Background Mobile devices, such as smartphones and tablets, use wireless networks to enable voice and data communications. These wireless networks comprise several components. For example, cell sites—a base station equipped with an antenna—receive and transmit radio signals to mobile devices. In addition to traditional “macro cells,” 5G networks also use smaller wireless infrastructure, known as “small cells,” which can be installed on existing structures, including macro towers, buildings, utility poles, or streetlights. Base station controllers manage communications between the cell site and the mobile switching center, or the “core network.” The core network then directs the communication to landline phones, other cell phones, or the internet. Finally, backhaul facilities, such as fiber optic cables or microwaves, transport the communications (See fig. 1.). Cell sites use radio frequency spectrum to receive and transmit radio signals to and from mobile devices. Spectrum is a finite natural resource used to provide a variety of communication services to businesses and consumers, as well as federal, state, and local governments. Businesses and consumers use spectrum for a variety of wireless services including mobile voice and data, Wi-Fi- and Bluetooth-enabled devices, broadcast television, radio, and satellite services. Federal, state, and local governments’ uses of spectrum include national defense, law enforcement communication, air traffic control, weather services, military radar, and first responder communications. The frequency bands have different characteristics that make them more or less suitable for specific purposes. For example, different bands have different limits to the amount of information that they can carry, known as “data capacity,” and different levels of ability to effectively penetrate or bend around physical obstacles and cover distances, known as “propagation.” Regarding wireless communication: Low-band spectrum (generally defined as under 1 gigahertz (GHz)) typically has relatively low data capacity but has propagation characteristics that enable transmission over longer distances and penetration of buildings and other physical barriers better than higher bands. Mid-band spectrum (generally defined as between 1 GHz and 6 GHz) tends to provide greater data capacity than low bands and has better propagation qualities than higher bands. High-band spectrum (generally defined as those above 24 GHz) allows for high data capacity but has relatively limited propagation, to the point that bands at higher frequencies (according to FCC, those above 95 GHz) are most prone to obstruction by natural or manmade objects, such as trees or glass. In the United States, two federal agencies are primarily responsible for managing spectrum. FCC is the federal agency responsible for allocating spectrum for consumer and commercial purposes (as well as state and local government uses), assigning spectrum licenses to those entities, and making spectrum available for use by unlicensed devices. Licensing assigns frequencies of spectrum, in a specific area, and—generally speaking, according to FCC officials—to a specific entity, such as a telecommunications company. NTIA is responsible for establishing policy on regulating federal spectrum use. NTIA assigns frequencies to government agencies, maintains federal spectrum use databases for those assignments, and oversees, in cooperation with other relevant federal agencies, which spectrum bands reserved for federal government use might be made available for commercial use. Approximately every 10 years since around the early 1980s, wireless carriers have deployed a new generation of technology, and each development has changed how people and businesses use mobile communication. These technologies can bring greater speed and capabilities to mobile networks and can provide new revenue streams for carriers and economic gains for national economies. For example, a trade organization representing carriers reported that U.S. leadership in developing and deploying 4G brought in significant economic benefits, adding billions of dollars to the U.S. economy. The carriers we spoke with are currently developing and deploying 5G networks, which will allow for enhanced mobile broadband, offering greater speed and higher data capacity than previous generations of mobile wireless networks. Carriers in the United States are currently deploying 5G as “hybrid” 5G, which uses 5G technologies in combination with existing 4G networks to improve the networks’ speed by enhancing the technology that connects a user device to a core network. In the future, carriers that want to deploy “standalone” 5G will have to replace their existing 4G network infrastructure with new 5G equipment to enhance the core network. The new, standalone 5G networks will allow for additional enhanced capabilities, such as lower “latency,” and will be better able to support other advanced use cases (see fig. 2). Carriers have thus far deployed limited 5G services as hybrid 5G networks in the United States, and are taking different approaches with regard to spectrum use for 5G. For example, some carriers told us that they are relying on low-band spectrum for their 5G network. Other carriers are using high-band spectrum in limited locations. In both cases, customers need to purchase new 5G-capable smartphones to use these hybrid 5G networks. In general, telecommunications networks, including mobile networks, provide important economic and educational opportunities to communities, but different socioeconomic groups and groups in different geographic areas have historically received different levels of access to telecommunications services, leading to a disparity called the “digital divide.” A number of factors explains the digital divide. For example, as we have reported in the past, rural areas tend to have conditions—such as low population density or difficult terrain—that can increase the costs for carriers to deploy and maintain networks. Furthermore, lower-income households may have access to the necessary infrastructure for service but may not be able to afford the service. FCC Lacks Comprehensive Strategic Planning to Guide Spectrum Policy for 5G Deployment Experts Identified Availability of Mid-Band Spectrum as a Key Deployment Challenge Experts we convened told us that the lack of sufficient access to mid- band spectrum is a key challenge to deploying 5G, noting that mid-band spectrum is particularly important for 5G deployment because of its network characteristics and potential to be interoperable with other 5G networks worldwide. Experts stated that the availability of mid-band spectrum to carriers in the United States is not yet sufficient to meet carriers’ needs for 5G network deployment because of existing congestion within the band. Experts stated that carriers will need a mix of low-, mid-, and high-band spectrum when deploying 5G networks because of the network characteristics unique to each spectrum band. For example, one expert noted that mid-band spectrum provides 5G network characteristics that cannot be achieved using solely low- or high-band spectrum. Signals using mid-band spectrum have better propagation (i.e., ability to effectively penetrate or bend around physical obstacles and cover distances) than signals using high-band spectrum (see fig. 3) and carry more data than low-band spectrum. Global harmonization of spectrum, or the use of the same spectrum bands among countries around the world, helps ensure that 5G devices will work across countries. Countries that harmonize spectrum for 5G may benefit by making international travel and communication more convenient. For example, consumers from countries that deploy 5G using the same spectrum bands will have the benefit of roaming across networks. Spectrum harmonization also creates economies of scale that can reduce the costs of manufacturing wireless devices and deploying network equipment. Countries, including the United States, have identified specific frequencies in mid-band spectrum that may be used for 5G. However, experts told us that, as currently allocated, mid-band spectrum is highly congested, leading to an insufficient amount available for carriers to deploy 5G networks in the United States. According to NTIA officials, current mid-band spectrum users—known as “incumbents”—include federal government users that have primary access rights to the spectrum and face challenges in readily transitioning to new or less favorable spectrum bands. For example, agencies’ existing technologies may be designed specifically for their existing spectrum bands. Additionally, according to FCC officials, it is becoming increasingly challenging to relocate federal users out of a spectrum band entirely and into a new band due to a variety of factors, including concerns about potential interference as well as greater spectrum use in recent years. According to experts, large consecutive portions of spectrum will be necessary for commercial users deploying 5G networks. Using smaller or non- consecutive portions of spectrum may limit the capability of the network. FCC Has Taken Actions to Increase Spectrum Availability According to FCC officials, FCC has taken several actions to make additional spectrum available for carriers planning to deploy 5G networks. Some examples of FCC’s actions to make low-, mid-, and high-band spectrum available for 5G deployment include: Low-Band: FCC concluded an auction in 2017 for low-band 600 megahertz (MHz) spectrum licenses, assigning 70 MHz for licensed wireless operations. Such spectrum auctions allow FCC to use competitive bidding to choose from among two or more applications for a spectrum license. Mid-Band: FCC issued a Report and Order in July 2019 that made spectrum licenses within the 2.5 GHz band accessible to nonfederal users. High-Band: FCC held its first auctions for high-band 5G spectrum in the 24 GHz and 28 GHz bands in 2018 and 2019. FCC also began an auction of 3,400 MHz of spectrum in the upper 37, 39 and 47 GHz bands in December 2019; bidding in this auction concluded on March 5, 2020. FCC officials told us that they are aware that mid-band spectrum will be particularly important for 5G deployment despite congestion amongst federal users in this spectrum range. FCC is taking steps to make some additional mid-band spectrum available. For example, in February 2020, FCC announced that it had adopted new rules to auction 280 MHz of mid- band spectrum, which can be used for 5G purposes. This spectrum, (3.7 to 3.98 GHz) is currently being used primarily by satellite operators. In March 2020, FCC released a public notice seeking comment on procedures to be used for the auction of this spectrum, which is currently scheduled to begin on December 8, 2020. As another example, according to FCC, in April 2020 FCC provided for expanded Wi-Fi use in 1,200 MHz of spectrum in the 6 GHz band. Such advanced Wi-Fi networks, FCC told us, will be capable of working hand-in-hand with commercial networks to enable robust 5G device broadband connectivity and may be able to help alleviate commercial wireless network congestion. Other activities, according to FCC, include: (1) opening a proceeding in the 3.1 to 3.55 GHz band to consider potential shared use between federal operations and flexible use commercial services; and (2) authorizing a private entity to deploy a low-power terrestrial nationwide network in certain frequencies that will make available additional spectrum for advanced wireless services, including 5G. FCC and NTIA also developed a spectrum-sharing framework in the 3.5 GHz band that will increase the availability of this mid-band spectrum targeted globally for 5G. This framework separates users into three hierarchical “tiers,” giving differing priority access to the spectrum (3.55 GHz to 3.7 GHz, also known as the “Citizens Broadband Radio Service”) depending on the user’s tier. The first tier includes incumbents, such as federal users (e.g., U.S. Navy radar systems) and a number of commercial users. These users receive first priority and protection from all other users. Tier two users—referred to as “Priority Access Licensees”—are, according to FCC, wireless users that obtain licenses at auction or, following the auction, via secondary markets. These users, which can include wireless carriers, have access to the same mid-band spectrum when a tier one user is not using the spectrum, but FCC officials said these users will need to move to another frequency when a nearby tier one user accesses the same frequency. Third tier users access the band as available. FCC officials stated that this spectrum-sharing framework will allow for increased spectral utilization of mid-band spectrum in a band like 3.5 GHz and that individual users (e.g., the public using mobile devices) will not notice any difference in their network connection. According to FCC officials, the technology supporting this spectrum-sharing framework is now authorized for full commercial deployment. They also said that FCC certified administrators in January 2020 to coordinate this framework, which will allow for full commercial operation, and that FCC has scheduled to begin auctioning licenses for tier two users on July 23, 2020. Other federal agencies are also involved with managing spectrum in the United States. For example, NTIA, which manages federal spectrum use, is working with FCC on the technical design and implementation of the spectrum-sharing framework discussed above. NTIA is also seeking to identify additional spectrum for 5G, in conjunction with FCC. According to FCC, some of the most useful portions of mid-band spectrum are already occupied by a federal incumbent and FCC is limited in its ability to make this spectrum available for commercial use. According to NTIA officials, the agency is focused on meeting the spectrum requirements set forth in the Making Opportunities for Broadband Investment and Limiting Excessive and Needless Obstacles to Wireless Act (MOBILE NOW Act) of 2018, which requires NTIA and FCC to prepare a report by 2022 identifying potential spectrum for future use. For example, NTIA is currently studying the feasibility of spectrum sharing in the 3.45 to 3.55 GHz band. Overall, FCC’s efforts, in conjunction with NTIA, to date have primarily made more high-band spectrum available for 5G purposes. According to the Department of Commerce’s 2019 Annual Report on the Status of Spectrum Repurposing, 84 percent (4,950 MHz out of 5,863 MHz) of the spectrum made available by FCC and NTIA has been within high-band. According to the report, 12 percent (709 MHz of 5,863 MHz) of the spectrum FCC and NTIA have made available has been within mid-band. NTIA officials said there has been more of a focus on repurposing high- band spectrum because there is a far greater amount of this spectrum available for use and fewer incumbent users within this spectrum. Further, NTIA officials stated that these amounts are a snapshot as of the time the 2019 report was issued and the ratios will change, as additional spectrum is made available. Other recent FCC actions, including those described above, may make more mid-band spectrum available in the future. For example, FCC told us that it has a number of active proceedings that could make additional mid-band spectrum available to commercial users. FCC’s Plan to Guide 5G- Related Efforts Is Missing Key Elements of Strategic Planning To guide its 5G-related efforts, including spectrum management, FCC has developed its Facilitate America’s Superiority in 5G Technology Plan (5G FAST Plan). This Plan includes three “key components: (1) pushing more spectrum into the marketplace; (2) updating infrastructure policy; and (3) modernizing outdated regulations.” According to FCC officials, the 5G FAST Plan represents FCC’s strategy for supporting 5G, and these key components are FCC’s broad strategic goals for 5G. However, FCC has not laid out in the 5G FAST Plan how it will implement and assess progress toward the three key components. Our past work on strategic planning has identified related leading practices. These include identifying: (1) specific and measurable performance goals to show progress toward broad strategic goals; (2) the activities (also known as strategies) the agency will take to make progress toward its goals; and (3) related performance measures to assess actual progress made toward the performance goals. Although FCC’s 5G FAST Plan notes actions or strategies FCC has taken regarding managing spectrum for 5G, it does not clearly identify specific and measurable performance goals and related measures for spectrum management related to 5G deployment. For example, the plan notes that FCC’s actions on the 2.5 GHz, 3.5 GHz, and 3.7 - 4.2 GHz bands could make up to 844 MHz available for 5G, but these strategies are not related to any identified performance goals or measures. Without such strategic planning efforts, it is unclear if these actions will be sufficient to address the challenges experts raised about the lack of mid-band spectrum for 5G. Additionally, establishing performance goals and measures would allow FCC to assess its spectrum management strategies and track the progress it is making toward its goals. Further, according to FCC officials, the priorities noted in the 5G FAST Plan were not developed with outside entities, such as NTIA or other relevant stakeholders, including carriers. Leading practices, as identified in our previous work, show that successful organizations base their strategic planning, to a large extent, on the interests and expectations of their stakeholders, which could include other federal agencies, Congress, and others. Thus, involving stakeholders in the strategic planning process helps ensure that the agency’s efforts are targeted at the highest priorities. According to FCC officials, it can be difficult to set goals for specific amounts of spectrum to be made available because of, in part, the fast- changing nature of the telecommunications industry. While we recognize that setting such goals, measures, or strategies may be difficult, our past work on strategic planning has found that there is no more important element in results-oriented management than an agency’s strategic planning effort. This effort is the starting point and foundation for defining what the agency seeks to accomplish, identifying the strategies it will use to achieve desired results and then determining how well it succeeds in reaching results-oriented goals and achieving objectives. Proactively developing performance goals, strategies and measures— with the involvement of relevant stakeholders—to manage spectrum demands associated with 5G deployment would help ensure that sufficient amounts of spectrum in consecutive portions are made available to avoid delaying the deployment and limiting the capabilities of 5G networks. Additionally, by incorporating these key elements into its strategic planning for 5G, FCC would be able to assess its progress in managing spectrum, particularly the congested mid-band spectrum that is important to 5G deployment. FCC Lacks Comprehensive Strategic Planning to Mitigate the Likelihood of 5G to Widen the Digital Divide Experts Warned That 5G Deployment Would Likely Widen the Digital Divide Experts we convened told us that 5G deployment, especially high-band 5G networks, will likely widen the existing digital divide, particularly between urban and rural areas, as well as within urban areas. Experts and stakeholders told us that 5G using high-band spectrum is likely to be first deployed in areas already equipped with much of the necessary infrastructure (i.e., fiber and power). Experts said these areas are generally more urban, densely populated, high-income areas as opposed to rural or low-income areas. Stakeholders told us that rural areas will see 5G deployed mostly on lower frequencies, on which signals can propagate further but which cannot carry the same bandwidth (i.e., data throughput) as higher frequencies can. Within urban settings, experts said that high-band 5G networks are more likely to be deployed in commercially viable areas, including those parts of a city that already are equipped with fiber and power and, presumably, already benefit from the most advanced mobile broadband services available. For example, an expert representing the wireless industry stated that only about 10 percent of the District of Columbia would receive 5G services using high- band spectrum, as it would be cost-prohibitive for the carriers to install 5G using this spectrum beyond that 10 percent of the city. Experts told us that individuals without access to 5G networks will not be able to take advantage of the use cases that 5G promises, including the high-speed connections offered by enhanced mobile broadband. Experts stated that this situation will greatly affect, among other things, the economic and educational opportunities that 5G promises to make possible. We have previously reported on the digital divide, or the varying levels of access to technologies such as internet and wireless services among different socioeconomic groups, as well as groups in different geographic areas. For example, as we have reported in the past, rural areas tend to have conditions—such as low population density or difficult terrain—that can increase the costs for carriers to deploy and maintain networks in those areas. Furthermore, lower-income households may be located in areas with access to the necessary infrastructure for certain services but may not be able to afford them. The challenge for some households to afford the most advanced mobile communications services would become worse if carriers charge more for 5G services. An Expert’s Perspective on the Digital Divide “Employers who want to ensure that their workforce has access to 5G, or their factory floor has access to 5G, won't locate in communities that don't have those services, thereby exacerbating the existing digital divide.” FCC Has Efforts to Close the Digital Divide but Has Not Developed Specific and Measurable Performance Goals and Related Strategies and Measures FCC has taken steps to address digital divide issues, with some of these efforts potentially affecting the digital divide as it relates to 5G deployment. For example, according to FCC officials, FCC issued a recent order approving a merger between two mobile carriers that included certain service requirements to increase 5G access nationwide. FCC told us that the merged company will face significant financial penalties if it fails to meet these requirements. Additionally, FCC has established financial support that may be used for 5G-related efforts. The Universal Service Fund provides financial support to carriers through different programs, each targeting a particular group of telecommunications carriers or consumers. For example, one of these programs, the High Cost Program, provides support in rural or remote areas where the customer base is relatively small and the cost of installing infrastructure is high. According to FCC officials, the support provided by the Universal Service Fund can evolve over time to address emerging technologies, including 5G. For example, the officials stated that in response to recent hurricanes in the Caribbean, the Universal Service Fund is currently being used to support deployment of fiber and power in parts of Puerto Rico and the U.S. Virgin Islands, which will help support future deployment of 5G in those areas. Further, in December 2019, the FCC Chairman announced his intention to establish the “5G Fund,” which would make up to $9 billion in Universal Service Fund support available to carriers to deploy 5G services in rural areas of the United States. In April 2020, FCC issued a Notice of Proposed Rulemaking and Order seeking comments on the framework for the 5G Fund and on approaches to identifying eligible areas for support. Although FCC’s actions could help address the digital divide, its existing planning documents for 5G do not include key elements that would allow FCC to understand the effects of these efforts as they relate to 5G deployment. Neither FCC’s strategic plan for 2018 through 2022 nor its 5G FAST Plan include specific performance goals—or related strategies and measures—that would allow FCC to assess the effectiveness of its efforts to close the digital divide associated with 5G deployment. For example, FCC’s strategic plan for 2018 through 2022 includes a strategic goal and performance goals to close the digital divide, but the performance goals are not specific or measurable. Further, neither the strategic plan nor the 5G FAST Plan include specific performance measures regarding the effects of 5G on the digital divide. Moreover, while FCC’s strategic plan states that a strategy to help close the digital divide is that it will set rules to encourage and facilitate the development of 5G networks, the strategy is not associated with specific performance goals or measures regarding the effects of 5G on the digital divide. Additionally, the 5G FAST Plan identifies a number of current and future strategies for FCC but does not include specific performance goals or measures that would allow it to understand what those strategies are intended to achieve and the effects those strategies are having on the digital divide as 5G networks are deployed. These omissions are contrary to leading practices of results-oriented organizations identified in previous GAO work. These leading practices call for performance goals and related strategies and measures, as we previously described. Such leading practices, as previously noted, include identifying: (1) specific and measurable performance goals to show progress toward broad strategic goals; (2) the activities (also known as strategies) the agency will take to make progress toward its goals; and (3) related performance measures to assess the results of the strategies and actual progress made toward the performance goals. FCC officials said that they are focusing on reducing the digital divide and have set high-level goals, but have not established goals specific to 5G. However, by establishing specific and measurable performance goals for 5G with related strategies and measures, FCC will have greater assurance that it has properly planned actions to effectively address the likely adverse effects on the digital divide as 5G networks are deployed. For example, specific goals for 5G will help FCC assess the effectiveness of its recent decision to make $9 billion in Universal Service Fund support available to carriers to deploy 5G services. The High Cost of 5G Infrastructure May Affect 5G Deployment Experts Identified Economic Issues as a Key Challenge Experts told us that deploying 5G infrastructure will be very costly for carriers. According to international standards established for 5G networks, to support all the new capabilities of 5G, carriers will need to replace their 4G core networks with new 5G equipment. These standalone 5G networks will provide new capabilities such as ultra- reliable low latency communications that could enable the development of new, more advanced use cases. In the meantime, carriers are currently deploying hybrid 5G, which uses existing 4G network infrastructure, but they still must make some upgrades to their 4G equipment and in some instances, deploy additional cell sites, such as small cells, to provide hybrid 5G service. These small cells can be installed on existing structures, such as buildings or streetlights. See figure 4 for examples of small cells. Some carriers are deploying 5G using low-band spectrum, which is much less costly to deploy because carriers can use their existing 4G cell towers. However, low-band spectrum does not enable the same data speeds as other types of 5G. As discussed previously, the United States has made a large amount of high-band spectrum available for 5G. The use of such spectrum increases the cost of 5G infrastructure deployment because it requires more small cell installations. Experts suggested that, because of the increased costs, carriers may limit deployment of high- band 5G network equipment to high-density areas such as sections of cities or stadiums. Moreover, a recent Defense Innovation Board report referenced a preliminary study that indicated that carriers would have to install approximately 13 million base stations, at a cost of approximately $400 billion, to deliver 5G service using this high-band spectrum to 72 percent of the population. In addition to installing the actual cell site equipment, each small cell site has costs associated with it: Fiber: Experts told us that fiber deployment is critical to the success of 5G. They noted that getting enough fiber in place to support the large increase in small cells will require a massive infrastructure deployment. For example, experts stated that currently there is not enough fiber in the ground in most places to support 5G. The fiber network must also have the capacity to handle the increased traffic from 5G. Experts told us that the new fiber needed for 5G will be costly to install, both in urban and rural areas. For example, installing fiber in urban areas can be costly due to local rules and difficulty accessing the right-of-way. In rural areas, fiber deployment costs are high because carriers must install fiber over longer distances to reach customers. Power: In addition to fiber, new cell sites also require a power source. While some small cells are being installed on light poles that have an existing power source, an expert noted that sometimes these are only powered on at night. Another expert noted that carriers may need to install back-up power sources, in case of a power outage. Permitting: When installing a new cell site, carriers generally must seek approval from the federal, state, or local government that controls the right-of-way or property where the cell site is to be located. This may require carriers to pay permitting fees or meet certain aesthetic requirements. Experts told us that the fact that different cities have different permitting regimes drives up the cost to build infrastructure. For example, experts told us that making sure small cells meet different localities’ requirements for design, dimension, and other aesthetic requirements is difficult for carriers and could slow deployment. However, other experts noted that these local permitting processes enable local governments to ensure 5G is being deployed in such a way that would benefit their citizens. For example, according to a report by the National League of Cities, San Jose, California created a tiered pricing structure to encourage carriers to cover more of the city. The city plans to use some of the revenues from this permitting process to help close the digital divide in the city, for example by allowing people to check out devices at libraries. Experts’ Perspectives on Permitting Costs “There are several thousand municipalities in the United States, each of which has different paperwork, processes, and payment mechanisms for siting small cells, which increases 5G deployment cost and time and inhibits the rollout of the networks.” “5G deployment requires many more small cells than 4G required macro cells, thereby increasing the reliance on public right-of-ways. As a result, we have seen cities restricted from charging market rates for permitting. However, cities play a really crucial role in ensuring that the deployment of these technologies and the use of public right-of-ways is coupled with public interest obligations.” Carriers’ current financial condition will also affect how they deploy 5G, including where and what type of networks they deploy. Experts noted that carriers in the United States may not currently have the capital required to fund large-scale deployments of 5G due, in part, to the costs of recent business decisions. Additionally, an expert mentioned that carriers would likely only be able to afford to deploy high-band spectrum in small sections of cities. Another expert predicted that carriers may not replace existing 4G equipment until it becomes less reliable over time, leading to a more comprehensive roll-out of 5G in 6 to 8 years. A representative from a carrier said that while it did not anticipate any additional revenue from 5G deployment, carriers still must deploy 5G because to not do so would place their companies at extreme risk of losing large numbers of customers, potentially eroding their revenue base. Experts’ Perspectives on Economic Challenges to 5G Deployment “Most of the major carriers in the United States aren't in great financial shape. They've leveraged up and have made acquisitions into new spaces. …The challenge for these carriers is do they have the billions of dollars required for another large-scale capital program, or do they just sort of put it out there because it’s good PR.” “Right now, from an economic standpoint, there isn't a strong case for making this enormous investment in 5G and it feels like it's more of a defensive play by carriers.” Experts also noted that consumers are not always willing to pay more for 5G service, which reduces carriers’ ability to recoup their deployment investments. For example, one expert questioned whether consumers in the United States were willing to pay anything more for 5G, and another noted that carriers are currently charging the same price for 5G and 4G service. Additionally, experts told us that there is no clear use case currently developed for 5G in the United States, besides enhanced mobile broadband. The 5G use cases often cited, such as remote surgery or autonomous vehicles, are unlikely to be developed in the near future. Without such use cases, they said, carriers lack a strong business case for deploying 5G. Other experts noted, however, that 4G use cases— such as social media or ride sharing apps—did not exist when carriers started to deploy 4G, but were developed after 4G was in place. Similarly, experts predicted that 5G use cases would be developed after 5G networks were available in the United States. FCC and Others Have Taken Some Steps to Reduce Deployment Costs To help reduce the cost of deploying 5G infrastructure, FCC has taken steps to expedite the permitting and review of small cells. For example, FCC issued a Programmatic Agreement for the Collocation of Wireless Antennas, which reduces the regulatory approval process for collocating small cells that are on existing infrastructure, such as utility poles. In addition, FCC adopted an order and declaratory ruling regarding state and local government reviews of small cell applications, which set parameters for fees and time frames for these reviews. This Order went into effect in January of 2019; however, it is currently being challenged in federal court. FCC also adopted an order that, among other things, exempted the construction of small cells from compliance with federal historic preservation and environmental review that were applied to large macro towers. A recent federal court decision, overturned the exemption and the FCC repealed the section of the order. In addition to the steps FCC has taken to limit regulatory and permitting costs, experts suggested that carriers could consider sharing their network infrastructure to reduce their capital expenditure for deploying 5G. Through infrastructure sharing agreements, two or more carriers share infrastructure such as radio antennas or fiber to deliver service to users. This sharing reduces deployment costs for carriers and allows them to deploy in areas where the costs would normally be prohibitive, such as rural areas. Such sharing agreements can increase choices for consumers, as more carriers can afford to operate in areas they would not normally be able to. FCC officials said that industry is already moving toward greater shared infrastructure and FCC’s efforts are designed to promote it. However, such sharing agreements may have the potential to decrease competition, if not well monitored. In addition, a carrier may not be willing to share infrastructure with other carriers for fear of losing its competitive advantage. For example, according to a report by the Body of European Regulators, a carrier that is the only one offering service in a certain area could lose competitive advantage and not be rewarded for its investments in the area under a sharing agreement. Infrastructure sharing is common in other countries; the same report by the Body of European Regulators found that carriers in 14 European countries had active sharing agreements with joint deployment in place. For example, in Spain, some carriers share their mobile networks in areas with fewer than 175,000 inhabitants. According to the report, 5G will further incentivize network sharing, as carriers need to deploy more small cells and fiber. Experts told us, however, that such sharing agreements were uncommon in the United States. Instead, carriers typically install their own network infrastructure, leading to overlapping networks and higher overall deployment costs. FCC officials said they recognize the benefits of infrastructure sharing, especially for 5G, but said that the decision about whether to share infrastructure is ultimately up to each carrier. Officials noted that carriers will use their own economic and engineering analysis in determining how to deploy 5G. Conclusions 5G networks could create significant economic benefits for the United States, as companies develop products and technologies to access 5G’s new capabilities. Carriers currently face challenges to deploying 5G, however, which could delay or even limit the United States’ opportunity to realize those benefits. FCC has taken a number of actions regarding 5G deployment, but it has not clearly developed specific and measurable performance goals and related measures–with the involvement of relevant stakeholders, including NTIA–to manage the spectrum demands associated with 5G deployment. This makes FCC unable to demonstrate whether the progress being made in freeing up spectrum is achieving any specific goals, particularly as it relates to congested mid-band spectrum. Additionally, without having established specific and measurable performance goals with related strategies and measures for mitigating 5G’s potential effects on the digital divide, FCC will not be able to assess the extent to which its actions are addressing the digital divide or what actions would best help all Americans obtain access to wireless networks. Recommendations for Executive Action We are making the following two recommendations to FCC: The Chairman of FCC should develop, in coordination with NTIA and other relevant stakeholders, specific and measurable performance goals—with related strategies and measures—to manage spectrum demands associated with 5G deployment. (Recommendation 1) The Chairman of FCC should develop specific and measurable performance goals—with related strategies and measures—to determine the effects 5G deployment and any mitigating actions may have on the digital divide. (Recommendation 2) Agency Comments and Our Evaluation We provided a draft of this report to FCC and NTIA for review and comment. FCC provided written comments, which we have reprinted in appendix II. FCC and NTIA also provided technical comments, which we incorporated as appropriate throughout our report. In its written comments, FCC neither agreed nor disagreed with our recommendations. FCC described the challenges associated with developing performance goals for managing the spectrum demands associated with 5G deployment. Specifically, FCC stated that such goals could limit the options available to manage spectrum demands. Instead, FCC stated that it adopts specific and measurable performance goals— with related strategies and measures—during ongoing rulemakings, which allow FCC to establish engineering, economic, or other technical outcomes. We acknowledge in our report that setting specific and measurable performance goals, strategies, and measures can be challenging, but continue to believe such strategic planning would benefit FCC’s spectrum management efforts. We did not identify what specific and measurable performance goals, strategies, and measures FCC should develop because FCC is in the best position to make such determinations. However, as we describe in our report, FCC still has not engaged in this strategic planning effort. Our past work has found that there is no more important element in results-oriented management than an agency’s strategic planning effort. That effort should be the starting point and foundation for FCC to define what it seeks to accomplish, identify the strategies it will use to achieve desired results, and then determine how well it succeeds in reaching results-oriented goals and achieving objectives. Related to our recommendation for FCC to develop specific and measurable performance goals to determine the effects 5G deployment and any mitigating actions may have on the digital divide, FCC noted that it is taking regulatory actions and providing funds designed to reduce the digital divide. FCC further said that it remains committed to promoting robust 5G deployment nationwide and, consistent with our recommendation, will continue to explore new ways to evaluate how it may impact efforts to close the digital divide. As agreed with your offices, unless you publicly announce the contents of this report earlier, we plan no further distribution until 15 days from the report date. At that time, we will send copies to the appropriate congressional committees, the Chairman of the FCC, the Secretary of the Department of Commerce, and other interested parties. In addition, the report will be available at no charge on the GAO website at https://www.gao.gov. If you or your staff have any questions about this report, please contact me at (202) 512-2834 or Vonaha@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff who made key contributions to this report are listed in appendix III. Appendix I: Objectives, Scope, and Methodology This report examines the challenges, and the federal government’s efforts, related to 5G deployment with regard to: (1) managing spectrum; (2) closing the digital divide; and (3) addressing economic issues. These were the top three challenges to 5G deployment identified by the 17 experts we convened. To identify challenges to 5G deployment, we issued a brief questionnaire to 146 GAO-identified stakeholders with knowledge of 5G networks. These stakeholders included officials from the federal government, as well as representatives from academia, industry, and consumer groups. Stakeholders were identified by reviewing previous GAO reports and through background research and were selected to provide a range of perspectives on 5G deployment. We asked these stakeholders to identify challenges to deploying 5G networks in the U.S. and received 23 responses. We conducted a content analysis to categorize the responses into a final set of 13 challenges. See table 1 for a list of the challenges. Because content analysis relies on the judgment of coders to determine whether qualitative data reflects particular categories, we took several steps to ensure that this judgment remained objective, accurate, and consistent. These steps included using independent coders from two different mission teams within GAO to ensure consistent judgment of categories. The independent coders were in general agreement on the challenges categories. On the basis of this high level of agreement between coders, as well as a review by a third independent analyst, we are confident that our content analysis represents an objective, accurate, and consistent assignment of these coding categories. We then convened a meeting of 17 experts to discuss the above challenges to 5G deployment. Our meeting of experts was held at the National Academies of Sciences, Engineering, and Medicine (NASEM) in October 2019 over one-and-a-half days. Staff from NASEM assisted us in identifying experts for the meeting. To identify the experts appropriate for this meeting, NASEM relied on staff experience and professional judgment drawn from its Computer Science and Telecommunications Board. We selected the final panel of experts in consultation with NASEM staff with the goal of ensuring that a broad range of views was represented from multiple 5G-related areas, such as those of wireless carriers, academia, and consumer and industry groups. See table 2 for a list of the experts that participated in the meeting. The meeting was moderated by GAO staff who guided the experts through questions about each challenge to 5G deployment. The experts also discussed potential actions the federal government could take to address those challenges and were asked to identify the most significant challenges to 5G deployment. This meeting of experts was planned and convened with the assistance of NASEM to better ensure that a breadth of expertise was brought to bear in its preparation; however, all final decisions regarding meeting substance and expert participation are the responsibility of GAO. Any conclusions and recommendations in GAO reports are solely those of the GAO. The meeting was recorded and transcribed to ensure that we accurately captured the experts’ statements, and we reviewed and analyzed the transcripts as a source of evidence. We edited experts’ quotations from the transcripts for clarity and conciseness to include in this report. In addition to the experts we spoke to on the panel, we also interviewed 16 stakeholders—as well as officials from the Federal Communications Commission (FCC), the National Telecommunications and Information Administration (NTIA), and the National Institute of Standards and Technology—to further understand the challenges to 5G deployment. We selected these stakeholders based on our prior telecommunications work, other 5G literature, and recommendations from stakeholders we interviewed to provide a range of perspectives on 5G deployment. Stakeholders were from two universities, four industry associations, five wireless carriers, as well as five local governments and organizations. To identify these local governments, we selected a group of cities to include those where wireless carriers have announced they will launch 5G services, and selected a mix of cities where there was local opposition to 5G, as well as cities with state or local laws regarding small cell permitting. We then selected lower-population density cities in the same states as those cities, using U.S. Census data. To select these cities, we identified the county with the median population density of the state, and then selected the city which holds the county seat. We attempted to contact all the selected cities and were able to schedule and hold interviews with representatives from Los Angeles, California; Jacksonville, Florida; Greenville, Illinois; and Naples, Florida. The information we obtained from these interviews is not meant to be generalizable to other cities’ experiences, but is meant to provide illustrative examples of actual 5G deployment. See table 3 for a complete list of stakeholders we interviewed. Finally, to assess the federal government’s actions to address challenges to 5G deployment, we reviewed relevant statutes and literature, along with reports and documents from FCC and the Department of Commerce. For example, we reviewed FCC reports and orders related to 5G networks, the Department of Commerce’s Spectrum Repurposing Report, along with planning reports such as FCC’s Facilitate America’s Superiority in 5G Technology Plan (5G FAST Plan) and FCC’s and the Department of Commerce’s strategic plans. In addition, we interviewed FCC and NTIA officials about their efforts to address 5G deployment challenges. We compared FCC efforts to address 5G deployment challenges to its own strategic goals and relevant leading practices for performance management identified in our prior body of work. We conducted this performance audit from February 2019 to June 2020 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. Appendix II: Comments from the Federal Communications Commission Appendix III: GAO Contact and Staff Acknowledgments GAO Contact Andrew Von Ah, (202) 512-2834 or vonaha@gao.gov. Staff Acknowledgments In addition to the contact named above, Keith Cunningham (Assistant Director); Daniel Paepke (Analyst in Charge); Oluwaseun Ajayi; Carol Bray; Vijay D’Souza; Wayne Emilien; Jonathan Felbinger; Richard Hung; Catrin Jones; Michael Krafve; Kaelin Kuhn; Hannah Laufe; Dan Luo; Neelaxi Lakhmani; Brian Mazanec; Jamilah Moon; Cheryl Peterson; Erika Prochaska; Malika Rice; Oliver Richard; Pamela Snedden; Andrew Stavisky; Hai Tran; Christopher Turner; Tatyana Walker; and Michelle Weathers made key contributions to this report.


Background More than a dozen federal agencies—known as National Drug Control Program agencies—have responsibilities for drug prevention, treatment, and law enforcement activities. For example, the Department of Health and Human Services (HHS) has led efforts to expand access to drug treatment, and the Departments of Justice (DOJ) and Homeland Security (DHS) have taken lead roles in limiting the availability of illicit drugs through criminal investigations and prosecutions. The Anti-Drug Abuse Act of 1988 established ONDCP to enhance national drug control planning and coordination. In this role, the office is 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 Programs and the budget for those programs, and (4) evaluating the effectiveness of national drug control policy efforts. Until its 2018 reauthorization, ONDCP had been operating under the provisions of the ONDCP Reauthorization Act of 2006 pursuant to annual appropriations acts. In October 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the SUPPORT Act) was enacted and reauthorized ONDCP and a number of its programs. The SUPPORT Act aims to address overprescribing and opioid misuse in the United States and includes provisions involving law enforcement, public health, and healthcare financing and coverage. Under both the ONDCP Reauthorization Act of 2006 and the SUPPORT Act, 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. Prior to the SUPPORT Act, the Director was required to promulgate a National Drug Control Strategy on an annual basis, while under the SUPPORT Act, generally, the National Drug Control Strategy is required to be developed every two years. ONDCP did not issue a National Drug Control Strategy for 2017 or 2018 despite the statutory requirement. Under both the ONDCP Reauthorization Act of 2006 and the SUPPORT Act, 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. Preliminary Observations on the 2019 National Drug Control Strategy As part of our ongoing work, we are reviewing the 2019 National Drug Control Strategy that ONDCP issued on January 31, 2019. Agency officials told us that they began preparing the National Drug Control Strategy in early 2018—prior to the enactment of the SUPPORT Act in October 2018. Officials stated that the National Drug Control Strategy was intended to respond to the requirements of the ONDCP Reauthorization Act of 2006, which was the applicable law at that time. In light of ONDCP’s stated approach, we based our preliminary analysis of the National Drug Control Strategy on the ONDCP Reauthorization Act of 2006. However, the SUPPORT Act retained certain similar requirements for the National Drug Control Strategy contained in the prior law. According to ONDCP, the 2019 National Drug Control Strategy provides a high-level vision of federal drug control efforts by focusing on prevention, treatment and recovery, and reducing the availability of illicit drugs. The 2019 National Drug Control Strategy designates one overarching strategic objective—to reduce the number of lives lost to drug addiction— and provides some general descriptions of federal agencies’ activities. However, our preliminary observations related to the 2019 National Drug Control Strategy indicate that it does not include several pieces of required information, including the following: Quantifiable and measurable objectives. The National Drug Control Strategy was required to include “annual quantifiable and measurable objectives and specific targets to accomplish long-term quantifiable goals that the Director determines may be achieved during each year beginning on the date on which the National Drug Control Strategy is submitted.” However, our work showed that the 2019 National Drug Control Strategy does not include this information. While it lists seven items that it designates as measures of performance or effectiveness, it does not indicate how they would be quantified or measured, or targets to be achieved each year. For example, one of the measures of performance relates to educating the public, especially adolescents, about drug use. However, it lacks information on how ONDCP would measure its efforts to educate adolescents, as well as targets ONDCP hopes to achieve, such as the number of adolescents educated or specific knowledge gains. Further, none of the seven 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. For example, one of the Strategy’s measures of effectiveness is that evidence-based addiction treatment, particularly medication-assisted treatment for opioid addiction, is more accessible nationwide for those who need it. However, there is no information on the current level of treatment access, any targets for expanding access, or any associated timeline by which ONDCP hopes to achieve desired results. Program and budget priorities. The National Drug Control Strategy was required to include “a 5-year projection for program and budget priorities.” While the 2019 National Drug Control Strategy outlines several high-level priorities, including a top priority to address the current opioid crisis and its associated deaths, it does not include such a 5-year projection. Specific assessments. The National Drug Control Strategy was required to include specific assessments related to illicit drug use. For example, the National Drug Control Strategy was required to include “an assessment of the reduction of illicit drug availability.” This assessment was to be measured by, among other things, the quantities of cocaine, heroin, marijuana, methamphetamine, ecstasy, and other drugs available for consumption in the United States; the amount of marijuana, cocaine, heroin, methamphetamine, ecstasy, and precursor chemicals and other drugs entering the United States; and the number of illicit manufacturing laboratories seized and destroyed as well as the number of hectares of marijuana, poppy, and coca cultivated and destroyed domestically and in other countries. The 2019 National Drug Control Strategy does not include this information. In addition, the National Drug Control Strategy was required to include “an assessment of the reduction of the consequences of illicit drug use and availability.” This assessment was to include the burden illicit drug users placed on hospital emergency departments; the annual national health care cost of illicit drug use; and the extent of illicit drug-related crime and criminal activity. Similarly, the 2019 National Drug Control Strategy does not include this information. Performance measurement system. The ONDCP Director was required to submit “as part of the National Drug Control Strategy a description of a national drug control performance measurement system.” Among other things, this system was to describe the sources of information and data that would be used for each performance measure incorporated into the performance measurement system. This system was also to coordinate the development and implementation of national drug control data collection and reporting systems to support policy formulation and performance measurement. Further, the system was to monitor consistency across the drug-related goals and objectives of the National Drug Control Program agencies and ensure that each agency’s goals and budgets support are fully consistent with the National Drug Control Strategy. The 2019 National Drug Control Strategy does not contain a description of such a national drug control performance measurement system. As part of our ongoing work, we also asked ONDCP for information regarding how ONDCP officials determined the adequacy of National Drug Control Program agencies’ budget submissions without a National Drug Control Strategy in effect for 2017 and 2018. The National Drug Control Program Budget is to provide information on federal drug control funding requested by the executive branch to implement the National Drug Control Strategy. National Drug Control Program agencies are required to submit to ONDCP the portion of their annual budget requests dedicated to drug control activity undertaken by the department, agency, or program. Agencies are to prepare these as part of their overall budget submission to the Office of Management and Budget for inclusion in the President’s annual budget request. ONDCP is required to review and certify whether these budgets are sufficient to support the relevant goals and objectives outlined in the National Drug Control Strategy and then include these budgets in the consolidated National Drug Control Program Budget, which the President issues alongside his budget each year. As of March 4, 2019, ONDCP had not provided information on how it accomplished the required determination. In addition, as of March 4, 2019, the President’s FY 2020 budget, and the accompanying National Drug Control Program Budget, had not been released. We will continue to consider ONDCP’s activities in this area as part of our ongoing work. As part of our ongoing work, we will also discuss the 2019 National Drug Control Strategy with ONDCP and plan to examine how ONDCP intends to address additional requirements in the SUPPORT Act. The lack of information in the 2019 National Drug Control Strategy on assessing progress toward its objective to reduce lives lost reflects findings in our previous reports. Our prior work in general, and our work on federal drug control efforts in particular, has consistently emphasized the importance of setting clear priorities through measurable and quantifiable goals, and assessing progress toward those goals over time, in order to achieve results. For example: In March 2018, we reported on federal agencies’ efforts—including those of ONDCP—to limit the availability of and enhance their response to illicit opioids, such as heroin and fentanyl. We reviewed five strategies related to combating illicit opioids and determined that only one included outcome-oriented performance measures that aim to assess the effectiveness of its efforts—ONDCP’s Heroin Availability Reduction Plan (HARP). In contrast, we found that ONDCP’s High Intensity Drug Trafficking Areas (HIDTA) programs’ Heroin Response Strategy did not include any outcome-oriented performance measures. Outcome measures address the results of programs and services, such as reductions in overdose deaths, and they can help in assessing the status of program operations, identifying areas that need improvement, and ensuring accountability for results. Among other things, we recommended in March 2018 that ONDCP coordinate with the HIDTAs to establish outcome-oriented performance measures to assess progress towards the goals set out in the Heroin Response Strategy. While ONDCP neither agreed nor disagreed with our recommendation, ONDCP told us in June 2018 that they had engaged with leaders from the HIDTAs participating in the Heroin Response Strategy to develop performance measures, including some outcome performance measures. As of March 4, 2019, this recommendation has not yet been addressed and ONDCP has not provided additional information on these efforts. We continue to believe that establishing these measures would enhance the HIDTAs’ ability to assess whether these efforts are producing intended results. In October 2017, we reported on HHS’s efforts to reduce the prevalence of opioid misuse and the fatalities associated with it by expanding access to medication-assisted treatment (MAT) for opioid use disorder. These efforts included four grant programs that focus on expanding access to MAT in various settings (including rural primary care practices and health centers) and implementing regulatory and statutory changes that expanded treatment capacity by increasing patient limits for a MAT medication—buprenorphine—and by expanding the types of practitioners who can prescribe it in an office-based setting. We found that HHS had not established performance measures with targets that would specify the results that HHS hoped to achieve through its efforts, and by when. We concluded that without this information, 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. Among other things, we recommended that HHS establish performance measures with targets related to expanding access to MAT for opioid use disorders. 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, in part because HHS did not provide information on measures related to the treatment capacity of providers who prescribe or administer MAT medications, which HHS had identified as another way to measure access. We continue to believe that fully implementing this recommendation will help ensure that invested resources in the program are yielding intended 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 make other management decisions. Although agencies may struggle to effectively use this approach, regular performance reviews and evidence- based policy tools can help them incorporate performance information into federal decision-making. Without effective long-term plans, such as a national strategy, that clearly articulate goals and objectives and without specific measures to track performance, federal agencies cannot fully assess whether taxpayer dollars are invested in ways that will achieve desired outcomes. 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. We are continuing with ongoing and planned work to monitor and assess federal drug control efforts. 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. GAO Contact and Staff Acknowledgments If you or your staff has any questions concerning this testimony, please contact Triana McNeil at (202) 512-8777 (McNeilT@gao.gov) or Mary Denigan-Macauley at (202) 512-7114 (DeniganMacauleyM@gao.gov). Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this statement. In addition to the contacts named above, Joy Booth (Assistant Director), Will Simerl (Assistant Director), Michelle Loutoo Wilson (Analyst in Charge), Billy Commons, Helen Desaulniers, Wendy Dye, Jane Eyre, Kaitlin Farquharson, and Jan Montgomery made key contributions to the testimony. Other staff who made key contributions to the reports cited in the testimony are identified in the source products. Related GAO Products Drug Control: DOD Should Improve Its Oversight of the National Guard Counterdrug Program. GAO-19-27. Washington, D.C.: January 17, 2019. Colombia: U.S. Counternarcotics Assistance Achieved Some Positive Results but State Needs to Review the Overall U.S. Approach. GAO-19-106. Washington, D.C.: December 12, 2018. 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. Substance Use Disorder: Information on Recovery Housing Prevalence, Selected States’ Oversight, and Funding. GAO-18-315. Washington, D.C.: March 22, 2018. Substance-Affected Infants: Additional Guidance Would Help States Better Implement Protections for Children. GAO-18-196. Washington, D.C.: January 19, 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. Counternarcotics: Overview of U.S. Efforts in the Western Hemisphere. GAO-18-10. Washington, D.C.: October 13, 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. Opioid Addiction: Laws, Regulations and Other Factors Can Affect Medication-Assisted Treatment Access. GAO-16-833. Washington, D.C.: September 27, 2016. Anti-Money Laundering: U.S. Efforts to Combat Narcotics-Related Money Laundering in the Western Hemisphere. GAO-17-684. Washington, D.C.: August 22, 2017. International Mail Security: Costs and Benefits of Using Electronic Data to Screen Mail Need to Be Assessed. GAO-17-606. Washington, D.C.: August 2, 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. Drug-Free Communities Support Program: Agencies Have Strengthened Collaboration but Could Enhance Grantee Compliance and Performance Monitoring. GAO-17-120. Washington, D.C.: February 7, 2017. Highlights of a Forum: Preventing Illicit Drug Use. GAO-17-146SP. Washington, D.C.: November 14, 2016. Drug Enforcement Administration: Additional Actions Needed to Address Prior GAO Recommendations. GAO-16-737T. Washington, D.C.: June 22, 2016. State Marijuana Legalization: DOJ Should Document Its Approach to Monitoring the Effects of Legalization. GAO-16-419T. Washington, D.C.: April 5, 2016. Firearms Trafficking: U.S. Efforts to Combat Firearms Trafficking to Mexico Have Improved, but Some Collaboration Challenges Remain. GAO-16-223. Washington, D.C.: January 11, 2016. Prenatal Drug Use and Newborn Health: Federal Efforts Need Better Planning and Coordination. GAO-15-203. Washington, D.C.: February 10, 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. Prescription Pain Reliever Abuse: Agencies Have Begun Coordinating Education Efforts, but Need to Assess Effectiveness. GAO-12-115. Washington, D.C.: December 22, 2011. This is a w ork of the U.S. government and is not subject to copyright protection in the United States. The published product may be reproduced and distributed in its entirety w ithout further permission from GAO. How ever, because this w ork may contain copyrighted images or other material, permission from the copyright holder may be necessary if you w ish to reproduce this material separately.