Why This Matters Psychedelics can change a person’s perceptions and sense of self, which has promising medical applications. While more research is needed, including on adverse effects, psychedelics may reduce depression and other conditions. Key Takeaways Hundreds of clinical trials have examined psychedelics, including for treating PTSD and depression. Researchers struggle to distinguish genuine effects of psychedelics from the placebo effect. The medical use of psychedelics also raises questions for policymakers about how to balance potential benefits with research limitations and patient safety. The Science What are psychedelics? Psychedelics are hallucinogenic drugs that can temporarily alter a person’s mood and perceptions. Like a class of drugs known as selective serotonin reuptake inhibitors (SSRI), which are often prescribed for mental health care, psychedelics affect serotonin levels (see fig. 1). At certain doses, psychedelics may be used for medical purposes. For example, MDMA (also called ecstasy), LSD, and psilocybin (a hallucinogen found in some mushrooms) have been examined as potential treatments for PTSD and depression. What is known? Psychedelics work primarily by changing how a person’s brain processes serotonin. This may cause vivid visions, or feelings of insightfulness or connection. Between 2015 and early 2025, over 340 trials on psychedelics began or were completed, according to ClinicalTrials.gov. For example, one study found that psilocybin reduced depression symptoms more than escitalopram, an SSRI. While most psychedelics have no federally approved medical uses, several U.S. government agencies have supported such research. For example, in December 2024, the Department of Veterans Affairs planned research to combine MDMA and psychotherapy to treat veterans with PTSD. Several states have also considered or passed legislation allowing medical use of psychedelics. Psychedelics may have non-life-threatening side effects, such as headaches or vomiting. In some cases, the use of these drugs can lead to safety risks due to impairment, or illicit psychedelics may be contaminated with dangerous substances such as fentanyl. While some research suggests that the use of psychedelics does not typically lead to physical addiction, the adverse effects of these drugs have not been fully studied. Figure 1: The Science Behind Psilocybin (Psychedelic Mushrooms) and MDMA What are the knowledge gaps? There is still much to learn about the potential benefits and adverse effects of psychedelics, including how they may be influenced by preexisting conditions or used in combination with psychotherapy. The effects of psychedelics can be difficult to predict and may depend on factors such as the dosage and unique biology of the person receiving the treatment. Moreover, data are limited since many of these clinical trials have been conducted on small groups of participants. In blind clinical trials, participants are typically randomly selected to receive either a treatment or a placebo without being told which. This allows researchers to more easily differentiate between the effects of a given treatment and any placebo effect, in which participants who receive a placebo still report a benefit because they expect that the treatment will help. Because of the distinct effects of psychedelics on recipients, it is difficult to prevent trial participants from knowing whether they received the treatment. This may complicate efforts to design such trials and interpret their findings. Clinical trials have tried to work around this by using an active placebo, such as a low dose of a psychedelic. Alternatively, researchers might compare the treatment with a more typical one, such as an SSRI. Opportunities Mental health. Research has shown that psychedelics, such as psilocybin and MDMA, decrease fear and anxiety, with the potential to positively affect behavior in combination with therapy. For example, a clinical trial with patients with treatment-resistant PTSD demonstrated that combining MDMA and psychotherapy was effective, well-tolerated, and had no major adverse effects years later. Pain management. Psychedelics appear to show promise for patients with certain headache disorders and cancer pain. According to a few studies, drugs such as LSD and psilocybin appeared to alter pain perception by activating serotonin receptors and reducing inflammation. Challenges Accessibility. LSD, MDMA, and psilocybin remain illegal at the federal level, categorized as Schedule I substances, which have no federally approved medical uses. To conduct research on these drugs, scientists need to follow several steps. These include obtaining permission from the U.S. Drug Enforcement Administration, finding clinical grade drugs to test, and identifying appropriate spaces in which to test and store these drugs. Federal approval. Difficulties associated with conducting large, blind trials of psychedelics have limited researchers’ ability to determine the safety and effectiveness of these drugs, which is required for them to gain approval from the Food and Drug Administration (FDA). FDA approval is generally required before prescription drugs can be marketed for sale in the U.S. Policy Context And Questions How could research be structured to help policymakers better understand any potential benefits and adverse effects of the medical use of psychedelics? How could research on medical use of psychedelics be conducted to better reflect requirements for FDA approval? What steps could policymakers take to weigh the potential benefits and risks of psychedelics, considering policy implications, resource demands, and patient needs? Selected References National Institute on Drug Abuse. “Psychedelic and Dissociative Drugs.” Accessed January 21, 2025. https://nida.nih.gov/research-topics/psychedelic-dissociative-drugs A. Wem et al., “A Systematic Review of Study Design and Placebo Controls in Psychedelic Research,” Psychedelic Medicine, vol. 2, no. 1 (March 2024). For more information, contact Karen L. Howard, PhD at (202) 512-6888 or howardk@gao.gov.

Increased Capabilities, Future Plans GAO has delivered reliable, nonpartisan information on science and technology for decades. Beginning in 2019, we rapidly expanded our science and technology expertise. We now provide comprehensive products and services to meet almost any congressional S&T need. Our work includes: To meet congressional S&T needs, we have created a strong foundation that we use to produce our products and services. This includes: Staff expertise. The staffing of our science and technology team increased from 49 in 2019 to a projected 175 in 2025. These staff collectively hold more than 100 advanced degrees, including 41 PhDs, with expertise in areas such as microbiology, materials chemistry, and aerospace engineering. We have also expanded staffing in several other GAO teams, including our information technology and cybersecurity team. Congressional outreach: To ensure all congressional staff can access our expertise, we stay in routine touch with relevant committees and all Interested staff, including 20 committees with an interest in S&T. A new initiative is a program in which GAO senior officials serve as "ambassadors" to individual Members who are neither committee nor subcommittee chairs or ranking members. In addition, we recently launched an ongoing series of expert presentations at the Longworth House Office Building, which were attended by staff from 12 committees and 59 Member offices. The Innovation Lab. With a staff of 15, our Innovation Lab develops new data science tools. It also provides hands-on expertise for our reporting on artificial intelligence (AI) and other emerging technologies. Its products include a range of use cases for AI within GAO and an AI Accountability Framework for the federal government. The Vital Importance of Science and Technology Congress has a substantial interest in science and technology, which powers the U.S. economy and touches every part of the federal government. To take one prominent example, artificial intelligence could transform virtually all sectors of American life, as well as introduce both efficiencies and risks at federal agencies. Similarly, gene editing could lead to new cures, as well as complicate the work of agencies overseeing health care. Congress needs reliable and timely information to understand and respond to the implications of such emerging technologies for society and for the federal government’s finances. For more information, contact Sterling Thomas at (202) 379-4595 or ThomasS2@gao.gov.

What GAO Found Better management of the federal government's real property portfolio is needed to effectively dispose of underused buildings, collect reliable real property data, enhance the security of federal facilities, and improve the condition and configuration of federal buildings. These management challenges have led GAO to include Managing Federal Real Property on GAO's High-Risk List since 2003. Underused buildings. Federal agencies have long struggled with underused space, which costs millions of dollars. Enacted in January 2025, the Utilizing Space Efficiently and Improving Technologies Act requires agencies to measure building utilization and plan to dispose of underused space. This Act, combined with effective implementation, would address GAO's 2023 recommendation on the need for governmentwide guidance on measuring space utilization. Data reliability. Without reliable data, it is difficult to support effective real property management and decision-making. The General Services Administration has worked with federal agencies to improve its Federal Real Property Profile database but has not yet fully corrected property location data. The Department of Defense improved its real property data as well, but further efforts are needed, including better coordination with military services to fill key vacant real property positions. Facility security. The Department of Homeland Security has taken steps to improve facility security, but more progress is needed. Contract guards did not detect prohibited items being brought into federal facilities in about half of GAO's 27 covert tests in 2024. This is a rate comparable to the Federal Protective Service's (FPS) own covert testing results. In addition, FPS has not yet fully deployed the Post Tracking System. Under development since 2013, the system was supposed to verify that all guards are qualified but faces technical and data reliability problems. Building condition. This year GAO added “Building Condition” to the existing real property high-risk area. The federal government's annual maintenance and operating costs for its 277,000 buildings were about $10.3 billion in fiscal year 2023. Further, federal agencies have deferred maintenance and repairs on many buildings, creating a backlog. GAO found that these needs had more than doubled, from $170 billion to $370 billion between fiscal year 2017 and 2024. In addition, agency officials told GAO that headquarters buildings are poorly configured and need renovations to meet present-day workforce requirements. Why GAO Did This Study The federal government's real property holdings are vast and diverse, costing billions annually to occupy, operate, and maintain. GAO added federal real property to its High-Risk List in 2003 for several reasons. These reasons include that the government retained more real property than it needed, did not have reliable property data to support decision making, and struggled to secure federal buildings. This statement discusses key actions taken by Congress and the executive branch since the High-Risk update in 2023 and actions needed to address four federal real property issues: (1) underused buildings, (2) data reliability, (3) facility security, and (4) building condition. This statement is based on GAO's prior work and reflects GAO's 2025 High-Risk update, released in February 2025.

What GAO Found The Coast Guard has nearly 40,000 shore infrastructure assets that include boat stations, piers, and buildings from which it carries out operations. In its internal annual 2023 report on its shore infrastructure, the Coast Guard rated the overall condition of its shore infrastructure as “mediocre to fair” and found that nearly half of these assets were operating beyond their expected service life, as shown in figure 1. Information on Coast Guard Shore Infrastructure as of Fiscal Year 2023 The Coast Guard faces a growing backlog of shore infrastructure projects that will cost at least $7 billion to address as of June 2024, according to Coast Guard data. Years of deferred maintenance have contributed to the backlog’s growth, according to Coast Guard officials. However, the President’s budget requests for the Coast Guard’s shore infrastructure from FY 2019 to FY 2025 have not included funding levels that the Coast Guard has identified would meet its targets. As we have previously reported, the gaps between budget requests and funding targets for shore infrastructure have persisted for years. In 2019, GAO made six recommendations to help the Coast Guard better manage its shore infrastructure by improving its condition assessments and its budget-related data reporting, among other things. As of February 2025, the Coast Guard has fully addressed two of those recommendations and taken steps toward addressing three of them. For example, in response to GAO’s previous recommendations, the Coast Guard is in the process of systematically assessing the condition of its shore infrastructure. However, it has not yet fully implemented tools and analyses, such as models to predict investment outcomes, analyze trade-offs, and make resource decisions, that could help reduce the costs of maintaining its shore infrastructure. One recommendation remains unaddressed—that the Coast Guard include supporting details about competing project alternatives and report trade-offs in congressional budget requests and related reports. Coast Guard officials said they are considering publishing annual reports that provide key information about the Coast Guard’s shore infrastructure assets as a step towards addressing this recommendation. Fully addressing all six of GAO’s 2019 recommendations could help the Coast Guard more efficiently manage existing resources, including to reduce costs and position the Coast Guard and Congress with better information to address shore infrastructure challenges. Why GAO Did This Study The Coast Guard’s mission is to protect and defend over 100,000 miles of U.S. coastline and inland waterways. The scope of shore infrastructure extends beyond piers and lighthouses. It includes housing units, training centers, and command centers that direct Coast Guard missions. The Coast Guard faces multiple backlogs of shore infrastructure projects that have more than doubled in amount since GAO’s 2019 report. GAO was asked to review issues related to Coast Guard shore infrastructure. This testimony summarizes our February 2025 report entitled Coast Guard Shore Infrastructure: More Than $7 Billion Reportedly Needed to Address Deteriorating Assets and focuses on three areas: (1) the condition of Coast Guard shore infrastructure, (2) reported project backlogs, and (3) budget transparency to address Coast Guard funding targets. To inform our report we reviewed Coast Guard documentation, analyzed data, and interviewed agency officials. More detailed information on the scope and methodology of our work can be found in our February 2025 report. For more information, contact Heather MacLeod at (202) 512-8777 or macleodh@gao.gov.

What GAO Found The Coast Guard has nearly 40,000 shore infrastructure assets that include boat stations, piers, and buildings from which it carries out operations. Other support infrastructure includes utility systems, training facilities, and housing units as shown below. Together, the value of these assets is $24.5 billion, according to Coast Guard data. Example of Coast Guard Shore Infrastructure (Housing for Coast Guard Personnel in Kodiak, AK) The Coast Guard faces a growing backlog of shore infrastructure projects that will cost at least $7 billion to address as of June 2024, according to Coast Guard data. However, the President’s budget requests from fiscal year 2019 to fiscal year 2025 for the Coast Guard’s shore infrastructure have not included funding levels that the Coast Guard has identified would meet its targets. According to the Coast Guard, the funding targets to sustain shore infrastructure varied from approximately $439 million in fiscal year 2019 to $709 million in fiscal year 2025. Actual funding levels varied from approximately $255 million in fiscal year 2019 to $415 million in fiscal year 2024. In 2019, GAO made six recommendations to help the Coast Guard better manage its shore infrastructure. As of February 2025, the Coast Guard has fully addressed two of those recommendations and taken steps toward addressing three of them. For example, as a result of GAO’s recommendations, the Coast Guard is in the process of systematically assessing the condition of its shore infrastructure. However, it has not yet fully implemented tools and analyses—such as models to predict investment outcomes, analyze trade-offs, and make resource decisions—that could help reduce the costs of maintaining its shore infrastructure. One recommendation remains unaddressed—that the Coast Guard should include supporting details about competing project alternatives and report trade-offs in congressional budget requests and related reports. Coast Guard officials said they are considering publishing annual reports that provide key information about shore infrastructure assets as a step towards addressing this recommendation. Fully addressing all six of GAO’s 2019 recommendations could help the Coast Guard more efficiently manage existing resources, including reducing costs and positioning the Coast Guard and Congress with better information to address shore infrastructure challenges. Why GAO Did This Study In 2019, GAO reported that about 45 percent of the Coast Guard's shore infrastructure was beyond its agency-expected service life and that the Coast Guard faced infrastructure project backlogs of at least $2.6 billion. GAO was asked to review issues related to Coast Guard shore infrastructure. This report provides information on the extent to which the Coast Guard addressed GAO’s 2019 recommendations related to managing the condition of its shore infrastructure. GAO also examined the nature and condition of Coast Guard shore infrastructure and its project backlogs as of June 2024. To conduct this work, GAO analyzed Coast Guard documentation on its overall management of shore infrastructure and its processes as of fiscal year 2024 for assessing the condition of facilities. GAO analyzed Department of Homeland Security budget data for fiscal years 2019 through 2025, including Coast Guard shore infrastructure funding targets. GAO also interviewed Coast Guard officials. For more information, contact Heather MacLeod at (202) 512-8777 or macleodh@gao.gov.

What GAO Found A shutdown of the national airspace in 2023 due to the outage of an aging air traffic control (ATC) system prompted the Federal Aviation Administration (FAA) to conduct an operational risk assessment to evaluate the sustainability of all ATC systems. Of the 138 systems, 51 (37 percent) were deemed unsustainable by FAA and 54 (39 percent) were potentially unsustainable. Many unsustainable and potentially unsustainable systems have critical operational impacts on the safety and efficiency of the national airspace. In September 2024, GAO found several weaknesses in how FAA manages investments to modernize these systems. FAA's progress has also been slow, taking years to establish cost, schedule, and performance baselines for investments that GAO selected for its review. As of May 2024, completion dates for planned investments for systems that GAO deemed especially concerning were at least 6 to 10 years away. Four such systems did not have associated investments. Air Traffic Control (ATC) System Sustainability and Operational Impact Ratings A November 2023 GAO report found that since 2018, FAA had made mixed progress on its multi-decade effort to modernize air traffic management (i.e., the Next Generation Air Transportation System (NextGen)). Across four critical program areas GAO assessed (e.g., navigation and communications), FAA met some milestones for deploying systems but missed others, some by several years. The COVID-19 pandemic, which delayed system testing and other activities, contributed to those missed milestones. GAO found that closer adherence to five of nine program management leading practices, such as those related to life-cycle cost estimates and risk mitigation strategies, could better position FAA to manage the program and realize safety and efficiency benefits. GAO's 2023 and 2024 reports made recommendations to FAA to help address shortcomings in the agency's management of NextGen and ATC system investments. For example, weaknesses exist in FAA's risk mitigation approach. GAO recommended FAA develop a risk mitigation plan for NextGen and report to Congress on its risk mitigation efforts for all unsustainable and critical systems. Doing so would help FAA systematically examine risk mitigation options and increase transparency. FAA has fully addressed two GAO recommendations: conducting root cause analysis on programs that exceed baselines and managing investments in segments. However, critical risk mitigation recommendations and others remain open. Why GAO Did This Study FAA is responsible for the safety and efficiency of more than 45,000 flights daily. Critical to that effort are numerous ATC systems that enable air traffic controllers to monitor weather, conduct navigation and surveillance, manage communications, and more. However, ATC systems have been aging, and GAO has long reported that FAA has faced challenges upgrading those systems and implementing its multi-billion-dollar modernization of air traffic management, referred to as NextGen. Addressing these challenges is particularly important given that FAA expects to manage an increasingly congested and complex airspace in the future. This testimony discusses (1) the sustainability of FAA's air traffic control systems, and FAA's efforts to manage and oversee system modernization; (2) FAA's efforts to implement NextGen; and (3) actions needed for improvement. It draws primarily from GAO's September 2024 report on unsustainable ATC systems and November 2023 report on NextGen.

What GAO Found The Department of Defense (DOD) is implementing a new approach to satellite communications (SATCOM) that aims to integrate existing and planned DOD systems, as well as a range of commercial options, into a department-wide SATCOM enterprise. Traditionally, the SATCOM systems that the department depends upon to send and receive information over long distances have relied on a small number of high-cost satellites along with ground stations and user terminals that each connect to a single type of satellite. The failure of one part of these systems would disrupt transmissions. With DOD's new approach, satellite constellations, ground systems, and user terminals would operate as networked, integrated systems. Compared to the traditionally linear structure of independent SATCOM systems, these integrated architectures would allow multiple paths for communications to reach their destination and multiple points of access to add resilience. DOD plans to implement elements of the new approach within the next 5 years. Shift from Linear Satellite Communications Systems to Integrated Architectures To accomplish this shift, DOD is increasing coordination among SATCOM stakeholders and with commercial SATCOM providers. Implementing enterprise SATCOM also depends on DOD enacting two key components: automating resource allocation and implementing integrated architectures. To support these components, DOD is also expanding its use of commercial SATCOM capabilities. Both components of this shift face challenges. First, while DOD has begun automating SATCOM resource allocation, obtaining the different forms of access and permissions to enable data sharing is a challenge, according to officials. Second, DOD is acquiring necessary SATCOM systems, such as user terminals that connect to multiple satellite systems or constellations. However, the historically slow speed of system acquisitions poses a challenge to fielding these systems in time to support DOD's plans. While DOD is making initial progress toward enterprise SATCOM, the harder part of this shift—developing and integrating hybrid SATCOM systems and networks—lies ahead. GAO found that while DOD tracks progress on the components of enterprise SATCOM, it lacks comprehensive reporting on progress toward these outcomes. Such reporting would help DOD identify and mitigate delays as early as possible, as well as inform Congress of progress. Why GAO Did This Study GAO has reported for over a decade on the longstanding challenges DOD faces in acquiring and delivering SATCOM systems, including cost and schedule overruns. In 2020, the Chief of Space Operations declared that SATCOM had to evolve from disparate systems into a single enterprise to operate in contested environments, be more resilient, and address evolving threats. DOD is now starting to shift its approach to SATCOM acquisition to provide more secure, interoperable systems that aim to better leverage the $500 billion global space market. But, as GAO found in 2024, DOD averages 10 years to acquire and deliver new systems (GAO-24-106831). A Senate report includes a provision for GAO to review DOD's SATCOM planning efforts. GAO's report addresses (1) DOD's coordination and acquisition of SATCOM, including any plans to use commercial SATCOM; and (2) the extent to which DOD is ensuring SATCOM acquisitions can deliver interoperable capabilities. GAO reviewed and analyzed DOD's operational needs, plans, and other relevant documentation. GAO also interviewed cognizant officials from across the Office of the Secretary of Defense, military departments, and the commercial SATCOM industry.

What GAO Found In order for the Department of Defense (DOD) to optimize its use of real property, it seeks to periodically review its inventory to identify unneeded or underused facilities. In support of this effort, DOD provided guidance to its components to ensure consistency of utilization measurement and reporting across the department. However, GAO found that the military services have not fully followed this guidance and are reporting inconsistent and inaccurate real property data. For example, the Air Force uses a standard methodology to calculate utilization rates for each facility, but the Navy and Marine Corps report average utilization rates across a set of similar facilities. Without taking actions to hold the military services accountable for following its utilization guidance, DOD will continue to lack a clear picture of the department's portfolio of real property. Vacant Historic Building Required to Be Maintained at Ft. Bliss, Texas The military services have taken steps to improve efficiency in managing space utilization within DOD real property. For example, the Army is piloting a tool to improve visibility of space utilization in properties measured by square footage. However, the services continue to face challenges in optimizing space given the need to support unexpected requirements and maintain temporary facilities. For example, some installations are using relocatable structures, such as trailers, to fulfill immediate needs until permanent facility space is identified. Other installations are maintaining older buildings at increased costs because replacement or demolition funds are insufficient, or because the buildings are historic and are required to be preserved. The services have not assessed and managed the risks associated with their management of real property because they have not issued guidance addressing these areas. If the services were to issue such guidance, they could better meet requirements for quality facilities, complete the demolition of old and unneeded facilities in a timely manner, and avoid costly partial renovations that do not adequately meet mission needs. Why GAO Did This Study DOD manages one of the largest real property portfolios within the federal government. This includes over 700,000 facilities with a replacement value of about $2.2 trillion, as of fiscal year 2023. DOD has faced long-standing challenges in optimizing its use of this property. GAO continues to monitor DOD's efforts in improving the reliability of government-wide real property information as part of the Managing Federal Real Property high-risk area. The cost to build and maintain real property represents a significant financial commitment. Senate Report 117-39, accompanying a bill for the National Defense Authorization Act for Fiscal Year 2022, includes a provision for GAO to review DOD's approach to reducing excess real property, including facility disposal. This report examines the extent to which the military services (1) consistently and accurately report the use of their facilities, and (2) face challenges in managing and, when appropriate, disposing of facilities at selected installations. GAO reviewed guidance and documents, analyzed real property data, evaluated information from a non-generalizable sample of 19 installations that we based on the data of excess, surplus, and low utilization rates, and visited eight of these installations. GAO also interviewed relevant officials.