Drug Control Policy: Information on Status of Federal Efforts and Key Issues for Preventing Illicit Drug Use
Published: 2017-07-26T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: According to the National Institute on Drug Abuse, in 2015, the most recent year for which national data are available, over 52,000 Americans died from drug overdoses, or approximately 144 people every day. Policymakers, criminal justice officials, health care providers, and the public at large are turning with renewed attention to the drug epidemic and its impact on our nation. To help reduce illicit drug use and its consequences, ONDCP oversees and coordinates the implementation of national drug control policy across the federal government.
This statement addresses: (1) the federal government's progress in achieving Strategy goals, (2) results from a Comptroller General's Forum on preventing illicit drug use, and (3) the findings of GAO's recent review of ONDCP's DFC Support program.
This statement is based on GAO's prior work issued from May 2016 through February 2017, with selected status updates as of July 2017, and updates from ONDCP's National Drug Control Budget Funding Highlight reports issued from fiscal year 2016 to fiscal year 2018. For the updates, GAO used publically available data sources that ONDCP uses to assess its progress on Strategy goals, and interviewed ONDCP officials.
section_title: What GAO Found
paragraphs: The federal government has made mixed progress toward achieving the goals articulated in the 2010 National Drug Control Strategy (Strategy). In the Strategy, the Office of National Drug Control Policy (ONDCP) established seven goals related to reducing illicit drug use and its consequences by 2015. In many instances, the data used to assess progress in 2015 have only recently become available. GAO's review of this updated data indicates that, as of July 2017, the federal government made moderate progress toward achieving two goals, limited progress on two goals, and no progress on the other three goals. However, none of the overall goals in the Strategy were fully achieved. For example, progress had not been made on the goal to reduce drug-induced deaths by 15 percent. Drug-induced deaths instead increased from 2009 to 2015 by 41.5 percent. Although progress was made reducing the 30-day prevalence of drug use among 12- to 17-year-olds from the 10.1 percent reported in 2009, the goal of reducing prevalence to 8.6 percent by 2015 was not achieved. According to ONDCP, as of July 2017, work is currently underway to develop a new strategy.
In June 2016, GAO convened a diverse panel of experts, including from ONDCP to advance the national dialogue on preventing illicit drug use. The panel focused on (1) common factors related to illicit drug use; (2) strategies in the education, health care, and law enforcement sectors to prevent illicit drug use; and (3) high priority areas for future action to prevent illicit drug use. According to forum participants, illicit drug use typically occurs for the first time in adolescence, involves marijuana, and increasingly, legal prescriptions for opioid-based pain relievers. Forum participants also discussed strategies available in the education, health care, and law enforcement sectors for preventing illicit drug use. For example, forum participants championed the use of school- or-community-based prevention programs that research has shown to be successful in preventing illicit drug use and other behaviors. They also identified several high priority areas for future actions to prevent illicit drug use, including: supporting community coalitions, consolidating federal funding streams for prevention programs, and reducing the number of opioid prescriptions.
In February 2017, GAO issued a report on the Drug-Free Communities Support Program (DFC)—a program that ONDCP and the Substance Abuse and Mental Health Services Administration (SAMHSA) jointly manage. This program aims to support drug abuse prevention efforts that engage schools, law enforcement, and other sectors of a community to target reductions in the use of alcohol, tobacco, marijuana, and the illicit use of prescription drugs. GAO reported that ONDCP and SAMHSA had strengthened their joint management of the program by employing leading collaboration practices; however, the agencies could enhance DFC grantee compliance and performance monitoring. For example, SAMHSA did not consistently confirm grantees had completed plans to achieve long-term goals after exiting the program. GAO recommended that SAMHSA develop an action plan to strengthen DFC grant monitoring and ensure it sends complete and accurate information to ONDCP. SAMHSA concurred with GAO's recommendations and reported in April 2017 that its actions to address them should be completed by this fall.

section_title: Letter
paragraphs: I am pleased to be here today to discuss GAO’s recent work related to  the Office of National Drug Control Policy (ONDCP). Though drug abuse  in our nation is not a new phenomenon, the scale and impact of illicit drug  use in this country has reached new heights. Policy makers, criminal  justice officials, health care providers, and the public at large are turning  with renewed attention to the drug epidemic and its impact on our nation.  Deaths from drug overdoses have risen steadily over the past two  decades and are the leading cause of death due to injuries in the United  States. In fact, according to the Centers for Disease Control and  Prevention (CDC), drug overdose deaths surpass the annual number of  traffic crash fatalities, as well as deaths due to firearms, suicide, and  homicide. In 2015, the most recent year for which national data are  available from the National Institute on Drug Abuse (NIDA), over 52,000  Americans died from drug overdoses, or approximately 144 people every  day.
ONDCP is responsible for, among other things, overseeing and  coordinating the implementation of national drug control policy across the  federal government to address illicit drug use. In this role, the Director of  ONDCP is required annually to develop a National Drug Control Strategy  (the Strategy), which is to set forth a comprehensive plan to reduce illicit  drug use through programs intended to prevent or treat drug use or  reduce the availability of illegal drugs. According to ONDCP, work is  currently underway to develop a new Strategy. ONDCP is also  responsible for developing a National Drug Control Program Budget  proposal for implementing the Strategy. For fiscal year (FY) 2018, a total  of $27.8 billion was requested to support federal drug control efforts. As I  will detail in my statement, this represents an increase of about $280  million over the annualized Continuing Resolution (CR) level in FY 2017.
Today, I will discuss (1) the federal government’s progress achieving the  National Drug Control strategy goals, (2) results of a Comptroller General  (CG) Forum on preventing illicit drug use, and (3) the findings of our  recent review of ONDCP’s Drug-Free Communities (DFC) Support  program.
This statement is based on our prior work issued from May 2016 through  February 2017 with selected updates as of July 2017. In performing the  work for our May 2016 testimony, we analyzed available data on progress  toward achieving Strategy goals, as well as documents related to  ONDCP’s monitoring mechanisms. For this statement we updated the  information and data where appropriate from publically available data  sources and ONDCP’s Fiscal Year 2016 through Fiscal Year 2018  National Drug Control Budget Funding Highlights reports, and interviews  with ONDCP officials. For our November 2016 CG Forum, we convened  and moderated a panel of education, health care, and law enforcement  officials and summarized the viewpoints shared on common factors  related to illicit drug use; strategies in the education, health care, and law  enforcement sectors to prevent illicit drug use; and high priority areas for  future action to prevent illicit drug use. For our February 2017 report on  the DFC, we analyzed agency policies, interviewed agency officials,  analyzed coordination efforts against relevant key practices GAO  identified previously, reviewed files obtained from a non-generalizable  random sample of grant recipients and interviewed a random subset of  these grantees. More detail on our scope and methodologies can be  found in each of these respective products.
We conducted the work on which this statement is based in accordance  with generally accepted government auditing standards. Those standards  require that we plan and perform the audit to obtain sufficient, appropriate  evidence to provide a reasonable basis for our findings and conclusions  based on our audit objectives. We believe that the evidence obtained  provides a reasonable basis for our findings and conclusions based on  our audit objectives.
subsections: section_title: Background
paragraphs: ONDCP was established by the Anti-Drug Abuse Act of 1988 to, among  other things, enhance national drug control planning and coordination and  represent the drug policies of the executive branch before Congress. In  this role, the office is responsible for (1) developing a national drug  control policy, (2) developing and applying specific goals and  performance measurements to evaluate the effectiveness of national drug  control policy and National Drug Control Program agencies’ programs,  (3) overseeing and coordinating the implementation of the national drug  control policy, and (4) assessing and certifying the adequacy of the  budget for National Drug Control Programs.
ONDCP is required annually to develop the National Drug Control  Strategy, which sets forth a plan to reduce illicit drug use through  prevention, treatment, and law enforcement programs, and to develop a  National Drug Control Program Budget for implementing the strategy.  National Drug Control Program agencies follow a detailed process in  developing their annual budget submissions for inclusion in the National  Drug Control Program Budget, which provides information on the funding  that the executive branch requested for drug control to implement the  strategy. Agencies submit to ONDCP the portion of their annual budget  requests dedicated to drug control, which they prepare as part of their  overall budget submission to the Office of Management and Budget for  inclusion in the President’s annual budget request. ONDCP reviews the  budget requests of the drug control agencies to determine if the agencies  have acceptable methodologies for estimating their drug control budgets,  and includes those that do in the Drug Control Budget. In FY 2016, the  budget contained 38 federal agencies or programs.
There are five priorities for which resources are requested across  agencies: substance abuse prevention and substance abuse treatment  (which are considered demand-reduction areas), and domestic law  enforcement, drug interdiction, and international partnerships (which are  considered supply-reduction areas) as shown in figure 1. ONDCP  manages and oversees two primary program accounts: the High Intensity  Drug Trafficking Areas (HIDTA) Program and the Other Federal Drug  Control Programs, such as the DFC Support Program. ONDCP previously  managed the National Youth Anti-Drug Media Campaign which last  received appropriations in fiscal year 2011. Also, from fiscal year 1991 to  fiscal year 2011, ONDCP managed the Counterdrug Technology  Assessment Center (CTAC).
According to ONDCP, federal drug control spending increased from $21.7  billion in FY 2007 to the approximately $27.5 billion that was allocated for  drug control programs in FY 2017 as shown in figure 2. Spending on  supply reduction programs, such as domestic law enforcement,  interdiction, and international programs increased 16 percent from $13.3  billion in FY 2007 to $15.4 billion in FY 2017. However, federal spending  for demand programs—treatment and prevention— increased at a higher  rate from FY 2007 through FY 2017. Spending in these two programs  increased 44 percent from $8.4 billion in FY 2007 to $12.1 billion in FY  2017. As a result, the proportion of funds spent on demand programs  increased from 39 percent of total spending in FY 2007 to 44 percent in  FY 2017.
According to ONDCP’s National Drug Control Budget Fiscal Year 2018  Highlights, the proposed budget supports $1.3 billion in investments  authorized by the Comprehensive Addiction and Recovery Act (CARA),  the 21st Century Cures Act, and other opioid-specific programs to help  address the opioid epidemic, including funding prevention and treatment  efforts. Allocated funding for treatment increased in FY 2017 to  approximately $10.6 billion, a 7.5 percent increase over FY 2016.  Funding for prevention increased slightly in FY 2017 to about $1.5 billion,  a 1.4 percent increase from FY 2016.
According to its FY 2018 Budget Highlights document, ONDCP considers  three main functions to address the drug supply: Domestic Law  Enforcement, Interdiction, and International. For Domestic Law  Enforcement, ONDCP noted that federal, state, local, and tribal law  enforcement agencies play a key role in the Administration’s approach to  reduce drug use and its associated consequences. ONDCP also stated  that interagency drug task forces, such as the HIDTA program, are critical  to leveraging limited resources among agencies. Allocated funding for  domestic law enforcement in FY 2017 is approximately $9.3 billion, which  is similar to its FY 2016 spending level.
According to ONDCP, the United States continues to face a serious  challenge from the large-scale smuggling of drugs from abroad which are  distributed to every region in the nation. Interdiction funds support  collaborative activities between federal law enforcement agencies, the  military, the intelligence community, and international allies to interdict or  disrupt shipments of illegal drugs, their precursors, and their illicit  proceeds. Allocated funding in support of Interdiction for FY 2017 is  approximately $4.6 billion, a decrease of 3.5 percent from FY 2016.
International functions place focus on collaborative efforts between the  U.S. government and its international partners around the globe.  According to ONDCP, illicit drug production and trafficking generate huge  profits and are responsible for the establishment of criminal networks that  are powerful, corrosive forces that destroy the lives of individuals, tear at  the social fabric, and weaken the rule of law in affected countries. In FY  2017, approximately $1.5 billion was allocated to international functions,  which is similar to its FY 2016 spending level.
section_title: The Federal Government Has Made Mixed Progress But Has Not Fully Achieved the Overall 2010 Strategy Goals
paragraphs: As we previously have stated, the 2010 National Drug Control Strategy  was the inaugural strategy guiding drug policy under the previous  Administration. According to ONDCP officials, it sought a comprehensive  approach to drug policy, including an emphasis on drug abuse prevention  and treatment efforts and the use of evidence-based practices— approaches to prevention or treatments that are based in theory and have  undergone scientific evaluation. ONDCP established two overarching  policy goals in the 2010 Strategy for (1) curtailing illicit drug consumption  and (2) improving public health by reducing the consequences of drug  abuse, and seven overall sub goals under them that delineate specific  quantitative outcomes to be achieved by 2015, such as reducing drug- induced deaths by 15 percent. To support the achievement of these two  policy goals and seven sub goals (collectively referred to as overall  goals), the Strategy included seven strategic objectives and multiple  action items under each objective, with lead and participating agencies  designated for each action item. Strategy objectives include, for example,  “Strengthen Efforts to Prevent Drug Use in Communities” and “Disrupt  Domestic Drug Trafficking and Production.” Subsequent annual  Strategies provided updates on the implementation of action items,  included new action items intended to help address emerging drug- related problems, and highlighted initiatives and efforts that support the  Strategy’s objectives.
In March 2013, we reported that ONDCP and the federal agencies lacked  progress on achieving the Strategy goals and were in the process of  implementing a new mechanism to monitor progress. As we reported in  May 2016, ONDCP and the federal agencies had made moderate  progress toward achieving one goal, limited progress on three goals, and  no demonstrated progress on the remaining three goals. For example,  we reported that the rate of drug use for young adults aged 18 to 25 had  increased since 2009, moving in the opposite direction of the goal.  However, we also reported that HIV infections attributable to drug use,  one of the strategy’s sub-measures, had decreased from 2009 to 2014  and had exceeded the strategy’s established target. In many instances,  the data used to assess progress, while the most up to date at the time,  were several years old. Based on the most recent data available,  although some of the sub-measures, such as decreasing tobacco use by  eighth graders, were achieved, none of the seven overall goals in the  Strategy have been fully achieved as of July 2017. Table 1 shows the  2010 Strategy goals and progress toward meeting them as of July 2017.
Federal drug control agencies made mixed progress but did not fully  achieve any of the four overall Strategy goals associated with curtailing  illicit drug consumption. For example:
Progress was made on the goal to decrease the 30-day prevalence of  drug use among 12- to 17-year-olds by 15 percent. The data source  for this measure— SAMHSA’s National Survey on Drug Use and  Health (NSDUH)— indicated that in 2015, 8.8 percent of 12- to 17- year-olds reported having used illicit drugs in the past month.
Progress was not made on the goal to decrease the 30-day  prevalence of drug use among young adults aged 18 to 25 by 10  percent. Specifically, the reported rate of drug use for young adults  was 21.4 percent in 2009 and 22.3 percent in 2015, moving in the  opposite direction of the goal. Marijuana remained the drug used by  the highest percentage of young adults. According to the 2015  NSDUH, 19.8 percent of young adults reported having used marijuana  in the past month. The rates of reported marijuana use for this  measure increased by 9 percent from 2009 to 2015.
Progress was also mixed on the remaining three overall Strategy goals  associated with reducing the consequences of drug use. For example:
Progress was not made on the goal to reduce drug-induced deaths by  15 percent. According to the CDC’s National Vital Statistics System,  which collects information on all deaths in the United States, 55,403  deaths were from drug-induced causes in 2015, an increase of 41.5  percent compared to 2009 and 66.5 percent more than the 2015 goal.  The CDC’s December 30, 2016 Morbidity and Mortality Weekly  Report stated that 52,404 of these deaths were from drug overdoses,  the majority of which (63 percent) involved opioids.
The goal to reduce drug-related morbidity by 15 percent has two sub- measures, and progress had been made on one but not the other.  Specifically, HIV infections attributable to drug use decreased by 29  percent from 2010 to 2015, exceeding the established target.  However, the number of emergency room visits for substance use  disorders increased by 19 percent from 2009 to 2011. The data  source for this measure— SAMHSA’s Drug Abuse Warning  Network—indicated that pharmaceuticals alone were involved in 34  percent of these visits and illicit drugs alone were involved in 27  percent of them. According to the 2013 Drug Abuse Warning  Network report, the increase in emergency room visits for drug misuse  and abuse from 2009 to 2011 was largely driven by a 38 percent  increase in visits involving illicit drugs only.
section_title: Themes from a Comptroller General Forum on Preventing Illicit Drug Use
paragraphs: To advance the national dialogue on preventing illicit drug use, including  preventing individuals from using illicit drugs for the first time, we  convened and moderated a diverse panel of health care, education, and  law enforcement experts, including from ONDCP, on June 22, 2016. The  panel focused on (1) common factors related to illicit drug use; (2)  strategies in the education, health care, and law enforcement sectors to  prevent illicit drug use; and (3) high priority areas for future action to  prevent illicit drug use, and our November 2016 report summarized the  themes from the forum.
Forum participants identified a number of common factors related to illicit  drug use. For example, the participants agreed that first time illicit drug  use typically starts in adolescence and typically involves marijuana,  however, prescription pain relievers are increasingly a pathway to illicit  drug use. Other common factors include: a family history of substance  abuse, conflict within the family, and the early onset of anxiety disorders  or substance use, among others.
Forum participants also noted several strategies available in the  education, health care, and law enforcement sectors for preventing illicit  drug use:
Education. Forum participants championed the use of school-or  community-based prevention programs that research has shown to be  successful in preventing illicit drug use and other behaviors. These  programs include: Life Skills, Strengthening Families Program: For  Parents and Youth 10-14, and Communities That Care. These  programs focus generally on combatting a range of risky behaviors,  giving participants skills to recognize and manage their emotions, and  strengthening family and community ties.
Health care. Forum participants identified and discussed three  principle health care strategies for preventing illicit drug use: (1)  having providers adhere to the CDC’s guideline for prescribing opioids  for chronic pain, (2) having providers use prescription drug monitoring  programs (PDMP)—state-run electronic databases used to track the  prescribing and dispensing of prescriptions for controlled  substances—and (3) having primary care providers screen and  intervene with patients at risk for illicit drug use.
Law Enforcement. Forum participants identified four law enforcement  strategies for preventing illicit drug use: (1) enforcing laws prohibiting  underage consumption of alcohol and tobacco, (2) building trust  between law enforcement and local communities, (3) using peers to  promote drug-free lifestyles, and (4) closing prescription drug “pill  mills” — medical practices that prescribe controlled substances  without a legitimate medical purpose—and other efforts to reduce the  supply of illicit drugs.
Forum participants also identified several high priority areas for future  action to help prevent illicit drug use, including the misuse of prescription  drugs. Some examples include:  supporting community coalitions comprising the health care,  education, and law enforcement sectors that work in concert to  prevent illicit drug use at the local level;  consolidating federal funding streams for multiple prevention  programs into a single fund used to address the risk factors for a  range of unhealthy behaviors, including illicit drug use;  increasing the use of prevention programs that research has shown to  be effective, such as those that are well-designed and deliver  persuasive drug prevention messages on a regular basis;  identifying and pursuing ways to change perceptions of substance  abuse disorders and illicit drug use, such as emphasizing that a  substance abuse disorder is a disease of the brain and can be treated  like other diseases;  supporting drug prevention efforts in primary care settings, such as  exploring ways to reimburse providers for conducting preventative  drug screenings; and  reducing the number of prescriptions issued for opioids.
section_title: Agencies Have Strengthened Collaboration of Drug- Free Communities Support Program but Could Enhance Grantee Compliance and Performance Monitoring
paragraphs: In February 2017, we issued a report on the Drug-Free Communities  Support Program (DFC)—a program that ONDCP and SAMHSA jointly  manage. This program aims to support drug abuse prevention efforts that  engage schools, law enforcement, and other sectors of a community to  target reductions in the use of alcohol, tobacco, marijuana, and the illicit  use of prescription drugs. We examined the extent to which the two  agencies (1) use leading processes to coordinate program administration  and the types of activities funded, and (2) have operating procedures that  ensure DFC grantee compliance and provide a basis for performance  monitoring.
In 2008 we had previously reported that ONDCP and SAMHSA needed to  establish stronger internal controls and had not fully defined each  agency’s roles and responsibilities for the management of the DFC  program. In our February 2017 report, we found that ONDCP and  SAMHSA had improved their joint management of the program.  Specifically, we found that ONDCP and SAMHSA employed leading  collaboration practices to administer the DFC program and fund a range  of drug prevention activities. For example, ONDCP and SAMHSA had  defined and agreed upon common outcomes, such as prioritizing efforts  to increase participation from under-represented communities. The two  agencies also had funded a range of DFC grantees’ activities and report  on these activities in their annual evaluation reports. For example,  ONDCP reported that from February through July 2014, grantees  educated more than 156,000 youth on topics related to the consequences  of substance abuse. Other examples of grantees’ efforts included those  that enhanced the skill sets of community members, including parents, to  identify drug abuse or limit access to prescription drugs and those that  reduced language barriers precluding non-English speakers from  understanding drug prevention campaigns.
We also found that ONDCP and SAMHSA had operating procedures in  place, but SAMHSA did not consistently follow documentation and  reporting procedures to ensure grantees’ compliance and had not  accurately reported to ONDCP on grantee compliance. Based on a file  review we conducted, we found that SAMHSA followed all processes for  ensuring that the grant applicants whose files we reviewed had submitted  required documentation before SAMHSA awarded them initial grant  funding. However, SAMHSA was less consistent in adhering to  procedures for confirming documentation in later years of the program.  We found that the majority of grantees whose files we reviewed were  missing required paperwork to document how they planned to sustain  their programs after grant funds expired. Prior to our review, ONDCP and  SAMHSA officials were not aware of the missing data in the grant files.  We concluded that without close adherence to existing procedures, and a  mechanism to ensure that the documentation it reports to ONDCP is  accurate and complete, SAMHSA’s performance monitoring capacity was  limited. Moreover, SAMHSA could not be certain that grantees were  engaging in intended activities and meeting their long-term program  goals.
We made recommendations that SAMHSA develop an action plan to  strengthen the agency’s grant monitoring process and ensure ONDCP  gets complete and accurate information, among other things. SAMHSA  concurred with our recommendations and reported to us in April 2017 that  it is implementing actions to address our recommendations that should be  completed by this fall.
Chairman Gowdy, Ranking Member Cummings, and Committee  members, this concludes my prepared statement. I would be happy to  respond to any questions you may have.
section_title: GAO Contact and Staff Acknowledgements
paragraphs: For questions about this statement, please contact Diana Maurer at (202)  512-8777 or maurerd@gao.gov. Contact points for our Offices of  Congressional Relations and Public Affairs may be found on the last page  of this statement. Individuals who made key contributions to this  statement include Aditi Archer (Assistant Director), Joy Booth (Assistant  Director), Julia Vieweg, Sylvia Bascope, Jane Eyre, Stephen Komadina,  Mara McMillen, David Alexander, Billy Commons, and Eric Hauswirth.  Staff who made key contributions to the reports cited in this statement are  identified in the source product.
This is a work of the U.S. government and is not subject to copyright protection in the  United States. The published product may be reproduced and distributed in its entirety  without further permission from GAO. However, because this work may contain  copyrighted images or other material, permission from the copyright holder may be  necessary if you wish to reproduce this material separately.