Key Issues > Federal Efforts to Prevent Drug Misuse
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Federal Efforts to Prevent Drug Misuse

The number of overdose deaths in the United States from the use of illicit drugs and the misuse of prescription drugs has risen to unprecedented levels. This crisis has worsened despite dozens of ongoing federal, state, local, and private sector efforts to prevent drug misuse and to treat substance use disorders. 

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Over 70,000 people died from drug overdoses in 2017, according to the Centers for Disease Control and Prevention. Drug overdoses are the leading cause of death due to injuries in the United States; since 2011, they have outnumbered deaths, respectively, by firearms, motor vehicle crashes, suicide, and homicide, according to the Drug Enforcement Administration (DEA).

The use of illicit drugs and the misuse of prescription drugs—and the ways they affect individuals, their families, and the communities in which they live—are important challenges facing our nation. The federal government spent nearly $30 billion dollars on drug control efforts in 2017, including efforts related to prevention, treatment, international counternarcotics activities, and law enforcement. These efforts often involve multiple agencies and issue areas such as health care, education, and social services—and they face a number of challenges.

Limiting prescription drug misuse and illicit drugs

Federal agencies have ongoing efforts to curb the misuse of prescription drugs, as well as the supply of illicit drugs.

  • The Centers for Medicare and Medicaid Services (CMS) provides guidance to Medicare Part D plan sponsors about monitoring beneficiaries who receive opioid prescriptions. However, CMS needs to improve its efforts. For example, CMS does not collect sufficient information to know the total number of at-risk beneficiaries receiving high doses of opioid prescriptions—information that would help CMS assess its progress toward reducing misuse.
  • Federal agencies are working to limit the domestic availability of illicit synthetic opioids. For example, federal agencies like the DEA collaborate with foreign governments and international organizations to help limit the production of illicit synthetic opioids. However, some of the strategies that federal agencies use do not include outcome-oriented performance measures. Without such measures, agencies cannot assess whether their efforts are helping limit the availability of illicit synthetic opioids.
  • The U.S. Postal Service (USPS) and U.S. Customs and Border Protection (CBP) work with express consignment carriers like FedEx and DHL to inspect international express cargo and mail for illicit drugs entering the country. While express consignment carriers provide electronic advance data for inbound express cargo (allowing CBP to target its inspections), USPS is not required to provide similar information to CBP.
  • The National Guard counterdrug program supports federal, state, local, and tribal law enforcement organizations counterdrug activities. However, DOD lacks a strategy for this program, and needs to improve how it approves and funds these activities.

Measuring access to treatments

  • Opioids—both prescription and illicit—are currently the main driver of drug overdose deaths. One of the methods for treating opioid use disorder is medication-assisted treatment (MAT), which is a combination of behavioral therapy and medications like methadone and buprenorphine. The Department of Health and Human Services (HHS) has established a goal to expand access to MAT but needs to improve measurement of whether its efforts are successful or whether new approaches are needed.
  • Neonatal abstinence syndrome (NAS)—a condition causing withdrawal symptoms in newborns such as difficulties breathing and feeding—has also increased as a result of the opioid crisis. In May 2017, HHS published a strategy with key recommendations to help address some of the challenges related to treating NAS. However, HHS lacks a sound plan for implementing these recommendations, such as establishing priorities, stakeholder responsibilities, implementation timeframes, and methods for assessing progress.  

Curbing demand
In 2016, experts at a Comptroller General Forum identified several high-priority areas to help prevent illicit drug use and the misuse of prescription drugs. These include:

  • Supporting community coalitions made up of the health care, education, and law enforcement sectors that work in concert to prevent illicit drug use at the local level
  • Consolidating federal funding for multiple prevention programs into a single fund that  addresses a range of unhealthy behaviors (including illicit drug use)
  • Increasing the use of prevention programs that have been proven to be effective
  • Supporting drug prevention efforts in primary-care settings—such as reimbursing providers for conducting preventative drug screenings

National drug control strategy
The Office of National Drug Control Policy is responsible for overseeing and coordinating the implementation of U.S. drug policy, including the development of the National Drug Control Strategy. The 2010 Strategy included seven goals related to reducing illicit drug use and prescription drug misuse, but the government made mixed progress on achieving those goals. The 2019 Strategy focuses on reducing the availability of illicit drugs, as well as prevention, treatment and recovery.

Looking for our recommendations? Click on any report to find each associated recommendation and its current implementation status.

Videos

Reflections on Addiction and Recovery (First of Two Video Testimonials)
Reflections on Addiction and Recovery (Second of Two Video Testimonials)

Podcasts

Prescription OpioidsMonday, November 6, 2017
Combating Synthetic OpioidsThursday, April 12, 2018
State Marijuana LawsMonday, February 1, 2016
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