. To effectively address the disease, prevention, treatment, and recovery 

support services should be integrated into health care systems. The Principles document reaffirms that 

respect for human rights is an integral component of drug policy and recognizes that the best way to 

reduce the substantial harms associated with drugs is to reduce drug use itself. It supports the use of 

modern approaches to the drug problem, to include the expansion of medication-assisted therapies 

for drug treatment and criminal justice reforms such as alternatives to incarceration that break the cycle 

of drug use, crime, incarceration, and re-arrest. Finally, the Principles of Modern Drug Policy addresses 

the drug problem as a shared responsibility among nations, reaffirming support for the three United 

Nations drug conventions and calling for international cooperation to counter transnational organized 

crime and protect citizen security. 

Sweden proved to be a fitting setting in which to release the Principles of Modern Drug Policy, as it is a 

country with one of the most varied and instructive drug policy experiences in the world. More than 

50 years ago, the Government of Sweden undertook a social experiment in Stockholm:"legal prescription" of drugs under government and medical supervision for those with substance use disorders. The 

experiment quickly became problematic as participants began to divert the narcotics into illicit markets, 

and the program was terminated in 1967.' As a result of this negative experience with drug legalization, 

Sweden has become a global leader in advocating for balanced, evidence-based drug policies. 

Sweden's experience with drug liberalization is especially relevant today. In recent years, the debate 

about drug policy has lurched between two extremes. One side of the debate suggests that drug legalization is the "silver bullet" solution to drug control. The other side maintains a law enforcement-only 

"War on Drugs" mentality. 
7 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 9 here HDOC20.006

Neither of these approaches is humane, effective, or grounded in evidence. The Obama Administration 

supports a "third way" approach to drug control-one that is based on the results of considerable investment in research from some of the world's preeminent scholars on the disease of addiction. 

The Administration is doing its part to further the Principles, both at home and abroad. We have rebalanced national drug control policy to reflect the complexity of drug use as both a public health and 

public safety issue, dedicating more than $10.5 billion to prevention and treatment, compared to $9.6 

billion for domestic law enforcement. 

In the area of demand reduction, since 2009, the Administration has committed more than $370 million 

to the Drug Free Communities Support Program, which provides funding to community coalitions that 

organize to prevent youth substance use. We have worked to expand screening and brief intervention 

services in health care settings and ensure that treatment for substance use disorders is integrated 

into the mainstream health care system through the Affordable Care Act. The Office of National Drug 

Control Policy (ONDCP) has established-for the first time-a dedicated office responsible for policies 

and programs that support Americans in recovery from addiction. And we have supported the development of new medications to treat addiction and the implementation of medication-assisted treatment 

(MAT) protocols. MAT is being integrated into AIDS treatment through the President's Emergency Plan 

for AIDS Relief, the largest effort in history to treat a single disease. 

The Administration is also advancing criminal justice reform, supporting the efforts of more than 

2,700 drug treatment courts in the United States that provide approximately 120,000 offenders each 

year with drug treatment instead of prison? The Administration supports innovative community safety 

programs that have been proven to reduce crime and recidivism, such as enhanced probation and 

parole programs and "drug market intervention"programs that reduce open air drug markets and offer 

offenders a way out. In 2010, the President signed the Fair Sentencing Act into law, reducing the 1 00-

to-1 sentencing disparity between offenses for crack and powder cocaine. Through its support for the 

Second Chance Act, the Administration has underscored the importance of substance abuse treatment, 

employment, mentoring, and other services that improve the transition of individuals from the criminal 

justice system to a new life in the community. 

Internationally, the United States is helping safeguard human rights and is promoting evidence-based 

drug poliCies. In 2011, the nongovernmental organization Human Rights Watch released a report about 

inhumane conditions in Vietnamese treatment programs that claimed to be following the U.s. National 

Institute on Drug Abuse's (NIDA) programs were in fact not in 

accordance with NIDA's Principles and were not receiving funding from the u.s. National Institutes of 

Health. The Directors of ONDCP and NIDA reiterated the United States'strong support for safe and effective drug addiction treatment that is consistent with NIDA's Principles and internationally recognized 

human rights. In 2011 and 2012, the United States promoted best practices in demand reduction as the 

Chair ofthe Demand Reduction Experts Group of the Inter-American Drug Abuse Control Commission 

(known by its Spanish acronym, (lCAD). Since 2009, the United States has successfully sponsored UN 

resolutions on the issues of prevention, prescription drug abuse, drugged driving, and alternatives 

to incarceration. And through such programs as the Merida Initiative, the Caribbean Basin Security 

Initiative (CBSI), and the Central America Regional Security Initiative (CARSI), the United States has 

2 
8 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 10 here HDOC20.007

helped to expand judicial, social, educational, and law enforcement capacities to counter the influence 

oftransnational organized crime in the Western Hemisphere. 

The pages that follow describe in further detail the actions the Administration has taken to reduce drug 

use and its consequences, in accordance with the Principles of Modern Drug Policy and in pursuit of the 

drug policy goals established in 2010 by the President's first National Drug Control Strategy. Further information on progress toward achieving the goals of the Strategy will be provided in the 2013 Performance 

Reporting System Report.' 

3 
9 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 11 here HDOC20.008

Prevention is a foundational pillar of the National Drug Control Strategy and one of the Administration's 

highest drug policy priorities. The 2011 National Survey on Drug Use and Health (NSDUH)found that an 

estimated 22.6 million Americans age 12 and over were current (past month) iIIidtdrug users, including 

2.5 million young people between the ages of 12-17: These data demonstrate the need for a strong 

Federal commitment to substance use prevention. 

For substance use prevention efforts to be effective, they must be comprehensive in scope and take 

into account both risk factors (e.g., aggressive behavior, drug availability, and poverty) and protective 

factors (e.g., parental influence, academic competence, and family support).' Policies, programs, and 

messages that help youth abstain from drugs and alcohol are needed at home, in school, among peers, 

at workplaces, and throughout the community. Recent research has concluded that every dollar invested 

in school-based substance use prevention programs has the potential to save up to $18 in costs related 

to substance use disorders." 

Prevention efforts are most successful across settings to communicate consistent messages through 

school, work, religious institutions, and the media. Research shows that programs that reach youth 

through multiple sources can strongly impact community norms.7 It is imperative to reach parents and 

adult influencers as well as youth where they live, learn, work, and play with information aboutthe dangers of substance use and provide them with tools to help young people embrace a drug-free lifestyle. 

With this in mind, federally-supported efforts in 2012 helped states, tribal nations, and local communities 

continue to build a solid foundation for delivering and sustaining effective prevention services through 

such programs as the Substance Abuse and Mental Health Services Administration (SAMHSA) Substance 

Abuse Prevention and Treatment Block Grant, the Strategic Prevention Framework-State Incentive Grant, 

and the Partnerships for Success programs. Additionally, ONDCP's Drug Free Communities (DFC) Support 

Program provides direct funding and technical assistance to community-based coalitions that organize 

to prevent youth substance use. 

A number of Federal initiatives help ensure that communities, young people, parents, and professionals 

have the latest and most accurate information available to guide their prevention activities, particularly 

in response to some of the latest drug use trends, such as prescription drug abuse, marijuana, and synthetics (e.g.,"K-2;"'Spice;' and "bath salts"). For example, in 2012 the Above the Influence campaign, run 

by ONDCP in collaboration 

media, local radio advertising, and partnerships with community organizations to inform and inspire 

teens to reject illicit drugs. The Department of Agriculture's Children, Youth, and Families Education and 

Research Network has worked with NIDA to disseminate evidence-based prevention strategies. These 

and other activities culminated in a designating October 2012 as National 

Substance Abuse Prevention Month, during which communities nationwide were encouraged to take 

action to promote healthy, drug-free communities and workplaces. Red Ribbon Week, commemorated 

in honor of DEA Special Agent Enrique "Kiki" Camarena, who was killed in the line of duty in 1985, is 

S 
10 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 12 here HDOC20.009

DRUG 

observed during the final week of Prevention Month. Americans across the country participate by 

organizing community anti-drug events and making pledges to live drug-free lives. 

Federally-supported prevention activities conducted in 2012 focused on three major goals: (1) furthering 

the development of a national prevention system infrastructure; (2) facilitating dissemination of evidence-based drug prevention messaging, with an emphasis on marijuana, synthetics, and prescription 

drug abuse; and (3) enhancing the role of law enforcement in locally-based drug prevention initiatives. 

CollatJor,ate with 

The 2010 National Drug Control Strategy underscored the importance of preparing communities to 

provide effective prevention services. States playa critical role in thi~ffort, and SAMHSA continues to 

promote state-community prevention partnerships through its Partnerships for Success program. In 

2012, SAMHSA awarded 15 grants totaling more than $42 million to address underage drinking and 

prescription drug abuse among high-risk populations through the Strategic Prevention Framework 

Partnerships for Success II grants. These grants help build prevention capacity, develop data-driven 

strategies, implement comprehensive, evidenced-based approaches, and evaluate outcomes. Under 

the Department of Education's Safe and Drug-Free Schools and Communities programs, resources and 

technical assistance have been provided to state education agencies, as well as to school districts and 

schools, to implement programs to monitor and improve the school climate, while discouraging drug 

use. in addition, the Administration has proposed to create a new Successful, Safe, and Healthy Students 

Program at the Department of Education that would provide increased flexibility to States and school 

districts to design and implement strategies that best reflect the needs of their students and communities (and which may include programs that focus on drug and violence prevention). Community law 

enforcement officers receive support from the Department of Justice's (DOJ) Edward Byrne Memorial 

Justice Assistance Grant Program to support community drug prevention programs. The Department of 

Defense (DOD) as well as the Administration for Children and Families reaches some of our most"At Risk" 

kids through the National Guard ChalleNGe Program, and the Program to Enhance Safety of Children 

Affected by Substance Abuse respectively. 

Workplaces provide an opportunity to educate millions of Americans about the dangers of drugs and 

alcohol, reinforce drug-free norms, ensure the safety and wellness of employees, and offer assistance 

through referrals and support to employees who are experiencing substance use disorders themselves 

or within their families. The workplace is an ideal setting in which to deliver prevention messaging for 

working parents to deter substance use in their families. 

The Federal Drug-Free Workplace Program is a comprehensive program to achieve a drug-free workplace; it applies to the Federal workplace but also serves as a model for the private sector. Examples of 

approaches in the program include the use of written policies, employee education, supervisor training, 

employee assistance programs, and provisions to identify illegal drug use, including drug testing.s For 

6 
11 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 13 here HDOC20.010

L TO OUR 

example, the Department ofTransportation (DOT) oversees a strong drug and alcohol testing program to ensure public safety. During calendar year 2011, transportation employers conducted nearly 

5.7 million drug tests, and in the first 6 months of2012, they conducted nearly 3 million drug tests. DOT 

also provides outreach to the public in the forms of highly utilized websites, numerous presentations 

at conferences and meetings, and a variety of "tool kits" and guidance documents for employers and 

employees. Importantly, the DOT program also requires that transportation employees identified as 

having substance abuse problems are referred for evaluation and treatment. SAMHSA also funds the 

Preventing Prescription Abuse in the Workplace (PPAW) program to provide technical assistance to help 

civilian and military workplaces in communities reduce prescription drug abuse problems. The PPAW 

provides a variety of technical assistance resources to workplaces, SAMHSA's grantees, and community 

partners. 

In FY 2012, the Administration provided $85 million in DFC Support Program funds to support community-based prevention. This consisted of $7.9 million in new DFC grants to 60 communities and 

6 new OF( Mentoring grants, building on the $76.7 million in continuation grants that were awarded 

to 608 currently-funded DFC coalitions and 18 DFC Mentoring coalitions. Over the past 8 years, DFCs 

have achieved significant reductions in youth alcohol, tobacco, and marijuana use among middle school 

youth." 

7 
12 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 14 here HDOC20.011

ONDCP's National Youth Anti-Drug Media Campaign was created by Congress in 1998 to educate and 

prevent drug use among youth and has been the Nation's sole and consistent vehicle for providing 

national-level drug prevention messaging via mass media and public outreach. As the Media Campaign 

has been refined, this action item has been modified to reflect the Media Campaign's efforts under the 

Above the Influence brand (ATI). 

ATI has achieved a high 88 percent awareness level among teens, and the campaign continues to have 

aboYetheinfluence.com 

a strong presence on social networks. The ATI Facebook community recently surpassed 1.7 million "likes;' making it one ofthe 

largest teen-targeted Facebook presences among Federal 

Government or nonprofit youth organizations. Additionally, 

three independent peer-reviewed studies have confirmed that 

the Media Campaign is effective, relevant to youth, and instrumental to drug prevention efforts in communities across the 

country.l~16,17 

Local engagement with ATI has amplified the Media Campaign's effects. To foster youth participation 

at the community level, the campaign has partnered with more than 80 youth-serving organizations 

in over 45 cities to provide a recognized national platform that can be adapted to provide customized 

local advertising in ATI communities. More than 1,000 community organizations have received technical 

assistance and training through conferences and webinars. 

c. 

Parents and positive adult influencers, including mentors, playa vital role in healthy youth development 

and substance use prevention. A study of one national mentoring program notes that youth involved in 

mentoring are 46 percent less likely to begin using illegal drugs.laThe 4-H program is a youth organization supported by the National Institute of Food and Agriculture of the U.s, Department of Agriculture, 

8 
13 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 15 here HDOC20.012

L 

with the mission of "engaging youth to reach their fullest potential while advancing the field of youth 

development'With over 6 million young people ages 5-19 participating across the country, the program provides one-on-one mentoring and group mentoring for youth and assists them in developing 

long-term goals. More specifically, the 4-H Mentoring: Youth and Families with Promise program is a 

prevention program targeted to at-risk youth ages 10-14; these programs incorporate "family night out;' 

4-H activities such as club and social involvement, and one-to-one mentoring. 

Parents are often the source of the first messages children will hear about their health and wellbeing, and parents often ask how to talk to their children about staying drug-free. In October 

2012, NIDA launched a new research-based prevention tool, the ''',_' ... :C''',-':;:',: .. ,''':,_,'.""_'.:,,''''_:,'_.'C' 

which highlights parenting skills that are important to prevent the initiation and progression 

of drug use among youth. Based on the work of the Child and Family Center at the University of 

Oregon, the Family Check-Up contains five questions and discussion pOints to help parents better communicate with their children and prevent negative behaviors like substance use. Also 

in late 2012, the Department of Education partnered with the Drug Enforcement Administration 

(DEAl- to update and release a new version of their popular publication, _,:"",-,:-'~C2.,=:::::::':C,"':'.,:.:_::. 

A ONDCP also included materials to help parents talk with their children 

in 

9 
14 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 16 here HDOC20.013

3. 

In FY 2012, the u.s. Department of Education's Center for Alcohol, Drug Abuse, and Violence Prevention 

conducted trainings for college and university officials on creating a substance-free social and cultural 

environment on college campuses, engaging campus prevention experts, researchers, Federal partners, 

and representatives from the Collegiate Recovery Network. Because of a significant cut in appropriated 

funds for the Safe and Drug-Free Schools and Communities program, the Department no longer operates the Higher Education Center as a stand-alone technical assistance center. Instead, the Department 

has restructured and consolidated its technical assistance centers that focus on school climate and 

alcohol and drug use prevention at the elementary, secondary, and postsecondary levels to develop and 

share resources rnore cost-effectively and provide coordinated technical assistance. The new National 

Center on Safe Supportive Learning Environments begatioperations on November 1,2012. 

More research is needed to address the many variables pertaining to understudied drugs, such as synthetic cathinones and cannabinoids (e.g., "K2,""Spice~ and "bath salts"). To date, there has been limited 

substance abuse research conducted on these substances. The NIDA-supported Monitoring the Future 

Study began collecting data on teen use of synthetic cannabinoids in 2011 and synthetic cathinones 

in 2012 to help inform prevention efforts. NIDA also supports research to better understand how these 

emerging drugs affect the brain. In response to new substance use trends, ONDep will collaborate with 

Federal partners to develop a research agenda on emerging substances abused by youth. 

the 

The Office of the Surgeon General is developing a Call to Action to Prevent Prescription Drug Abuse among 

Youth that will outline speCific strategies that can be taken by multiple sectors of the community: youth, 

parents, law enforcement, community coalitions, and Federal, state, and local government and law 

enforcement agencies. This report will help implement the first pillar ofthe Administration's Prescription 

Drug Abuse Prevention Plan: Educating parents and youth on the dangers of prescription drug abuse. 

4. Criminal Justice <An,,,,,.. ... ,,,,,, 

Collaborate 

Law enforcement agencies can playa pivotal role in reducing substance abuse in communities; they 

should be a part of a comprehensive approach when addressing substance use. In 2012, ONDCP provided the Drugged Driving Toolkit to the National Association of School Resource Officers to help officers 

to identify, educate, and prevent youth drugged driving. In addition, DO) sponsors the interagency 

National Forum on Youth Violence Prevention, a working group mechanism that helps cities work with 

young people to deter youth violence in their communities by encouraging them to rise above the 

10 
15 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 17 here HDOC20.014

OUR 

negative influences in their lives. In 2012, four additional cities were added to DOJ's National Forum on 

Youth Violence Prevention: Camden, NJ, Minneapolis, MN, Philadelphia, PA, and New Orleans, LA. These 

bring the current total of cities participating to ten. 

The High Intensity Drug Trafficking Areas (HIDTA) program provides assistance to Federal, state, local, 

and tribal law enforcement agencies operating in areas determined to be critical drug trafficking regions 

of the United States. A number of HIDTAs emphasize prevention and treatment as part of their strategies.ln 2012, ONDCP awarded 20 HIDTA grants totaling $2.9 million to increase coordination between 

prevention programs and law enforcement. For example, the Washington/Baltimore HIDTA sponsors the 

Richmond Neighborhood Drug Intervention and Prevention Initiative, a program for nonviolent youth 

offenders that combines prevention, treatment, and intervention and offers educational and vocational 

opportunities. Young offenders who take part in the program gain the opportunity to reintegrate into 

the community with new skills. Additionally, the Department of Homeland Security (DHS) provided 

web-based training to community coalitions on strategies communities can use to prevent substance 

abuse. The National Guard Counterdrug Program's Civil Operations Division coordinates and provides 

services to anti-drug coalitions and other prevention providers at schools and in communities. Since 

2004, the five National Guard Counterdrug Schools have sponsored training for community coalitions. 

DENs Demand Reduction Section continues extensive public education through its teen website, 

~~1':l"":':l''!''.'''-\I';~':(;''':'':>f1l, and the parent website, DEA produced 

several educational publications targeting teens and parents, including Prescription for Disaster: How 

TeensAbuse Medicine. DEA collaborated with the Boys & Girls Clubs of America to produce Getit Straight 

for middle school youth and the Get it Straight Facilitator Guide. 

In 2012, SAMHSA sponsored the"U5. Counties along the Mexico Border Initiative;'which assists schools, 

community centers, workplaces, and local prevention providers along the border to assess population 

needs, resources, and readiness to provide culturally and linguistically appropriate programs. In addition 

to the border counties initiative, the NIDA-supported "VIDA" (Vulnerability Issues in Drug Abuse) Program 

prepares faculty and students to conduct drug abuse research and training for underrepresented communities. VIDA partnered with the University ofTexas-EI Paso to hold a conference for both behavioral 

health providers and researchers to present and discuss effective program strategies, including the use 

of promotores (community health workers) for populations along the border. 

11 
16 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 18 here HDOC20.015

Health care practitioners have the important responsibility of looking after their patients' general health 

and welfare. With the full implementation ofthe Affordable Care Act in 2014, many more people will 

be eligible for substance use disorder services. Expanding the range of doctors, physicians' assistants, 

nurses, counselors, social workers, and other specialists able to identify and ensure treatment for individuals with substance use disorders has important implications for the health of the American people 

and our Nation's economy. Further, we must continue to focus on efforts to expand and modernize the 

continuum of services health care practitioners provide for their patients, to include substance abuse 

services. 

A Team of Health Care Practitioners The health care field will continue to need to adopt and 

integrate evidence-based approaches to address substance use disorders. Successful integration of evidence-based approaches into mainstream health care 

will require health care practitioners to work in teams 

that often include specialists from other medical fields. 

To enhance this professional cooperation, team members will need to understand the disease of addiction 

to address a wide range of substance use problems in 

a variety of settings. 

A number of tools are available to help health care providers detect and address substance use disorders. 

Through Screening, Brieflntervention, and Referral to Treatment (SBIRT), practitioners ask their patients 

about their substance use (screening) to assess the risk of substance use disorders and then, if appropriate, provide a brief intervention or referral to treatment. SBIRT integrates and coordinates screening and 

treatment services and links those services to local specialized treatment programs through a network 

of early intervention and referral activities. 

The Affordable Care Act ends discrimination against people with pre-existing conditions, including 

people with mental health and substance use disorders. Insurers can no longer deny coverage to children 

because of a pre-existing condition, and, starting in 2014, refusing to cover anyone with a pre-existing 

condition will be prohibited. SBIRT helps identify people who may otherwise go undiagnosed with a 

chronic substance dependence problem (categorized prior to the Affordable Care Act as a pre-existing 

condition) and get them into care. SBIRT is an intervention approach to address risky use (counseling) and an opportunity to diagnose and refer patients to specialty treatment, all as covered services. 

Furthermore, a variety of health systems across the Nation are integrating SBIRT into electronic health 

records to better coordinate patient care. 

Research on SBIRT's effectiveness for alcohol and substance use problems indicates the approach leads 

to short-term health improvements and suggests potential long-term benefits.19•

20 

13 
17 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 19 here HDOC20.016

DRUG 

Data from SAMHSA grant programs help demonstrate the effect SBIRT has on patient health. Through 

the SAMHSA SBIRT initiative, patients experienced: 

Reductions in alcohol and drug use 6 months after receiving the intervention; 

Improvements in quality-of-life measures, including employment/education status, housing 

stability, and past 3D-day arrest rates; and 

Reductions in risky behaviors, including fewer unprotected sexual encounters.21 

In 2012, SAMHSA's Center for Substance Abuse Treatment funded the continuation of 27 SBIRT grants 

and three new multi-year grants. Grantfunds will further integrate SBIRTwithin medical treatment settings to provide early identification and intervention services to at-risk individuals within the context 

of their primary care provider. 

NIDA continues to encourage physicians and other health care professionals to screen for drug abuse, 

enhancing its tools and resources including its interactive screening tool that generates clinical recommendations. The tool is available on the NIDAMED website and is now optimized for mobile devices 

(described in more detail later in this chapter). Also in 2012, the Department of Health and Human 

Services' Agency for Healthcare Research and Quality funded 

a program of the University of Wisconsin School of Medicine and Public Health. The project 

produced information and tools to help employers promote employee health, including a cost-effective 

behavioral screening and intervention program." As Wisconsin's health care system moves toward systematically addressing substance use disorders in its patient population, initiatives such as this that rely on 

university and employer partnerships should be considered as a model for public-private collaborations .. 

14 
18 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 20 here HDOC20.017

In 2012, the number of states adopting the set of codes for SBIRT as a reimbursable service under their 

state Medicaid plans increased from 16 to 19 states. These codes are used to report medical services 

for private and public health insurance systems for reimbursement and claims processing. They also 

provide uniformity in language to provide reliable nationwide data collection. In Medicare, to assist 

more providers in using the codes, the Center for Substance Abuse Treatment partnered with the Centers 

for Medicare & Medicaid Services' (CMS) Medicare Learning Network to develop materials and coding 

instructions for Medicare code reimbursement. 

In 2012, SAMHSA continued to fund training for medical residents and allied health professionals on 

SBIRT. Since the grant was initiated in 2009, nearly 4,700 medical residents and 10,300 allied health 

professionals have been trained. Information about SBIRT training curricula is available for health 

care providers on SAMHSA's An Addiction TechnologyTransfer Center (ATTC) for SBIRT has 

been established through SAMHSA's ATTC network, and will be providing extensive resources for the 

implementation of SBIRTto SAMHSA grantees (with the exception of current SBIRT grantees) and other 

interested health care entities. 

15 
19 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 21 here HDOC20.018

In 2012, the Department of Veterans Affairs (VA) and the DOD developed 

health care providers for military personnel/veterans deliver evidence-based treatment 

consistent with both Departments' Clinical Practice Guidelines to further reduce drug abuse among 

military members and their families. The toolkit increases knowledge and facilitates treatment decisions for both providers and patients. It includes a pocket guide to help providers treat patients and 

improve outcomes by assisting with symptom recognition, treatment, and management; a booklet that 

highlights MAT for alcohol dependence that provides patients with the knowledge to make informed 

choices regarding their treatment; and a brochure for family members about substance use disorders 

and support-focused resources. 

To provide additional training and education for Military Health System medical providers who prescribe 

potentially addicting medications, an interactive video training entitled "Do No Harm"was developed 

by the Uniformed Services University of the Health Sciences (USUHS) to illustrate the most important 

points about prescription medication misuse. The interactive video training addresses the incidence 

of medication misuse; risk factors and risk stratification of patients for medication misuse; steps to 

mitigate medication misuse; and indications for referral to subspecialty providers. This training will be 

disseminated to medical providers in 2013. 

Finally, in 2011, the Women's 

women veterans face numerous challenges that put them at greater risk of homeless ness and substance 

abuse. The "Trauma Guide" is meant to address the psychological and mental health needs of women 

veterans by offering best practices to service providers for engaging female veterans. The guide offers 

observational knowledge and concrete guidelines for modifying practices with the goal of increasing 

re-entry outcomes. 

16 
20 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 22 here HDOC20.019

2. 

17 
21 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 23 here HDOC20.020

Investing in treatment for substance use disorders reduces health care costs, reduces other costs to 

society, and saves lives.26•

27.,8,29 Despite its proven efficacy, only a modest percentage of those needing 

treatment access it. In 2011,21.6 million persons aged 12 or older needed treatment for an illicit drug 

or alcohol use problem, but only 2.3 million persons (1 0.8 percent of those needing treatment) received 

it'o Studies have demonstrated that patients receiving certain evidence-based treatment approaches 

achieve longer sustained periods of abstinence and/or decreased use than patients in comparison 

conditions.31,32,33.34,35,36.37.3B 

Factoring in public health, crime, and lost productivity, illicit drug use cost the country an estimated $193 

billion in 2007.39 Findings from one California study suggest employee substance use can be extremely 

costly to employers and that substance abuse treatment for 60 days or more can save over $8,200 per 

person in health care and productivity costs:oThe Affordable Care Act will expand mental health and 

substance use disorder benefits and parity protections for 62 million Americans. Beginning in 2014, 

all new small group and individual private market plans will be required to cover mental health and 

substance use disorder services as part of the health care law's Essential Health Benefits categories, and 

mental health benefits will be covered at parity. Also beginning in 2014, insurers will no longer be able 

to deny anyone coverage because of a pre-existing condition. 

In addition, as part of its efforts to better address substance use-both in the workplace and elsewhere-SAMHSA will continue to work toward adoption of electronic health records. This technology 

is needed to better integrate substance use disorder services with broader health systems services, 

support the integration of evidence-based practices, and improve quality, coordination, and accountability. Ongoing training, technical assistance, consultation, and evaluation are needed to support this 

transition. 

The Administration is working with states, tribes, local governments, treatment and recovery support 

services providers, and other stakeholders to develop systems and services that support sustained 

recovery. An essential component of this effort is promoting the use of recovery support services-nonclinical services that target people in or seeking recovery. These services are often provided by people 

who are themselves in sustained recovery and are employed by or volunteer at peer-led recovery 

community organizations. Evidence shows that expanding recovery support services increases the 

percentage of people that successfully navigate the passage from early recovery to stable recovery. 

While limited research has been conducted on recovery support services, there is nonetheless evidence 

of their effectiveness. For example, residence in an Oxford House, a form of peer-run recovery residence, 

is associated with reduced substance use, increased employment, and improved self-regulation.41 

Moreover, the Oxford House model has been found to be cost-effective:2 An evaluation of the Texas 

Access to Recovery program found that services "most closely related to the process of recovery" (e.g., 

19 
22 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 24 here HDOC20.021

CO:-':TROL 

individual recovery coaching, recovery support groups, spiritual support groups, and relapse prevention 

groups) were associated with positive recovery outcomes.43 Research on the Washington State Access 

to Recovery program found participation in the program was associated with increases in length of stay, 

treatment completion, rates of employment,44 and reductions in Medicaid costS.45 

Recognizing the value of recovery support services, the Administration has prioritized the further development of recovery support services and recovery-oriented service systems. Given the developmental 

nature of substance use disorders and the benefits ofintervening early, ONDCP is giving special attention 

to substance use disorders among adolescents and young adults. Data from NSDUH (2011) bear out the 

need for such a focus. Among young adults aged 18 to 25, rates of substance use disorders are nearly 

three times those found in adults over the age of 25 (21.4 percent versus 6.3 percent), while 6.9 percent 

of young people aged 12 to 17 were estimated to have substance use disorders."· 

Very often laws, rules, policies, and practices create barriers to sustained recovery. For example, individuals with a drug conviction may be denied housing, professional licenses, employment, and educational 

opportunities. When this occurs, it is not only people in recovery who pay a price, but also their families 

and the broader community. This is why modifying or eliminating laws, rules, policies, and practices 

that create barriers to recovery remains one of the Administration's priorities. We must also support 

the development of a robust recovery research agenda to improve our understanding of what policies, 

services, and approaches best support recovery. 

Addi(:tio,n Treatment Be 

.. " ..... "'''''''' Health 

Substance use disorder services are one of the ten categories of essential health benefits specified in 

the Affordable Care Act, providing more people with access to treatment services. Health Centers are 

preparing for coverage expansion in a number of ways. For example, in 2012, the SAMSHA- and HRSAfunded Center for Integrated Health Solutions provided training to Federally Qualified Health Centers 

on substance abuse services, including a webinar on best practices in SBIRT. This webinar is posted on 

Integrated Health Solutions website dedicated to expanding 

SBIRT skills for the health care workforce. 

In 2011, the Indian Health Service hired additional behavioral health specialists, including chemical 

dependency counselors, and offered training scholarships to support the development of new behavioral health specialists. Important steps were also taken to pave the way for integrating SBIRT into Indian 

Health Service emergency clinics. 

20 
23 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 25 here HDOC20.022

In February 2011, the VA launched a website with information about resources available to help veterans 

and their family members answer questions, find support, get treatment, and recover from substance 

use disorders. In addition, VA offers resources for VA health care practitioners, to include: 

(TMS) courses: VA'sTMS courses provide information to VA 

practitioners on opioid therapy practices in inpatient and outpatient settings, including the 

use of opioids for acute pain (including patient controlled analgesia) and chronic pain. Courses 

focus on the management of complex pain patients and on the treatment of pain in primary 

care rural health care settings. 

ance to primary care clinicians, specialists, researchers and other health professionals as they 

encounter patients with persistent pain and its complications. 

VA is preparing to participate in state Prescription Drug Monitoring Programs (PDMPs). The Administration 

worked with the Congress to secure language in the FY 2012 Consolidated Appropriations Act to allow 

VA to share prescription drug data with state PDMPs, an important development to ensure safe prescribing and patient safety for our veterans. Publication of an interim final rule on February 11,2013 

amended VA's regulations conceming the sharing of certain patient information in order to implement 

VA's authority to participate in state PDMPs. VA is developing the informatics solution for each VA medical 

center to submit prescription data. 

In 2012, the Institute of Medicine's study on current substance use problems within the u.s. military 

found that a long history of alcohol and other drug misuse and abuse has been transformed by increasing rates of prescription drug abuse among service members, while heavy alcohol use and binge drinking continue to be a concern within the military.'7To address substance use disorders among service 

members, the Institute of Medicine recommends that evidence-based prevention, screening, diagnosis, 

and treatment practices be incorporated into the principles and structures of DOD policies. ONDep will 

continue to work closely with DOD to ensure thattraining, credentialing, and staffing requirements for 

substance use disorders are achieved; that treatment services are implemented systematically; and that 

these services are expanded and improved for all military branches. 

Electronic health records assist service providers in making decisions and developing appropriate 

courses of treatment based on patients'full medical history, including treatments, medications, and therapies performed and prescribed by other providers. In 2012, SAMHSA, (MS, and the Health Resources 

and Services Administration established two health information technology plans for substance use 

disorder treatment providers to use as models to automate and standardize data collection, information sharing, and service reimbursement. Also in 2012, SAMHSA conducted 15 webinars on health care 

reform activities, including state insurance exchanges, tribal consultation, health homes, and account21 
24 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 26 here HDOC20.023

able care organizations, and provided an overview of Medicaid expansion and opportunities under the 

Affordable Care Act 

E. 

On February 23, 2011, the Department of Health and Human Services published a notice in the Federal 

Register stating that the Surgeon General of the United States has "determined that a demonstration 

needle exchange program (or more appropriately called syringe services program or SSP) would be 

effective in reducing drug abuse and the risk that the public will become infected with the etiologic 

agent for acquired immune deficiency syndrome:'This determination was required by law to permit 

the expenditure of Substance Abuse Prevention and Treatment Block Grant funds for syringe services 

programs. Unfortunately, the Congress reinstated the ban on most Federal funding for syringe services 

programs in the FY 2012 Omnibus appropriations bill. 

...... , .... "' ... Patients 

NIDA has made the development of addiction medications a top priority, particularly for stimulants (e.g., 

cocaine, methamphetamine), marijuana, and polysubstance addiction for which there are no approved 

medications. To garner more pharmaceutical involvement, NIDA is taking the approach of "de-risking" 

compounds in the early stages of discovery-awarding large grants up-front for shorter durations 

to encourage quicker results among closely monitored grantees or to allow a change in direction as 

needed. This more nimble strategic approach was prompted in part by the successful clinical trial of 

Probuphine'M, supported by 2-year American Recovery and Reinvestment Act funding. Probuphine 

is a form of buprenorphine that is implanted under the skin and allows continuous delivery of the 

medication for 6 months after a single treatment, potentially eliminating the need for a daily dose and 

reducing the potential for diversion and abuse. Titan Pharmaceuticals, the manufacturers of Probuphine, 

announced in October 2012 that it filed a New Drug Application with the FDA, which has granted the 

application priority review and will determine if Probuphine'M meets approval standards. 

NIDA is also funding a promising approach to treat stimulant and other substance use disorders that 

uses anti-drug enzymes or antibodies to neutralize the substance while it is still in the bloodstream, 

keeping it from entering the brain. To help advance the marketability of this approach, two recent 

NIDA-supported preclinical studies have developed a strategy that uses non-infective viruses modified 

to deliver (harmlessly) a gene that codes for the desired enzyme or antibody. Preliminary results show 

that, once expressed in the body after a single injection of the virus carrier, these gene products can 

interfere with the pharmacological effects of the target drug for a long time. 

ONDCP will continue to work with NIDA and the FDA to ensure new medications are brought through 

development and testing. It is critical that these medications are then made available in the market, 

particularly in underserved communities such as rural areas and other locations with limited treatment 

infrastructure. 

22 
25 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 27 here HDOC20.024

While new medications continue to be developed, broader adoption of existing medicines to manage 

substance use disorders is necessary. In one important step, the DOD is working on a proposed rule 

to lift the prohibition on covering the treatment of substance use disorders through maintenance on 

substances with addictive potential, such as methadone or buprenorphine. 

SAMHSA intends to provide training on core business operations practices to at least 250 substance 

abuse provider and recovery support organizations each year through the Provider Business Operations 

Learning Networks project (BHBusiness). SAMHSA has launched the BHBusiness project and is in the 

process of developing the learning modules and provider application/selection criteria. 

ONDCP and the Department of Health and Human Services worked with Federal partners to develop 

consensus recommendations for 14 behavioral health-related clinical quality measures. Each measure 

supports one or more of the Institute of Medicine domains of health care quality, promoting effective, 

safe, efficient, patient-centered, equitable, and timely care. These mental health and substance use 

disorder treatment measures will be included in the Center for Medicare & Medicaid Services' Electronic 

Health Records Meaningful Use Incentive Program. The Meaningful Use program provides Federal 

incentives to help health care providers adopt electronic health records. 

In 2012, the FDA, NIDA, SAMHSA, and the Centers for Disease Control and Prevention (CDC) worked 

together to develop approaches to reduce opioid overdose fatalities and identify issues related to more 

widespread availability of and access to naloxone A detailed discussion of the Administration's overdose 

prevention and intervention efforts is included under"Policy Focus: Preventing Prescripticm Drug Abuse:' 

Individuals involved in the criminaljustice system have disproportionately high rates of substance use 

disorders and infectious diseases, including HIVIAIDS. Effective linkage to HIV treatment can not only 

improve health outcomes for offenders but also limit HIV's spread in the community. NIDA seeks to 

enhance HIV and other infectious disease screening and treatment for offenders. NIDA is supporting 

research to develop and test strategies for identifying criminal justice-involved individuals who have 

not recently been tested (seek), provide them with HIV testing (test), and initiate, monitor, and maintain 

Highly Active Antiretroviral Therapy (HAART) for those who test positive (treat). These grants will test 

strategies to link HIV+ individuals in criminal justice settings to HIV care in the community; use trained 

peers to help access and sustain HIV services; integrate HIV testing and treatment into jail and prison 

settings; integrate HIV and addiction treatment; and study the impact of seek, test, and treat strategies 

at the community level. NIDA's Criminal Justice-Drug Abuse Treatment Studies, a multisite research 

collaborative, is also testing implementation strategies for an HIV continuum of care-that is, screening 

23 
26 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 28 here HDOC20.025

and counseling, risk-reduction interventions, and continuity of antiretroviral treatment from prison or jail 

into the community. SAMHSA is also working to achieve the complementary goals of the National Drug 

Control Strategy and National HIV/AIDS Strategy through various grant programs focusing on minority 

populations at risk for HIV, injection drug users, and those being served by substance use treatment 

centers. 

to HprnIfPI'\! 

SAMHSA's Access to Recovery (ATR) Program gives grants to states and tribes to provide vouchers 

to people who are seeking or are in recovery, enabling them to choose the treatment and recovery 

support services they need. Recovery support services are non-clinical in nature and can include peer 

recovery coaching or job readiness and employment services, transportation, and recovery housing, 

among many other services. In 2011, the most recent year for which data are available, the program 

exceeded its capacity expansion goal by a Significant margin, serving 47,036 individuals, or 140 percent 

of its goal of 33,500. Six months after admission to the program, 82.1 percent of participants reported 

no substance use during the past month, and 96.7 percent of participants reported no involvement or 

reduced involvement with the criminal justice system. Additionally, 90 percent of participants reported 

increased interaction with family members and friends who were supportive of their recovery during 

the 6 months post-admission.4s 

and "e\~Uldll'JI that Impede KP(TI\I,C'n! 

In 2012, ONDCP reviewed procedures and practices related to the administration of Federal student 

loans and grants to identify potential barriers to recovery. Formerly, the law made individuals with a past 

drug conviction ineligible for Federal financial aid. Now the law only restricts the eligibility of individuals convicted of a drug offense that was committed while they were receiving Federal financial aid. To 

help reduce confusion that could arise for applicants with a past drug conviction, the Department of 

Education changed the online version of the Free Application for Federal Student Aid (FAFSA) form so 

students who have not previously received Federal Student Aid-and are therefore not affected by the 

restrictions currently in the law-are not asked about past drug convictions. ONDCP is currently working 

with the Department of Education to identify additional steps to reduce potential barriers to Federal 

student assistance. ONDep is also working with the Department of Housing and Urban Development 

(HUD) and the Interagency Reentry Council to highlight the importance of helping people reentering the 

community from incarceration to access public housing and federally-subsidized privately held housing. 

In December 2012, SAMHSA issued a revised Federal rule governing the dispensing of buprenorphine 

in opioid treatment programs. Previously, a patient prescribed buprenorphine through an opioid treatment program needed to be in stable treatment for 9 months before the physician was authorized to 

permit dispensing of take-home medication. Under the new rule, the physician is afforded discretion 

to determine when and how to dispense take-home medication. 

24 
27 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 29 here HDOC20.026

c. 

ONDCr, SAMHSA, and a range of non-governmental organizations are collaborating to expand community-based recovery support services. ONDCP has participated in the ongoing development of voluntary 

national accreditation standards for recovery community organizations and has nearly tripled the size 

of its Recovery-Oriented Systems of Care Learning Community for states, tribes, and local governments, 

bringing its membership to 16 jurisdictions. ONDCP also participated in the development of webinars 

and a training institute on collegiate recovery programs. Additionally, SAMHSA conducted a policy 

academy for states wishing to implement the Recovery-Oriented Systems of Care framework. ONDCP 

continues to highlight the needs of adolescents and young adults in recovery, to include promoting 

the importance of recovery high schools and collegiate recovery programs. 

25 
28 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 30 here HDOC20.027

Decades of scientific study show that addiction is a disease of the brain that can be prevented and 

treated. While smart law enforcement efforts will always playa vital role in protecting communities 

from drug-related crime and violence, we cannot arrest our way out of the drug problem. Over the past 

3 years, the Administration has sought to reform the criminal justice system to more effectively address 

individuals with substance use disorders and reduce recidivism. When an individual becomes involved 

with the criminal justice system, it may be their first opportunity to obtain substance abuse treatment. 

The need for treatment is underscored by new data on drug use rates among arrestees. The 2011 Arrestee 

Drug Abuse Monitoring (ADAM) program indicates that in each of the 10 participating metropolitan 

areas, more than halfof the adult males arrested for crimes-misdemeanors and felonies-tested 

positive for at least one drug.49 

The Administration supports alternatives to incarceration such as drug courts, diversion programs, 

enhanced probation and parole programs, and other supervision strategies that include communitybased treatment and services. Through DOJ's Justice Reinvestment Initiative, the Administration is working at the state and county level to analyze prison and jail populations and corrections expenditures. 

This analysis will support the development of policies to decrease costs and recidivism and reinvest 

savings into community supervision programs and services, including substance abuse treatment services. Currently, 17 states and 18 counties are participating in this initiative.soThe Administration is also 

reducing barriers to reentry and recovery for formerly incarcerated individuals by reviewing regulations 

and policies, clarifying misconceptions, correcting unnecessary barriers, and supporting treatment and 

other services for formerly incarcerated individuals. 

Placing more non-violent individuals with substance use disorders on community supervision and 

proViding treatment and other services is gaining acceptance among criminal justice scholars and 

practitioners. Education for criminal justice and law enforcement professionals on the science of 

addiction and the neurological effects of drug use can help facilitate more innovation in the field. In 

addition, criminal justice professionals should include the use of MAT as appropriate for those in the 

juvenile and criminal justice systems. At the Federal level, research is underway to identify the best 

strategies for implementing MAT in criminal justice settings. For example, with funding from NIDA, the 

Federal Bureau of Prisons (BOP) has partnered with Texas Christian University to conduct a five-year 

Medication-Assisted Treatment Implementation in Community Correctional Environments (MATICCE) 

research project; preliminary results are expected in 2013. 

In addition, more can be done to prevent young people from entering or spiraling further into the 

justice system due to substance use disorders. In July 2012, NIDA announced it is seeking proposals 

for multisite studies focusing on the continuum of substance abuse prevention and treatment services 

delivered to youth under juvenile justice supervision. These studies will be developed and conducted 

across a variety of community-based supervision settings, including juvenile probation, truancy and 

teen courts, and adolescent drug courts to determine the effectiveness of evidence-based substance 

abuse interventions in real world settings. The multisite studies are expected to begin in July 2013. 

27 
29 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 31 here HDOC20.028

PII"~viri~ Communities 

Markets and 

The Drug Market Intervention (DMI) model has proven effective in shutting down open-air drug markets 

through community-based solutions and direct engagement among law enforcement, prosecutors, 

drug dealers, their families, and communities. The Bureau of Justice Assistance (BJA) supports the 

implementation and operations of the DMI model through its DMI Training and Technical Assistance 

Initiative conducted by Michigan State University (MSU) for existing and new sites. To date, there have 

been 24 sites trained through this initiative. In FY 2013, MSU's training and technical assistance effort 

will be coordinated with BJA-supported efforts underway at the John Jay College of Criminal Justice and 

the National Network for Safe Communities. MSU's DMI Training and Technical Assistance Initiative has 

been extended to December 31,2013. The National Network for Safe Communities' project was initiated 

in October 2012 and will be supported for a period of 3 years. The National Institute of Justice (NU) is 

evaluating seven sites trained as part of this BJA initiative. Four of the seven sites have implemented 

OMI to date. The evaluation is focusing on the effects ofthese OMI efforts on open air drug markets. The 

evaluation will be completed in 2015. 

The National Youth Violence Prevention Forum is a White House-led initiative commissioned by the 

President in 2010, linking cities and Federal agencies together to implement strategies and programs 

to prevent youth and gang violence in the United States. The Administration has engaged community 

and faith-based leaders through Forum meetings and site visits to the Forum participating cities.51 In 

2012, the Forum added four new cities: Camden, NJ; Minneapolis, MN; New Orleans, LA; and Philadelphia, 

PA.52 These interactions deliver information and identify training and technical assistance and funding 

resources for cities in their efforts to reduce youth violence, of which drug-related crime is a significant 

subset. 

The Administration supports research into innovative criminal justice approaches to share with communities throughout the country. In 2011, BJA funded the Honest Opportunity Probation with Enforcement 

Demonstration Field Experiment (HOPE OFE) in four jurisdictions. Based on the success of Hawaii's 

Opportunity Probation with Enforcement (HOPE) initiative, these two-year projects will use drug testing 

and swift and certain sanctions to reduce probation violations. The HOPE DFE is currently underway 

and BJA has been conducting site visits and providing technical assistance for four selected sites. 53 NU 

is conducting an evaluation to determine the effectiveness of the HOPE model at the four sites. The 

evaluation results are expected in summer 2015. 

28 
30 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 32 here HDOC20.029

Addressing the challenges of pretrial justice is a necessary component of criminal justice reform. 

First convened in October 2011 and continued in 2012, the Office of Justice Programs Pretrial Justice 

Workgroup focused on improving the costly pretrial justice system. Two pretrial risk assessment tools are 

currently being implemented in Colorado and Florida. These tools assist criminal justice professionals in 

making decisions about particular individuals during pretrial. BJA also issued two publications: "Pretrial 

Risk Assessment 1 01" and "Using Technology to Enhance Pretrial Services: Current Applications and 

Future Possibilities;' In support of DOJ's commitment to promoting best practices for interventions at 

the front-end of the criminal justice system, the NIJ funded a $1 million Multisite Evaluation of District 

Attorneys' Pretrial Diversion Programs in FY 2012. 

Including DWI and Veterans Treatment Courts, the National Association of Drug Court Professionals 

reported a total of 2,734 drug court programs in the United States as of June 2012.54 In FY 2012, BJA 

awarded over $20 million for various drug court projects, including drug court implementation and 

expansion grants as well as national and statewide training and technical assistance grants; SAMHSA 

separately awarded over $12.4 million for 42 grants to expand substance abuse treatment capacity in 

adult and family drug courts. SAMHSA provided extensive technical assistance and training to its drug 

court grant cohort, including training on trauma-informed care, addressing minority population needs, 

screening and assessment of risk and severity, and motivational interviewing to improve clinical services 

delivery to drug court clients. SAMHSA and BJA also jointly awarded nearly $2 million to enhance services, coordination, and treatment in adult drug courts. BJA continues to engage with practitioners to 

promote the 21 curricula developed for veterans courts, tribal healing to well ness courts, courts serving 

individuals with co-occurring disorders, adult drug courts, and courts facing cultural proficiency issues. 

f:\.crll!£':'.fl:19J.~fiI:~cs,'~f':f!J:()J:'.~il~{l<':''-I.f1''~I.tr(I\l~:,jolmly HmOleo by BJA and NU, produced a webinar 

in 2012 on seven components of successful programming based on NIl's Multisite Adult Drug Court 

Evaluation and other rigorous research. It also provided training and technical assistance to DWI (driving 

while intoxicated) courts. Through the National Association of Drug Court Professionals, BJA supported 

10 mentor drug courts nationwide and BJA worked with the Center for Court Innovation to select 

regional mentor community courts in Seattle, Dallas, and Hartford to assist jurisdictions in establishing 

community courts. Community courts are problem-solving courts that focus on neighborhood crime 

and public safety issues. To date, there are approximately 40 community courts in the United States. 

Educating criminal justice professionals on the science of addiction and models of effective interventions is critical to criminal justice reform. The "Justice leaders Symposium: Enhancing Court Efficiency 

through Emerging Addiction Science" trains judges and criminal justice professionals on the science 

of addiction and potential interventions along the continuum of the criminal justice system, including 

29 
31 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 33 here HDOC20.030

MAT.55The initiative held one national training and one state training in 2012 for approximately 75 judges 

and criminal justice professionals. 

The Administration is committed to the fair and equal application of the Nation's laws. In recognition of 

this commitment, the President signed the Fair Sentencing Act in 2010. Priorto the Fair Sentencing Act, 

the disparity in sentencing between offenses for crack cocaine and powder cocaine was 1 00-to-1. With 

the enactment and retroactive application of the Fair Sentencing Act, the disparity in sentencing has 

been dramatically reduced. This marks the first time in 40 years that Congress has reduced a mandatory 

minimum sentence. 

E. 

To bring effective alternatives to incarceration to scale, the Administration supports research and evaluations of different approaches being implemented in the field. Since 2011, NIJ has supported two research 

projects on sentencing and community corrections practices that promote effective and cost-efficient 

alternatives to incarceration. The first, which is expected to be completed in fall 2013, analyzes drug law 

policy changes in the State of New York. The second, expected to be completed in fall 2014, is studying 

a validated assessment tool being used in three New York City drug courts. 

in 

The number of women in prison increased by 646 percent between 1980 and 2010.56,57 According to the 

Bureau of Justice Statistics, 25 percent of women in state prisons are incarcerated for a drug offense,58 

In addition, women in prison are more likely than men to have chronic and/or communicable medical 

problems."The National Institute of Corrections'Women Offenders Initiative is developing an evidencebased, gender-informed curriculum to help managerial-level corrections practitioners analyze policies 

and practices relevant to women in the criminal justice system. The National Institute of Corrections' 

Women Offenders Initiative and the Research Division are developing an online guide for video visitation, to be released in March 2014. Theguide will assist correctional institutions in developing visitation 

protocols aimed at strengthening the bonds between incarcerated parents and their children, family 

members, and communities. The guide will enhance appropriate connections and provide a means to 

address barriers that inhibit on-site visitation. The National Resource Center on Justice Involved Women, 

in partnership with BJA and the National Institute of Corrections, provides training and technical assistance services to crimina! justice professionals on issues relating to justice-involved women:" 

Like other problem-solving courts, Veterans Treatment Courts focus on treatment and personal accountability to address substance abuse and mental health disorders without resorting to traditional incarceration.ln June 2012, there were 104 Veterans Treatment Courts-a dramatic increase from 2010, when 

.. 30 
32 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 34 here HDOC20.031

THE CYCLE OF 

there were only 20 in the country." These courts work with VA, state and local veterans' agencies, and 

other organizations that provide services and opportunities specifically targeted at veterans to aid in 

recovery and reentry. In addition, VA developed a new Veterans Reentry Search Service (VRSS), an online 

system to determine inmates'veteran status and facilitate outreach to connect them to veterans' services 

once released. VRSS is currently undergoing pilot testing, and will be made widely available in 2013.62 

Through the National Association of Drug Court Professionals, BJA supports training for new veterans 

treatment courts and has trained 58 veterans treatment court teams to date. 

H. 

To improve its efforts to connect incarcerated veterans to substance abuse and reentry services, the 

VA Veterans Justice Outreach Programs consulted with corrections administrators, service providers, 

and veterans to review its existing procedures for outreach to incarcerated veterans. Based on these 

consultations, and in recognition of the varying complexity of veterans' reentry needs, VA advised its 

field outreach staffin January 2012 to begin reentry planning with incarcerated Veterans as soon as their 

needs warranted, rather than focusing solely on those with the nearest release dates. The result of this 

guidance has been the initiation of outreach to veterans while they are still incarcerated, a practice that 

helps ease the veterans'transitions back to their communities upon release. 

I. 

The Bureau of Indian Affairs Office of Justice Services has a dedicated Division of Drug Enforcement 

with trained and experienced special agents who work with tribal law enforcement agencies providing 

technical support and operational assistance. The division also works in conjunction with other drug 

enforcement entities on investigations in and around Indian Country. Additional drug training programs 

are offered at the Indian Police Academy (lPA). Courses on drug trafficking interdiction, Spanish immersion, and basic and advanced drug investigations are also being conducted. 

In August 2011, in accordance with the Tribal Law and Order Act of 201 0 (Title II ofPublicLaw 111-211), 

a memorandum of understanding was signed by the Departments of Justice, Interior, and Health and 

Human Services that mandated, among other things, the expansion and improvement of substance 

abuse prevention, intervention, treatment, and criminal justice services. The resulting Tribal Justice Plan 

emphasizes further development of alternatives to incarceration in Indian Country. BJA supports training 

for tribal healing to wellness courts and, through its Adult Drug Court program and the Indian Alcohol 

and Substance Abuse program, provides funding to tribes to increase alternatives to incarceration for 

substance abusing offenders in Indian Country. In July 2012, more than 200 American Indian youth and 

adult leaders from 53 tribal communities across the country convened at the week-long 2012 National 

Intertribal Youth Summit in Washington, DC. The Summit provided a unique opportunity for Federal 

officials to hear directly from tribal youth on topics such as education, health, cultural preservation, civic 

engagement, and leadership development. 

31 
33 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 35 here HDOC20.032

A. with 

Drug testing with swift and certain sanctions, such as short periods of incarceration, has shown promise 

as a way to reduce probation and parole violations, and the Administration supports further research 

into its potential for broader applicability. Currently, NIJ is conducting two field experiments that are 

expected to be completed by the fall of 2013. The first field experiment is a drug testing and graduated 

sanctions program within the Department of Corrections in Delaware, assessing the implementation 

process of such a program in a large urban probation department. The second project, which began in 

2011, is a 5-year follow-up with the probationers from the 2007 HOPE program evaluation. 

Over the past 3 years, the Admi"nistration has focused on reducing recidivism and decreasing the use 

of incarceration for substance abusing offenders. With its new "Smart Probation: Reducing Prison 

Populations, Saving Money, and Creating Safer Communities" grant program, BJA awarded over 

$3.5 million to nine grantees:'These 2-year grants support the development and implementation of 

evidence-based probation programs to improve success rates, reduce recidivism, and address the needs 

of medium- to high-risk offenders and special populations. 

Criminal to int('n/Pr,p 

To address the issue of heavy drug use and criminal activity, SAMHSA's Center for Substance Abuse 

Treatment supports the dissemination of information to the criminal justice field that advocates the 

use of MAT, including medications to reduce and eliminate opioid and alcohol dependence as part of 

an effective substance abuse treatment regimen. For the past 2 years, SAMHSA supported workshops 

at major conferences such as the National Association of Drug Court Professionals Drug Court Training 

Conference to educate participants on the use ofthese medications and reduce resistance to their use. 

In March 2011, the Center for Substance Abuse Treatment held an expert panel meeting on MAT and the 

Criminal Justice System, focusing on MAT research, challenges to acceptance in the justice system, and 

recommendations to better achieve incorporation of MAT as a viable option in treatment planning and 

delivery. The 8ureau of Prisons also participated in a research project to explore collaboration between 

criminal justice agencies and MAT providers. SAMHSA will continue its partnership with 8JA in FY 2014 

on a number of joint public health and public safety activities, including further promotion of MAT in 

the criminal justice field as an evidence-based practice when providing substance abuse treatment. 

32 
34 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 36 here HDOC20.033

Co-occurring disorders, particularly the combination of substance use disorders and mental illness, pose 

significant challenges not only to public health but also to public safety. Substance abuse is a key risk 

factor for violence among individuals with mental illness. Recent research shows that those with both 

a severe mental illness and a substance use disorder have a greatly increased relative risk for violence 

(more than 11 times) compared to those with neither diagnosis:4 Co-occurring substance use and 

mental disorders have also been found to increase the risk of suicide.5O However, it is also the case that 

people with severe mental illness are more likely to be victims of violent crimes than to commit them. 

The SAMHSA Center for Mental Health Services funds programs that address the particularly difficult problem of co-occurring disorders. The agency's Jail Diversion and Trauma program decreases 

crimina !justice involvement for this population. As of April 2012, the percentage of clients who had no 

involvement in the criminal justice system improved from 42.6 percent upon entry to the program to 

93.4 percent at 6 months post-admission, exceeding the target of 92 percent. The Center for Mental 

Health Services Treatment for Homeless grant program aims to increase abstinence rates among the 

homeless population. As of April 2012, it achieved a 64.7 percent increase in abstinence between intake 

and 6 months post-admission. In addition, as of April 2012, the increase in housing from baseline to 

follow-up reached 131.2 percent, surpassing the target increase of 50 percent. The Center for Substance 

Abuse Treatment continued its requirement that all grantees screen for co-occurring disorders in its FY 

2012 solicitation for adult drug courts and targeted capacity expansion/HIV programs. 

33 
35 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 37 here HDOC20.034

Jail and prison are key access pOints for individuals needing treatment, but many do not receive it. 

According to the Bureau of Justice Statistics, 68.0 percent of jail inmates, 53.4 percent of state inmates, 

and 45.5 percent of Federal inmates suffer from alcohol or drug dependence or abuse-and yet only 

7 percent of jail inmates, 15 percent of state inmates, and 17 percent of Federal inmates receive treatment.66,6? In FY 2012, BJA awarded $8.5 million in Residential Substance Abuse Treatment for State 

Prisoners formula grants to 50 states and five u.s. territories. In 2012, BJA provided training and technical 

assistance to help those jurisdictions provide more effective treatment services. In FY 2013, BOP will 

move to increase its Residential Drug Abuse Program (RDAP) by 26 percent by committing to 20 new 

or expanded program sites. This represents an increase of over 1,700 available treatment beds and an 

estimated 3,400 additional RDAP participants each year as these new and expanded programs become 

fully operational. RDAP is BOP's most intensive treatment program; participants live in a unit separate 

from the general population, and the program is based on a cognitive behavioral model with treatment 

services, educational activities, and work assignments. In FY 2012, BOP committed resources to open 

two Spanish language program sites, one male and one female, in the fourth quarter of FY 2013. All 

current BOP treatment protocols are available to the public through the National Institute of Corrections 

library. As formerly incarcerated individuals reenter the community, it remains important that they be 

educated regarding the services available to them after their release. 

NIDA's CJ-DATS also tests strategies for how best to implement effective substance abuse treatment 

within the criminal justice system. in the past year, CJ-DATS began data collection on its MedicationAssisted Treatment Implementation in Community Correctional Environments (MATICCE) protocol. 

MATICCE is testing implementation approaches to improve service coordination between community 

correctional agencies and local treatment agencies; to increase the number of persons in corrections 

who are provided MAT; and to improve community corrections agents' knowledge and perceptions 

about MAT and their intent to refer appropriate individuals to community-based MAT services. Data 

collection is expected to be completed in FY 2013, 

Through Second Chance Act programming, the Administration provides funding for projects to help 

the formerly incarcerated receive treatment, explore employment opportunities, and rebuild their 

lives. in 2012, BJA awarded over $23.5 million for several new projects covering co-occurring disorders, 

family-based treatment, technology career training, mentoring, reentry support programs, and the 

National Reentry Resource Center. BJA awarded over $6 million to seven state corrections departments 

through the Adult Offender Comprehensive Statewide Recidivism Reduction Demonstration Program 

to implement long-term strategies to reduce recidivism using evidence-based programs and practices.68 

34 
36 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 38 here HDOC20.035

Adult 

Individuals with criminal conviction records face barriers that extend beyond their sentences. State and 

Federal laws and rules restrict their access to many government benefits and opportunities, making it 

difficult for them to successfully return to society. These restrictions and sanctions, known as collateral 

consequences, have been promulgated with little coordination in various sections of state and Federal 

codes, making it difficult to identifY all the penalties and disabilities that are triggered by conviction for 

a particular offense. Though some collateral consequences serve an important and legitimate public 

safety or regulatory function, many do not and rather serve as additional punishment without due 

process protections. In September 2012, the ==c=_:ccc_==_,,,-_c_,-cc=== -__ = ___ -=_c ___ =:_:L-:::_:_=_:cc_:c ___ =-=_:::::::c:=_ 

(NICCC) was launched-a project of NIJ and the American Bar Association. The NICCC is a public online 

database of the legal sanctions and penalties of state and Federal offenses affecting individuals with a 

criminal record. Currently, the collateral consequences from 12 states and the Federal system are available." Data from other states will be available online by fall 2013. Previously, Attorney General Holder 

sent a letter to all state attorneys general asking them to use the NICCC to review their state laws for 

collateral consequences and eliminate or modifY those that do not impact public safety. 

Housing 

For many of the formerly incarcerated, access to affordable housing is a critical piece of reentry that will 

allow them to rebuild their relationships and explore educational or employment opportunities. The 

Administration for Children and Families awarded $6 million for the Project Reunite demonstration, 

which will bring the formerly incarcerated and their families together in stable housing. The award 

went to four grantees, and implementation of the 3-year pilot began in 2012. Also in 2012, HUD trained 

92 Regional and Field Office staff in reentry efforts and resources that will support communities to 

address these needs. HUD continues promoting the various subsidized housing options that are available to the formerly incarcerated, including HUDNA Supportive Housing, Family Unification Vouchers, 

and Shelter Plus Care. In determining admission or termination of assistance for a current or potential 

resident who has previously engaged in alcohol abuse or illegal drug use, a public housing agency 

(PHA) may assess whether the individual is rehabilitated or participating in a rehabilitation program. 

HUD issued two letters in 2011 to all PHAs and Housing Choice Voucher Owners and Agents uplifting 

current HUD policy regarding an individual's participation in drug court as evidence of participation in 

a supervised alcohol or drug rehabilitation program. 

D. to 

Lack of employment can be a significant obstacle to successful reentry, and the Reintegration of 

Ex-Offenders-Adult Program seeks to encourage employment for the formerly incarcerated through 

job training, mentoring, and other transitional services. In May 2012, the Department of Labor awarded 

$20.5 million to 18 nonprofit organizations for employment-related services for formerly incarcerated 

adults who are returning to high-poverty and high-crime communities. Since 2010, the Department's 

Reintegration of Ex-Offenders-Adult Program has awarded more than $32 million in grants. Grantees 

will use the funds to provide occupational training that leads to credentials in high-demand indus35 
37 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 39 here HDOC20.036

tries, mentoring, and assistance in connecting formerly incarcerated adults with supportive services 

such as housing, substance abuse programs, and mental health treatment. Since the initiation of the 

Reintegration of Ex-Offenders grants in 2007 (originally called the Prisoner Reentry Initiative), performance outcomes have been strong. As of June 30, 2012, this grant program exceeded all Government 

Performance and Results Act (GPRA) goals for Program Year 2011 (which ended on June 30, 2012). 

In June 2012, the Department of Labor awarded more than $12 million to 9 grantees to provide 

gender-specific reentry services and support for formerly incarcerated women and girls to improve 

their long-term labor market prospects. Services include job training that leads to credentials in highdemand industries, employment preparation, mentoring, intensive case management/life coaching, 

and assistance connecting to supportive services such as housing, substance abuse and mental health 

treatment, and assistance with parenting and child reunification. 

E. 

The Bureau of Justice Statistics is working to produce data on national recidivism rates, which are valuable but often difficult to obtain. The Bureau of Justice Statistics is developing a software program for 

standardizing data found in criminal records collected from the Federal Bureau of Investigation (FBI) 

and all state criminal history repositories. Using these data, the Bureau of Justice Statistics is currently 

working on two recidivism studies. One follows for 5 years a cohort of individuals released from state 

prisons in 2005, while the other assesses the 5-year recidivism patterns of individuals placed on Federal 

probation in 2005. As of July 2012, ali necessary data had been received and the Bureau of Justice 

Statistics anticipates completing its analysis in 2013. 

Juveniles require special attention due to their vulnerability to substance use disorders and the fact that 

adult services are often ineffective when applied to them. In 2012, the Office of Juvenile Justice and 

Delinquency Prevention (OJJDP) awarded over $7.5 million for several programs, including Juvenile 

Drug Courts under the Reclaiming Futures Program, the Family Drug Courts Program, and the Enforcing 

Underage Drinking Laws Discretionary Program's Initiative to Reduce Underage Drinking in the Military. 

In addition, OJJDP engaged with Federal partners through its Coordinating Council on Juvenile Justice 

and Delinquency Prevention to promote effective models for substance abuse and mental health 

treatment, prevention, and intervention. In calendar year 2013, OJJDP will align the data in their Model 

Programs Guide with the data in share a common criteria and database. 

36 
38 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 40 here HDOC20.037

Chapter 5. Disrupt Domestic Drug 

Trafficking and Production 

Criminal organizations, both transnational and domestic, can be found in every part of the United 

States. Using illicit crossborder tunnels, parcel services, or other means, these organizations unlawfully 

smuggle and distribute both illegal and diverted legal drugs in our communities. They are responsible 

for a significant amount of the violence and crime associated with drug trafficking, and their actions 

threaten the well-being of citizens and the fabric oflnstitutions at every level. 

Federal, state, local, and tribal law enforcement agencies play an integral role inthe Administration's 

balanced approach to reducing drug use and its consequences. In targeting criminal organizations, law 

enforcement agencies prevent drug traffickers from extending their corrosive reach further into our 

Nation's communities. Maximizing Federal support for drug law enforcement task forces is critical to 

leveraging limited resources. Sharing and exchanging intelligence, whether on internationally-based 

traffickers, trafficking on tribal lands, or smuggling through drug trafficking corridors, ensures Federal, 

state, local, and tribal law enforcement are working together on targeted threats and taking full advantage of available resources. 

Security along the Mexican and Canadian borders also plays a significant role in reducing drug trafficking, use, and its consequences. While illicit substances move from Mexico to the United States, a 

substantial amount of weapons and illegal currency flows from the United States to Mexico. Although 

much attention is understandably drawn to the Southwest border, it is also important to remain 

vigilant and cognizant of the threats and risks posed along the S,22S mile border between the United 

States and Canada. Traffickers exploit the vast tracts of land and extensive waterways along the border 

to transport and distribute drugs in both directions: for instance, MDMA (Ecstasy) and marijuana are 

transported from Canada into the United States, while cocaine is trafficked from the United States into 

Canada. Meanwhile, illicit proceeds from the sale of drugs cross the border in both directions, as do 

gang members, traffickers, and couriers. 

The Administration recognizes that each part of the country has distinct drug-related challenges, requiring tailored responses that acknowledge the needs and draw upon the strengths of that particular 

community. In some communities, for example, it is necessary to address drugs such as heroin, which 

is experiencing a resurgence in some areas of the country.70 In other communities, the focus may be on 

aggressively targeting new threats like synthetic drugs. The Nation's law enforcement community must 

continue to focus on existing threats and collect information and data to address emerging threats. 

It remains important that Federal, state, local, and tribal law enforcement agencies work together with 

prevention and treatment specialists to provide a balanced, holistic approach to reducing drug use and 

its consequences. 

37 
39 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 41 here HDOC20.038

NATIONAL DRUG CONTROL STRATEGY 

1. Federal Enforcement Initiatives Must be Coordinated with 

and Tribal Partners 

A. Maximize Federal Support for Drug Law Enforcement Task Forces 

Federal funding for drug law enforcement task forces enables state and local law enforcement agencies 

to participate in joint investigations, promotes local and regional coordination, and helps minimize 

duplication of efforts. In 2011, HIDTA-funded initiatives disrupted or dismantled 2,942 drug trafficking 

organizations, removing significant quantities of drugs from the market and seizing $728,753,436 in cash 

and $210,428,628 in non-cash assets." 5tate and local law enforcement agencies are active partiCipants 

in Organized Crime Drug EnforcementTask Forces (OCDETF) Strike Forces. For FY 2012, state and local 

enforcement agencies were participating in 4,719 out of 5,171 OCDETF investigations (91.3 percent). 

B. Improve Exchange and Information 

Systematic collection, analysis, and secure dissemination of accurate and timely intelligence are critical to 

thwarting the activities of criminal organizations. For example, the HIDTA Investigative Support Centers 

(lSCs) and Domestic Highway Enforcement program have used the DHS Homeland Security Information 

38 
40 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 42 here HDOC20.039

CHAPTER 5. DISRUPT DOMESTIC DRUG TRAFFICKING AND PRODUCTION 

Network (HSIN) to share products and requests for information with their partners, including fusion 

centers, Regional Information Sharing System centers, the EI Paso Intelligence Center (EPIC), and the 

OCDETF Fusion Center (OFC). In FY 2012 the OFC generated 3,029 unique intelligence products that 

were disseminated to 11,780 investigators in the field. These intelligence products provided analysis on 

14,145 targets. This number of targets analyzed represents an 11 percent increase over FY 2011. 

At the Nation's borders, the Border Enforcement SecurityTask Forces (BESTs) have expanded to a total 

of 34 locations in 16 states and in Puerto Rico. The two most recently commissioned BEST locations are 

Nogales (March 2012) and Casa Grande, Arizona (July 2012). 

Along the Nation's highways, the HIDTA Domestic Highway Enforcement Initiative integrates intelligence 

from border/source enforcement efforts and transit/destination investigation activity. Increased awareness from the HIDTA Domestic Highway Enforcement initiative resulted in the submission of8,650 seizure 

reports to EPIC's National Seizure System in 2011, compared to 5,257 reports in 2009. 

C. Ensure State and Local Law Enforcement Access to Federal Information on" 

Mexico-Based Traffickers 

Current intelligence on Mexico-based traffickers must be readily available to state, local, and tribal law 

enforcement. State and local law enforcement agencies, knowingly or unknowingly, are many times the 

first to encounter suspects associated with Mexico-based traffickers. The EPIC Border Fusion Intelligence 

Section provides fused all-source intelligence support to Federal, state, local, and tribal law enforcement activities along the U.s.-Mexico border. EPIC's Tactical Operations Section will be preparing the 

Gatekeeper Project assessments for the Southwest border for FY 2013. These assessments will include 

in-depth analysis of each trafficking corridor's criminal infrastructure-its strengths, weaknesses, and 

abilities to effectlvely transport drugs across the border. 

The Financial Crimes Enforcement Network (FinCEN), a bureau of the U.s. Department of the Treasury, 

safeguards the financial system from illicit use, counters money laundering, and promotes national 

security through the collection, analysis, and dissemination of financial intelligence and the strategic 

use of financial authorities. FinCEN provides 135 state and local law enforcement agencies with direct 

access to financial data through its FinCEN portal and directly supports state and local investigative 

efforts through its participation in the Southwest Border Anti-Money Laundering Alliance (5WBAMLA), 

with whom it shares finished intelligence products. In 2012, FinCEN produced three strategic intelligence 

advisories on evolving money laundering trends and created 35 money services business (MSB) agent 

analyses for Federal and state agencies that quantify, compare, and contrast remittance activity of MSB 

agents in order to facilitate detection of suspicious activity in Southwest border states. 

D. Promote Law Enforcement Collaboration Along Drug-Trafficking Corridors via 

"GatewaylDestination" Initiatives 

Drug-related violence often occurs along drug, money, and weapon trafficking corridors; therefore, law 

enforcement Information sharing across the primary trafficking corridors and into the Southwest border 

region is essential. Increased technology integration at more border ports of entry has forced smugglers 

to seek other alternatives to smuggle illicit drugs, such as illicit aossborder tunnels or ultralight aircraft. 

39 * 
41 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 43 here HDOC20.040

Ni\TIONAL DRUG CONTROL STRATEGY 

DEA continues to provide access to the DEA Internet Connectivity Endeavor (DICE), an Internet-based 

deconfliction tool. Through DICE, state and local law enforcement receive notifications involving overlaps 

of investigative data among Federal, state, and local investigations. DICE is sponsored by over 102 DEA 

field division, district, and resident offices, and at the most recent count, DICE has over 10,000 active 

users (40 percent state, local, or tribal and 60 percent Federal law enforcement). 

E. Assist Tribal Authorities to f'~~ •• ~+T,"f-h on Tribal Lands 

Seven HIDTA programs are currently collaborating on enforcement operations and training with tribal 

nations.73 In Arizona, for example, the HIDTA has provided training and equipment to tribal law enforcement while also coordinating a task force interdiction effort with state and local law enforcement. 

The FBI, in collaboration with the DOJ Office oflegal Education, provided approximately 22 drug-related 

training courses in FY 2011 and FY 2012 to tribal nations. These courses included instruction in evidence 

collection and interview and interrogation. The FBI also assessed drug and gang threats on tribal lands 

located on or near the Northem and Southwest borders. In November 2011, the FBI conducted a Violent 

Crime Threat Assessment with Ysleta Del Sur Pueblo (Texas), and, in 2012, conducted another atTohono 

O'odham (Arizona). 

In February 2010, the OFC launched an Indian Country Initiative to support field agents, analysts, and 

task force officers assigned to investigations in Indian Country through the generation of timely intelligence products. 

In FY 2012, the OF( Indian Country Initiative completed 35 product requests on a total of 136 investigative targets and provided Indian Country training and information presentations at eight partner 

agency office locations. Approximately 95 percent of all Indian Country requests exhibit a nexus to drug 

distribution in Indian Country (the remaining 5 percent are associated with violence, gangs, burglary, 

theft, and money laundering). 

F. Ensure Comprehensive Review of Domestic Drug Threat 

ONDCP's Office of Intelligence will collaborate with its intelligence community colleagues in DHS, DOJ, 

the Office of the Director of National Intelligence (ODNI), and other relevant agencies to ensure that 

national policy makers are provided with the best possible domestic all-source counterdrug intelligence 

analysis. In addition, ONDCP will continue to collaborate with DEA as DEA analysts assume the lead on 

an interagency National Drug Threat Assessment from the National Drug Intelligence Center, which 

closed in June 2012. 

ONDCP's late-20l2 survey querying Federal, state, and local partners regarding their need for analyticat products is an example of this evolving process. ONDCP will coordinate with ODNI, DHS, other DOJ 

entities, SAMHSA, CDC, and other applicable intelligence community and law enforcement agencies to 

further develop and refine the requirements for domestic, strategic, all-source drug intelligence analysis 

and to improve the quality, scope, sophistication, and usefulness of products presented to policy maker<;. 

40 
42 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 44 here HDOC20.041

41 
43 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 45 here HDOC20.042

NATIONAL DRUG CONTROL STRATEGY 

2. U.S. Borders Must be Secured 

A. Southwest Border Counternarcotics Strategy 

The Southwest border is a major arrival zone for drugs, weapons, and money, and the implementation 

of the National Southwest Border Counternarcotics Strategy is critical to addressing these threats?6 The 

Administration has been steadfast in its commitment to border security. From FY 2009 to 2012, DHS 

seized 71 percent more currency, 39 percent more drugs, and 189 percent more weapons along the 

Southwest border as compared to FY 2006 to 2008.77 In February of 2012, President Obama signed the 

Ultralight Aircraft Smuggling Prevention Act of 2012, which treats the use of ultralight aircraft for drug 

smuggling the same as other aircraft. Another piece of legislation, the Border Tunnel Prevention Act 

of 2012, provided law enforcement and prosecutors with additional tools to locate illicit crossborder 

tunnels, identify criminals, and punish those involved in illegal activity. 

B. Develop National Arrival Zone Task Force Imnlp,m,'ot."tif1n Plan 

The 201 0 Strategy assigned The Interdiction Committee the task of developing a National Arrival Zone 

Task Force Implementation Plan. During 2011 and 2012, a team of experts from a wide array of Federal 

agencies conducted a review of the organizations, tools, and processes focused on the rapid facilitation and coordination ofinterdiction operations within the arrival zone. The team found that since the 

publication of the 2010 Strategy, a number of efforts has fulfilled the intent of the proposed National 

Arrival Zone Task Force, Significantly increasing operational coordination and information sharing in 

the Southwest border region. These initiatives include the implementation of the National Southwest 

Border Counternarcotic5 Strategy, the establishment of the DHS Joint Field Command in Arizona, the 

standup of the Alliances to Combat Transnational Threats, the expansion of the OF(' the standup of the 

Border Intelligence Fusion Section and JointTask Force-North Intelligence Operations at EPIC, and the 

implementation of the DHS Maritime Operations Coordination Plan. 

C. Develop National Plan for Southbound Interdiction of Currency and Weapons 

The enormous amount of money generated by drug sales in the United States and its outward flow 

across the Southwest border fuels the operations of violent drug trafficking organizations. In FY 2012, 

efforts were underway to expand the co-location of OCDETF agencies at the San Diego Strike Force 

with the addition of the ICE, Homeland Security Investigations (HIS) BEST Marine Task Force. By the 

end ofthe second quarter of FY 2012, OCDETF Co-located Strike Forces had been established in eleven 

key locations.78These co-located Strike Forces are prosecutor-led and intelligence-driven, aggressively 

targeting the highest-level drug trafficking organizations while also functioning as a central point of 

contact for OCDETF agents and prosecutors nationwide. In addition, DEA expanded the National License 

Plate Reader Initiative and Concealed Trap Initiative. The National License Plate Reader Initiative is a 

complex camera and alerting system strategically located along the Southwest border, which is utilized 

as an investigative tool to monitor and interdict roadway conveyances suspected of transporting bulk 

cash and other contraband. The Concealed Trap Initiative targets those service providers who build 

concealed trap compartments or utilize natural voids in conveyances and residences for drug trafficking 

organizations to transport or conceal drug proceeds. 

42 
44 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 46 here HDOC20.043

CHAPTER S. DISRUPT DOMESTIC DRUG TRAFFICKING AND PRODUCTION 

As of May 2012, the OFC, which investigates bank accounts with suspicious activity, targeted 

1,611 individuals and companies. The OFC Proactive AssetTargeting Team identified 7,155 bank 

accounts, 2,253 vehicles, and 2,793 businesses with suspicious activity, and seized assets totaling 

$28,038,408. The purpose of these financial leads is to identify assets that are available for seizure and 

forfeiture. This information exploits links between drug trafficking organizations and other criminal 

activity worldwide for use by law enforcement. 

D. Coordinate Efforts to Secure the Northern Border Against 

In January 2012, following an extensive consultation process, the Administration released the National 

Northern BorderCounternarcotics Strategy, a national framework for ongoing efforts to reduce the drug 

threats on both sides of the United States-Canada border. Under this Strategy, numerous departments 

and agencies are charged with implementing 41 specific action items. A report on the progress of 

implementing each of these action items and identified performance measures will be released in 

calendar year 2013. The Government of Canada has been a partner in this process,imd its collaboration 

is reflective of the two-way nature ofthe drug problem at the border. 

During FY 2012, the U.s. Border Patrol and Canadian law enforcement partners planned and executed 

50 different Integrated Border Enforcement Team (lBET) operations along the northern border. The Red 

River IBET, which is physically located in Canada (Altona, Manitoba), opened its doors in the spring of 

2012 as the first co-located IBET office. The United States and Canada also have implemented Integrated 

Cross-Border Maritime Law Enforcement Operations that combine specially trained law enforcement 

personnel from both nations on one vessel and designate them with cross-border law enforcement 

authority. Through each agency's respective operations center, the U.s. Customs and Border Protection 

(CBP) Office of Air and Marine (OAM) has a mutual agreement with the Royal Canadian Mounted Police 

(RCMPl and the Canadian Border Services Agency (CBSAl to conduct aviation-related "Hot Pursuit" chases 

of suspect drug traffickers. CBP's Office of Intelligence and Investigative Liaison, working jointly with 

CBP operational components and DEA, continue to coordinate with its Canadian counterparts from the 

RCMP and the CBSA to exchange information on drug trafficking trends and address issues related to 

human trafficking and smuggling, weapons trafficking, and border violence. 

E. Deny Use of Ports and Routes of Ingress and Egress Between the Ports 

Air and maritime ports represent a unique challenge with regard to drug-related threats. In FY 2012, 

CBP International Liaison Units initiated several operations that coordinated U.s. Federal, state, and local 

law enforcement agencies with international (Government of Mexico) forces to disrupt and dismantle 

transnational criminal organizations. Some of the operations are year-round efforts employing a wholeof-government approach. 

F. Surveillance r1r"""tirm< 

Drug traffickers continue to dedicate significant resources to monitoring the operations of United 

States interdiction agencies. Along the Southwest border, for instance, drug trafficking organizations 

employ large numbers of strategically-placed spotters who closely observe the enforcement activities 

43 
45 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 47 here HDOC20.044

NATIONAL DRUG CONTROL STRATEGY 

of CBP officers and agents, canines, and inspection technology. In turn, these spotters provide guidance 

to traffickers on entering the United States. Traffickers also use advanced technology to intercept law 

enforcement communications. 

Law enforcement agencies employ countermeasures to target the tactics and methods of transnational 

criminal organizations and to locate and apprehend spotters as they conspire to traffic and smuggle 

drugs, money, weapons, and humans. While the details of such countermeasures are understandably 

sensitive, they may include frequent and random personnel rotations, as well as unannounced surges 

in enforcement activity, both on the ground and in the air. 

3. focus National Efforts on ~neCllnc Problems 

A. Counter Domestic M •• th;,mnh",t"mi Production 

The Administration remains committed to reducin~ the production, trafficking, and use of methamphetamine. In 2011, over 9,000 methamphetamine laboratories were seized nationwide. The number 

of laboratories seized was approximately double that in 2007, although seizures remained low in states 

such as Oregon and Mississippi, where pseudoephedrine is available only by prescription." Nationwide, 

the laboratories seized in the last few years are smaller and produce significantly smaller quantities; however, the danger posed by these small toxic labs and drugs they produce remains significant. Although 

the number of past month methamphetamine users decreased from 731,000 to 439,000 between 2006 

and 2011, this demand continues to fuel domestic methamphetamine production.so 

In 2012, Federal, state, and local agencies from the United States were joined by delegations from 

Canada, Mexico, and China at the National Methamphetamine and Pharmaceuticals Initiative (NMPJ) 

annual conference in San Antonio, Texas. On the margins of this conference, a ground breaking meeting 

occurred between Mexican and Chinese law enforcement and prosecutorial officials, resulting in the 

opening of a jOint intelligence and case sharing effort that hopefully will identify suspicious chemical 

shipments from China to Central America and Mexico and ultimately reduce the role of China as a source 

country for chemicals diverted to clandestine methamphetamine laboratories in Mexico and elsewhere. 

B. Interior Corridors Movement and ,]Y"f+,rk&>Y< Use of America's 

Drug traffickers use our Nation's roads and highways to move large amounts of drugs, currency, weapons, 

and other illicit contraband. The Domestic Highway Enforcement (DHE) initiative has funded specialized 

equipment, training, intelligence-sharing activities, and operational capabilities to deter this threat. The 

DHE strategy is based on collaborative, intelligence-led policing to enhance law enforcement efforts 

on interstate highways speCifically identified as drug trafficking corridors. In FY 2011, DHE task forces 

removed over $500 million worth of drugs and disrupted or dismantled 69 drug trafficking organizations. 

Two of the biggest seizures came from the Northwest HIDTA, which seized approximately 290,000 dosage units of ecstasy, and the NewYorkiNew Jersey HIDTA. which had a cash seizure of nearly $3 million. 

EPIC System Portal (ESP) account holders are able to obtain a HSIN account via the ESP's Domestic 

Highway Enforcement section. Once a user is vetted, they can access the HSIN via a link within the ESP. 

The website allows Domestic Highway Enforcement informational reports and current trends associated 

with drug trafficking to be used by law enforcement officers across the Nation. 

44 
46 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 48 here HDOC20.045

CHAPTER 5. DISRUPT DOMESTIC DRUG TRAFFICKING AND PRODUCTION 

C. Eradicate Marijuana Cultivation 

Remote marijuana grow sites on public lands pose a significant threat to public safety and the environment. The cultivation of marijuana frequently entails the diversion of water resources, the clearing of 

native brush, and the use of banned pesticides. In a 2012 study, researchers documented poisonous 

chemicals and toxicants at an abandoned marijuana cultivation site situated within territory inhabited 

by fishers, a rare forest carnivore declared a candidate species for listing under the Federal Endangered 

Species Act." 

At the Federal level, the effort to eliminate marijuana production on our pUblic lands is led by the Public 

Lands Drug Control Committee. The committee aligns policies and coordinates programs to support 

field-level eradication operations, investigations, and intelligence and information sharing. Central to this 

process is the work of the public lands agencies, which identify and document the marijuana threat in 

the areas under their jurisdiction. This information will inform the development of the Domestic Cannabis 

Cultivation Assessment, a comprehensive, national-level strategic assessment of cannabis cultivation and 

marijuana production in the United States. 

D. Stop Indoor Marijuana Production 

Because of pressure from marijuana eradication efforts, many cultivators have been forced to abandon 

large outdoor cannabis plots in favor of easier-to-conceal indoor cultivation. The detection of these 

indoor grows has proven challenging for law enforcement. In 2012, DEA and partner agencies seized 

more than 2,500 indoor grow operations, with more than 302,000 plants eradicated. 

E. Partner with Local law Enforcement Agencies to Combat Street, Prison, and IVIC'tolfCVCle 

Drug Gangs 

Law enforcement agencies continue to work to disrupt and dismantle dangerous street gangs. In May of 

2012, the National Gang Intelligence Center (NGIC) launched NGIC Online, an information system with 

web-based tools that enables law enforcement agencies to gain access to a variety of resources."""" EPIC 

has created a Gang Initiative to focus on establishing links between criminal gang activity and transnational/domestic drug trafficking and terrorism-related organizations. In FY 201 0, DOJ's National Gang 

Targeting, Enforcement, and Coordination Center (GangTECC) was partnered with the Special Operations 

Division (SOD). After supporting only approximately 100 cases in 3 years prior to the SOD merger, under 

the operational direction of SOD, the GangTECC Section supported over 800 cases in just its first full year 

at SOD. Further, in FY 2012 alone, SOD-supported gang cases accounted for approximately 900 arrests. 

45 
47 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 49 here HDOC20.046

NATIONAL DRUG CONTROL STRATEGY 

In one example of an effective cross-country gang investigation, in 2012, the Ohio HIDTA's Northern 

Ohio Law Enforcement Task Force and FBI Los Angeles jointly worked to identify and disrupt a large scale 

drug trafficking organization linked to the LA-based Grape Street Crips. The investigation revealed that 

a drug trafficking organization responsible for the transportation of cocaine to Cleveland and other u.s. 

cities was affiliated with the LA street gang. In February 2012, multiple search warrants were initiated in 

Operation Soap Scrambling that resulted in the disruption of the drug trafficking organization. 

In another example in 2012, the ICE/Homeland Security Invesitgations (HSI) San Diego Gang 

Investigations Group, in coordination with other HSI components and Federal, state, and local law 

enforcement partners, conducted an investigation that identified more than 40 targets linked to 

13 separate and documented street gangs. The investigation culminated in 31 Federal arrests and 

31 state arrests. In addition, agents seized significant quantities of drugs, cash, vehicles, firearms, and 

ammunition. 

F. Disrupt Illicit Financial Networks b}l,Exp,!oiling Cash Seizures 

DEA works to identify co-conspirators, shell corporations, and assets utilized by drug trafficking organizations globally, and evidence and intelligence gleaned from its investigations often provide critical 

information on terrorist financing. Through EPIC's Bulk Currency Unit, extensive research is conducted 

on bulk currency seizures, providing intelligence information to law enforcement agencies for tactical 

and operational support. In FY 2011, DEA denied a total of $2.88 billion in revenue from drug trafficking 

and money laundering organizations through asset and drug seizures. 

In 2012, DEA conducted 13 financial investigation training seminars, which were offered to Federal, 

state, and local law enforcement officials. In addition, OCDETF and the Department of Justice Criminal 

Division's Asset Forfeiture and Money laundering Section partnered to provide ten financial investigation seminars in FY 2012, training more than 730 Federal, state, local, and tribal agents and prosecutors. 

The OFC Pro-Active Asset Targeting Team (PATT) was established in September 2010 and identifies 

criminal case connections through review and analysiS of FinCEN's suspicious activity reports (SARs). The 

OFC has identified over $3 billion of assets and has passed these leads to law enforcement for seizure. 

ICE, spearheaded by the National Bulk Cash Smuggling Center (BCSC), uses its primary jurisdictional 

authorities to target violations of bulk cash smuggling, unlicensed money couriers, and interstate transportation of criminal proceeds. In FY 2012, the BCSC partnered with EPIC in establishing and managing 

the EPIC Bulk Currency Unit, which is headed by an ICE/HSISection Chief and staffed with intelligence 

personnel from ICE, DEA, and FBI. 

G. National Parcel Post Initiative 

The National Parcel Post Initiative focuses on drug trafficking organizations using parcel shipping services 

to transport illegal drugs and drug proceeds. In 2012, 17 HIDTAs funded a parcel post task force. These 

investigations rely on full cooperation and full information sharing among all HIDTA member agencies, 

task forces, fellow agencies, and task forces in other jurisdictions. 

CBP, the Transportation Security Administration (TSA), and the United States Postal Service are working with the Universal Postal Union and others in the international postal community to enhance the 

screening of international mail prior to its conveyance to the United States. The parties are developing 

* 46 
48 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 50 here HDOC20.047

"HAPTER .5. DISRUPT DOMESTIC DRUG TRAFFICKING A]\;D PRODUCTIO]\; 

the foundations for providing advance electronic data on international mail packages to allow CBP and 

TSA to perform risk-based targeting prior to foreign departure and entry into the domestic mail supply 

chain. This strategy will enhance CBP's ability to identifY, interdict, and disrupt the movement of illicit 

narcotics as well as stem the persistent threat posed by the smuggling of counterfeit pharmaceuticals 

and gray market goods. This approach is also linked to the Long Term Strategy for the Screening of 

International Mail and the Global Supply Chain Strategy. 

H. Establish Int,~r;l,aPI1CV On Drug ICn,'bn,n""",ri Children 

Over a decade ago, the Drug Endangered Children (DEC) movement was founded to address the 

growing phenomenon of children living in unsafe and unhealthy drug environments. There were some 

responses at the state level, but prior to the establishment of the Federal Interagency Drug Endangered 

Children Task Force, a cohesive and coordinated Federal response was lacking. Initiated by the 2010 

National Drug Control Strategy, the DEC Task Force focused on gathering and produCing educational 

resources (model protocols, programming, promising practices, and downloadable checklists) to aid 

law enforcement, child welfare workers, health and education profeSSionals, and children's advocates 

nationwide to protect children. In addition, it expanded the definition of drug endangered children to 

include any children living in an environment where drugs, including pharmaceuticals, are illegally used, 

possessed, trafficked, diverted, andlor manufactured. In 2012, the DHS Federal Law EnforcementTraining 

Center (FLETC) assembled experts from the National DEC Training and Advocacy Center, the National 

Alliance for Drug Endangered Children, criminal Justice professionals, and FLETC staff to develop two 

courses on drug endangered children to be offered in the summerof2013 to Federal, state, local, tribal, 

and International law enforcement agencies. DEA continues to raise awareness and provide training 

on DEC issues for domestic and international law enforcement profeSSionals, educators, social service 

professionals, first responders, and community leaders. 

47 
49 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 51 here HDOC20.048

The United States works around the world to disrupt and dismantle drug production and trafficking organizations. Bilateral as well as regional counterdrug partnerships are essential to our efforts. 

Experience has demonstrated that successful strategic interventions depend upon focused political 

will-sustained over several administrations-by both the United States and leaders of regional allies. 

They further require the careful staging of joint efforts, protecting pUblic security, applying pressure to 

transnational criminal organizations, ensuring the presence and stability of democratic governance and 

the rule of law, ensuring and enforcing human rights protections, and providing economic incentives 

to develop, enfranchise, and empower marginalized populations. 

While the United States works on a daily basis with partners around the world, U.s. agencies are focused 

intently on addressing the most direct drug threats to our citizens. The Western Hemisphere remains 

a key area of concentration. Progress has been made in reducing the production of cocaine, and u.s. 

cocaine use is at historic lows, yet challenges remain.86 

The nations of Central America are grappling with significant threats linked to the global drug trade. 

The majority of the cocaine produced in Colombia is transshipped by maritime conveyance as well as 

by land and air toward the United States, usually through the Central American landmass and adjoining waters. Peruvian and Bolivian cocaine likely travels by air and sea destined primarily for markets in 

Europe, Latin America, Asia, and Australia. Ongoing interdiction efforts have forced traffickers to shift 

precursor shipments from Mexico to Central and South America for eventual use in methamphetamine 

manufacture.8

'This illicit drug and precursor chemical trade has contributed to violence, gang activity, 

and disorder in several countries in Central America. Further enhancements are needed to confront this 

challenge, such as improving air, land, and maritime interdiction cooperation in the region, supporting 

host-nation disposal of seized precursor chemicals, and intensifying cooperation with law enforcement 

officials on stopping precursor chemical diversion. The United States is already working to improve 

efforts in these areas under the existing five pillars of the State Department-coordinated regional CARSI 

initiative and through Joint InteragencyTask Force (JIATF) South's efforts in coordinating the interagency 

and multinational Operation MARTILLO. These efforts are designed to bring together the capabilities of 

the entire U.s. Government to support our Central American partners addressing the range of threats 

facing the region. 

The culture and common values of the United States and Mexico are intertwined, and our prosperity and 

stability are inextricably linked. Because of this close relationship, both nations recognize the benefit of 

mutual cooperation now and in the future as strategic security partners. Mexico continues its campaign 

against transnational criminal organizations that operate on both sides of the shared international 

boundary. Joint collaborative efforts, supported by the Merida Initiative, have promoted closer cooperation among Mexican and U.s. agencies and have resulted in significant successes. For example, in April 

2012, the Mexican Attorney General's Office indicated that 23 of the 37 most wanted criminals had been 

killed or arrested; a federal penitentiary academy has been established; and more than 7,500 federal 

and 19,000 state justice sector personnel had been trained on their responsibilities under Mexico's new 

49 
50 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 52 here HDOC20.049

NATIONAL DRUG CONTROL STRATEGY 

accusatorial judicial system. Nonetheless, the huge revenue flow to transnational criminal organizations, 

from the drug trade and a range of criminal smuggling activities, continues to have a destabilizing effect 

on the entire Hemisphere. The United States will work with the new administration in Mexico to continue 

joint efforts to disrupt, dismantle, and ultimately defeat these violent networks, reducing their negative 

impact on regional stability and the national security of Mexico and the United States. 

It also remains important that we support the nations of the Caribbean in order to ensure that the 

progress made in partnership with Mexico and Central America does not result in a displacement of the 

threat to that region. Through the Caribbean Basin Security Initiative, the United States has committed 

$203 million in funding over 3 years to assist the nations of the region in the areas of maritime and aerial 

security, law enforcement capacity building, border and port security and firearms interdiction,justice 

sector reform, and crime prevention and at-risk youth programs. 

In Afghanistan, in spite of an increase in total poppy cultivation in 2012, there was a decline in opium 

production due to crop disease and poor growing conditions.as Signaling our continued commitment 

to Afghan-led drug control efforts is necessary to couriier the illicit opiate trade. Russia, through the 

Bilateral Presidential Commission Counternarcotics Working Group, has become an important partner 

for coordination of policy and joint action on drug control issues. Coordination with the European Union, 

Japan, the Colombo Plan, and the UN Office of Drugs and Crime (UNODC)-key donors in providing 

assistance to developing nations-has been intensified to maximize the effectiveness of aid programs. 

China and India are increasingly important partners in international efforts to address the precursor 

chemical and synthetic drug trade and counter money laundering by drug cartels operating in our 

Hemisphere. 

The United States continues to coordinate with international partners not only to construct criminal 

cases, capture major kingpins, and seize drugs and the illicit proceeds of crime, but also to build institutional capability, support economic alternatives to drug production, and promote collaborative efforts 

in prevention, treatment, and research, thereby assisting global partners in acquiring the capabilities 

to overcome the consequences of drug use. 

1. Collaborate with International Partners to Oi~:l'Iu,t 

A. Conduct Joint Counterdrug Operations with International Partners 

The United States continues to conduct joint counterdrug operations with international partners, both 

through bilateral relationships and via multilateral forums. Bilaterally, DENs Sensitive Investigative 

Unit (SIU) sponsors over 40 investigative and intelligence task forces of varying size in 11 countries. 

Participating countries include Afghanistan, Colombia, Dominican Republic, Ecuador, Guatemala, 

Mexico, Panama, Paraguay, Peru, Ghana, and Thailand. A new SIU program was established in Honduras 

in 2012 along with a vetted unit in Nigeria. In 2012, DEA also opened new offices in Montevideo, Uruguay 

and in Sofia, Bulgaria. The u.s. Coast Guard (USCG) conducted numerous jOint maritime counterdrug 

operations in the Caribbean and Eastern Pacific maritime transit zone and off the coast of West Africa 

through a series of bilateral maritime counterdrug agreements. Multilaterally, DENs International Drug 

Enforcement Conference (IDEe) continues to serve as a global forum to share drug-related intelligence 

and to develop operational strategies to address transnational drug trafficking. The next IDEC meeting 

will take place in Moscow in 2013. 

SO 
51 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 53 here HDOC20.050

CHAPTER 6, STRENGTHEN INTERNATIONAL PARTNERSHIPS 

B. Work with Partner Nations and OAS/CICAD to "tn~nrlth"n Institutions in the 

Western Hemisphere 

Hemispheric efforts to promote stronger drug control institutions continued to accelerate in 2012. The 

United States chaired the Demand Reduction Experts Group of ClCAD. Under ONDCP leadership, the 

expert group developed guidance to promote best practices in the areas of prescription drug abuse, 

drugged driving, prevention efforts by community coalitions, and substance abuse data collection. 

These best practices documents will help guide the work of CICAD and participating governments 

in the years ahead. DEA and USCG also participated in CICAD Expert Working Groups on anti-money 

laundering, chemicals and pharmaceuticals, and maritime interdiction, all of which produce guides 

and model regulations and legislation for use by OAS countries. The U.S. Government continued to 

work within the OAS/CICAD Intergovernmental Working Group to revise the Multilateral Evaluation 

Mechanism, which provides a common set of standards by which national drug control programs can 

be evaluated and improved. 

51 
52 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 54 here HDOC20.051

NATIONAL DRUG CONTROL STRATEGY 

C. Work with Partners in Europe, Africa, and Asia to Disrupt Drug Flows in the 

Trans-Atlantic and Trans-Pacific Regions 

The Department of State and DOD continue to coordinate interagency efforts to promote bilateral and 

regional cooperation against drug trafficking and transnational organized crime in Europe, Africa, and 

Asia. Efforts to promote coordination among donor nations regarding narcotics trafficking and transnational crime in West Africa was the focus of a U.s.-hosted February 2012 G8 Roma-Lyon Group meeting. 

Over the past year, the Administration has expanded efforts to address transnational organized crime in 

Africa, including drug trafficking, money laundering, and human trafficking through training programs, 

joint investigations, and enhanced information and intelligence sharing. These efforts are aided by an 

expanded DEA presence in Africa. The United States coordinates an array of drug issues through semiannual drug policy discussions in Brussels with the EU Commission and member state representatives. 

U.s. Africa Command conducted the Africa Maritime Law Enforcement Partnership, placing a USCG Law 

Enforcement Detachment on a u.s. Navy ship to conduct joint patrols with Cape Verge, Senegal, The 

Gambia, and Sierra Leone. The USCG is a member of both the 20-member North Atlantic Coast Guard 

Forum and the six-member North Pacific Coast Guard Forum, two distinct international organizations 

that promote multilateral cooperation between mernber coast guards. 

D. Coordinate with Global Partners to Prevent "tr,th"tir Production and 

Precursor Chemical Diversion 

In 2012, U.s. agencies pushed on multiple fronts to confront the use of new tactics, precursor chemicals, 

and transshipment routes now employed by chemical traffickers and methamphetamine manufacturers. U.s. agencies worked with partner nations in the Western Hemisphere, particularly the Central and 

South American countries that have been targeted by chemical traffickers, and with chemical producing 

countries. ONDCP led an interagency visit to China in September 2012, which included representatives from DEA, the State Department, the Internal Revenue Service, DHS, and JIATF West, to further 

U.S.-Chinese information sharing and case collaboration on synthetic drugs and chemicals. During 

the discussions, both sides agreed to improve collaboration on investigations of methamphetamine 

precursor chemical diversion, particularly to Central America. Similar themes were explored on a more 

functional level by the DOJ-Ied Counternarcotics Working Group of the U.s.-Sino Joint Liaison Group on 

Law Enforcement Cooperation (JLG). U.s. agencies, especially DEA and JIATF West, are increasing efforts 

to track the global precursor trade as it expands to new countries in the Middle East, Africa, and Asia. 

Unlike cocaine trafficking, which employs non-commercial maritime methods forthe movement of illicit 

drugs, commercial maritime shipping containers are the dominant conveyance for methamphetamine 

precursor chemicals. In 2012, JIATF West continued to mature the Illicit Tracking Cell's (lTC) efforts to 

identify, track, and provide actionable intelligence to law enforcement, leading to record interdictions 

related to methamphetamine precursor chemicals transiting globally via commercial maritime cargo. 

52 
53 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 55 here HDOC20.052

&, STRENUTHEN 

E. Global Prevention and Treatment Initiatives through Cooperation 

with the United Nations, the Organization of American States, the Colombo Plan, and 

Other Multilateral Organizations 

Under the leadership of the Department of State, u.s. international demand reduction initiatives have 

continued to mature. In 2012, 75 drug-free community coalitions were established in Latin America (11 

in Brazil, four in Colombia, four in Guatemala, two in Mexico, 50 in Peru, two in Honduras and two in 

Bolivia). In addition, 33 substance abuse treatment programs were established in Afghanistan, including 

centers focused on the needs of women and children. ONDCP placed prevention and treatment at the 

center of the drug policy discussion by emphasizing their importance in the Principles of Modern Drug 

Policy. The Principles document clearly communicates the u.s. approach to the drug problem and was 

released in May 2012 in Stockholm at the 3rd World Forum Against Drugs. 

F. of Health Interventions for Injection 

Drug Users 

The President's Emergency Plan for AIDS Relief (PEPFAR) leverages resources and services from host 

countries and multilateral organizations to support expanded coverage of health Interventions. 

Countries supported by PEPFAR resources have been expanding their national programs to provide core 

interventions including community-based outreach, counseling and testing, MAT, antiretroviral therapy, 

and prevention, diagnosis, and treatment of viral hepatitis and tuberculosis. These evidence-based 

interventions, along with country-level strategies to create an enabling environment with supportive 

laws, policies, and regulations, have been identified by the World Health Organization, UNOO(, and 

UNAIDS as essential interventions that can help in the treatment of opioid dependence and the prevention of HIV and other blood-borne diseases. The United States-through PEPFAR-directly supported 

life-saving antiretroviral treatment for more than 4.5 million men, women, and children worldwide in 

2012. The United States is the first and largest donor to the Global Fund to Fight AIDS, TuberculosiS, and 

Malaria. To date, the United States has provided more than $7.1 billion to the Fund?" 

53 
54 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 56 here HDOC20.053

NATIONAL DRUG CONTROL STRATEGY 

G. Enhance the Relationship with Russia Under the U.s.-Russia Bilateral 

Presidential Commission to Encourage Counternarcotics Cooperation 

Counterdrug collaboration between the United States and Russia expanded in 2012 due to year-round 

coordination and two meetings of the Counternarcotics Work Group (CNWG) of the Bilateral Presidential 

Commission. The first meeting, in Chicago in late 2011, focused on improving public health prevention 

and treatment interventions and included discussions of Federal, state, and local cooperation on border security. During the May 2012 St. Petersburg meeting, the co-chairs signed a document outlining 

the CNWG's success and agreed to further information exchanges on effective drug treatment and 

rehabilitation programs. The delegation also met with individuals in recovery at the St. Petersburg City 

Narcological Hospital and attended a graduation ceremony for counternarcotics officers from Central 

Asia and Afghanistan. 

2. 

A. 

!:i1J1:)port the 

Countries 

Control Efforts 

..,rr,pnlnniPn Strategic P",'tnPr<.h;r,< Mexico 

Source and Transit 

The Merida Initiative has made significant progress since its implementation in 2008, with the biggest 

accomplishment being the mutual fostering of security, protection, and prosperity. From 2008-2012 

DEA coordinatedlconducted 117 training courses for Mexican partner agencies with a total of 3,737 

participants. These courses have focused on a variety of areas induding money laundering investigative 

techniques, proper evidence handling for judicial proceedings, how to maintain the integrity of a crime 

scene, and how to properly perform law enforcement intelligence analysis. To date, the Department of 

State has provided more than 300 polygraph instruments and peripheral equipment to Mexican federal 

and state vetting centers, as well as training, assessment, mentoring, and other professionalization 

services for police internal affairs units. In 2012, the State Department delivered the last two UH-60M 

Blackhawk helicopters to the Mexican Federal Police, bringing the cumulative total to six under the 

Merida Initiative. Also through Merida, four CASA CN-235 aircraft were provided to the Mexican Navy, and 

CBP's Office of Air and Marine provided a modified radar monitoring system to the Mexican Government 

to increase Mexico's air domain awareness on the border with the United States. This system will 

improve collaboration with CBP's Air and Marine Operations Center. In the field of demand reduction, 

in April 2012, ONDeP and NIDA concluded a memorandum of understanding to fund the u.s. portion 

of a bi-national SBIRT study in Los Angeles. The Mexican part of the study, to be conducted in Tijuana, 

is funded by the Merida Initiative and should conclude in 2013. The focus of assistance in 2013 will be 

on training, sustainment, and consolidating gains. 

B. Nexus and the Narcotic!;-C'Drn Nexus in 

The December 2012 U.S. Counternarcotics Strategy for Afghanistan demonstrates the Administration's 

commitment to building Afghan capacity to disrupt the illicit narcotics trade and to break the narcoticsinsurgency nexus. As the world's leading supplier of heroin and illegal opiates, Afghanistan's continued 

high levels of opium production provide the Taliban with funding streams and undermines domestic 

54 
55 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 57 here HDOC20.054

security, stability, and rule of law. As the International Security Assistance Force transitions security 

responsibility to Afghan forces, a parallel transition of counternarcotics program oversight is occurring 

between U.s. agencies and the Afghan Government. Working with Afghan partners, international allies, 

and multilateral organizations, the United States continues to share a commitment for the establishment of effective, sustainable, Afghan-led programs, critical to Afghan security and regional stability. 

The Afghan Ministry of Counter Narcotics has displayed increased capacity and political will, as evidenced by the 154 percent increase in opium eradication (3,810 hectares vs. 9,672 hectares) during the 

2011-2012 growing season." 

In 2012, DEA provided support to law enforcement activities with Honduran authorities that resulted 

in a significant decrease in trafficking by air into Honduras for the duration of the deployment. In 2012, 

DEA added a new SIU in Honduras that will greatly expand law enforcement capacity. The FBI's National 

Gang Task Force and the U.s. Department of State conducted the Central American Law Enforcement 

Exchange program to promote best practices among law enforcement officials from across Central 

America. Among other capacity-building efforts, the Department of State has begun planning, through 

CARS!, efforts to prevent precursor chemical diversion and to build capacity for safe disposal of seized 

chemicals. 

In 2012, Caribbean and u.s. officials developed and began implementation of a viable Maritime Security 

Strategy for the majority of Caribbean countries that project capabilities out to, and slightly beyond, 

their territorial seas (the 12-mile boundary). Assessments of existing fingerprint equipment carried out 

in The Bahamas, Guyana, Jamaica, Suriname, Trinidad and Tobago, and the seven Eastern Caribbean 

countries identified six different collection systems that required upgrades or replacement to permit 

the sharing of fingerprint data within the region. Also, in FY 2013, the United States will provide over 

$1 ° million for upgrades and overhauls to the Air Wing equipment of the Regional Security System, 

which provides counternarcotics and other security related protection to seven independent nations 

in the Eastern Caribbean. 

The United States helps provide alternatives to opium poppy cultivation in Afghanistan through capacity 

building for farmers, agribusinesses, and national and provincial institutions; value chain development; 

infrastructure development; and agricultural credit extension. In 2009, the United States Agency for 

International Development (USAID) established"lncentives-Driving Economic Alternatives-North, East, 

West in Afghanistan;' a 5-year cooperative agreement to implement alternative development projects. 

Through intensive value chain development, the project continues to increase incomes and employment, especially in poppy-prone areas. Approximately 900,000 households have benefited, and 10,000 

hectares have improved licit cultivation. 

55 
56 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 58 here HDOC20.055

In FY 2012, USAID continued to support alternative development projects in Bolivia, Colombia, Ecuador, 

and Peru, benefiting over 34,000 households and supporting over 44,000 hectares of alternative crops in 

the Andean region. SpeCifically in Colombia, USAID supported the development and initiation of more 

than 850 activities in the field, successfully leveraging $49 million or nearly 60 percent of total value 

from public and private sector sources. USAID's small infrastructure activities included improvements 

to health, education, sports, and cultural facilities; improvement and maintenance of tertiary roads; 

and support for the construction of water and sewage systems, benefiting more than 16,400 people. 

In Peru, licit sales from fanners USAID directly assisted in cacao, oil palm, and coffee production totaled 

$35.2 million at farm-gate prices and generated 15,763 equivalentfulHime jobs. For every $1 of USAID's 

investment in technical assistance, $240 in Peruvian public investment was leveraged. 

In 2012, the u.s. Government developed the Roadmap for u.s. Engagement in Central American Citizen 

Security, which guides United States engagement with Central America over the short- (2012-2013) to 

mid-term (2014-2017). The strategic guidance in this document will inform the development of agency 

program implementation plans that include programmatic details and measures of effectiveness and will 

support the five CARSI Pillars: Safe Streets; Disrupt the Movement of Criminals and Contraband; Strong, 

Capable, and Accountable Governments; Effective State Presence in Communities at Risk; and Enhanced 

Levels of Cooperation. In 2012, during quarterly meetings with the ambassadors from the Central 

American nations and visits by DEA and DOJ experts to the region, precursor chemical smuggling was 

identified as a major threat. Through the CARSI program, the State Department, in conjunction with 

DEA and the OAS, are developing programs to support host-nation capacity to safely dispose of seized 

precursor chemicals, as well as ways to tighten laws and increase interdiction capacity in the region. 

Bilateral and regional counternarcotics cooperation in the Western Hemisphere continues to be a 

major focus for U.s. agencies. In July 2012, the Government of Mexico hosted a meeting to support 

the combating crime pillar of the Central America Integration System (SICA) Security Strategy. Partner 

countries and organizations provided updates on their assistance to Central America and the SICA 

member states expressed their desire for greater cooperation at the regional leveL Also in July, ONDCP 

led a u.s. delegation to an international drug conference in Lima, Peru. More than 61 countries and nine 

international organizations attended the 2-day conference that induded focused panel discussions on 

demand reduction, supply reduction, and alternative development. The resulting "Lima Declaration" 

reaffirmed confidence in the UN Conventions that form the basis of the international drug control system. The United States will continue to encourage partner nations, particularly Colombia, to assist the 

countries in Central America with capacity building and information-sharing to face the transnational 

criminal organizations operating in the region. 

56 
57 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 59 here HDOC20.056

u.s. Government assistance to Colombia is declining from the peak years of Plan Colombia as programs 

transition as planned from u.s. to Colombian control. In 2012, the u.s. Govemment continued to support 

aerial eradication, essential for disrupting today's drug trafficking networks and thwarting cultivation 

in Colombia's more remote areas. The constant pressure on illegal coca cultivation has resulted in a 

sharp decrease in the amount of cocaine produced in Colombia over the last decade, coinciding with a 

significant decline in the rate of current cocaine States. Colombia has also gained the 

capacity to export the lessons it learned to allies in the region (over 1,985 personnel from other countries 

were trained by the Colombian National Police in 2012, of those, police officers). The 

Government of Colombia's National Consolidation Plan, which the United States supports, is helping 

to bring the civilian elements ofthe state to remote, previously ungoverned parts of the country. Many 

poor farmers previously forced to grow coca can now safely piant legal alternative crops without fear of 

guerrilla retribution. Colombia's revitalization is reflected economic growth, foreign direct investment, 

and its reemergence as a center of art and culture. 

57 
58 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 60 here HDOC20.057

The intelligence, law enforcement, and defense communities are continuing efforts to develop a more 

complete understanding ofthe primary drug trafficking organizations that threaten the United States 

and its partner countries. FY 2012 accomplishments included a renewed foclis on cOllnterdrug and 

transnational organized crime issues within national priorities; major studies on priority countries and 

organizations; extensive bilateral cooperation with partner nations including Mexico and Colombia; 

and an August 2012 conference on understanding cocaine production and trafficking trends. The U.s. 

Government will continue intelligence collection and analysis primary illicit organizations; improve 

upon data and information-sharing systems; and ensure the coordination of specialized intelligence 

centers such as EPIC, the OF(, SOD, and the Narcotics and Transnational Crime Support Center. 

in 

Transnational criminal organizations continue to employ non-commercial maritime methods for the 

initial movement of illicit drugs through the Western Hemisphere Transit Zone. Targeting these bulk 

shipments before they are broken down into smaller loads has the greatest impact on reducing the flow 

toward the United States, relieves pressure on Central American partner nations, and reduces illicit revenue streams. Interdiction efforts in 2012 were bolstered by Operation MARTILlO, an effort coordinated by 

JIATF South with Western Hemisphere and European partners targeting illicit trafficking routes in coastal 

waters along the Central American isthmus. As of the end of FY 2012, Operation MARTllLO had disrupted 

over 106 metric tons of cocaine in and around Central America. According to the Consolidated Counter 

Drug Database (CCDB), in FY 2012, 211 metric tons of cocaine were removed (seized or disrupted), 

of 889 metric tons moving through the Transit Zone, as documented. This constitutes 23.8 percent 

removal rate which, while well short of the annual target, is consistent with the historical average of 

25 percent over the past decade. The decline in interdiction assets (sea and air) in the Western Hemisphere 

continues to be of great concern at the national leveL The U.s. Government will examine options to 

address the continuing drug trafficking threat in the Transit Zone. 

58 
59 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 61 here HDOC20.058

c. 

u.s. agencies continue to integrate counter-illicit finance tools in their efforts against drug trafficking 

and transnational criminal organizations. In FY 2012, the Office of Foreign Assets Control designated 

dozens of entities tied to Mexican drug trafficking organizations-including the Sinaloa and Zetas 

organizations-under the Foreign Narcotics Kingpin Act, freezing their assets and financial transactions 

under u.s. jurisdiction. The u.s. and Mexican Attorneys General signed an agreement in March 2012 to 

share approximately $6 million in forfeited funds to support Mexican efforts to target illicit finances and 

enhance bilateral cooperation. The United States will continue to build on such cooperation by sharing 

counter-illicit finance tools, best practices, and information. 

In addition, ICE has developed an Illicit Pathways Attack Strategy (lPAS) that focuses on illicit finance 

and money laundering activities of transnational organized crime networks operating in the Western 

Hemisphere. The pathways approach enables ICE/HSI to use intelligence and analysis to identify the 

means and methods being used by multiple organizations. Once identified, ICE can analyze whether 

there are key convergence points that can be investigated and vulnerabilities that can be identified 

and addressed. For high-risk criminal networks, the focus is on the investigation and prosecution of 

the leadership, co-conspirators and facilitators, with disruption and deterrence operations taking place 

simultaneously with arrests. For high-risk pathways, efforts are focused on building multinational coordinated investigations and building the capacity of partner nations to identify, investigate, and prosecute 

criminal networks and disrupt criminal activity. 

u.s. Government agencies continue to identify and exploit the vulnerabilities of the leadership of those 

drug trafficking and transnational criminal organizations primarily responsible for moving drugs into 

the United States and laundering money. Bilateral efforts yielded numerous successes against such 

organizations in FY 2012, while domestic efforts have broken up networks within the United States. For 

instance, collaboration between the "BACRIM" unit in the U.s. Attorney's Office for the Southern District 

of Florida and the 001 Criminal Division's Office of International Affairs resulted in total extraditions 

from Colombia reaching a high of 183 in FY 2012."BACRIM"is an abbreviation for"bandas criminales;' or 

criminal bands, which are loosely associated criminal groups that sprang up after the demise of the major 

cartels in Colombia and represent one of the greatest international security challenges facing Colombia 

today. In addition, the OCDETF Program continues to use the Attorney General's Consolidated Priority 

Organization Target (CPOT) list to target the most significant drug trafficking and money laundering 

organizations responsible for the Nation's illicit drug supply. Of the 68 active FY 2012 CPOTs, 42 were 

indicted, 22 were arrested, and 4 were extradited. Since implementation of the CPOT list in June 2002 

through FY 2012,36 CPOT organizations have been disrupted and 53 dismantled. 

59 
60 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 62 here HDOC20.059

The policies and programs presented in the National Drug Control Strategy are evidenced-based; they are 

based upon scientifically rigorous studies published either by government sources or in peer-reviewed 

literature. The findings from this research are used by the Administration to formulate and assess policies 

and programs to address drug use and its c:onsequenc:es. 

For example, in 2011, the Administration released the Prescription Drug Abuse Prevention Plan, which 

includes specific actions that can be taken in four distinct areas: education, monitoring, proper medication disposal, and enforcement. The impetus for producing the Plan was the growing accumulation 

of data from several indicator systems showing the troubling prevalence of prescription pain reliever 

abuse and its consequences. NSDUH, for example, indicated that in 2009, 5.3 million Americans age 

12 and older (2.1 percent of the population) had used a pain reliever non-medically in the past month. 

The Centers for Disease Control and Prevention noted that there were nearly 28,000 unintentional drug 

overdose deaths in 2007-pain relievers were involved in such deaths more frequently than were either 

cocaine (1.93 as many times) or heroin (5.39 as many times)'" Finally, treatment admissions for which 

prescription opioids were the primary cause of the admission rose 535 percent between 1999 and 

2009."6 With the release of the 2011 NSDUH, the Nation has seen a 12 percent decline in prescription 

drug abuse among those 12 and older.97 This good news indicates that policy interventions to reduce 

the misuse of prescription drugs may be having an effect. 

Much of the evidence base used by policymakers to assess the effectiveness of drug policies and programs is derived from several key Federal data systems, including the 

National Survey on Drug Use and Health (NSDUH), 

Drug Abuse Warning Network (DAWN) 

Treatment Episode Data Set (TEDS), 

Monitoring the Future (MTFj study, 

System to Retrieve Information on Drug Evidence (STRIDE), 

National Seizure System (NSS), 

Arrestee Drug Abuse Monitoring II (ADAM) program, and the 

National Vital Statistics System (NVSS). 

These data systems and many more are fundamental to the operation of ONDCP's Performance 

Reporting System. The status of the Government's efforts to achieve the Strategy's goals is assessed 

with the data from these systems. These data systems also provide the information that populates the 

National Drug Control Strategy Data Supplement, a compendium of the leading indicators of drug use, 

drug supply, and related consequences. 

61 
61 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 63 here HDOC20.060

These data systems are not static; they require continual review and updating to ensure their methods 

incorporate the latest scientific advancements in survey design and data collection. 

For example, in 1999 and 2002, the NSDUH implemented several modifications to address falling 

response rates-a critical factor in any population survey-and improve the accuracy of responses, 

including adoption of computer-assisted self-administration of much of the interview, increases in the 

monetary incentive paid to respondents, re-training of survey interviewers, expansion of the sample, 

and the re-naming of the survey. These enhancements increased response rates, enabling production 

of state-level estimates, increased respondent participation and confidentiality, and improved the 

accuracy and precision of the resulting estimates. SAMHSA, the Federal agency responsible for NSDUH, 

is currently planning a fe-design of the survey in 2015 to update the survey methodology and to revise 

or include questions to better measure recent trends in drug use behavior, attitudes, and related issues. 

SAMHSA is working with the CDC's National Center for Health Statistics to collect data on adverse 

consequences of substance use through the newly formed National Hospital Care Survey, which will 

enable estimates of the number and characteristics of drug-related emergency department 

This solution is not without trade-offs. While the costs of obtaining the data will be constrained, the data 

on drug-involvement in ED visits will not be as detailed under the new system as it was under DAWN 

due to sample constraints. However, the new system will provide data on such visits not previously 

available, including patient disposition following the ED visit. The new data system is scheduled to be 

operational by the end of 2013. 

The NSDUH provides policymakers with the most detailed picture of drug use and related issues among 

the U.s. population 12 and older. NSDUH data are used by the government to assess the progress the 

Nation is making in achieving the goals of the Strategy and the Prescription Drug Abuse Prevention Plan. 

It is also used by researchers to study such issues as medical marijuana, drug-related risk and protective factors, and the prescription drug abuse epidemic. As noted previously, SAMHSA, in consultation 

with ONDCP and other Federal and non-governmental experts, is planning a re-design of the survey 

for 2015 to incorporate updates to the methodology and to improve its ability to provide estimates of 

emerging drug problems, especially prescription drug abuse. Field-testing of some of the new data 

elements took place in 2012. 

The Drug and Alcohol Services Information System is composed of three data sets: (1) the TEDS, containing data on substance abuse treatment admissions, by state; (2) the National Survey of Substance Abuse 

Treatment Services (N-SSATS), containing administrative data on the Nation's treatment providers; and 

(3) the Inventory of Substance Abuse Treatment Services (I-SATS), a listing of the Nation's treatment 

providers. These data sets provide policymakers and the public with critical information regarding the 

62 
62 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 64 here HDOC20.061

Nation's treatment system, including the name, location, and specialty of providers (I-SATS); characteristics (e.g., source of payment, staffing, number of clients) of the providers (N-SSATS); and the number 

and characteristics of clients in treatment (TEDS). 

Drug prices are also of great interest to communities, as they provide a snapshot of what drugs are 

available and how easy they are to obtain. Currently, DEA tracks the price of drugs as part of ongoing 

casework (the System to Retrieve Information on Drug Evidence, or STRIDE) or through a few recurring 

drug purchase programs. From these DEA data, national trends for drug prices and purities are developed for the four major drugs (cocaine, heroin, marijuana, and methamphetamine) in various market 

levels and are published annually in the National Drug Control Strategy Data Supplement. 

DEA has been pursuing several possibilities for improved assessment of street drug prices and purities. 

DEA contacted counterparts at state/local forensic labs seeking specimens for subsequent analysis. 

However, unlike DEA, the state/locallabs do not retain drug samples; specimens are returnedto the 

acquiring law enforcement agencies, which will not release them for various reasons, ranging from 

legal restrictions to wanting to maintain all of the evidence until adjudication. DENs National Forensic 

Laboratory Information System (NFLlS) has recorded some state/loca! labs that do collect purity information. A query capability of NFLIS drug purity data, accessible to analysts, is being investigated. This 

repository would permit analysts to extract the latest drug purity data in u.s. localities to monitor trends 

and compare geographic fluctuations. 

Although national surveys provide invaluable data on overall drug prevalence, there is special value 

in studying drug use among arrested persons. The Arrestee Drug Abuse Monitoring (ADAM) study is 

conducted annually to provide law enforcement in select areas with data on drug use among arrestees 

in their jurisdictions. This survey is unique among Federal drug related surveys due to its confirmatory 

urinalysis test. While not nationally representative, these data provide special insights into regional drug 

use trends. As Colorado Governor John Hickenlooper noted in 2010 while serving as Mayor of Denver, 

"It is important to accurately track drug use for those arrested, especially with drug use being prevalent 

in so many arrest cases ... The report offers a good snapshot into the varying drug problems different 

cities face across the country:' 

The was published in spring 2012. A special analysis of expanded data 

collection in New York City was prepared at the request of the New York City Police Commissioner to 

inform policymakers on judicial diversion for eligible drug-using offenders. Due to lower funding, the 

ADAM II study in 2012 was reduced to cover just five markets (New York City, Chicago, Atlanta, Denver, 

and Sacramento). The continuation of ADAM in the five markets in 2012 and 2013 is funded in part by 

the Bureau of Justice Assistance. 

63 
63 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 65 here HDOC20.062

At ONDCP's request, SAMHSA studied the feasibility of adding questions to the NSDUH to enable estimation of marijuana consumption (i.e., the amount of the drug consumed). Results indicated, however, that 

respondents were unable to reliably provide such information, As an alternative to a direct estimate of 

drug consumption, ONDCP has funded research to model such estimates, Data from several sources, 

including the NSDUH, ADAM, MTF, and STRIDE are analyzed to determine how many users there are 

of particular drugs, how frequently they use these drugs, and how much they spent the last time they 

acquired them. Data on the price and purity of drugs from STRIDE enable researchers to estimate how 

much of each drug consumers obtained (and presumably consumed) given a certain price paid for 

those drugs, In early 2012, ONDCP published annual consumption estimates through 2006; an update 

taking the estimates through 201 0 is currently in production and is scheduled to be completed in 2013.'8 

Tabulation of drug seizures is the foundation for reporting statistics on the trends, activities, and patterns related to drug supply reduction policy, EPIC has completed its integration of historical seizure 

data from the Federal-wide Drug Seizure System (FOSS) with the latest NSS data. Federal agencies are 

collaborating on improving the consolidation and de-duplication of drug seizure data electronically to 

provide more accurate and timely tabulations, With standardization offield definitions, strategic seizure 

reports will be possible to inform policymakers on the latest drug trafficking trends. A draft template for 

a strategiC drug seizure report is expected in FY 2013. Concurrently, the CCDS is working to incorporate 

NSS data into its system to ensure that all relevant seizures are captured. 

Illicit drug trafficking is a global problem, and improved data on foreign drug markets enhances our 

understanding of the latest trends. ONDCP is funding a study to integrate all available information on 

drug trends to estimate drug expenditures by American users, the number of users, and estimates of 

consumption. DEA conducted a study of cocaine movement toward the United States using Carbon 14 

dating to improve the modeling of cocaine flow from South America:' ONDCP published a study that 

estimated the number of cocaine users in the United States, expenditures on illicit drugs, and the amount 

consumed CCDB, which focuses on worldwide cocaine movement, was enhanced to 

track worldwide movements of opiates (primarily heroin and opium) and methamphetamine precursors. Interagency analysts are being organized to participate in collecting data for these two new CCDS 

modules. The opiates database should provide a more comprehensive, regional view of the Southwest 

Asia heroin threat, and validation sessions are occurring for the initial methamphetamine precursor 

data. In addition, the State Department's INL Bureau conducted an Afghanistan National Urban Drug 

Use Survey to give the most accurate estimate to date on Afghanistan drug prevalence rates. 

64 
64 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 66 here HDOC20.063

DEA conducted four studies in in rAIA~nh"on departments of Caqueta, Vichada, Bolivar, and 

Valle del Cauea that were instrumental in nptprmilninfl leaf yields that led to improved P<l·"Yl~T'" 

of pure cocaine production potential. DEA also conducted a study of how the changes in the production of cocaine HCI Bolivia increased the purity and, therefore, the production potential for cocaine 

in Bolivia. The U.s. Govemment planning to a yield study Peru over thc" next year to 

get an up-to-date snapshot. Also, the U.s. will conduct a heroin lab efficiency study 

Afghanistan and an opium yield study in Burma. These studies should help improve heroin production 

data in these two source countries. Finally, 2012, the Government of Mexico expressed interest in 

conducting heroin and marijuana yield studies in Mexico, but those have been delayed at least 

due to national elections. Cooperation from 

in improved potential production estimates. 

Success at reducing the Nation's use problem occurs at the local level through the efforts of community coalitions, treatment providers, recovery support service providers, law enforcement, and others. 

SAMHSA, with the assistance of its Federal partners, developing system of local indicators. In 

FY 2013, a pilot program to develop and implement the system selected sites will undertaken. 

65 
65 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 67 here HDOC20.064

Every year, thousands offatalities occur in the United States that involve drugged driving.'Dl Drugs other 

than alcohol that can affect driving performance include illicit drugs and medications (prescribed and 

over-the-counter) with the potential to alter behavior, It has been 3 years since the President identified 

drugged driving as a national priority in the inaugural National Drug Control Strategy and set an ambitious goal ofreducing drugged driving in America by 10 percent by 2015, To meet the President's goal, 

ONDCP continues to work closely with Federal partners, state and local governments, public health 

offiCials, law enforcement agencies, membership organizations, and community groups to bolster 

awareness, 

Success in achieving the Strategy's goal will be measured with data from the National Highway Traffic 

Safety Administration's (NHTSA) National Roadside Survey. While data from this survey will not be available until 2014, results from the NSDUH are used 'as an alternate source of data to determine whether the 

Nation is likely to be on track to achieve this goal. In 2011, according to the NSDUH, 9.4 million persons 

(3,7 percent) of the population aged 12 or older reported driving under the influence of illicit drugs 

(including the nonmedical use of prescription-type drugs) during the past year. This is a 12 percent 

decrease from the rate in 201 0 (4.2 percent) and 2009 (4.2 percent),'02 

While the data are encouraging, we must remain focused on reducing this threat to public health and 

safety, The 2012 National Drug Control Strategy focused on four key areas of the Administration's efforts 

to reduce drugged driving: Increase public awareness; enhance legal reforms to get drugged drivers off 

the road; advance technology for drug tests and data collection; and increase law enforcement's ability 

to identify drugged drivers, These efforts remain the Administration's focus for the upcoming year, 

To raise national awareness, in 2012 the President once again declared December National Impaired 

Driving Prevention Month, In addition to forging new relationships and extending our public outreach, 

ONDCP will continue to work with such national partners as Mothers Against Drunk Driving (MADD) 

and RADD; The Entertainment Industry's Voice for Road Safety to produce educational programming 

for youth and raise awareness about the dangers of drugged driving, 

ONDCP has established strong collaborations with DOT, speCifically NHTSA and the Office of Drug and 

Alcohol Policy and Compliance; the Department of Health and Human Services, specifically NIDA and 

SAMH5A; and the National Transportation Safety Board. Because of these partnerships, progress in 

research is being made and several key projects are underway, The Administration will continue to support research to improve the standards and reliability for drug testing, induding the development of a 

reliable and widely-available roadside test for the detection of the presence of drugs in drivers' systems, 

Law enforcement plays a critical role in reducing drugged driving, and ONDCP will continue to support 

additional training for patrol officers to recognize impaired drivers. Progress has also been made in 

making training more accessible to law enforcement In 2013, ONDCP and the NHTSA will launch the 

online version of NHTSA's Advanced Roadside Impaired Driving Enforcement program (ARIDE), making 

training available to an even larger number of officers, 

We know from the decades-long efforts to reduce drunk driving that progress is possible, Since 1973, 

there has been a 71 percent decrease in the percentage of alcohol-impaired drivers on the road on 

67 
66 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 68 here HDOC20.065

weekend is now driving 

policymaking, and legislation. The following accomplishments are evidence that we are moving 

right direction on this important issue. 

ing states with the advice and the technical assistance needed to pursue drugged driving legislation. 

Due to growing drug use by drivers, 17 states in the 

past to reduce threilts to public health and public safety. For example, administrative license revocation 

their administrative license revocation laws to cover drugged as well as drunk drivers. 

68 
67 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 69 here HDOC20.066

Strong data provide the basis for sound policy, and the Administration has made significant strides in 

research and data collection over the past 3 years. ONDCP provided support to NHTSA to accelerate the 

next iteration of the National Roadside Survey to be completed with results by 2014. This survey is critical 

to providing data on randomly selected drivers by testing their blood or saliva to confirm the presence 

of drugs. Another study conducted by NHTSA is the Crash Risk Study. This study, conducted in Virginia 

Beach, Virginia, is assessing the relative risk of becoming involved in a crash after consuming drugs; 

results are expected in 2013. ONDCP has partnered with NHTSA and NIDA to support driver simulator 

research to examine driving impairment as a result of marijuana and combined marijuana and alcohol 

use and correlate it with the results of oral fluid testing to identify behavioral indicators of impairment. 

by 

Outreach and education regarding drugged driving has gained momentum across the Nation. Over 

the past 3 years, the President has declared December National Impaired Driving Prevention Month. 

In 2012, much was accomplished by way of national partnerships, published opinion editorials, community roundtables, conferences, ONDCP dissemination, webinars, and 

Federal and state level engagement. Significant partnerships include working with Mothers Against 

Drunk Driving (MADD) and RADD: The Entertainment Industry's Voice for Road Safety. ONDCP will 

seek to build new relationships while continuing public awareness efforts with the Students Against 

Destructive Decisions (SADD), the Governors Highway Safety Association, the American Association of 

Motor Vehicles Administrators, the Lifesavers Conference, the National Organizations for Youth Safety, 

the NationalTransportation Safety Board, the National Association of School Resource Officers, and the 

National Association of Drug Court Professionals. 

on 

Equipping our Nation's law enforcement officers with the best possible training is an integral part of 

reducing drugged driving crashes. ONDCP has partnered with DOT and NHTSA to develop an online 

version ofNHTSA's ARIDE program, that will be available in 2013. These training modules allow more law 

enforcement officers and prosecutors to receive advanced training on drugged driving enforcement. 

During 2013, the Administration will continue to raise awareness for ARIDE training through national and 

local outreach opportunities. Additionally, the Administration continues to recognize the importance 

of officers who are trained and certified as DREs. 

Develop ,-,-;.;nn;,rn Use 

Presence 

There have been considerable developments in research for the use of oral fluid (saliva) for drug testing. Oral fluid can provide a quick and non-invasive specimen for drug testing, particularly in cases 

where drugged driving is suspected. In 2011, ONDCP entered into an interagency agreement with 

SAMHSA supporting the development of guidelines on toxicology laboratory standards for detecting 

drugs and/ortheir metabolites in oral fluids. While the primary purpose of these Federal guidelines are 

for workplace testing, they are critical for developing roadside detection devices needed for drugged 

driving enforcement. 

69 
68 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 70 here HDOC20.067

The misuse and abuse of prescription medications has taken a devastating toll on the public health and 

safety of our Nation. Increases in substance abuse treatment admissions, emergency department visits, 

and-most disturbingly-deaths attributable to prescription drug overdoses are placing enormous 

burdens upon communities across the country.'04,IDS.'06 So pronounced are these consequences that 

the CDC has characterized prescription drug overdose as a public health epidemic, a label that further 

underscores the need for urgent policy, program, and community-led responses.'O? 

Data from 2011 show that approximately 6.1 million Americans reported that they used prescription 

drugs non-medically in the past month.'

°

s In 2011, 2.3 million Americans aged 12 or older used these 

medications non-medically for the first time, the largest share of whom 0.9 million) started with pain 

relievers, most of which contained opioids like Oxycontin', hydrocodone, codeine, and methadone.109 

There are also indications that for some, oral prescription opioid abuse is followed by injection of opiates 

and eventual use of heroin, an illicit opiate.Ho•

m Heroin use appears to be increasing, particularly among 

younger people outside of metropolitan areas.'" NSDUH data indicate the number of persons who were 

past year heroin users in 2011 (620,000) was significantly higher than the number in 2007 (373,000).113 

This widespread abuse is having very real consequences. In 2010 alone, more than 1.3 million emergency 

department visits involved the non-medical use of prescription drugs--more than double the estimate 

from 6 years earlier and outnumbering visits involving all other illicit drugs combined."4 Data also show 

a more than five-fold increase in addiction treatment admissions for individuals primarily abusing 

prescription pain relievers from 2000 to 2010.115 And the number of 18- to 25-year-olds admitted for 

treatment due to heroin increased from approximately 43,000 in 2000 to approximately 68,000 in 2010."6 

Perhaps most alarming, however, is that in 2010 more than 38,300 Americans died from drug overdose, 

with prescription drugs-particularly opioid pain relievers-involved in a significant proportion of those 

deaths. This means that on average more than 100 Americans die from drug overdoses every day in 

this country."] Opioid pain relievers were involved in over 16,600 of these deaths, apprOXimately four 

times the number of deaths just a decade earlier in 2000.'18 Overdose fates among heroin users are also 

known to be high, with approximately one quarter of heroin users experiencing an overdose annually 

and some researchers estimate approximately 1 percent dying annually.'19 Opioid pain relievers are now 

involved in more overdose deaths than heroin and cocaine combined. All drug overdose deaths now 

even outnumber deaths from gunshot wounds or from motor vehicle crashes.uo 

The considerable public health and safety consequences of prescription drug abuse underscore the 

need for action. In April 2011 ,the Administration released its comprehensive Prescription Drug Abuse 

Prevention Plan, 

upon the Administration's National Drug Control Strategy, the Plan brings together a wide range of 

stakeholders to reduce diversion and abuse of prescription drugs. It strikes a balance between our need 

to prevent diversion and abuse of pharmaceuticals and the need to ensure legitimate access, focusing 

on four major pillars, each designed to intervene at a critical juncture in the process of diversion and 

71 
69 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 71 here HDOC20.068

abuse. These pillars include education for prescribers and the public; prescription monitoring; safe drug 

disposal; and effective enforcement. 

There are signs that the national effort to reduce and prevent prescription drug abuse is working. The 

latest survey data show the number of people currently abusing prescription drugs has decreased significantly, from 7.0 million in 2010 to 6.1 million in 2011, a nearly 13 percent decrease.l2l We also know 

that past month non-medical use of prescription drugs among young adults ages 18-25 was significantly 

lower in 2011 (5.0 percent) compared to just one year earlier (201 0,5.9 percent), a trend that is also true 

for the abuse of pain relievers among this age group.122 

While these trends are promising, we know there is much more to do. Indications of increasing heroin 

use in some areas of the country underscore the need for further research on the relationship between 

prescription drug abuse and heroin use. The Administration is focused on accomplishing the goals of the 

Prescription Drug Abuse Prevention Plan and addressing some of the most pronounced consequences 

of this epidemic, including overdose deaths and emerging issues like NAS and increases in heroin use. 

Family practitioners, internists, dentists, and pain specialists are charged with the important task of managing their patients'pain, often by prescribing opioid pain relievers. Surveys of health care professionals 

and medical schools reveal significant gaps in education and training on pain management, substance 

abuse, and safe prescribing practices.123 For these reasons, the Administration continues to support 

mandatory education for prescribers, as called for in the Prescription Drug Abuse Prevention Plan. 

Several states, including Iowa, Massachusetts, and Utah have recognized this need and passed mandatory prescriber education legislation. These laws require important education for health care providers 

on the abuse potential of prescription medications and the best ways to deliver quality care while 

ensuring patient and public safety. 

As state leaders take steps to expand critical training in this area, the Administration continues to support 

other education efforts across the country. SAMHSA is providing training on prescription drug abuse 

for physicians and other health professionals both online and, since 2007, in 47 sites in 20 states with 

particularly high rates ofopioid dispensing. These training programs are providing important knowledge 

and tools for medical professionals responsible for safely prescribing these medications. In addition, the 

FDA has developed a Risk Evaluation and Mitigation Strategy (REMS) for extended-release and longacting (ERllA) opioids. Announced in July 2012, the REMS risk management plan for these medications 

requires all manufacturers of ER/LA opioids to make training available for prescribers of these medications.124The manufacturers have also developed information that prescribers can use when counseling 

patients about the risks and benefits of opioid use. The FDA expects that the training will be provided 

free or at low-cost by continuing education providers and that at least 60 percent of the approximately 

320,000 licensed prescribers of ER/LA opioids will be trained within 4 years from when training is available. Lastly, under its Safe Use Initiative, FDA has convened a workgroup and has developed a draft 

model Patient Provider Agreement (PPA). The workgroup will be pilot testing the model PPA in clinical 

72 
70 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 72 here HDOC20.069
71 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 73 here HDOC20.070

cases outside 

practice, mills;' and other sources of diversion. In 2006, states had POMPs. Today, 49 states 

have laws authorizing PDMPs, operational programs. Missouri and Washington, 

DC, have yet to authorize PDMPs. 

All states 

other with several more pending 

adopted Prescription Monitoring Information Exchange (PM IX) Architecture. The PMIX Architecture 

formal set of technical requirements that existing and future 

to enable data 

information from these within systems to promote more regular 

and consistent use of POMP data as a standard part of patient care. The Administration working with 

state health and law enforcement 

and increase prescriber and a 

ONOCP is working with the Office of the National Coordinator for Health information Technology (ONC) 

at HHS, SAMHSA, and CDC to explore connecting POMPs with 

patients 

phase of the Enhancing Access 

2012 and resulted in evaluations of pilot sites in six states, including Indiana, Michigan, Nebraska, North 

Dakota, Ohio, and Washington, The the ease and effectiveness 

IT connectivity configurations. Overall, the 

pilot studies successfully demonstrated the ability to enhance access to POMPs health IT as well 

as the associated benefits to health care providers and dispensers. The project is currently in its second 

phase, which scheduled to conclude in 2013. 

has funded 

Health Record (EHR) Integration alld Illteroperobility Expansion project The purpose of this program is to: 

1) improve real-time access to POMP data by integrating PDMPs into existing technologies, like 

order to improve the ability of state POMPs to reduce the nature, scope, and extent of prescription drug 

abuse; and strengthen by make 

the changes necessary to increase their interoperability. Grant funds will enable states to integrate their 

POMPs into EHR and other health information technology systems to expand utilization by increasing the 

production and distribution of unsolicited reports and alerts to prescribers and dispensers of prescription 

data. Grant funds will also be used 

This grant 

administrators and leadership to 

implement Memoranda data 

74 
72 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 74 here HDOC20.071

programs and has overcome barriers resulting from lack offunding, privacy act provisions, and differences among state PDMPs. BJA and IHS continue to address ongoing issues to ensure data privacy and 

reporting requirements to ensure that PDMPs and prescribing data can be used to address prescription 

drug abuse among tribal communities. 

The DOD prescription data repository, the Pharmacy Data Transaction Service (PDTS), conducts online, 

real-time prospective drug utilization review against a patient's complete medication history for each 

new or refilled prescription before it is dispensed to the patient. Currently, the DOD shares prescription 

data with state PDMPs through the TRICAREMail Order Pharmacy and Retail Network Pharmacies. The 

DOD is assessing various technical approaches and levels of effort to determine the best solution for 

military treatment facility pharmacies to share data with state PMDPs. 

The Administration worked with the Congress to secure language in the FY 2012 Consolidated 

Appropriations Act to allow VA to share prescription drug data with state PDMPs, an important development to ensure safe prescribing and patient safety for our veterans. Publication of an intel'im final rule 

on February 11,2013 amended VA's regulations concerning the sharing of certain patient information 

in order to implement VA's authority to participate in state PDMPs. VA is developing the informatics 

solution for each VA medical center to submit prescription data. Other Federal PDMP databases will 

move toward integration with state PDMPs. 

Research shows that over 70 percent of people using prescription pain relievers nonmedically report getting them from a friend or relative the last time they used the drugs.126 Safe and proper disposal programs 

allow individuals to dispose of unneeded or expired medications in a safe, timely, and environmentally 

responsible manner. DEA has partnered with hundreds of state and local entities to coordinate several 

National Prescription Drug Take Back Days in communities across the country. Through these events, 

DEA has collected and safely disposed of over two million pounds (1 ,018 tons) of unneeded or expired 

medications, many of which were sitting in drawers and medicine cabinets, vulnerable to misuse.'" 

These "Take Back Days" were a critical first step in safely collecting, disposing, and preventing diversion 

ofthese medications. 

The passage of the Secure and Responsible Drug Disposal Act in October 2010 was a critical step forward in expanding prescription drug disposal nationwide. The DEA Notice of Proposed Rulemaking for 

the Disposal of Controlled Substances, published on December 21,2012, outlines the Administration's 

proposal to make safe disposal of prescription drugs more convenient and accessible for all Americans. 

To help ensure a reduction in the amount of prescription drugs available for diversion and abuse, a 

drug disposal program needs to be easily accessible to the public, environmentally friendly, and costeffective. The proposed rule would allow authorized pharmacies and other authorized DEA-registered 

entities to host permanent collection receptacles, administer mail-back programs, and make easy,safe 

disposal of these medications a reality for communities nationwide. DOD has actively promoted DENs 

National Prescription Drug Take Back Days among the military population, and, with final regulations 

implementing the Disposal Act on the horizon, all persons (civilian and military) will be able to more 

readily remove unwanted controlled substances from their households. 

75 
73 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 75 here HDOC20.072

Pill 

Doctor shopping and pill mill operations have presented significant challenges for law enforcement 

agencies in a number of states. Innovative enforcement strategies and collaboration among Federal, 

state, and local law enforcement agencies and criminal justice leaders are helping many communities 

shut down these illegal operations. Florida is a great example of this success. According to DEA, 90 of 

the top 100 oxycodone purchasing physicians in the Nation were located in the State in 201 O. While not 

all of these doctors were operating unethically or illegally, many were, and the State took steps to shut 

them down. State leaders passed laws that stopped doctors operating at these pain dinics from being 

able to dispense controlled substances. These state actions, combined with a number of significant 

enforcement actions led by DEA and state and local agencies, have resulted in a decreased number of 

rogue pain clinics. As a result, oxycodone purchases by doctors in Florida have dropped dramatically. In 

fact, according to DEA, there was a 97 percent decrease in oxycodone purchases by doctors in Florida 

in 2011 compared to 2010, and the number of Florida doctors appearing on the list of the top 100 

oxycodone-purchasing physicians dropped from 90 in 2010 to only 13 in 2011. 

While Florida's progress is promising, these combined actions may be causing doctor shoppers and others seeking diverted prescription drugs for abuse to turn to other states in the region. There have been 

notable increases in prescribers purchasing oxycodone in Georgia and Tennessee. Among oxycodonepurchasing prescribers, 21 located in Georgia and 11 in Tennessee are now among the top 1 00. In order 

to prevent pill mill operators and improper prescribers from simply migrating to other areas of the 

country, the Administration is working with state and local leaders to learn from Florida's experience 

and explore enforcement, regulatory, and legislative options to prevent diversion and its consequences. 

The Administration remains committed to coordinated Federal, state, and loca! efforts. DEA's Tactical 

Diversion Squads, multiagency HIDTA Task Forces, and other collaborative enforcement groups will 

continue to shut down pill mills, build cases against improper prescribers, and stop flows of diverted 

prescription medications. In FY 2012, the National Institute of Justice awarded three new grants to 

promote research on illegal prescription drug market interventions: Identifying High Risk Prescribers 

Using PDMP Data: A Tool for law Enforcement; Non-Medical Use of Prescription Drugs: Policy Change, 

Law Enforcement Activity, and Diversion Tactics; and Optimizing Prescription Drug Monitoring Programs 

to Support law Enforcement Activities. 

The Administration has taken steps to reduce the role of illegal Internet pharmacies in pharmaceutical 

diversion. The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 requires all Internet 

pharmacies to obtain a special DEA registration and report monthly to DEA; to disclose detailed information on their home page; and to provide no pharmaceuticals to individuals who have not had at least 

one face-to-face evaluation by a prescribing medical practitioner. The law allows DEA to better monitor 

unlawful internet pharmacy operations and reduces the number of Internet pharmacies distributing 

controlled substances illegally. DEA will continue to focus on online operations illegally diverting these 

medications and will continue to partner with international, state, and loeallaw enforcement agencies 

to further suppress illegal online sources of prescription drug diversion. 

76 
74 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 76 here HDOC20.073

The Administration is focused on improving law enforcement capabilities to address prescription drug 

diversion from "pill mills" and rogue prescribers. The National Methamphetamine and Pharmaceuticals 

Initiative (NMPI), funded through ONDCP's HIDTA program, has provided critical training on pharmaceutical crime investigations to law enforcement agencies across the country. In FY 2011 alone, NMPI helped 

provide training in pharmaceutical crime investigations and prosecutions to over 2,500 law enforcement 

and criminal justice professionals. These efforts continue to disseminate critical knowledge and skills 

to the enforcement professionals that enable them to address pill mills operating in their jurisdictions. 

As noted previously, approximately 100 Americans died from drug overdose every day in 2010, with 

a majority of those overdose deaths involving prescription drugs.128 Drug overdose deaths now even 

outnumber deaths from gunshot wounds or from motor vehicle crashes."· Opioid overdoses persist as 

a major cause of preventable death in the United States. In response to this public health emergency, 

the Administration established a goal of reducing drug-induced deaths by 15 percent by 2015. To meet 

this goal, the Administration is seeking to address the full range of individuals at risk for overdose and 

collaborate with a diverse range of partners to promote education and intervention. 

Naloxone (brand name Narcanm ) is an opioid antagonist that has long been used as an emergency 

intervention to reverse the potentially fatal respiratory depressant effects of an opioid overdose (opioids 

include licit drugs such as morphine, codeine, oxycodone, methadone, and hydrocodone as well as 

Schedule I illicit drugs such as heroin). Naloxone can be given by injection into a muscle or with a nasal 

spray device into the nose. When administered to an individual who has taken opioids, it is believed 

naloxone dislodges the opioids from the opioid receptors in the brain. This can reverse the effects of an 

overdose and help restore breathing that may have slowed or stopped during the overdose episode.no 

As death typically does not occur until several hours after an opioid overdose, there is a window of 

opportunity to intervene by calling 911, giving rescue breathing, and by the administration of naloxone 

by a trained lay person.13),m 

The Administration is also examining legal impediments that might discourage individuals from calling 

911 in the event of an overdose. Several states, including California, Illinois, Massachusetts, and New 

Mexico have passed Good Samaritan laws, which provide immunity from drug posseSSion prosecutions for overdose victims and witnesses who seek medical aid. As these laws are implemented, the 

Administration will carefully monitor the impacts on public health and public safety. 

Research has shown that naloxone is an important and cost-effective tool to prevent overdoses and 

ultimately reduce drug use and its consequences.133The Administration has taken a number of steps to 

educate the public, law enforcement profeSSionals, health care providers, and others about overdose 

prevention. ONDCr, CDC, and SAMHSA are working with first responders to identify and address any 

gaps in training, access, and use of naloxone by first responders. In early 2012, various HHS components 

(FDA,Office of the Assistant Secretary for Health, NIDA, and CDC) held 

importance of naloxone in reducing overdose deaths and examining regulatory avenues for the use of 

naloxone by non-medical personnel. At the meeting, FDA described pathways to approve alternative 

non-injectable formulations of naloxone and over-the-counter approval of the drug. 

77 
75 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 77 here HDOC20.074

As the Administration enters a second term-and the Strategy enters its fourth year---we have reason 

to be optimistic about the future of our efforts to reduce drug lise and its consequences in the United 

States. We are working at every leve! and in every setting to help prevent drug use before it starts. 

Screening and brief intervention services are expanding in the health care system, and the full implementation of the Affordable Care Act will increase access, quality, and innovation in substance abuse 

treatment. We have made an unprecedented commitment to support individuals in recovery and will 

continue to support their cause and celebrate their success. We have brought increased attention to 

the issues of maternal addiction and neonatal abstinence syndrome. Through the Prescription Drug 

Abuse Prevention Plan and overdose prevention efforts, we are making progress against one of the 

most significant public health epidemics of our time. 

The Administration has also taken action through legislation, research, and policy reform to create a 

more fair and equitable criminal justice system---one that is better equipped to address the needs of 

substance-involved offenders while also protecting the safety of our communities. Early indications are 

emerging that our efforts to strengthen public safety on our roadways by reducing the prevalence of 

drugged driving are working. In the area of domestic law enforcement, artificial "silos" continue to be 

reduced through increased coordination not only among law enforcement agencies but also between 

the law enforcement and public health sectors. And in the international environment, we have brought 

a renewed focus to the immediate drug-related threats we face in the Western Hemisphere~while also 

taking important steps to promote human rights and evidence-based public safety and public health 

approaches around the world. 

This progress is not irreversible, however. We must continue to support the public health and public 

safety programs that have proven effective in reducing drug use and its consequences. And we must 

continue to get the facts out about the health risks of drug use. In a debate that is often dominated by 

the two extremes of legalization on one hand or a "war on drugs" on the other, we are charting a balanced "third way" approach to drug policy. This approach is supported by science and is exemplified by 

the Advocates for Action profiled throughout this Strategy. Their stories of dedication, leadership, and 

purpose remind us that the American experience is one of constant progress toward a better tomorrow. 

79 
76 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 78 here HDOC20.075

ARIDE 

ATI 

ATR 

BEST 

BJA 

BOP 

CADCA 

CARSI 

CBP 

CBSI 

CCDB 

CDC 

CME 

CMS 

CNWG 

CPOT 

DASIS 

DAWN 

DEA 

DEC 

DFC 

DICE 

DMI 

DOD 

DOT 

EPIC 

ER 

ER/LA 

Advanced Roadside Impaired Driving Enforcement 

Abovethelnftuence 

Access to Recovery 

Border Enforcement SecurityTask Force 

Bureau of Justice Assistance 

Federal Bureau of Prisons 

Community Anti-Drug Coalitions of America 

Central America Regional Security Initiative 

U.S. Customs and Border Protection 

Caribbean Basin Security Initiative 

Consolidated Counterdrug Data Base 

Centers for Disease Control and Prevention 

Continuing Medical Education 

Centers for Medicare & Medicaid Services 

Counternarcotics Working Group 

Consolidated Priority Organizational Target 

Drug and Alcohol Services Information System 

Drug Abuse Warning Network 

Drug Enforcement Administration 

Drug Endangered Children 

Drug Free Communities 

DEA I nternet Connectivity Endeavor 

Drug Market Intervention 

U.s. Department of Defense 

U.S. Department ofTransportation 

EI Paso Intelligence Center 

Emergency Room 

Extended-Release/Long-Acting 

81 
77 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 79 here HDOC20.076

ESP 

FAFSA 

FBI 

FDA 

FDSS 

HIDTA 

HIV 

HOPE 

HSI 

HSIN 

HUD 

ICE 

IDEC 

INL 

ISC 

I-SATS 

JIATF 

MADD 

MAT 

MATIICCE 

NAS 

NFLIS 

NHTSA 

NICCC 

NIDA 

NIJ 

NMPI 

NSDUH 

NSS 

Epic System Portal 

Free Application for Federal Student Aid 

Federal Bureau of Investigation 

Food and Drug Administration 

Federal-wide Drug Seizure System 

High Intensity Drug Trafficking Area 

Human Immunodeficiency Virus 

Hawaii's Opportunity Probation with Enforcement or Honest Opportunity 

Probation with Enforcement 

Homeland Security Investigations 

Homeland Security Information Network 

u.s. Department of Housing and Urban Development 

U.s. Immigration and Customs Enforcement 

International Drug Enforcement Conference 

Bureau of International Narcotics and Law Enforcement Affairs 

Investigative Support Center 

Inventory of Substance Abuse Treatment Services 

Joint InteragencyTask Force 

Mothers Against Drunk Driving 

Medication-Assisted Treatment 

Medication Assisted Treatment in Community Corrections Environment 

Neonatal Abstinence Syndrome 

National Forensic Laboratory Information System 

National Highway Traffic Safety Administration 

National Inventory of Collateral Consequences of Conviction 

National Institute on Drug Abuse 

National Institute of Justice 

National Methamphetamine and Pharmaceuticals Initiative 

National Survey on Drug Use and Health 

National Seizure System 

82 
78 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 80 here HDOC20.077

OAS/CICAD 

OCOETF 

OFC 

OONI 

OJJDP 

ONOCP 

PACT 

POMP 

PEPFAR 

PHA 

PRS 

RDAP 

SAMHSA 

SBIRT 

SIU 

SPSS 

TEDS 

TASC 

TSA 

UN 

UNODC 

UPU 

USAID 

USCG 

VA 

VIDA 

Organization of American States/Inter-American Drug Abuse Control Commission 

Organized Crime Drug EnforcementTask Forces 

OCDETF Fusion Center 

Office of the Director of Nationailntelligence 

Office of Juvenile Justice and ,,,,,nm ,p,\ru Prevention 

Office of National Drug Control Policy 

Police and Communities Together 

Prescription Drug Monitoring Program 

President's Emergency Plan for AIDS Relief 

Public Housing Authority 

Performance Reporting System 

Residential Drug Abuse Program 

Substance Abuse and Mental Health Services Administration 

Screening, Brief Intervention, and Referral to Treatment 

Sensitive Investigative Unit 

Self-Propelled Semi-Submersible 

Treatment Episode Data Set 

Treatment Alternatives for Safe Communities 

Transportation Security Administration 

United Nations 

United Nations Office on Drugs and Crime 

Universal Postal Union 

United States Agency for International Development 

U.s. Coast Guard 

u.s. Department of Veterans Affairs 

Vulnerability Issues in Drug Abuse program 

83 
79 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 81 here HDOC20.078

L United Nations Office and policy: 

the evidence. Retrieved from 

2. National Association of Drug Court Professionals. (2012). Types of drug courts. Retrieved from 

The PRS was developed in accordance with the Government Performance and Results 

6. 

analysis. 

Abuse l-'reverltio'n. 

Chou, (., Montgomery, 

in decreasing drug use in high-risk adoles·· 

cents. American Journal of Public Health, 944-948. 

Bush, 

9. Ibid. 

277-90. 

11. Booth, (2002). The impact of drinking and drinking consequences on ch,,,"."~'~ 

unemployment outcomes at·risk drinkers in six northern states. Rp.hmtin,·nl ',,-j''''f".p< 

De Simone, J. (2002). use and ,'rrml,wrn,,,,t 

13. 

BS 
80 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 82 here HDOC20.079

14. ICF International. (2012). Drug-Free communities support program national evaluation: 2011 

interim findings report. Report prepared for the Office of National Drug Control Policy. 

Fairfax, VA. Retrieved 

15. Slater, M.D., Kelly, K.J., Stanley, L.R, Lawrence, F.R., & Comella, M.L.G. (2011). Assessing media 

campaigns linking marijuana non-use with autonomy and aspirations: 'Be under your own 

influence'and ONOCP's'Above the influence: Prevention Science, 12 (1),12-22. 

16. Carpenter, C.S. & Pechmann, C. (2011). Exposure to the above the influence antidrug advertisements and adolsescent marijuana use in the United States, 2006-2008. American Journal of 

Public Health, 101(5),948-54. 

17. Scheier, L.M., Grenard, J.L., & Holtz, K.D. (2011). An empirical assessment of the above the influence advertising campaign. Jaurnal of Drug Education, 41 (4),431-461. 

18. Grossman, J.B., Resch, N.L., & Tierney, J.P. (2000). Making a difference: An impact study of big 

19. Babor, T.F., McRee, B.G., Kassebaum, P.A., Grimaldi, P.L., Ahmed, K., & Bray, J. (2007). Screening, 

brief intervention, and referral to treatment (SBIRT): Toward a public health approach to the 

management of substance abuse. Substance Abuse, 28(3),7-30. 

20. Madras 8., Compton w., Avula, D., Stegbauer, T., Stein, J., & Clark, H.W. (2009). Screening, brief 

intervention, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and 6 months later. Drug and Alcohol Dependence, 99 (1-3), 

280-295. 

21. Unpublished data from SAMHSA's Services Accountability Improvement System, July 2012. 

22. Lecoanet, R, et al. (2010). Screening, brief intervention, and referral to treatment, Wisconsin 

initiative to promote healthy lifestyles; An evaluation of the implementation and operation of 

wiphl in wisconsin clinical settings. University of Wisconsin Population Health Institute. 

23. Patrick, S.w., Schumacher, RE., Benneyworth, 8.0., Krans, E.E., McAllister, J.M., & Davis, M.M. 

(2012). Neonatal abstinence syndrome and associated health care expenditures: United 

States, 2000-2009. Journal of the American Medical Association, 307(18), 1934-40. Retrieved 

from :=:r:::'-c:.: .. ::...c:.::. :.::.'.:': :.:.:.::::::' .. :2.': .. :J': ::: . . '."."':'1:':.:':..:'2':',:":",,, 

24. Full video of the meeting is available in 4 parts on the White House YouTube channel: 

25. Jones, H.E., Kaltenbach, K., Heil, S.H., Stine, S.M., Coyle, M.G., Arria, A.M., O'Grady, K.E., Selby, 

P., Martin, P.R, & Fischer, G. (2010). Neonatal abstinence syndrome after methadone or 

86 
81 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 83 here HDOC20.080

buprenorphine exposure. New England Journal of Medicine, 363, 2320-31. Retrieved from 

26. Etner, S., Huang, D., Evans, E., Ash, DR., Hardy, M., Jourabchi, M., & Yih-Ing, H. (2006). benefit-cost 

in the California treatment outcome project: Does substance abuse treatment "pay for itself"? 

Health Services Research, 41 (7), 192-213. 

27. Estee, 5., He, L, Mancuso, D., & Felver, B. (2006). Medicaid wstoutcomes. Olympia, Washington: 

Department of Social and Health Services, Research and Data Analysis Division. 

28. Mancuso, D., & Flever, B.E.M. (201 0) Bending the health care cost curve by expanding alcohol! 

drug treatment. Olympia, Washington: Department of Social and Health Services, Research 

and Data Analysis Division. 

29. Scott, CK, Dennis, M.L., laudet, A., Funk, R.R., & Simeone, R.s. (2011). Surviving drug addiction: 

'nle effect of treatment and abstinence on mortality. American Journal of public Health 101 (4), 

737-744. 

30. Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 

national survey on drug use and health: Summary of national findings. Office of Applied 

Studies, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD. Retrieved 

from mr'Y/,!\A/IA/IAI 

31. Examples of evidence-based approaches are Medication Assisted Therapy (MAT), Motivational 

EnhancementTherapy, Contingency Management Interventions/Incentives, the Matrix 

Model, Multidimensional Family Therapy, MultisytemicTherapy, and Brief Strategic Family 

Therapy. 

32. Petry, N.M., Tedford, J., Austin, M., Nich, C, Carroll, K.M., & Rounsaville, B.l (2004). Prize reinforcement contingency management for treating cocaine users: How low can we go, and with 

whom? Addiction, 99(3),349-360. 

33. Petry, N.M., Martin, B., & Simeic, E, Jr. (2005). Prize reinforcement contingency management 

for cocaine dependence: Integration with group therapy in a methadone clinic. Journal of 

Consulting and Clinical Psychology, 73(2), 3.54-359. 

34. Henggeler, S.W., Cling em peel, WG., Brondino, MJ., & Pikrel, S.G. (2002). Four-year follow-up of 

multisystemic therapy with substance-abusing and substance-dependent juvenile offenders. 

Journal of the Academy of Child and Adolescent Psychiatry, 41 (7), 868-874. 

35. Bali, SA, Martino, S., Nich, c., Frankforter, T. L, Van Horn, D., Crits-Christoph, P., Woody, G., Obert, 

J.L, Farentinos, c., & Carroll, K.M .. (2007). Site matters: Multisite randomized trial of motivational enhancement therapy in community drug abuse clinics. Journal of Consulting and 

Clinical Psychology, 75(4), 556-567. 

36. Rawson, RA, Marinelli-Casey, P., Anglin, M.D., Dickow, A., Frazier, Y., Gallagher, C, et al. (2004). A 

multi-site comparison of psychosocial approaches for the treatment of methamphetamine 

dependence, Addiction, 99, 708-717. 

87 
82 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 84 here HDOC20.081

37. Santisteban, DA, Suarez-Morales, L., Robbins, M.s., & Szapocznik, J. (2006). Brief strategic family therapy: Lessons learned in efficacy research and challenges to blending research and 

practice. Family Process, 45(2), 259-271. 

38. Liddle, HA, Dakof, G.A., Turner, R.M., Henderson, C.E., & Greenbaum, P.E. (2008). Treating adolescent drug abuse: A randomized trial comparing multidimensional family therapy and cognitive behavior therapy. Addiction, 103(10), 1660-1670. 

39. National Drug Intelligence Center. (2011). The economic impact of illicit drug use on American 

society. Washington, D.C: United States Department of Justice. Retrieved from 

l~ttp{,iv'''''!.V<i:1l1:;ti<:~g0.'fifJl.9'i<:~£ll~:L!;'~t+;7;ll,l±!Z'llJ?:p~dt Costs by category included public 

health: $11 A 16,232,000; crime: $61,376,694,000; and lost productivity: $120,304,004. Taken 

together, these costs total $193,096,930,000, with the majority share attributable to lost 

productivity. 

40. Jordan, N., Grissom, G., Alonzo, G., Dietzen, L., & Sangsland, S. (2007). Economic benefit of chemical dependency treatment to employers. Journal afsubstance Abuse Treatment, 34, 311-319. 

41. Jason, L.A., Olson, B., Ferrari, J.R., Majer, J.M., Alvarez, J., Stout, J. (2007). An examination of main 

and interactive effects of substance abuse recovery housing on multiple indicators of adjustment. Addiction, 102, 1114-1121. 

42. Lo Sasso, A.T., Byro, E., Jason, L.A., Ferrari, J.R., & Olson, B. (2012). Benefits and costs associated 

with mutual-help community-based recovery homes: The Oxford House model. Evaluation 

and Program Planning, 35(1), 47-53. 

43. Mangrum, L. (2008). Final evaluation report: Creating access to recovery through drug courts. 

Austin, Texas: Texas Department of State Health Services, Mental Health and Substance Abuse 

Services Division, Gulf Coast Addiction Technology Transfer Center. 

44. Krupski, A., Campbell, K., Joesch, J.M., Lucenko, B.A., & Roy-Byrne, P. (2009). Impact of Access 

to Recovery services on alcohol/drug treatment outcomes. Journal of Substance Abuse 

Treatment, 37(4), 435-42. 

45. Wickizer, T.M., Mancuso, D., Campbell, K., & Lucenko, B. (2009). Evaluation of the Washington 

State Access to Recovery project: Effects on Medicaid costs for working age disabled clients. 

journal of Substance Abuse Treatment, 37(3), 240-6. 

46. Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 

national survey on drug use and health: Summary of national findings. Office of Applied 

Studies, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD. Retrieved 

from nrrn', ,'IAilAiIAl 

47. Institute of Medicine. (2012). Substance use disorders in the u.s. armed forces. Washington, DC. 

Retrieved from 

48. U.s. Department of Health and Human Services. (2012). Fiscal Year 2013 Substance Abuse 

and Mental Health Services Administration: Justification of Estimates for Appropriations 

Committees. Rockville, MD. 

88 
83 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 85 here HDOC20.082

49. Office of National Drug Control Policy. (2012). Arrestee drug abuse monitoring program: 2011 

annual report. Executive Office of the President: Washington, DC Retrieved from 

50. States: Arkansas, Delaware, Georgia, Hawaii, Kansas, Kentucky, Louisiana, Missouri, New 

Hampshire, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South 

Dakota, and West Virginia. Counties: Alachua County, Fl; Allegheny County, PA; Charlottesville 

and Albemarle County, VA; Delaware County, OH; Denver City and County, CO; Eau Claire 

County, WI; Grant County, IN; johnson County, KS; King County, WA; Lane County, OR; 

Mecklenburg County, NC; Milwaukee County, WI; New York City, NY; San Francisco City and 

County, CA; Santa Cruz County, CA; Travis County, TX; Yamhill County, OR; and Yolo County, 

CA. 

51. ·Participating agencies include the Departments of Justice, Education, Labor, 

Development, Health and Human Services, and the White House Office 

Neighborhood Partnerships, ONDCr, and the Domestic Policy Council. 

I-;Hth."~''';.r' and 

52. The original six Forum cities are Boston, MA; Chicago, IL; Detroit, MI; Memphis, TN; Salinas, CA; 

and San Jose, CA. 

53. Clackamas County, OR; Essex County, MA; Saline County AR; Tarrant County, TX. 

54. National Association of Drug Court Professionals. (2012). Types of drug courts. Retrieved from 

55. The Symposium is a partnership of the Center for Substance Abuse Treatment, the National 

Institute on Drug Abuse, the Bureau of Justice Assistance, the National Judicial College, and 

the Center for Health and Justice atTreatment Alternatives for Safe Communities. 

56. Guerino, P., Harrison, P.M., & Sabol, W. (2011). Prisoners in 2010. Washington, DC: Bureau of Justice 

Statistics. Retrieved from IJ!iEj'I:lJ.5:.2Jip:lJS(j~i2"IS~)llt~:,I[l'J.tli'Pc!!iJ:llCl:£..df. 

57. Calahan, M. & Parsons, L (1986). Historical Corrections Statistics in the United States, 1850 .. 1984. 

Rockville, MD: Bureau of Justice Statistics. Retrieved from 

58. Carson, E. & Sabol, W. (2012). Prisoners in 2011. Washington, DC: Bureau of Justice Statistics. 

Retrieved from l:t!e:J'<it)[;,()1tJ..uls,<i'?HI.Ov/(C'rlt'2.11.t./L?c ... c., ..... , .. , .. _ .. L ..... . 

59. Maruschak, L. (2008). Medical problems of prisoners. Washington, D.C: Bureau of Justice 

Statistics. Retrieved from £l!iJE.II?l~O\lIS()lrlt~Il!lE,llI:i/.!'.trr'~ilf'.I~/Il'lE'!~lll. 

60. 

61. Justice for Vets. (2012). The history. Retrieved from I1ttp:!i'vv\j~JtJ.~~!s.E;lgl\f~!t~ 

62. Sites include the Federal Bureau of Prisons; the Maryland Department of Corrections, including 

the Baltimore City Jail; the Iowa Department of Corrections; the California Department of 

Corrections; the Vermont Department of Corrections, and the Okaloosa County (FL) Jail. 

89 
84 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 86 here HDOC20.083

63. The grantees include Aurora, CO; Connecticut Judicial Branch; County of San Diego; Minnesota 

Department of Corrections; Montana Department of Corrections; Oregon Department of 

Corrections; South Carolina Department of Probation, Parole and Pardon Services; Travis 

County Adult Probation; and Wisconsin Department of Corrections. 

64. Van Dom, R., Voiavka,J., & Johnson, N. (2011). Mental disorder and violence: Is there a relationship beyond substance use? Social Psychiatry Psychiatric Epidemiology, 47(3), 487-503. 

65. Tondo, l., Baldessarini, RJ., Hennen, J., et al. (1999). Suicide attempts in major affective disorder 

patients with comorbid substance use disorders. Journal of Clinical Psychiatry, 60 Suppl2; 

63-69. 

66. Karberg, J.e., & James, D.J. (2005). Substance dependence, abuse, and treatment of jail inmates, 

2002. Washington, DC: Bureau of Justice Statistics. Retrieved from 

67. Mumola, e.J., & Karberg, J.e. (2006, rev. 2007). Drug use and dependence, state and federal prisoners, 2004. Washington, DC: Bureau of Justice Statistics. Retrieved from 

68. The grantees include the Arkansas Department of Community Corrections; Georgia Department 

of Corrections; Kansas Department of Corrections; Louisiana Department of Public Safety and 

Corrections; New York Department of Corrections and Community Supervision; Rhode Island 

Department of Corrections; Ohio Department of Rehabilitation and Correction. 

69. The 12 states include Colorado, Florida, Georgia, Iowa, Minnesota, Nevada, New York, Rhode 

Island, South Carolina, Texas, Vermont, and Wisconsin; see 

70. Centers for Disease Control and Prevention. (2010). Unintentional drug poisoning in the United 

States. National Center for Injury Prevention and Control. 

71. Policia de Puerto Rico. (2011). Asesinatos ocurridos por region y motivo. - 2011. Division de 

Estadfsticas de la Ciminalidad. 

72. Office of National Drug Control Policy. (2012). High Intensity Drug Trafficking Areas Program 

Report to Congress. Washington, DC. 

73. Participating HIDTAs include Southwest Border/Arizona Region, Northwest, Oregon, New York! 

New Jersey, Central Valley, New Mexico, and North Texas. 

74. American Association of Poison Control Centers. (2013). Synthetic marijuana data, updated 

75. American Association of Poison Control Centers. (2013). Synthetic bath salts data, February 28, 

2013. Retrieved from 

90 
85 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 87 here HDOC20.084

76. While developing the 2013 National Southwest BorderCountemarcotiC5 Strategy, ONDCP 

convened consultation meetings in Los Angeles, Santa Fe, Phoenix, and San Antonio, and 

received input from Federal, state, local. and tribal law enforcement officials and prevention 

specialists on the border. 

77. Written testimony of the Secretary of Homeland Security before 

the United States Senate Committee on the Judiciary; February 

13,2013. Retrived from 1'1ttf':Ll\V\N\~':or~:9l()\f.ll1(·WSI 

78. U.S. Department of Justice. (2012). FY2013 Interagency Crime and Drug Enforcement 

Congressional Budget Submission. Washington, DC. The eleven locations are Boston, New 

York, San Juan, Tampa/Sarasota, Atlanta, Chicago, Denver, San Diego, PhoenixlTucson, EI 

Paso/Las Cruces, and Houston/Laredo/McAllen/San Antonio. 

79. Drug Enforcement Adminsitration. Data from the National Seizure System. 

80. Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 

national survey on drug use and health: Summary of national findings. Office of Applied 

Studies, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MO. Retrieved 

81. Gabriel, MW., Woods, L.W., Poppenga, R., Sweitzer, R.A., Thompson, C, et al. (2012). Anticoagulant 

rodenticides on our public and community lands: Spatial distribution of exposure and poisoning of a rare forest carnivore. Retrieved from 

82. United States Attorney's Office for the Eastern District of California. (2012). US Attorneys 

announce final statistics on Operation Mountain Sweep. 

83. Departments and agencies involved in Operation Mountain Sweep included the Department of 

Justice, u.s. Forest Service, the National Guard, the Bureau of Land Management, the National 

Park Service, the Drug Enforcement Administration, the Department of Homeland Security, 

the u.s. Fish and Wildlife Service, and state and loc3113w enforcement agencies. 

84. These resources include the system's library of intelligence products and images, post announcements, officer safety reports, a Requests for Information (RFI) portal, and a training and events 

calendar. 

85. NGIC houses intelligence analysts from the Bureau of Alcohol, Tobacco, Firearms and Explosives; 

Federal Bureau of Prisons; Drug Enforcement Administration; Department of Homeland 

Security; Department of Defense; Federal Bureau of Investigation; and the U.s. Marshals 

Service. 

86. Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 

national survey on drug use and health: Summary of national findings. Office of Applied 

Studies, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. RockVille, MD. Retrieved 

from flt!!~:/j~AfIIoII:A!:3'3i1ll b~~!O_VJ'<:Ja.t il/I~~cllil 

91 
86 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 88 here HDOC20.085

87. U.s. Department of State. (2012). International narcotics control strategy report. Washington, DC. 

Retrieved from n~.E{f\;!"2v.,:.~~,~,-e:9.()IJ!),ill"1ll!!;{()I·CJ}~t"':~ll{\!~I{j.t5:+~J';!/j::n.!fI11l.':-E1{~()ill:Jlil. 

88. Unpublished u.s. Government estimates. 

89. Johnson, D.T. (2012). Recommendations for a new administration: Justice and police reform for 

safer, more secure societies. Washington, DC: Center for Strategic and International Studies. 

Retrieved from 

90. President's Emergency Plan for AIDS Relief. (2012). AIDS 2012 update: Latest PEPFAR results. 

Retrieved from 

91. United Nations Office on Drugs and Crime. (2012). Afghanistan opium survery 2012: Summary 

92. Office of National Drug Control Policy. (2012). Survey shows significant drop in cocaine produc93. Office of Nation a! Drug Control Policy. (2012). ADAM 11: 2011 annual report. Retrieved from 

94. Substance Abuse and Mental Health Services Administration. (2010). Results from the 2009 

National Survey on Drug Use and Health: Volume I. Summary of National Findings (Office of 

Applied Studies, N5DUH Series H-38A, HHS Pulbication No. SMA 10-4S86Findings). Rockville, 

MD. 

95. Centers for Disease Control and Prevention. (2010). Unintentional drug poisoning in the United 

States. Atlanta, GA. Retrieved from 

96. Substance Abuse and Mental Health Services Administration. (2011). Treatment episode data set 

(TEDS) 1999-2009: National admissions to substance abuse treatment services, OASIS series: 

5-56, HH5 Publication No. (SMA) 11-4646. Rockville, MD. Retrieved from 

97. Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 

national survey on drug use and health: Summary of national findings. Office of Applied 

Studies, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD. Retrieved 

from 1 rE::',,:1 ~lc!"'f~I1.~'i:",=,'-"-":.':':'le~:"I._!.II'I.11 

98. Office of National Drug Control Policy. (2012). What America's users spend on illegal drugs, 2000-

2006. Washington, DC: Executive Office of the President. 

99. Ehleringer, J.R., Casale, J.E, Barnette, J.E., Xu, X., Lott, MJ., & Hurley, J. (2012). 14C analyses quantify time lag between coca leaf harvest and street-level seizure of cocaine. Forensic Science 

International, 214,7-12. 

92 
87 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 89 here HDOC20.086

100. Office of National Drug Control Policy. (2012). What America's users spend on illegal drugs, 

2000-2006. Washington, DC: Executive Office of the President. 

101. National HighwayTraffic Safety Administration. (2010). Traffic safety facts: Drug involvement of 

fatally injured drivers. DOT HS 811 415. Washington, DC: U.s. Department ofTransportation. 

102. Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 

national survey on drug use and health: Summary of national findings. Office of Applied 

Studies, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. RockVille, MD. Retrieved 

103. National HighwayTraffic Safety Administration. (2009). Results of the 2007 national roadside 

survey of alcohol and drug use by drivers. Report No. DOT HS 811 175. Washington, DC: U.s. 

Department ofTransportation. 

104. Substance Abuse and Mental Health Services Administration. (2011). Treatment episode data 

set (TEDS) 1999-2009: National admissions to substance abuse treatment services, OASIS 

series: S-56, HHS Publication No. (SMA) 11-4646. Rockville, MD. Retrieved from 

105. Substance Abuse and Mental Health Services Administration. (2012). Highlights of the 2010 

drug abuse warning network (DAWN) findings on drug-related emergency department visits. 

Washington, DC: U.s. Department of Health and Human Services. Retrieved from 

106. Centers for Disease Control and Prevention, National Center for Health Statistics. Data on underlying cause of death 2000-201 0 from the CDC WONDER online database. Data extracted 

October 2012. 

107. Centers for Disease Control and Prevention. (2012). CDC grand rounds: Prescription drug 

overdoses-a u.s. epidemic. Morbidity and mortality weekly report. Retrieved from 

108. Nonmedical use is defined as use without a prescription of the individual's own or simply for 

the experience or feeling the drugs cause. 

109. Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 

national survey on drug use and health: Summary of national findings. Office of Applied 

Studies, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD. Retrieved 

from rmn'; ,"MIM\AI 

110. Lankenau, S.E., Teti, M., Silva, K., Bloom, J..1., Harocopos, A., & Treese, M. (2012). Initiation into 

prescription opioid misuse amongst young injection drug users. International Journal of Drug 

Policy, 23, 37-44. Retrieved from 

111. Peavy, K.M., Banta-Green, C.1., Kingston, S., Hanrahan, M., Merrill, J.D., & Coffin, P.O. (2012). 

Hooked on prescription-type opiates prior to using heroin: Results from a survey of syringe 

exchange clients. Journal of Psychoactive Drugs, 44(3),259-265. 

93 
88 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 90 here HDOC20.087

112. Unpublished data from NIDA. 

113. Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 

national survey on drug use and health: Summary of national findings. Office of Applied 

Studies, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD. Retrieved 

114. Substance Abuse and Mental Health Services Administration. (2012). Highlights of the 2010 

Drug Abuse Warning Network (DAWN) findings on drug-related emergency department 

visits. Retrieved from 

115. Substance Abuse and Mental Health Services Administration. (2012). Treatment Episode Data 

Set (TEDS) substance abuse treatment admissions by primary substance of abuse, according 

to sex, age group, race, and ethnicity, United States [2000 and 2010 tablesl. Retreived from 

116. Ibid. 

117. Centers for Disease Control and Prevention, National Center for Health Statistics. Data on underlying cause of death 2000-2010 from the CDC WONDER online database. Data extracted 

October 2012. 

118. Ibid. 

119. Darke,S., Mattick, R.P., & Degenhardt, L. (2003). The ratio of non-fatal to fatal heroin overdose. 

Addiction, 98, 1169-1171. 

120. Centers for Disease Control and Prevention. (2012). National vital statistics reports: Deaths: Final 

data for 2009. Retrived from 1~t!E:/./ItJ.\AI\i~cc(j~.g()\jjlr:~tys~'(j~tilI'clIf5:/'<l<~iltl,=~2(Jl~~I~il~~[\(j!-_ 

121. Substance Abuse and Mental Health Services Administration. Results from the 20 11 National 

Survey on Drug Use and Health: summaty of National Findings. U.s. Department of Health and 

Human Services. [September 2012J. Available: 

122. Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 

national survey on drug use and health: Summary of national findings. Office of Applied 

Studies, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD. Retrieved 

from --j~~-----,~ 

123. Mezei, L., et al. (2011). Pain education in North American medical schools. The Journal of Pain, 

12(12),1199-1208. 

124. Food and Drug Administration. (2012). Extended Release (ER) and LongActing (LA) Opioid Analgesics Risk Evaluation and Mitigation Strategy 

(REMS). Retrieved from 
89 


tjames on DSK6SPTVN1PROD with HEARINGInsert offset folio 91 here HDOC20.088

125. Alliance of States with Prescription Monitoring Programs. (2012). Status ofPMPs. Retrieved from 

126. Substance Abuse and Mental Health Services Administration. (20l2). Results from the 2011 

national survey on drug use and health: Summary of national findings. Office of Applied 

Studies, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD. Retrieved 

from mrn'//\AI\NW 

127. Drug Enforcement Administration. (2013). Drug disposal National take-back initiative. 

Retrieved 

128. Centers for Disease Control and Prevention, National Center for Health Statistics. Data on underlying cause of death 2000-2010 from the CDC WONDER online database. Data extracted 

October 2012. 

129. Centers for Disease Control and Prevention. (20'12). National vital statistics reports: Deaths: Final 

data for 2009. Retrieved from l~tfl:/.lV>l.\/cIIr~':~(J.Sg.~Vl·.l:l(115/a_a~:l\I5j\:l<~!l,~~~l"I:".~3E!.J~r. 

130. Boyer, E. (2012). Drug therapy: Management of opioid analgesic overdose. The New Eng/and 

Journal of Medicine, 367, 146-55. 

131. Baca, c.r. & Grant, KJ. (2005). Take-home naloxone to reduce heroin death. Addiction, 100(12), 

1823-31. 

132. Sporer, K., Firestone, J., & Isaacs, M. (1996). Out-of-hospital treatment of opioid overdoses in an 

urban setting. Academic Emergency Medicine, 3(7), 660-67. 

133. Coffin, P.O., & Sullivan, S.D. (2013). Cost-effectiveness of distributing naloxone to heroin users for 

lay overdose reversal. Annals of Internal Medicine, 158(1), 1-9. 

o 

95