oversight

Drug Policy: Assessing Treatment Expansion Efforts and Drug Control Strategies and Programs

Published by the Government Accountability Office on 2019-05-09.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                          United States Government Accountability Office
                          Testimony
                          Before the Committee on Oversight and
                          Reform, House of Representatives


                          DRUG POLICY
For Release on Delivery
Expected at 11 a.m. ET
Thursday, May 9, 2019



                          Assessing Treatment
                          Expansion Efforts and
                          Drug Control Strategies
                          and Programs
                          Statement of Triana McNeil,
                          Acting Director, Homeland Security and Justice
                          and
                          Mary Denigan-Macauley,
                          Acting Director, Health Care




GAO-19-535T
                                             May 9, 2019

                                             DRUG POLICY
                                             Assessing Treatment Expansion Efforts and Drug
                                             Control Strategies and Programs
Highlights of GAO-19-535T, a testimony
before the Committee on Oversight and
Reform, House of Representatives




Why GAO Did This Study                       What GAO Found
Over 70,000 people died from drug            In an effort to reduce the prevalence of opioid misuse and the fatalities associated with it,
overdoses in 2017, according to the          the Department of Health and Human Services (HHS) has made expanding access to
most recently available Centers for          medication-assisted treatment (MAT) for opioid use disorder a priority since 2015. MAT is
Disease Control and Prevention data.         an approach that combines behavioral therapy and the use of certain medications like
Opioids are currently the main driver of     methadone and buprenorphine. GAO reported in September 2016 that several factors
these deaths. For people who are             could affect patients’ access to MAT, such as availability of qualified practitioners and
addicted to or misuse opioids, MAT           their capacity to meet patient demand. GAO also reported in October 2017 on HHS efforts
                                             to expand access to MAT for opioid use disorder and recommended, among other things,
has been shown to be an effective
                                             that HHS establish measures to better determine progress toward goals. While HHS
treatment. GAO has a body of work on
                                             established performance measures with targets to increase the number of prescriptions
drug policy, including on treatment for      for certain MAT medications, it has not yet fully implemented this recommendation.
opioid use disorder and on ONDCP’s           Further action to measure the treatment capacity of providers would help HHS determine
coordination and oversight of federal        whether a sufficient number of providers are becoming available to evaluate and treat
drug control efforts. GAO also               patients who could benefit from MAT.
identified federal efforts to prevent drug
misuse as an emerging issue requiring
close attention in its March 2019 High
Risk report.
This statement includes information
from GAO’s 2016 and 2017 reports on
access to MAT for opioid use disorder,
including selected recommendation
updates as of May 2019. It also
includes information from GAO’s
March 2019 testimony with preliminary
observations on the 2019 National
Drug Control Strategy and on GAO’s
ongoing work regarding ONDCP’s
efforts. For recommendation updates,
GAO reviewed HHS documents and
spoke with HHS about its recent
efforts.

What GAO Recommends
                                             The Office of National Drug Control Policy (ONDCP)—responsible for coordinating and
GAO has previously recommended               overseeing efforts by more than a dozen federal agencies to address illicit drug use—
that HHS establish performance               issued the 2019 National Drug Control Strategy on January 31, 2019. The Strategy
measures with targets to better gauge        encourages the use of evidence-based approaches to treatment and making MAT a
progress toward achieving agency             standard of care for opioid addiction. However, as GAO testified in March 2019, the
goals for expanding access to MAT.           Strategy does not include certain information required by law, such as annual objectives
HHS concurred and has taken some             that are quantifiable and measurable. Further, while the Strategy lists some items that it
steps to address the recommendation.         designates as measures of performance or effectiveness related to MAT, it lacks
                                             information on the current level of treatment access or any associated timeline by which
                                             ONDCP hopes to achieve desired results. Such information could help prioritize activities
                                             across federal agencies and measure progress over time, which previous GAO work has
                                             shown to be important for achieving results. ONDCP’s responsibility to develop the
                                             National Drug Control Strategy and coordinate among federal agencies offers the agency
                                             an opportunity to guide activities to address the unprecedented number of drug overdose
View GAO-19-535T. For more information,      deaths. As part of its ongoing work, GAO will continue to assess ONDCP’s efforts and
contact Triana McNeil at (202) 512-8777 or   consider recommendations as appropriate. GAO plans to issue a product by the end of
McNeilT@gao.gov or Mary Denigan-
                                             the calendar year.
Macauley at (202) 512-7114 or
DeniganMacauleyM@gao.gov.
                                                                                          United States Government Accountability Office
Letter
         Letter




         Chairman Cummings, Ranking Member Jordan, and Members of the
         Committee:

         We are pleased to be here today to discuss our prior work on access to
         medication-assisted treatment (MAT) for those who misuse or are
         addicted to opioids—a condition known as opioid use disorder—as well
         as our ongoing work on the Office of National Drug Control Policy’s
         (ONDCP) strategies and programs. 1 Over 70,000 people died from drug
         overdoses in 2017, and opioids are currently the main driver of these
         deaths, according to the Centers for Disease Control and Prevention. 2
         The Acting Secretary of the Department of Health and Human Services
         (HHS) declared the opioid crisis a public health emergency on October
         26, 2017. 3 Given the number of agencies engaged in federal drug control
         efforts and the range of activities that these efforts span—from prevention
         and treatment to interdiction, international operations, and law
         enforcement—these activities represent a considerable federal
         investment. According to the President’s fiscal year (FY) 2020 budget,
         federal drug control funding for FY 2018 was $33 billion. In our March
         2019 High-Risk report, we identified federal efforts to prevent drug misuse
         as an emerging issue requiring close attention. 4



         1
          GAO, Opioid Use Disorders: HHS Needs Measures to Assess the Effectiveness of
         Efforts to Expand Access to Medication-Assisted Treatment, GAO-18-44 (Washington,
         D.C.: Oct. 31, 2017) and GAO, Opioid Addiction: Laws, Regulations, and Other Factors
         Can Affect Medication-Assisted Treatment Access, GAO-16-833 (Washington, D.C.: Sept.
         27, 2016). We are also conducting ongoing work on ONDCP in response to a provision in
         21 U.S.C. § 1708a(b) that GAO routinely examine ONDCP's programs and operations, as
         well as in response to 2018 congressional requests.

         2
          Department of Health and Human Services, Centers for Disease Control and Prevention,
         National Center for Health Statistics, Drug Overdose Deaths in the United States, 1999-
         2017, No. 329 (Washington, D.C.: November 2018).

         3
          A public health emergency triggers the availability of certain authorities under federal law
         that enable federal agencies to take certain actions in response. See GAO, Opioid Crisis:
         Status of Public Health Emergency Authorities, GAO-18-685R (Washington, D.C.: Sep.
         26, 2018).

         4
          Every two years at the start of a new Congress, GAO calls attention to agencies and
         program areas that are high risk due to their vulnerabilities to fraud, waste, abuse, and
         mismanagement, or are most in need of transformation. See GAO, High-Risk Series:
         Substantial Efforts Needed to Achieve Greater Progress on High-Risk Areas,
         GAO-19-157SP (Washington, D.C.: Mar. 6, 2019).




         Page 1                                                                          GAO-19-535T
             As federal agencies engage in drug control efforts, ONDCP is responsible
             for, among other things, overseeing and coordinating the implementation
             of national drug control policy across the federal government. 5 These
             responsibilities include the Director of ONDCP promulgating a National
             Drug Control Strategy, and assessing and certifying the adequacy of the
             National Drug Control Program agencies’ budget submissions. 6

             In our testimony today, we will discuss findings from our 2016 and 2017
             reports on access to MAT for opioid use disorder, as well as updates, as
             of May 2019, on actions HHS has taken in response to the key
             recommendation we made in our 2017 report. We will also discuss our
             ongoing examination of ONDCP’s strategies and programs, including our
             scope and objectives. For our prior work, we reviewed federal laws and
             regulations pertaining to MAT medications, reviewed key documents from
             HHS and other sources, and interviewed stakeholders to identify factors
             that affect access to MAT. We applied internal control standards for
             defining objectives and evaluating results to assess HHS’s evaluation
             plans for its efforts to expand access to MAT, and we interviewed HHS
             officials about their efforts. More detailed information on the scope and
             methodology can be found in the published reports. To update the status
             of our recommendation, we reviewed documents HHS provided and
             spoke with the agency about its recent, related efforts.

             We conducted the work on which this statement is based in accordance
             with generally accepted government auditing standards. Those standards
             require that we plan and perform the audit to obtain sufficient, appropriate
             evidence to provide a reasonable basis for our findings and conclusions
             based on our audit objectives. We believe that the evidence obtained
             provides a reasonable basis for our findings and conclusions based on
             our audit objectives.


             Research has shown that MAT for opioid use disorder reduces opioid use
Background   and increases treatment retention compared to abstinence-based
             treatment (where patients are treated without medication). MAT combines
             behavioral therapy and the use of certain medications (methadone,
             buprenorphine, and naltrexone). Methadone and buprenorphine suppress

             5
                 21 U.S.C. § 1702(a)(2).

             6
                 21 U.S.C. § 1703(b)(2) and 21 U.S.C. § 1703(c)(3)(E).




             Page 2                                                           GAO-19-535T
withdrawal symptoms and control the craving for opioids, while naltrexone
suppresses the euphoric effects of opioids. 7 Treatment can occur as part
of federally regulated opioid treatment programs or in other settings, such
as health care providers’ offices, within certain restrictions. HHS made
expanding access to MAT a priority as part of its March 2015 Opioid
Initiative, and has continued to do so under its five-point Opioid Strategy,
announced in April 2017. 8

Along with HHS, more than a dozen federal agencies—known as National
Drug Control Program agencies—have responsibilities for drug treatment
activities, as well as prevention and law enforcement activities. 9 For
example, the Department of Justice has a lead role in limiting the
availability of illicit drugs through criminal investigations and prosecutions.
Since its creation under the Anti-Drug Abuse Act of 1988, 10 ONDCP has
been responsible for (1) leading the national drug control effort, (2)
coordinating and overseeing the implementation of national drug control
policy, (3) assessing and certifying the adequacy of National Drug Control




7
 Methadone and buprenorphine suppress withdrawal symptoms in detoxification therapy
and control the craving for opioids in maintenance therapy. Both drugs are opioids that
activate opioid receptors and carry risks of misuse. Both drugs can also be prescribed for
pain. Naltrexone is used for relapse prevention because it suppresses the euphoric effects
of opioids, and it carries no known risk of misuse.

8
 The Opioid Strategy’s five priority areas are: (1) strengthening public health surveillance,
(2) advancing the practice of pain management, (3) improving access to treatment and
recovery services, (4) targeting the availability and distribution of overdose-reversing
drugs, and (5) supporting cutting edge research.

9
 Currently under 21 U.S.C. § 1701(11), “the term ‘National Drug Control Program Agency’
means any agency (or bureau, office, independent agency, board, division, commission,
subdivision, unit, or other component thereof) that is responsible for implementing any
aspect of the National Drug Control Strategy, including any agency that receives Federal
funds to implement any aspect of the National Drug Control Strategy, but does not include
any agency that receives funds for drug control activity solely under the National
Intelligence Program or the Joint Military Intelligence Program.” In addition to ONDCP,
these agencies include the departments of Agriculture, Defense, Education, Health and
Human Services, Homeland Security, Housing and Urban Development, Interior, Justice,
Labor, State, Transportation, Treasury, and Veterans Affairs, as well as the Court
Services and Offender Supervision Agency for the District of Columbia, and the Federal
Judiciary.
10
    Pub. L. No. 100-690, 102 Stat. 4181.




Page 3                                                                          GAO-19-535T
Programs and the budget for those programs, and (4) evaluating the
effectiveness of national drug control policy efforts. 11

Under the October 2018 Substance Use-Disorder Prevention that
Promotes Opioid Recovery and Treatment for Patients and Communities
Act (the SUPPORT Act) and the previous ONDCP Reauthorization Act of
2006, the Director of ONDCP is required to promulgate the National Drug
Control Strategy and work with National Drug Control Program agencies
to develop an annual National Drug Control Program Budget. 12 ONDCP
did not issue a National Drug Control Strategy for 2017 or 2018 despite
the statutory requirement. 13 Under the SUPPORT Act and the ONDCP
Reauthorization Act of 2006, the National Drug Control Strategy is to set
forth a comprehensive plan to reduce illicit drug use and the
consequences of such illicit drug use in the United States by limiting the
availability of and reducing the demand for illegal drugs. 14 On January 31,
2019, ONDCP issued the 2019 National Drug Control Strategy.




11
     21 U.S.C. § 1702(a). See also, 21 U.S.C. § 1702(a) (2017).

12
     21 U.S.C. § 1703(b)(2) and (c)(2). See also, 21 U.S.C. § 1703(b)(2) and (c)(2) (2017).

13
   Prior to ONDCP’s 2018 reauthorization, ONDCP had most recently been reauthorized
by the ONDCP Reauthorization Act of 2006, Pub. L. No. 109-469, 120 Stat. 3502, through
fiscal year 2010. The ONDCP Reauthorization Act of 2006 “repealed” the provisions
related to ONDCP effective September 30, 2010. However, ONDCP continued to operate
under the provisions of that Act pursuant to its annual appropriations acts. See e.g.,
Consolidated Appropriations Act, 2017, Pub. L. No. 115-31, 131 Stat. 135, 340-41 (2017),
Consolidated Appropriations Act, 2018, Pub. L. No. 115-141, 132 Stat. 348, 548-50
(2018).
14
     21 U.S.C. § 1705(b). See also, 21 U.S.C. § 1705(a)(1) (2017).




Page 4                                                                           GAO-19-535T
                      In our September 2016 report, we identified key factors that can affect
Factors that Can      access to MAT for opioid use disorder. 15 These included:
Affect Access to
                            Laws and Regulations: Two MAT medications—methadone and
Opioid Use Disorder   •
                            buprenorphine—are regulated like other controlled substances under
Treatment and               the Controlled Substances Act (CSA) when used to treat pain and
                            have additional requirements that apply when used to treat opioid use
Federal Efforts to          disorder. 16 For example, methadone is classified as a drug with a
Measure Expansion           higher risk of abuse than buprenorphine and may generally only be
                            administered or dispensed within an opioid treatment program.
                            Buprenorphine may be administered or dispensed within an opioid
                            treatment program and may also be prescribed by a qualifying
                            practitioner who has received a waiver from HHS. The waivers place
                            a limit on the number of patients a qualifying practitioner may treat for
                            opioid use disorder.
                      •     Availability of qualified practitioners and their capacity to meet
                            patient demand: Qualified practitioners were lacking in certain
                            locations, and some practitioners may have been operating at full
                            capacity, leading to wait lists that can affect patients’ access.
                      •     Perceptions of MAT and its value among patients, practitioners,
                            and institutions: Perceived stigma about the use of MAT—especially
                            methadone—among patients could make them reluctant to seek
                            treatment, subsequently leading to social isolation and undermining
                            the chances of long-term recovery. In addition, some practitioners did
                            not believe, despite evidence, that MAT is more effective than
                            treatment without medication, and there were concerns that the
                            medications would be misused.
                      •     Availability and limits of insurance coverage for MAT: Patients
                            with no insurance coverage for MAT could face prohibitive out-of-
                            pocket costs that could limit their access to it, and coverage for MAT
                            varied for those individuals with insurance. Insurance plans, including
                            state Medicaid plans, did not always cover all the medications, and
                            they sometimes imposed limits on the length of treatment.

                      15
                          GAO-16-833.

                      16
                        Enacted in 1970, the CSA and its implementing regulations establish a framework
                      through which the federal government regulates the use of these substances for legitimate
                      medical, scientific, research, and industrial purposes, while preventing them from being
                      diverted for illegal purposes. See Pub. L. No. 91-513, tit. II, 84 Stat. 1236, 1242-84 (1970)
                      (codified, as amended, at 21 U.S.C. § 801 et seq.).




                      Page 5                                                                          GAO-19-535T
In our October 2017 report, we found that HHS had implemented five key
efforts to expand access to MAT for opioid use disorder but had not
established performance measures with targets that would specify the
results it hoped to achieve, and by when. 17 These five key efforts included
four grant programs that focus on expanding access to MAT in various
settings, including rural primary care practices and health centers. The
fifth key effort was implementation of regulatory and statutory changes
that expanded treatment capacity by increasing patient limits for a MAT
medication—buprenorphine—and expanded the types of practitioners
who can prescribe it in an office-based setting. We concluded that without
performance measures and associated targets, HHS would not have an
effective means to determine whether its efforts are helping to expand
access to MAT or whether new approaches are needed. 18

Among other things, we recommended in 2017 that HHS establish
performance measures with targets related to expanding access to MAT
for opioid use disorder. HHS concurred with the recommendation and in
February 2019, provided information that the agency had established
performance measures with targets to increase the number of
prescriptions for certain MAT medications—one of the potential ways to
measure access to MAT. However, the recommendation has not yet been
fully addressed because these performance measures do not address the
treatment capacity of providers who prescribe or administer MAT
medications, which HHS had identified as another way to measure
access. Measuring treatment capacity would help determine whether a
sufficient number of providers are becoming available to evaluate and
treat patients who may benefit from MAT. Fully implementing this
recommendation will help ensure that invested resources in the program
are yielding intended results.




17
 GAO-18-44.

18
  As we reported in GAO-18-44, gauging this progress was particularly important given
the large nationwide gap between the total number of individuals who could benefit from
MAT and the limited number who could access it based on provider availability at the time
of this report.




Page 6                                                                       GAO-19-535T
                    In March 2019, we testified before this committee about our ongoing work
Ongoing Review of   related to ONDCP’s strategies and programs. 19 According to ONDCP, the
ONDCP Strategies    2019 National Drug Control Strategy provides a high-level vision of
                    federal drug control efforts by focusing on prevention, treatment and
and Programs        recovery, and reducing the availability of illicit drugs. We testified that the
                    2019 National Drug Control Strategy designates one overarching
                    objective to reduce the number of lives lost to drug addiction, and
                    provides some description of federal agencies’ activities, including steps
                    to reduce the availability of illicit drugs. We also testified on our
                    preliminary observation that the 2019 National Drug Control Strategy
                    does not include certain information required by law, such as annual
                    objectives that are quantifiable and measurable.

                    For example, the 2019 National Drug Control Strategy encourages the
                    use of evidence-based approaches to treatment and making MAT a
                    standard of care for opioid addiction, which is consistent with HHS’s
                    efforts to expand access to MAT. Further, it lists some items that it
                    designates as measures of performance or effectiveness related to MAT.
                    One of the measures of effectiveness is that evidence-based addiction
                    treatment (particularly MAT for opioid addiction), is more accessible
                    nationwide for those who need it. However, the 2019 National Drug
                    Control Strategy lacks information on the current level of treatment
                    access or any associated timeline by which ONDCP hopes to achieve
                    desired results. As we previously testified, none of the measures has a
                    baseline of current performance or annual targets, and four of the seven
                    measures do not have associated timelines—which are important ways
                    that results could be quantified. As we noted in March, annual objectives
                    that are quantifiable and measurable could help prioritize activities across
                    federal agencies and measure progress over time, which previous GAO
                    work has shown to be important for achieving results.

                    As our prior work shows, using data—such as information collected by
                    performance measures and findings from program evaluations and
                    research studies—to drive decision-making can help federal agencies
                    improve program implementation, identify and correct problems, and




                    19
                     GAO, Drug Policy: Preliminary Observations on the 2019 National Drug Control
                    Strategy, GAO-19-370T (Washington, D.C.: Mar. 7, 2019).




                    Page 7                                                                   GAO-19-535T
make other management decisions. 20 Although our work continues to
show that agencies struggle to effectively use this approach, it has also
found that regular performance reviews and evidence-based policy tools
can help them incorporate performance information into federal decision-
making. Without specific measures to track performance, federal
agencies cannot fully assess whether taxpayer dollars are invested in
ways that will achieve desired outcomes.

We are continuing our ongoing examination of ONDCP’s strategies and
programs, which will help us further assess ONDCP’s coordination of
federal drug control policy and the degree to which it is meeting statutory
requirements. Specifically, we will provide additional information and
analysis on:

1. the extent to which ONDCP met requirements to develop a National
   Drug Control Strategy in 2017, 2018, and 2019, and what challenges,
   if any, ONDCP reports as having affected its ability to do so;
2. the extent to which ONDCP had processes and procedures in 2017
   and 2018 to oversee and coordinate select aspects of national drug
   control policy and what changes, if any, ONDCP reports due to the
   issuance of the 2019 National Drug Control Strategy; and
3. the requirements that ONDCP’s 2018 reauthorizing statute imposed
   and the steps the agency is taking to meet these requirements.

We are continuing to assess documentation and interview officials from
ONDCP. For example, we are in the process of reviewing statutory
requirements for the development of the National Drug Control Strategy
as well as the requirements of ONDCP’s 2018 reauthorizing statute. We
plan to review any processes and procedures that ONDCP followed as it
conducted its work and implemented interagency collaborative efforts,
and interview ONDCP officials to understand their planned approach for
meeting its requirements. As part of this work, we are meeting with other

20
  For example, see GAO, Managing for Results: Government-wide Actions Needed to
Improve Agencies’ Use of Performance Information in Decision Making, GAO-18-609SP
(Washington, D.C.: Sep. 5, 2018). In addition, the Government Performance and Results
Act of 1993 (GPRA), Pub. L. No. 103-62, 107 Stat. 285, sets out the performance planning
and reporting framework. The GPRA Modernization Act of 2010, Pub. L. No. 111-352, 124
Stat. 3866 (2011), enhanced GPRA by providing important tools that can help decision
makers address challenges facing the federal government, help resolve longstanding
performance and management problems, and provide greater accountability for results.




Page 8                                                                     GAO-19-535T
                  national drug control program agencies, such as HHS and the
                  Department of Justice, as well as the Office of Management and Budget,
                  to obtain their perspectives on ONDCP’s oversight and coordination of
                  national drug control policy in 2017 and 2018. We plan to publish the
                  results of our study by the end of this calendar year.

                  ONDCP’s responsibility to develop the National Drug Control Strategy
                  and coordinate among federal agencies offers the agency an important
                  opportunity to guide federal activities to address the unprecedented
                  number of drug overdose deaths. As such, we will continue to assess
                  ONDCP’s efforts and make recommendations as warranted. Findings
                  from our ongoing review of ONDCP’s efforts will also help to inform our
                  continuing body of work on the sufficiency of federal efforts to prevent
                  drug misuse, including work on treatment for opioid use disorder.

                  Chairman Cummings, Ranking Member Jordan, and Members of the
                  Committee, this concludes our prepared statement. We would be happy
                  to respond to any questions you may have at this time.


                  If you or your staff has any questions concerning this testimony, please
GAO Contact and   contact Triana D. McNeil at (202) 512-8777 (McNeilT@gao.gov) or Mary
Staff             E. Denigan-Macauley at (202) 512-7114 (DeniganMacauleyM@gao.gov).
                  Contact points for our Offices of Congressional Relations and Public
Acknowledgments   Affairs may be found on the last page of this statement. Individuals who
                  made key contributions to this testimony include Joy Booth, Will Simerl,
                  Michelle Loutoo Wilson, Billy Commons, Wendy Dye, Jane Eyre, Kaitlin
                  Farquharson, Natalie Herzog, and Jan Montgomery. Key contributors to
                  the prior work discussed in this testimony are listed in each respective
                  product.




                  Page 9                                                          GAO-19-535T
Related GAO Products
             Related GAO Products




             Drug Policy: Preliminary Observations on the 2019 National Drug Control
             Strategy. GAO-19-370T. Washington, D.C.: March 7, 2019.

             Opioid Crisis: Status of Public Health Emergency Authorities.
             GAO-18-685R. Washington, D.C.: September 26, 2018.

             Prescription Opioids: Medicare Needs Better Information to Reduce the
             Risk of Harm to Beneficiaries. GAO-18-585T. Washington, D.C.: May 29,
             2018.

             VA Health Care: Progress Made Towards Improving Opioid Safety, but
             Further Efforts to Assess Progress and Reduce Risk Are Needed.
             GAO-18-380. Washington, D.C.: May 29, 2018.

             Illicit Opioids: Office of National Drug Control Policy and Other Agencies
             Need to Better Assess Strategic Efforts. GAO-18-569T. Washington,
             D.C.: May 17, 2018.

             Illicit Opioids: While Greater Attention Given to Combating Synthetic
             Opioids, Agencies Need to Better Assess their Efforts. GAO-18-205.
             Washington, D.C.: March 29, 2018.

             Opioid Use Disorders: HHS Needs Measures to Assess the Effectiveness
             of Efforts to Expand Access to Medication-Assisted Treatment.
             GAO-18-44. Washington, D.C.: October 31, 2017.

             Preventing Drug Abuse: Low Participation by Pharmacies and Other
             Entities as Voluntary Collectors of Unused Prescription Drugs.
             GAO-18-25. Washington, D.C.: October 12, 2017.

             Prescription Opioids: Medicare Needs to Expand Oversight Efforts to
             Reduce the Risk of Harm. GAO-18-15. Washington, D.C.: October 6,
             2017.

             Newborn Health: Federal Action Needed to Address Neonatal Abstinence
             Syndrome. GAO-18-32. Washington, D.C.: October 4, 2017.

             Drug Control Policy: Information on Status of Federal Efforts and Key
             Issues for Preventing Illicit Drug Use. GAO-17-766T. Washington, D.C.:
             July 26, 2017.

             Medicaid Expansion: Behavioral Health Treatment Use in Selected States
             in 2014. GAO-17-529. Washington, D.C.: June 22, 2017.


             Page 1                                                           GAO-19-535T
           Related GAO Products




           Highlights of a Forum: Preventing Illicit Drug Use. GAO-17-146SP.
           Washington, D.C.: November 14, 2016.

           Opioid Addiction: Laws, Regulations, and Other Factors Can Affect
           Medication-Assisted Treatment Access. GAO-16-833. Washington, D.C.:
           September 27, 2016.

           Behavioral Health: Options for Low-Income Adults to Receive Treatment
           in Selected States. GAO-15-449. Washington, D.C.: June 19, 2015.

           Office of National Drug Control Policy: Office Could Better Identify
           Opportunities to Increase Program Coordination. GAO-13-333.
           Washington, D.C.: March 26, 2013.




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           Page 2                                                           GAO-19-535T
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                         Orice Williams Brown, Managing Director, WilliamsO@gao.gov, (202) 512-4400,
Congressional            U.S. Government Accountability Office, 441 G Street NW, Room 7125,
Relations                Washington, DC 20548

                         Chuck Young, Managing Director, youngc1@gao.gov, (202) 512-4800
Public Affairs           U.S. Government Accountability Office, 441 G Street NW, Room 7149
                         Washington, DC 20548

                         James-Christian Blockwood, Managing Director, spel@gao.gov, (202) 512-4707
Strategic Planning and   U.S. Government Accountability Office, 441 G Street NW, Room 7814,
External Liaison         Washington, DC 20548




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