Understanding the Classification of Cortisone
Cortisone is a powerful anti-inflammatory medication, but a common source of confusion surrounds its legal status. Some mistakenly associate it with illicit drug use or believe it is heavily regulated like narcotic pain relievers. The key to clarifying this misunderstanding lies in understanding the difference between the medical and chemical families of steroids.
Cortisone belongs to a class of medications called corticosteroids or glucocorticoids. These are potent anti-inflammatory and immunosuppressant drugs used to treat a wide array of conditions, from allergies and asthma to autoimmune disorders like rheumatoid arthritis. They are very different from anabolic steroids, which are synthetic variants of the male hormone testosterone, often abused for muscle growth and performance enhancement. The U.S. Drug Enforcement Administration (DEA) has explicitly stated that corticosteroids are not the same as anabolic steroids and are not classified as controlled substances.
Why Cortisone is Not a Controlled Substance
For a drug to be classified as a controlled substance under the U.S. Controlled Substances Act (CSA), it must possess a potential for abuse or dependency. The DEA, under the Department of Justice, maintains a list of controlled substances and assigns them to a specific schedule (I through V) based on their abuse potential and accepted medical use. Anabolic steroids, due to their potential for abuse, are listed as Schedule III substances. Corticosteroids, including cortisone, do not have a significant potential for abuse and are therefore not on this list.
The Role of the DEA and Prescription Status
While cortisone is not scheduled by the DEA, it is still a powerful medication that requires a prescription in most oral and injectable forms. This is a matter of medical supervision, not controlled substance regulation. The decision to require a prescription is based on the drug's potency and potential for serious side effects if not used correctly, not on its potential for recreational abuse. Some less potent topical corticosteroids, like certain concentrations of hydrocortisone, are available over the counter, further highlighting the low abuse potential.
Distinguishing Cortisone from Anabolic Steroids
To fully appreciate why cortisone isn't controlled, it helps to compare it directly with anabolic steroids. The DEA's regulations specifically make this distinction, noting that controlled anabolic steroids are chemically and pharmacologically related to testosterone, while corticosteroids like cortisone are explicitly excluded from this classification.
| Feature | Cortisone (Glucocorticoid) | Anabolic Steroids (Schedule III) |
|---|---|---|
| Controlled Substance Status | No | Yes |
| DEA Classification | Not scheduled by DEA | Schedule III (C-III) |
| Abuse Potential | Low potential for recreational abuse | Moderate to high potential for recreational abuse |
| Primary Medical Use | Anti-inflammatory, immunosuppressant | Treat low testosterone, wasting diseases |
| Legal Requirement | Prescription only for oral/injectable forms | Prescription only, strictly regulated |
| WADA Status (Athletes) | Prohibited in-competition (systemic use) | Prohibited at all times |
The Special Case of WADA and Sports Regulations
It is important not to confuse a drug's classification under the Controlled Substances Act with its status in athletic competitions. The World Anti-Doping Agency (WADA) has strict rules regarding the use of glucocorticoids, including cortisone.
WADA's regulations for glucocorticoids:
- Prohibited In-Competition: Systemic use via oral, injectable, or rectal routes is prohibited during competition.
- Permitted Out-of-Competition: Use is permitted outside of the competition period.
- Permitted In-Competition (Local): Local applications, such as topical creams, nasal sprays, and inhalations, are generally permitted with some restrictions.
Athletes must be aware of and adhere to these regulations, which are separate from federal laws governing controlled substances. The intent behind WADA's rules is to ensure fair play and prevent performance-enhancing effects, not to classify cortisone as a street drug.
Conclusion: Cortisone is Not Controlled, but Still Regulated
In summary, the answer to the question, "Is cortisone a controlled substance?" is a definitive no. While it is a powerful steroid, it is a corticosteroid, not an anabolic steroid, and lacks the abuse potential required for DEA scheduling. The regulations surrounding cortisone are concerned with its proper medical use and potential for serious side effects, leading to its prescription status in many forms. For athletes, additional rules apply from agencies like WADA, but these are separate from the legal classification of controlled substances. Patients should always use cortisone and other medications as prescribed by a healthcare provider. For further information on the legal definitions and scheduling of controlled substances, a great resource is the U.S. Department of Justice Drug Enforcement Administration website.
