September 27, 2021

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Former Colorado Judge Sentenced for Obstructing Federal Investigation of Drug Trafficking Organization

15 min read
<div>A former Colorado state court judge was sentenced Wednesday in the District of Colorado to a year and one day in prison for obstructing a federal task force investigation of a large-scale cocaine trafficking organization.</div>
A former Colorado state court judge was sentenced Wednesday in the District of Colorado to a year and one day in prison for obstructing a federal task force investigation of a large-scale cocaine trafficking organization.

More from: July 29, 2021

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  • Secretary Pompeo’s Meeting with French Foreign Minister Le Drian
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  • Chinese National Sentenced for Laundering Millions for Mexican Drug Cartels
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    A Chinese national was sentenced today to five years in prison and ordered to forfeit more than $4.2 million for laundering drug proceeds generated by large-scale cocaine trafficking in the United States.
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  • Former Owners of Telemarketing Company Agree to Pay At Least $4 Million to Resolve False Claims Act Allegations
    In Crime News
    Two Florida men have agreed collectively to pay at least $4 million to resolve allegations that they violated the False Claims Act by engaging in schemes to generate prescriptions for compounded drugs and refer those prescriptions to pharmacies in exchange for illegal kickbacks. Many of those prescriptions were billed to TRICARE, the federal health care program providing insurance for active duty military personnel, military retirees, and military dependents.
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  • Questions for the Record Related to the Benefits and Medical Care for Federal Civilian Employees Deployed to Afghanistan and Iraq
    In U.S GAO News
    GAO appeared before the House Subcommittee on Oversight and Investigations, Committee on Armed Services on September 18, 2007, to discuss the benefits and medical care for federal civilian and U.S. government contract employees deployed to Iraq and Afghanistan. This report responds to Congress' request that GAO provide answers to questions for the record from the hearing. The questions are (1) What are the congressional requirements for medical tracking of deployed military servicemembers and civilians? and (2) What work has GAO conducted on this topic?Following GAO's May 1997 report, Congress enacted legislation3 that required the Secretary of Defense to establish a medical tracking system to assess the medical condition of servicemembers before and after deployments to locations outside of the United States. This legislation was amended by a provision in the John Warner National Defense Authorization Act for Fiscal Year 2007. The current legislation amends elements of the system and the quality assurance program as well as adds criteria for referral for further evaluations and minimum mental health standards for deployment. Since the 1990s, GAO has highlighted shortcomings with respect to the Department of Defense's (DOD) ability to assess the medical condition of servicemembers both before and after their deployments. Following GAO's May 1997 report, Congress enacted legislation that required the Secretary of Defense to establish a medical tracking system for assessing the medical condition of servicemembers before and after deployments. In September 2003, we reported that the Army and Air Force did not comply with DOD's force health protection and surveillance requirements for many servicemembers deploying in support of Operation Enduring Freedom in Central Asia and Operation Joint Guardian in Kosovo. Our report also raised concerns over a lack of DOD oversight of departmentwide efforts to comply with health surveillance requirements. In September 2004, we reported similar issues related to DOD's ability to effectively manage the health status of its reserve forces. In November 2004, we reported that overall compliance with DOD's force health protection and surveillance policies for servicemembers who deployed in support of Operation Iraqi Freedom varied by service, by installation, and by policy requirement. In October 2005, we reported that evidence suggested that reserve component members have deployed into theater with preexisting medical conditions that could not be adequately addressed in theater, and that DOD had limited visibility over the health status of reserve component members after they are called to duty and is unable to determine the extent of care provided to those members deployed with preexisting medical conditions despite the existence of various sources of medical information. In February 2007, the Office of the Deputy Assistant Secretary of Defense for Force Health Protection and Readiness published a new instruction on force health protection quality assurance. This policy applies to military servicemembers, as well as applicable DOD and contractor personnel. The new policy requires the military services to implement procedures to monitor key force health protection elements such as pre- and post-deployment health assessments. In our June 2007 report on DOD's compliance with the legislative requirement to perform pre- and post-deployment medical examinations on servicemembers, DOD lacked a comprehensive oversight framework to help ensure effective implementation of its deployment health quality assurance program, which included specific reporting requirements and results-oriented performance measures to evaluate the services' adherence to deployment health requirements.
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  • Warfighter Support: DOD Needs a Complete Picture of the Military Services’ Prepositioning Programs
    In U.S GAO News
    The services preposition combat and support assets ashore and afloat worldwide, including in the Indo-Pacific region. Prepositioned assets include combat vehicles, equipment sets for engineering and construction, and protective gear for chemical or biological attacks. During the COVID-19 pandemic, the Department of Defense (DOD) used prepositioned medical assets for personnel in Guam, South Korea, and Germany. All of the services have reported some shortfalls in their prepositioned assets from 2015 through 2019—including mortars, combat vehicles, and medical equipment. In the Indo-Pacific region, for example, the Army reported shortfalls in equipment to construct bridges over difficult terrain. All services also cited challenges, such as insufficient storage space, storage facilities located far away from intended points of use, and the perishability of some assets. In some cases, the services are taking actions to address these shortfalls and challenges. In others, the services are accepting risk because, according to officials, not all shortfalls and challenges can be fully addressed. Sailors and Marines Offload Assets from a Prepositioning Ship during the COVID-19 Response in Guam DOD has taken steps to implement a joint oversight framework but does not have a complete view of the services' prepositioning programs. DOD revised two guidance documents—an instruction in 2019 and a strategic implementation plan in 2020—to establish a joint oversight framework. However, DOD has focused much of its joint efforts to date on preparing a required annual report to Congress on the status of the services' prepositioning programs. While the report provides some useful information, GAO found inaccurate and inconsistent information in multiple annual reports, which hinder their utility. DOD does not have a reporting mechanism or information-collection tool to develop a complete picture of the services' prepositioning programs. The current annual reporting requirement expires in 2021, which provides DOD with an opportunity to create a new reporting mechanism, or modify existing mechanisms or tools, to enable a complete picture of the services' prepositioning programs. By doing so, DOD could better identify gaps or redundancies in the services' programs, make more informed decisions to mitigate asset shortfalls and challenges, reduce potential duplication and fragmentation, and improve its joint oversight. The U.S. military services preposition critical assets at strategic locations around the world for access during the initial phases of an operation. DOD uses these prepositioned assets for combat, support to allies, and disaster and humanitarian assistance. For many years, GAO has identified weaknesses in DOD's efforts to establish a joint oversight framework to guide its ability to assess the services' prepositioning programs. This has led to fragmentation and the potential for duplication. Senate Report 116-48 included a provision for GAO to evaluate the services' prepositioning programs and associated challenges. This report (1) describes the types of assets the services preposition worldwide, as well as asset shortfalls and challenges the services have identified, and (2) assesses the extent to which DOD has made progress in implementing a joint oversight framework for the services' programs. To conduct this work, GAO reviewed DOD prepositioning documents and interviewed DOD and State Department officials from over 20 offices. This is a public version of a sensitive report that GAO issued in December 2020. Information that DOD deemed sensitive has been omitted. GAO recommends that DOD develop a reporting mechanism or tool to gather complete information about the military services' prepositioning programs for joint oversight and to reduce duplication and fragmentation. DOD concurred with the recommendation. For more information, contact Cary B. Russell at (202) 512-5431 or russellc@gao.gov.
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  • Overseas Conflicts: U.S. Agencies Have Coordinated Stabilization Efforts but Need to Document Their Agreement
    In U.S GAO News
    What GAO Found The Departments of State (State) and Defense (DOD), the U.S. Agency for International Development (USAID), and the U.S. Institute of Peace (USIP)—an independent, federally funded institute—reported conducting various efforts to address conflict prevention, mitigation, and stabilization for Iraq, Nigeria, and Syria in fiscal year 2017. For example, in Iraq, State supported efforts to remove improvised explosive devices from homes and infrastructure (see figure); USAID contributed to the United Nations to restore essential services; DOD provided immediate medical trauma supplies to the World Health Organization to treat injured civilians; and USIP conducted facilitated dialogs to enable local reconciliation in areas liberated from the Islamic State of Iraq and the Levant. Example of U.S. Department of State Stabilization Effort in Iraq In conducting U.S. conflict prevention, mitigation, and stabilization efforts, State, USAID, DOD, and USIP have addressed aspects of key collaboration practices such as elements of bridging organizational cultures and leadership. However, the agencies have not formally documented their agreement on coordination for U.S. stabilization efforts through formal written guidance and agreements that address key collaboration practices. GAO found the following, for example, with regard to the extent key collaboration practices have been used by these entities. Bridging organizational cultures: U.S. agencies have established various mechanisms to coordinate their efforts, such as interagency working groups and staff positions focused on coordination. USIP convenes interagency actors, including State, USAID, and DOD through various programs and events. Defining outcomes and accountability: One or more agencies have established some common outcomes and accountability mechanisms for their stabilization efforts in Iraq, Nigeria, and Syria. Moreover, through an interagency review of U.S. stabilization assistance, State, USAID, and DOD identified a need to develop an outcome-based political strategy outlining end states for U.S. stabilization efforts and strategic analytics to track and measure progress, among other needs. Written guidance and agreements: Although State, USAID, and DOD have developed a framework for stabilization, they have not documented their agreement on the key collaboration practices identified, such as defining outcomes and accountability and clarifying roles and responsibilities. According to key practices for enhancing interagency collaboration, articulating agreements in formal documents can strengthen collaborative efforts, and reduce the potential for duplication, overlap, and fragmentation. Why GAO Did This Study The United States has a national security interest in promoting stability in conflict-affected countries to prevent or mitigate the consequences of armed conflict, according to the 2017 National Security Strategy. State, USAID, and DOD have reported that a collaborative government approach is an essential part of maximizing the effectiveness of U.S. efforts in conflict-affected areas. GAO was asked to review U.S. conflict prevention, mitigation, and stabilization efforts abroad. This report (1) describes examples of conflict prevention, mitigation, and stabilization efforts that U.S. agencies and USIP conducted in Iraq, Nigeria, and Syria and their goals in fiscal year 2017 and (2) examines the extent to which U.S. agencies and USIP incorporated key collaboration practices to coordinate their efforts. GAO collected data from the agencies and USIP on their efforts and goals in Iraq, Nigeria, and Syria. GAO selected these countries based on U.S. national security interests, among other criteria. GAO reviewed agency and USIP documents, interviewed officials, and conducted fieldwork in Iraq, Nigeria, and Jordan. GAO assessed coordination against key practices identified by GAO to enhance interagency collaboration.
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  • Navy Shipyards: Actions Needed to Address the Main Factors Causing Maintenance Delays for Aircraft Carriers and Submarines
    In U.S GAO News
    The Navy's four shipyards completed 38 of 51 (75 percent) maintenance periods late for aircraft carriers and submarines with planned completion dates in fiscal years 2015 through 2019, for a combined total of 7,424 days of maintenance delay. For each maintenance period completed late, the shipyards averaged 113 days late for aircraft carriers and 225 days late for submarines. Maintenance Delays at Navy Shipyards for Fiscal Years 2015 through 2019 Unplanned work and workforce factors—such as shipyard workforce performance and capacity (having enough people to perform the work)—were the main factors GAO identified as causing maintenance delays for aircraft carriers and submarines. The Navy frequently cited both factors as contributing to the same days of maintenance delay. Unplanned work—work identified after finalizing maintenance plans—contributed to more than 4,100 days of maintenance delays. Unplanned work also contributed to the Navy's 36 percent underestimation of the personnel resources necessary to perform maintenance. The workforce factor contributed to more than 4,000 days of maintenance delay on aircraft carriers and submarines during fiscal years 2015 through 2019. The Navy has taken steps but has not fully addressed the unplanned work and workforce factors causing the most maintenance delays. First, the Navy updated planning documents to improve estimates and plans to annually update these data, but knowing whether changes improve results may take several years. Second, the Navy has consistently relied on high levels of overtime to carry out planned work. GAO's analysis found that high overtime among certain production shops, such as painting or welding, averaged from 25 to 32 percent for fiscal years 2015 through 2019, with peak overtime as high as 45 percent. Furthermore, shipyard officials told us that production shops at all four shipyards are working beyond their capacity. Overtime at such rates has been noted as resulting in diminished productivity. Third, the Navy initiated the Shipyard Performance to Plan initiative in the fall of 2018 to address the unplanned work and workforce factors, but it has not yet developed 13 of 25 planned metrics that could improve the Navy's understanding of the causes of maintenance delays. In addition, the Shipyard Performance to Plan initiative does not include goals, milestones, and a monitoring process along with fully developed metrics to address unplanned work and workforce weaknesses. Without fully developing metrics and implementing goals, action plans, milestones, and a monitoring process, the shipyards are not likely to address unplanned work and workforce weaknesses and the Navy is likely to continue facing maintenance delays and reduced time for training and operations with its aircraft carriers and submarines. For fiscal years 2015 through 2019, the Navy spent $2.8 billion in capital investments to address shipyard performance, among other things. However, the shipyards continue to face persistent and substantial maintenance delays that hinder the readiness of aircraft carriers and submarines. The Senate Armed Services Committee, in a report accompanying a bill for the National Defense Authorization Act for Fiscal Year 2019, included a provision for GAO to review Navy shipyards' performance. GAO evaluated the extent to which the Navy (1) completed maintenance at its shipyards on time on aircraft carriers and submarines in fiscal years 2015 through 2019, (2) has identified the main factors leading to maintenance delays, and (3) has addressed the main factors affecting any delays in that maintenance. GAO reviewed data related to Navy shipyard maintenance for fiscal years 2015 through 2019, analyzed factors contributing to delays and plans to address them, visited all four Navy shipyards, and met with Navy and shipyard officials. GAO is making three recommendations to the Navy, including updating workforce planning requirements to avoid the consistent use of overtime; completing the development of shipyard performance metrics; and developing and implementing goals, action plans, milestones, and monitoring results. The Navy concurred with all three recommendations. For more information, contact Diana Maurer, (202) 512-9627, MaurerD@gao.gov, or Asif A. Khan, (202) 512-9869, KhanA@gao.gov. 
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  • Overseas Real Property: Prioritizing Key Assets and Developing a Plan Could Help State Manage Its Estimated $3 Billion Maintenance Backlog
    In U.S GAO News
    What GAO Found The Department of State's portfolio of overseas assets and expenditures to operate them have grown, but State-allocated funding for maintenance has stayed nearly the same. For fiscal years 2015 through 2019, both the number and square footage of State's assets increased 11 percent and operations expenditures grew 24 percent. However, maintenance and repair funding has remained nearly unchanged. For example, State's allocation for Maintenance Cost Sharing—for projects collectively funded by State and tenant agencies overseas—was $399 million in fiscal year 2016 and $400 million in 2020. GAO found that more than one-quarter of State's overseas assets are in poor condition according to State's condition standard. Further, 20 percent (almost 400) of assets that State identifies as critical to its mission are in poor condition. Federal accounting standards recognize that what constitutes acceptable asset condition may vary by the importance of specific assets to agencies' missions. However, State set a single acceptable condition standard of “fair” for all assets and did not consider whether some assets, like chancery office buildings, were more critical to State's mission when estimating its $3 billion deferred maintenance backlog. Had State set a higher condition standard for critical assets, its backlog would be higher. By reassessing its condition standard, State could determine whether to adopt an approach that considers asset importance and that could help guide maintenance funding to key assets. Condition of U.S. Embassy Manila, Philippines – Left: Chancery Office Building; Right: Chancery Courtyard Showing Maintenance Issues, Including Mold and Water Damage State follows most, but not all, leading practices for managing deferred maintenance backlogs. Of the nine leading practices, GAO found that State followed five, partially followed three, and did not follow one. For example, State has goals, baselines, and measures for its facility management performance. However, State did not specifically request funding to address the backlog in its congressional budget requests. Officials said they had not found it necessary to specifically request such funding because they only determined that the backlog had substantially increased from $96 million in fiscal year 2019 to $3 billion in fiscal year 2020 after using a new methodology for estimating deferred maintenance and repair. In addition, State does not have a plan to address the backlog, but officials estimated it could take 30 to 40 years to eliminate the backlog with current funding levels. Developing such a plan with specific information on the funding and time frames needed to reduce the backlog would help decision makers better understand how funding levels affect backlog reduction. Why GAO Did This Study State's Bureau of Overseas Buildings Operations operates and maintains over 8,500 owned and leased real property assets, including both buildings and structures. According to State, at least 60 percent of a building's total lifecycle cost stems from operations and maintenance costs. GAO has reported that deferring maintenance and repairs can lead to higher costs in the long term and pose risks to agencies' missions. GAO was asked to review State's efforts to manage its operations and maintenance needs. This report examines (1) how operations and maintenance funding for overseas assets changed from fiscal years 2016 through 2020, (2) the condition and maintenance needs of State's overseas assets, and (3) the extent to which State has followed leading practices to address its deferred maintenance backlog. GAO analyzed State data on operations and maintenance funding and asset condition, as well as documentation related to leading facility management practices. GAO also met with State officials in headquarters and in seven embassies.
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  • Humanitarian and Development Assistance: Project Evaluations and Better Information Sharing Needed to Manage the Military’s Efforts
    In U.S GAO News
    What GAO FoundThe Department of Defense’s (DOD) management of its key humanitarian assistance programs reflects both positive practices and weaknesses:Alignment with strategic goals. DOD aligns its humanitarian assistance project planning with the goals outlined in U.S. and departmental strategies, and has clearly established processes for implementing its projects.Interagency project coordination. DOD has taken steps to coordinate with the Department of State (State) and the United States Agency for International Development (USAID) on projects, such as seeking concurrence on project proposals and embedding representatives from their agencies at its combatant commands, but coordination challenges remain.Poor data management. DOD does not have complete information on the status or actual costs of the full range of its Overseas Humanitarian, Disaster, and Civic Aid (OHDACA) projects. In addition, Humanitarian and Civic Assistance project data in DOD’s database differ from what DOD reports to Congress.Limited program evaluations. From fiscal years 2005 through 2009, DOD had not completed 90 percent of the required 1-year post-project evaluations for its OHDACA projects, and about half of the required 30-day evaluations for those projects, and thus lacks information to determine projects’ effects.Limited program guidance. DOD’s primary guidance for the OHDACA humanitarian assistance program is limited, is not readily accessible to all DOD personnel, and has not been updated for several years.Furthermore, DOD, State, and USAID do not have full visibility over each others’ assistance efforts, which could result in a fragmented approach to U.S. assistance. There are several initiatives under way to improve information sharing, including one directed by the National Security Council. However, no framework, such as a common database, currently exists for the agencies to readily access information on each others’ efforts. Moreover, the potential for overlap exists among agencies’ efforts in four areas: (1) health, (2) education, (3) infrastructure, and (4) disaster preparation. For example, both USAID and DOD are conducting health care projects in Yemen and building schools in Azerbaijan. Overlap may be appropriate in some instances, especially if agencies can leverage each others’ efforts. However, given the agencies’ information-sharing challenges, there are questions as to whether DOD’s efforts are an efficient use of resources since USAID serves as the lead U.S. development agency. State and USAID officials said that DOD’s humanitarian assistance efforts can be beneficial, especially when responding to disasters or supporting foreign militaries. However, officials said DOD’s efforts can have negative political effects, particularly in fragile communities where even small gestures, such as distributing soccer balls to a particular population, can be interpreted as exhibiting favoritism. While DOD’s funding for humanitarian assistance is small relative to the billions spent by State and USAID, its programs are expanding. Given interagency information challenges, the fiscally-constrained environment, and the similarity of agencies’ assistance efforts, DOD and the other agencies involved in foreign assistance could benefit from additional direction from Congress on DOD’s role in performing humanitarian assistance in peacetime environments.Why GAO Did This StudyIn recent years, the Department of Defense (DOD) has increased its emphasis and spending on humanitarian assistance efforts outside of war and disaster environments. From fiscal years 2005 through 2010, DOD obligated about $383 million on its key humanitarian assistance programs. Because civilian agencies, such as the Department of State and United States Agency for International Development (USAID) also carry out many assistance efforts, DOD’s efforts require close collaboration with these agencies. This report was conducted as part of GAO’s response to a statutory mandate and reviewed (1) DOD’s management of two key humanitarian assistance programs—the humanitarian assistance program funded through its Overseas Humanitarian, Disaster, and Civic Aid (OHDACA) appropriation and its Humanitarian and Civic Assistance program—and (2) the extent to which DOD, State, and USAID have visibility over each others’ efforts. To conduct this review, GAO analyzed funding and program information, and interviewed officials at DOD, State, USAID, nongovernment organizations, and 12 U.S. embassies.
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  • Justice Department Requires Divestiture In Order For Liberty Latin America To Acquire AT&T’s Telecommunications Operations In Puerto Rico And The U.S. Virgin Islands
    In Crime News
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  • Former Labor Union Chief of Staff Convicted of Health Care Fraud
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  • Department of State’s Counternarcotics Performance Management System
    In U.S GAO News
    Our recent reviews of U.S counternarcotics programs in Mexico and Afghanistan highlighted the need to improve the programs' performance measures to track progress. The Department of State (State) received over $1 billion in its fiscal year 2010 appropriation for international counternarcotics assistance programs. The vast majority of this funding--about 90 percent in fiscal year 2010--supports counternarcotics programs in five countries--Mexico, Afghanistan, Colombia, Peru, and Bolivia. State's Bureau of International Narcotics and Law Enforcement Affairs (INL) is primarily responsible for implementing U.S. assistance programs involving eradication of illicit crops, interdiction of drug trafficking, and drug demand reduction, which represented about 85 percent of State's counternarcotics appropriation in fiscal year 2010. INL implements a large share of its funding through contractors, primarily for aviation support for eradication and interdiction efforts. Congress asked us to review State's performance measures for its counternarcotics programs. On March 10, 2011, we briefed congressional staff on our preliminary findings in which we described State's performance management system, including State's standard indicators for measuring the performance of counternarcotics assistance in recipient countries and requirements for posts to develop project-specific performance measures. Following the briefing, in subsequent correspondence with your office, we agreed to provide to you the information presented in the briefing, updated with additional material, that describes (1) how State measures the performance of its international counternarcotics assistance efforts, and (2) the nature of its counternarcotics contracts and whether these contracts are linked to State's performance management system. This report provides a summary of the observations conveyed at this briefing.State measures the performance of its counternarcotics activities based on information provided by the Narcotic Affairs Sections (NAS) at overseas posts on both high-level indicators and project-level indicators. State currently has nine standard indicators for its eradication, interdiction, and drug demand reduction programs, which overseas posts report on, if applicable, to the Office of the Director of U.S. Foreign Assistance in annual Performance Plans and Reports. These reports include targets and results, and form the basis for State's annual reporting of results to the Office of National Drug Control Policy (ONDCP). In addition to these standard indicators, INL requires posts to develop project-specific performance measures and include them in letters of agreement (LOA) with recipient countries. According to State officials, INL is developing new guidelines for monitoring and evaluation, which would require posts to develop a performance management plan that defines each project's performance measures and establishes an approach for periodic monitoring. INL also reports results of its counternarcotics efforts for each country in its annual International Narcotics Control Strategy Report (INCSR), although this report does not necessarily identify performance targets in its country narratives. According to INL officials responsible for contract management, INL generally does not link the performance of individual contracts to its overall program performance assessments, in part because performance measures in contracts relate specifically to fulfillment of contract requirements rather than broad program goals. For example, performance measures in the aviation equipment and support contracts define targets for availability of aircraft and the number of flights to be conducted, not drug interdiction or eradication targets. In addition to aviation equipment and support, which constitute the bulk of contract obligations related to counternarcotics efforts, other INL counternarcotics contract activities include meal services and lodging for counternarcotics personnel, and commodities, such as fuel and vehicles. According to INL officials, State does not have a centralized inventory of counternarcotics contracts. Instead, contract data at State are disaggregated between the Narcotics Affairs Sections at overseas posts and the governmentwide FPDS. An INL official noted that INL has begun the process of developing its own database of counternarcotics contracts. Overseas posts are generally responsible for setting contract requirements and conducting contract oversight of counternarcotics activities.
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  • Opioid Use Disorder: Treatment with Injectable and Implantable Buprenorphine
    In U.S GAO News
    Of the medications used to treat opioid use disorder (OUD), only buprenorphine is both a controlled substance and available as an injection or implant. Buprenorphine is used to treat patients with OUD because it reduces or eliminates opioid withdrawal symptoms and blunts the euphoria or dangerous side effects of other opioids, such as heroin. When used to treat OUD, buprenorphine, in any form, is subject to additional laws and regulations that are overseen by the Drug Enforcement Administration (DEA), within the Department of Justice (DOJ) and the Substance Abuse and Mental Health Services Administration (SAMHSA), within the Department of Health and Human Services (HHS). To ensure patient safety when injectable and implantable buprenorphine is used, the Food and Drug Administration (FDA), within HHS has also required drug companies to establish risk evaluation and mitigation strategies to help ensure the benefits of these medications outweigh their risks. Providers and pharmacies must follow a number of specific steps based on federal requirements when providing treatment with injectable and implantable buprenorphine. Providers are responsible for prescribing, storing, and administering injectable and implantable buprenorphine, while pharmacies are responsible for dispensing these medications (see figure). Representatives GAO interviewed from provider groups and pharmacies said they did not find the steps involved in treating patients to be difficult overall. However, they stated that careful and timely coordination with each other and patients is needed at key steps of the process to ensure that the patient receives treatment. Representatives from provider groups and pharmacies reported that the risk of diversion of injectable and implantable buprenorphine is low. For example, all of the provider groups GAO spoke with said that diversion of injectable or implantable buprenorphine is unlikely, and representatives from three of the six provider groups said that the design of these formulations reduces opportunities for diversion due to how they are administered. Process for Treating Opioid Use Disorder with Injectable and Implantable Buprenorphine The use of injectable and implantable buprenorphine to treat OUD is relatively low compared to oral forms of buprenorphine. HHS has reported that about 7,250 prescriptions were issued for injectable and implantable buprenorphine in fiscal year 2019, compared to over 700,000 patients who received buprenorphine prescriptions for oral formulations to treat OUD or pain in that year. In 2018, SAMHSA estimated that about one-quarter of the estimated 2 million people with OUD had received some form of substance use treatment in the prior year. One form of treatment—medication-assisted treatment (MAT)— combines behavioral therapy with the use of certain medications. HHS has identified expanding access to treatment for OUD as an important strategy for reducing opioid morbidity and mortality, which includes increasing the number of injectable and implantable buprenorphine prescriptions. Congress included a provision in the SUPPORT Act for GAO to review access to and the potential for the diversion of controlled substances administered by injection or implantation. This report focuses on injectable and implantable controlled substances that can be used to treat OUD and specifically, describes the process for treating OUD with injectable and implantable buprenorphine and what is known about their use. GAO reviewed laws, regulations, and documentation from DEA, FDA, and SAMHSA governing the process of providing treatment with buprenorphine and interviewed officials from those agencies. GAO also interviewed representatives from stakeholder groups representing MAT providers; drug companies that manufacture injectable or implantable buprenorphine; and pharmacies that dispense these medications. HHS and DOJ reviewed a draft of this report, and GAO incorporated their technical comments, as appropriate. For more information, contact James Cosgrove at (202) 512-7114 or cosgrovej@gao.gov.
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