Illicit Drug Use
In the United States in 2014, at least 27 million people (ages 12 and older) engaged in illicit drug use—including the misuse of prescription drugs. Drug overdoses are now the leading cause of death by injury, surpassing auto accidents. Federal spending on drug control programs has increased over the last decade, but further strategies and actions are needed to curb illicit drug use, as well as the availability of illicit drugs.
Illicit drug use is widespread in the United States and has significant consequences. The Department of Justice’s (DOJ) National Drug Intelligence Center estimated that the economic impact of illicit drug use, including the costs of health care, crime, and lost productivity, was over $193 billion in 2007—and the number is likely higher today.
- 47,055 people died of drug overdoses in 2014, according to the Centers for Disease Control and Prevention (CDC)—the rate has more than doubled since 2000.
- 383% more infants were born exposed to illicit drugs in 2012 than in 2000—an increase from 1.2 babies per 1000 to 5.8—according to the CDC. Postnatal drug withdrawal can cause tremors, seizures, and feeding difficulties, among other things.
- Parental drug abuse has been one of the main reasons for children’s placement in foster care.
- According to the U.S. Department of Veterans Affairs, nearly one-third of veterans seeking substance abuse treatment also have post-traumatic stress disorder (PTSD). For these individuals, turning to alcohol or drugs may be perceived as a way to help cope with their PTSD symptoms.
- According to Federal Bureau of Prisons data, almost half of the current federal prison population is serving a sentence for drug-related crimes.
- Based on the Drug Enforcement Administration’s recent National Drug Threat Assessment, there are more than 33,000 domestic gangs involved in violent crimes related to drug trafficking and distribution.
Federal Spending on Drug Control
The amount of money that the federal government spent on drug control increased from $21.7 billion in fiscal year 2007 to about $30.6 billion in fiscal year 2016. However, while federal spending on treatment and prevention increased, money spent to reduce the drug supply (such as on domestic law enforcement) remained relatively constant.
Additionally, of the $14.7 billion allocated for treatment and prevention in fiscal year 2016, $13.2 billion was spent on treatment and $1.5 billion on prevention.
Figure: Federal Drug Control Spending for Fiscal Years 2007 through 2016
The Office of National Drug Control Policy
The Office of National Drug Control Policy (ONDCP) develops an annual strategy to reduce illicit drug use through prevention and treatment programs, as well as by decreasing the availability of illicit drugs. ONDCP’s 2010 strategy established seven specific goals to reduce illicit drug use and its consequences by 2015. However, ONDCP and federal agencies have only made moderate progress toward achieving one goal, limited progress on three goals, and no demonstrated progress on the remaining three goals. For example, no progress has been made to decrease the prevalence of drug use among young adults (ages 18 to 25) by 10 percent. In fact, the rate of drug use for this group increased from 21.4 percent in 2009 to 22 percent in 2014—primarily driven by marijuana use.
Limiting the Misuse of Prescription Drugs
Current federal law seeks to ensure that controlled substances, including certain prescription drugs, are available for legitimate uses while limiting their availability for abuse. For example, quotas limit the amount of certain substances that manufacturers can make available in the United States. Additionally, people handling controlled substances must register with the Drug Enforcement Agency (DEA). DEA also works to investigate, disrupt, and dismantle major drug trafficking organizations, although its efforts could be improved in a number of ways, particularly in these areas:
- administering the quota process for controlled substances,
- providing information and guidance to registrants, and
- complying with guidelines for overseeing confidential informants.
High Priority Areas for Action
Experts have 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 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;
- supporting drug prevention efforts in primary-care settings, such as exploring ways to reimburse providers for conducting preventative drug screenings
GAO-17-146SP: Published: Nov 14, 2016. Publicly Released: Nov 15, 2016.
What Forum Participants SaidIn individual presentations and group discussion, participants in a forum that GAO convened identified the common factors related to illicit drug use--the use of illicit drugs and the misuse of prescription drugs. According to forum participants, illicit drug use typically occurs for the first time in adolescence and involves marijuana. Forum participants also discussed...
GAO-16-833: Published: Sep 27, 2016. Publicly Released: Oct 27, 2016.
The Department of Health and Human Services (HHS) has stated that addressing opioid abuse is a high priority and is promoting access to medication-assisted treatment (MAT)--an approach that combines behavioral therapy and the use of medications--to combat the problem. Three medications are currently approved for use in MAT for opioid addiction--methadone, buprenorphine, and naltrexone. Methadone a...
GAO-16-737T: Published: Jun 22, 2016. Publicly Released: Jun 22, 2016.
In three reports issued during 2015, GAO made eleven recommendations to the Drug Enforcement Administration (DEA) related to administering the quota process for controlled substances, providing information and guidance to registrants, and complying with guidelines for overseeing confidential informants. As of June 2016, DEA had taken some actions to address these recommendations but had fully impl...
GAO-16-660T: Published: May 17, 2016. Publicly Released: May 17, 2016.
The Office of National Drug Control Policy (ONDCP) and federal agencies have made mixed progress toward achieving the goals articulated in the 2010 National Drug Control Strategy (Strategy) and ONDCP has established a mechanism to monitor and assess progress. In the Strategy, ONDCP established seven goals related to reducing illicit drug use and its consequences by 2015. As of May 2016, our analys...
GAO-16-257T: Published: Dec 2, 2015. Publicly Released: Dec 2, 2015.
GAO reported in March 2013 that the Office of National Drug Control Policy (ONDCP) and other agencies had not made progress toward achieving most of the goals in the 2010 National Drug Control Strategy (the Strategy) and ONDCP had established a new mechanism to monitor and assess progress. In the Strategy, ONDCP established seven goals related to reducing illicit drug use and its consequences to b...
GAO-15-471: Published: Jun 25, 2015. Publicly Released: Jul 27, 2015.
GAO's four nationally representative surveys of Drug Enforcement Administration (DEA) registrants showed that these registrants vary in the extent of their interaction with DEA related to their roles and responsibilities for preventing prescription drug abuse and diversion under the Controlled Substances Act (CSA). Specifically, GAO found that distributors and chain pharmacy corporate offices inte...
GAO-15-405: Published: May 12, 2015. Publicly Released: Jun 11, 2015.
The Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS) established criteria for the five grant programs covered by GAO's review that varied by program, but GAO found that CMHS did not document its application of criteria for about a third of the 16 grantees GAO reviewed. An example of how criteria varied by program is that one of the five...
GAO-15-66: Published: Oct 24, 2014. Publicly Released: Nov 24, 2014.
GAO identified 23 practices for addressing prescription drug fraud, waste, and abuse that fall within three categories based on GAO's Fraud Prevention Framework—prevention, detection and monitoring, and investigation and prosecution.The Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services' (CMS) activities to address prescription drug fraud, waste, and abuse in...
GAO-13-333: Published: Mar 26, 2013. Publicly Released: Apr 25, 2013.
The Office of National Drug Control Policy (ONDCP) and federal agencies have not made progress toward achieving most of the goals articulated in the 2010 National Drug Control Strategy (the Strategy), but are reported to be on track to implement most Strategy action items intended to support these goals. ONDCP established seven Strategy goals related to reducing illicit drug use and its consequenc...
GAO-13-170: Published: Jan 30, 2013. Publicly Released: Jan 30, 2013.
The four states GAO selected used funds provided under Title IV-B of the Social Security Act for a variety of child welfare services and other activities, and had different strategies for spending these funds. For instance, in fiscal year 2011 Virginia provided funding to all local child welfare agencies to spend on their own priorities, such as parenting classes. New Mexico targeted certain count...
GAO-12-115: Published: Dec 22, 2011. Publicly Released: Jan 23, 2012.
Key measures of prescription pain reliever abuse and misuse increased from 2003 to 2009. The largest increases were in measures of adverse health consequences such as emergency department visits, substance abuse treatment admissions, and unintentional overdose deaths, though increases were not consistent across all measures. Federal officials suggested that increasing availability of prescription...
GAO-11-863: Published: Sep 26, 2011. Publicly Released: Sep 26, 2011.
Federal law sets timelines for states' decisions about placing foster care children in permanent homes, and, in some cases, for filing to terminate parental rights. Some policymakers have questioned the reasonableness of these timelines for children of incarcerated parents and expressed interest in how states work with these families. GAO was asked to examine: (1) the number of foster care childre...