Key Issues > By Topic > Drug Misuse
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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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Drug misuse—the use of illicit drugs and the misuse of prescription drugs—has been a long-standing and persistent problem in the United States. National rates of drug misuse have increased over the past two decades and represent a serious risk to public health. This has resulted in significant loss of life and harmful effects to society and the economy, including billions of dollars in costs. The federal drug control budget for FY 2019 was over $36 billion, and it funded the efforts of over a dozen federal agencies that are working on prevention, treatment, international counternarcotics, and law enforcement activities.

Because of the devastating effects of this issue, National Efforts to Prevent, Respond to, and Recover from Drug Misuse will be added to the High Risk List in 2021. (This has been considered a High Risk area since March 2020 but it was not added to the High Risk List immediately because the federal government’s efforts were focused on the COVID-19 pandemic.) 

Federal agencies could begin addressing the issues related to drug misuse by implementing some outstanding recommendations, available for download (XLSX file and CSV file). Addressing the nation’s drug misuse challenges will require a comprehensive national strategy, limiting the supply of drugs, increasing access to treatments, and curbing demand.

National 2018 Estimates on Drug Misuse

Note: Large and small metro counties are in metropolitan statistical areas and have a population of 1 million or more and fewer than 1 million, respectively. Metropolitan statistical areas have at least one urbanized area, and include adjacent counties with a high degree of social and economic integration with the urbanized area. All other counties are non-metro counties. 

National Drug Control Strategy
The Office of National Drug Control Policy (ONDCP) is responsible for developing the National Drug Control Strategy, which helps prioritize, coordinate, and measure key efforts to address the drug crisis. But ONDCP could improve its efforts to effectively coordinate national efforts to address drug misuse. 

 In 2017 and 2018, ONDCP lacked a statutorily required National Drug Control Strategy, and the 2019 National Drug Control Strategy did not fully comply with the law. The 2020 National Drug Control Strategy made progress in addressing several statutory requirements, but fell short in meeting other requirements. For example, it did not include a list of drug misuse activities that federal agencies are undertaking, and the role of each activity in achieving long-term goals.

Limiting prescription drug misuse and illicit drugs

Federal agencies could improve their efforts to curb the misuse of prescription drugs, as well as the supply of illicit drugs, in a number of ways.

For example:

  • The Drug Enforcement Administration (DEA) collects industry-reported data on the sale and purchase of controlled substances and prescription drugs, including opioids. The data supports DEA’s investigations into whether drugs have been diverted to the illegal marketplace. DEA’s systems do not provide real-time analysis, but more robust analysis is possible. For example, DEA could use computer algorithms to proactively identify patterns and trends in drug distribution—e.g., to see when unusual volumes of drugs are disposed of vs. sold.
  • Federal agencies are working to limit the domestic availability of illicit synthetic opioids. For example, federal agencies 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 for these activities 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 Departments of Defense, Homeland Security, Justice, and State carry out international counternarcotics activities to disrupt the flow of illicit drugs and dismantle drug trafficking organizations. For example, the U.S. counternarcotics approach in Colombia includes disrupting drug trafficking, destroying coca crops, and supporting alternative livelihoods for coca farmers. However, the State Department has not comprehensively reviewed the benefits and limitations of this approach.
  • The Synthetics Trafficking and Overdose Prevention Act (STOP Act) of 2018 requires the U.S. Postal Service to provide data on international mail shipments to U.S. Customs and Border Protection (CBP). CBP then uses this data—e.g., the recipient’s address and description of contents—to target mail for inspection to find opioids. While the Postal Service and CBP have made progress implementing the act’s requirements, the Department of Homeland Security has yet to issue regulations to clarify the Postal Service’s responsibilities in providing this data.
  • The Department of Veterans Affairs (VA) has been working to address opioid safety for veterans, and has made progress with reducing opioid prescriptions. For example, VA has initiated a program to educate providers on best practices related to pain management and optimal opioid use. However, VA has not fully met all of its opioid safety goals, especially those related to opioid risk mitigation strategies (such as annual urine drug screenings). 

Increasing access to treatments

The federal government could further support improved access to treatments that can assist with drug misuse. 

  For instance:

  • Medicaid is one of the largest sources of coverage for individuals undergoing medication-assisted treatment (MAT), which combines medications like methadone and buprenorphine with behavioral therapy to treat opioid use disorders. The Department of Health and Human Services (HHS) has identified expanding access to MAT as important for reducing opioid use disorders and overdoses, and has taken action to increase access. However, some state and federal policies restrict Medicaid beneficiaries' access to MAT medications.
  • Veterans coping with the stresses of deployment or with readjusting to civilian life are at particular risk for drug and alcohol addiction. Veterans living in rural areas use the VA’s substance use disorder treatment services at the same rate as those in urban areas, but their access to these services is sometimes more limited. Providing treatment in rural areas poses challenges, such as a shortage of specialized providers and lack of transportation. VA is taking steps to address these challenges.   
  • 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.  
  • Federal law requires the governors of all states to provide assurances that their states have laws or programs that include policies and procedures to address the needs of infants affected by prenatal substance use. While HHS provides some guidance and technical assistance to implement this federal law, it needs to expand its assistance to help states better implement protections for children. 

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 together 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
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
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