Fast Facts

The Bureau of Prisons provides a portfolio of drug education and treatment programs to help federal inmates with substance use disorders. In fiscal year 2019, the Bureau began treating inmates with opioid use disorder via a new medication-assisted treatment program.

The Bureau is expanding this program, but hasn’t documented how it will gauge the additional agency personnel needed, how it plans to recruit and onboard them, or when the expansion will be completed.

Our 7 recommendations could help the Bureau effectively expand its medication-assisted treatment program and evaluate and manage its portfolio of drug education and treatment programs.

A Bureau of Prisons Drug Treatment Unit Decorated by Inmates to Promote Positive Values

Prison interior

Prison interior

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Highlights

What GAO Found

The Bureau of Prisons (BOP) provides a drug education program and five drug treatment programs to federal inmates. BOP's most intensive drug treatment program—the Residential Drug Abuse Program—requires inmates to reside in a treatment unit set apart from the general population. From fiscal years 2015 through 2019, BOP obligated about $584 million for its programs. In fiscal year 2019, it implemented a new medication-assisted treatment (MAT) program for inmates with opioid use disorder. This program combines cognitive behavioral therapy with the use of medications—naltrexone, buprenorphine, and methadone.

Number of Inmates Who Participated in Each of the Bureau of Prisons' (BOP) Drug Education and Treatment Programs in Fiscal Year 2019

Number of Inmates Who Participated in Each of the Bureau of Prisons' (BOP) Drug Education and Treatment Programs in Fiscal Year 2019

Notes: BOP information on participation in its drug education and treatment programs captures the total number of discrete inmates who participated in a given program at any point during fiscal year 2019. Inmates may have participated in more than one program. BOP implemented the MAT program in fiscal year 2019.

BOP is taking steps to expand its MAT program nationwide to ensure all eligible inmates have access to the program and estimates needing $76.2 million across fiscal years 2020 and 2021 to do so. However, it lacks key planning elements to ensure its significant expansion efforts are timely and effective. For example, BOP lacks documentation on its methods for determining the number of additional agency personnel it reports needing to support MAT program expansion; how it plans to recruit and onboard these personnel; and time frames and target goals for key milestones, such as when the expansion will be completed. Developing these planning elements would better position BOP to identify and complete the tasks and objectives necessary to successfully implement its MAT program.

BOP's existing plan for evaluating its drug treatment programs has not been implemented and omits key programs, including MAT. Without an updated plan for evaluating all of its programs, the agency risks continuing or implementing programs that may not be effective. BOP also lacks a plan that agency leadership can use to manage its expanded portfolio of drug education and treatment programs, particularly given the substantial financial investment of the MAT program. Developing and implementing such a plan would help ensure BOP is effectively using available resources and making informed decisions in managing its portfolio of drug education and treatment programs.

Why GAO Did This Study

BOP is responsible for managing the care and custody of approximately 175,000 federal inmates—an estimated 20 percent of whom have been diagnosed with a substance use disorder. Through its drug education and treatment programs, BOP aims to help these inmates avoid substance use after reentering society—a time when they are at a high risk of drug overdose.

GAO was asked to review BOP's efforts to provide drug treatment to federal inmates. This report (1) describes BOP's drug education and treatment programs and funding for them from fiscal years 2015 through 2019, (2) examines BOP's plans for expanding the MAT program, and (3) examines BOP's plans for evaluating and managing these programs. GAO examined program documentation and data, interviewed BOP officials regarding the provision of drug treatment, and conducted site visits that included four BOP institutions and one privately managed institution selected, in part, for the range of drug treatment programs offered.

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Recommendations

GAO is making seven recommendations to BOP, including to develop key planning elements for expanding its MAT program and to develop and implement a plan that agency leadership can use to manage its portfolio of drug treatment programs. The Department of Justice concurred with our recommendations.

Recommendations for Executive Action

Agency Affected Recommendation Status
Bureau of Prisons 1. The Director of BOP should develop and document the agency's methods for determining the number of additional agency personnel it reports needing to support its MAT program expansion. (Recommendation 1)
Open
BOP concurred with this recommendation and is taking steps to implement it. In June 2020, BOP stated it was working to identify the number of additional agency personnel needed to support its MAT program expansion, including evaluating existing program requirements and consulting with external subject matter experts. Further, in December 2020, BOP stated that given its existing structure of providing primary care services to inmates, BOP had identified its needs for additional agency personnel. To fully address this recommendation, BOP will need to provide documentation on how it determined the number of additional agency personnel it needs to fully implement the MAT program.
Bureau of Prisons 2. The Director of BOP should document how the agency plans to recruit and onboard additional personnel for expanding and implementing the MAT program. (Recommendation 2)
Open
BOP concurred with this recommendation and is taking steps to implement it. In June 2020, BOP stated that its recruiters for medical personnel positions needed to implement the MAT program were being trained to focus on promising candidates within a larger pool. Additionally, BOP stated that market factors had been established to incentivize new applicants and existing BOP personnel to engage in the MAT program. Further, in December 2020, BOP stated it had identified the requirements for implementing the MAT program and services that dictates specific requirements of medical providers working to provide MAT services. To fully implement this recommendation, BOP must provide more information and documentation supporting these steps, and additionally, provide information on how these and other steps relate to BOP's plans for recruiting and onboarding necessary personnel.
Bureau of Prisons 3. The Director of BOP should develop and document time frames and target goals for key milestones—including a completion date—for the MAT program expansion. (Recommendation 3)
Open
BOP concurred with this recommendation and, as of December 2020, indicated that it continues to develop and adjust target goals and milestones for MAT services expansion leading to full nationwide implementation. To fully implement this recommendation, BOP will need to provide evidence that it has developed and documented time frames and target goals for expanding the MAT program, including a target date for when the MAT program expansion will be completed.
Bureau of Prisons 4. The Director of BOP should update its program evaluation plan to include the MAT program and re-prioritize the time frames for evaluating all programs in the plan based on available funding and staffing levels for conducting evaluations. (Recommendation 4)
Open
BOP concurred with this recommendation and indicated in December 2020 that it was in the process of updating its program evaluation plan. To fully implement this recommendation, BOP will need to provide this updated plan along with supporting documentation outlining BOP's process for updating it.
Bureau of Prisons 5. The Director of BOP should implement the revised program evaluation plan based on available funding and staffing levels for conducting them. (Recommendation 5)
Open
BOP concurred with this recommendation and indicated in December 2020 that it will provide GAO with a revised program evaluation plan.
Bureau of Prisons 6. The Director of BOP should develop and document a plan for managing its portfolio of drug education and treatment programs, including the MAT program. This plan should, among other components, identify specific activities and resources necessary to achieve desired results. (Recommendation 6)
Open
BOP concurred with this recommendation and is taking steps to implement it. Specifically, as of December 2020, BOP stated it will develop a portfolio management plan to ensure necessary resources are secured and appropriately allocated in a manner consistent with the agency's strategic plan. To fully implement this recommendation, BOP will need to develop this plan to include, among other components, specific activities and resources necessary to effectively manage its portfolio of drug education and treatment programs.
Bureau of Prisons 7. The Director of BOP should implement BOP's plan for managing its portfolio of drug education and treatment programs. (Recommendation 7)
Open
BOP concurred with this recommendation and indicated in December 2020 that it would provide GAO with a plan for managing its portfolio of drug education and treatment programs.

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