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. The 2010 National Drug Control Strategy is the inaugural strategy guiding drug policy under President Obama’s 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. Drug abuse prevention includes activities focused on discouraging the first-time use of controlled substances and efforts to encourage those who have begun to use illicit drugs to cease their use. Treatment includes activities focused on assisting regular users of controlled substances to become drug free through such means as counseling services, inpatient and outpatient care, and the demonstration and provision of effective treatment methods. 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 subgoals 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 subgoals (collectively referred to as 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. 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 Drug Control Budget for implementing the strategy. National Drug Control Program agencies follow a detailed process in developing their annual budget submissions for inclusion in the Drug Control 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 contains 38 federal agencies or programs. There are five priorities for which resources are requested across agencies: substance abuse prevention and substance abuse treatment (both of which are considered demand-reduction areas), and drug interdiction, domestic law enforcement, and international partnerships (the three of 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. ONDCP previously managed the National Youth Anti-Drug Media Campaign which last received appropriations in fiscal year 2011. In the 2010 National Drug Control Strategy, ONDCP established seven goals related to reducing illicit drug use and its consequences to be achieved by 2015. As of May 2016, our analysis indicates that ONDCP and federal agencies have made moderate progress toward achieving one goal, limited progress on three goals, and no demonstrated progress on the remaining three goals. ONDCP officials stated that they intend to report on updated progress toward meeting the strategic goals in summer 2016. As of May 2016, overall, none of the goals in the Strategy have been fully achieved. Table 1 shows the 2010 Strategy goals and progress toward meeting them. ONDCP and federal drug control agencies have made mixed progress but have not fully achieved any of the four Strategy goals associated with curtailing illicit drug consumption. For example, progress has been 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)— indicates that in 2014, 9.4 percent of 12- to 17-year-olds reported having used illicit drugs in the past month. This represents a 7 percent decrease from the 2009 baseline for this measure. However, progress has not been 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 rate of drug use for young adults increased from 21.4 percent in 2009 to 22 percent in 2014, moving in the opposite direction of the goal. This increase was primarily driven by marijuana use. According to the 2014 NSDUH, 19.6 percent of young adults reported having used marijuana in the past month and 6.4 percent reported having used illicit drugs other than marijuana. The rates of reported marijuana use for this measure increased by 8 percent from 2009 to 2014 while the rates of reported use of illicit drugs other than marijuana decreased by 24 percent. Progress has also been mixed on the remaining three Strategy goals associated with reducing the consequences of drug use. For example, the goal to reduce drug-related morbidity by 15 percent has two measures, and progress has been made on one but not the other. Specifically, HIV infections attributable to drug use decreased by 34 percent from 2009 to 2014, 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—indicates 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. In addition, progress has not been made on the goal to reduce drug-induced deaths by 15 percent. According to the CDC’s National Vital Statistics System, 49,714 deaths were from drug-induced causes in 2014, an increase of 27 percent compared to 2009. This represents a significant departure from the 2015 goal. The CDC’s January 2016 Morbidity and Mortality Weekly Report stated that 47,055 of these deaths were from drug overdoses, the majority of which (61 percent) involved opioids. In March 2013, we reported that ONDCP established the Performance Reporting System (PRS) to monitor and assess progress toward meeting Strategy goals and objectives and issued a report describing the system with its 2012 Strategy. The PRS includes interagency performance measures and targets under each of the Strategy’s seven objectives, which collectively support the overarching goals discussed above. For example, one of the six performance measures under the Strategy’s first objective—Strengthen Efforts to Prevent Drug Use in Our Communities— is the average age of initiation for all illicit drug use, which has a 2009 baseline of 17.6 years of age and a 2015 target of 19.5 years of age. These PRS measures were established to help assess progress towards each objective. According to ONDCP, they are a tool to help indicate where the Strategy is on track, and when and where further attention, assessment, evaluation, and problem‐solving are needed. As part of our review for our March 2013 report, we assessed the PRS measures for the Strategy’s seven objectives and found them to be generally consistent with attributes of effective performance management identified in our prior work as important for ensuring performance measures demonstrate results and are useful for decision making. For example, we found that the PRS measures for the objectives were clearly stated, with descriptions included in the 2012 PRS report, and all 26 of them had or were to have measurable numerical targets. In addition, the measures were developed with input from stakeholders through an interagency working group process, which included participation by the Departments of Education, Justice, and Health and Human Services, among others. The groups assessed the validity of the measures and evaluated data sources, among other things. At the time of our review, the PRS was in its early stages and ONDCP had not issued its first report on the results of the system’s performance measures. ONDCP released its most recent annual PRS report in November 2015. The 2015 report assesses progress on the Strategy’s goals and the 28 performance measures and submeasures related to each of the Strategy’s seven objectives, which support the achievement of the goals. For each objective, the report classifies results on performance measures into five categories and identifies areas of progress on and challenges with achieving objectives. For example: Objective 1—Strengthen Efforts to Prevent Drug Use in Our Communities. The report indicates that sufficient progress has been made on reducing the average age of initiation for all illicit drugs to enable meeting the 2015 target. However, it notes that accelerated effort is needed to prevent youth marijuana use and counter youth perceptions that marijuana (including synthetic marijuana) use is not harmful. The report shows that the percent of respondents aged 12 to 17 who perceive a great risk in smoking marijuana once or twice a week decreased from 2009 to 2013, moving in the opposite direction of the 2015 target. Objective 3—Integrate Treatment for Substance Use Disorders into Health Care and Expand Support for Recovery.