Bureau of Prisons: Improved Planning Would Help BOP Evaluate and Manage Its Portfolio of Drug Education and Treatment Programs
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
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
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.
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 | 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) |
We found that the Bureau of Prisons (BOP) could better define key planning elements, including determining the number of personnel needed, to expand its Medication-Assisted Treatment (MAT) program. As a result, we recommended that BOP develop and document the agency's methods for determining the number of additional agency personnel it reports needing to support its MAT program expansion. In July 2022, BOP developed a plan to manage its MAT program that included a description of how it determined the number of personnel needed to support its MAT program. In March 2023, BOP updated this plan with more detail. Notably, BOP provided the specific number of MAT personnel within its Psychology Services Division, by discipline needed to support the MAT program both at the facility level and at central office (i.e., psychologists, clinicians, and psychology managers). BOP also provided the total number of personnel needed to support the MAT program within its Health Services Division. In September 2023, BOP officials clarified that they determined each of its facilities would require three full-time healthcare employees to effectively operate a 7-day a week MAT program with additional program oversight positions at the regional and central office levels (i.e., a registered nurse or social worker for screening, an advanced practice provider or physician for clinical evaluation and prescribing, and a pharmacist to lead a team to coordinate the medication administration and delivery process). In addition, in November 2023, BOP officials told us that some institutions would require and be able to fill a fourth healthcare position and the agency had requested additional positions for this purpose. The information BOP provided to support its determination for the number of necessary MAT personnel is consistent with our recommendation.
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| Bureau of Prisons | 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) |
We found that the Bureau of Prisons (BOP) could better define key planning elements, including recruitment and onboarding personnel, to expand its Medication-Assisted Treatment (MAT) program by documenting them. As a result, we recommended that BOP document its plans to recruit and onboard additional personnel for expanding and implementing the MAT program. In July 2022, BOP developed a recruitment plan that includes strategies to staff its MAT program, such as using recruitment incentives and expediting the process of converting interns to full-time staff. To help with onboarding personnel, in April 2021, BOP made a training course on MAT mandatory for all BOP staff. The recruitment plan and training materials for onboarding staff are consistent with our recommendation.
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| Bureau of Prisons | 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) |
We found that the Bureau of Prisons (BOP) could better define key planning elements, including developing and documenting time frames and target goals for key milestones, to expand its Medication-Assisted Treatment (MAT) program. As a result, we recommended that BOP develop and document time frames and target goals for key milestones-including a completion date-for the MAT program expansion. In February 2022, BOP developed a MAT program expansion plan that included time frames and target goals for milestones, such as developing a policy. In July 2022, BOP documented in its recruitment plan the target date for completing its MAT program expansion-by the end of calendar year 2022. The MAT expansion and recruitment plans are consistent with our recommendation.
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| Bureau of Prisons | 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) |
We found that the Bureau of Prisons (BOP) could better understand whether its drug treatment programs are effective by evaluating them. As a result, we recommended that BOP 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. In July 2021, BOP updated its program evaluation plan to include MAT. It also reprioritized the time frames for evaluating other programs. Further, in September 2021, BOP contracted with an external entity to evaluate its drug treatment programs and the statement of work for that contract has target completion time frames for conducting these evaluations. The updated program evaluation plan and statement of work are consistent with our recommendation.
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| Bureau of Prisons | The Director of BOP should implement the revised program evaluation plan based on available funding and staffing levels for conducting them. (Recommendation 5) |
BOP concurred with this recommendation and in July 2021 revised the program evaluation plan based on available funding and staffing levels. Further, in September 2021, BOP contracted with an external entity to evaluate its drug treatment programs and noted that it expected the external entity to complete its initial analyses in October 2022. In March 2023, BOP provided us with the contractor's first quarterly progress report for the period ending in December 2022. The report indicated that both descriptive and evaluative analyses - as well as a report on these findings- were to be completed by March 2023, but BOP did not provide evidence of the deliverables. In March 2024, BOP provided us with a preliminary report containing descriptive data and two additional quarterly progress reports from the contractor for the periods ending in June 2023 and September 2023. In July 2024, BOP told us that the external entity is conducting focus groups with program participants and BOP employees in fiscal year 2024 and collecting outcome data in fiscal year 2024 and fiscal year 2025. In July 2024, BOP told us they expect the external entity to complete the evaluation in September 2026. Given that the duration of this evaluation has taken longer than anticipated, and that its completion is critical to BOP's implementation of its evaluation plan, we will continue to monitor the status of this contract and keep this recommendation open until findings are issued.
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| Bureau of Prisons | 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) |
We found that the Bureau of Prison (BOP) could more effectively manage its portfolio of drug education and treatment programs though better planning. As a result, we recommended that BOP develop and document a plan for managing its portfolio of drug education and treatment programs, including its Medication-Assisted Treatment (MAT) program. This plan was to identify specific activities and resources necessary to achieve desired results. In March 2023, BOP developed a Drug Education and Treatment Program Management plan that defined goals for each drug education and treatment program, along with specific activities and resources to achieve those goals. The management plan is consistent with our recommendation.
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| Bureau of Prisons | The Director of BOP should implement BOP's plan for managing its portfolio of drug education and treatment programs. (Recommendation 7) |
We found that the Bureau of Prisons (BOP) could more effectively manage its drug education and treatment programs. As a result, we recommended that BOP implement its plan for managing its portfolio of drug education and treatment programs. In March 2023, BOP developed a Drug Education and Treatment Program Management plan that defined goals for each drug education and treatment program, along with specific activities and resources to achieve those goals. In March 2024, BOP provided monitoring reports showing participation data in drug education and treatment programs. In July 2024, BOP provided information on how it is monitoring the goals defined in its management plan. In addition, BOP told us that although they have not received additional funding for its drug education, nonresidential drug treatment program (NRDAP) and residential drug treatment program (RDAP), BOP assesses available resources and moves them accordingly. For example, BOP officials told us that if they notice a facility that has few individuals awaiting RDAP, but many awaiting NRDAP, officials readjust targets to allow for more participants in NRDAP and fewer in RDAP. These implementation steps are consistent with our recommendation.
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