The use of medications and recreational drugs is governed by a strict legal framework. In the United States, the Controlled Substances Act (CSA) of 1970 is the primary legislation. It regulates the manufacture, possession, and distribution of substances with potential for abuse or dependence. The DEA enforces this act and classifies substances into five schedules, determining their level of control.
The Controlled Substances Act (CSA) and its purpose
The CSA provides the legal framework for federal drug policy, considering a drug's potential for abuse, its accepted medical use, and the risk of dependence. It aims to balance the medical benefits of some drugs with the risks of improper use. This scheduling system allows the government to apply varying degrees of regulation.
The five schedules of controlled substances
The five drug schedules range from I to V, with Schedule I having the highest potential for abuse and dependence, and Schedule V the lowest.
Schedule I: High abuse potential, no accepted medical use
These substances have high abuse potential and no accepted medical use in the U.S.. Their use is only permitted under specific federal research protocols. Examples include heroin, LSD, Ecstasy, and marijuana.
Schedule II: High abuse potential with accepted medical use
Drugs in this category have high abuse potential and can lead to severe dependence. They have an accepted medical use, but with severe restrictions. Prescriptions are highly regulated and cannot be refilled. Examples include opioids like fentanyl and oxycodone, and stimulants like Adderall and Ritalin. Cocaine is also included for its medical use as a local anesthetic.
Schedule III: Moderate dependence potential
These substances have a lower abuse potential than Schedule I or II drugs, with potential for moderate physical or high psychological dependence. They have an accepted medical use. Prescriptions can be refilled up to five times in six months. Examples include anabolic steroids, ketamine, and codeine products with less than 90mg per dosage unit.
Schedule IV: Low dependence potential
These drugs have a low abuse potential relative to Schedule III and an accepted medical use. Abuse may lead to limited dependence. Prescribing rules are less strict than for Schedule II and III. Examples include benzodiazepines like Xanax and Valium, sleep aids like Ambien, and pain relievers like tramadol.
Schedule V: Lowest dependence potential
These substances have the lowest abuse potential among controlled drugs and an accepted medical use. They have limited risk of dependence relative to Schedule IV. They often contain small amounts of narcotics. Examples include cough preparations with low codeine content (like Robitussin AC), antidiarrheals like Lomotil, and pregabalin.
Controlled vs. non-controlled medications
Most common prescription drugs for conditions like high blood pressure are non-controlled. The key difference is the potential for abuse and dependence, which subjects controlled substances to stricter government oversight. While all prescription drugs require a doctor's order, only controlled substances are under the DEA's special regulations. Non-controlled drugs are regulated by the FDA for safety and efficacy.
How are controlled substances regulated?
Regulation involves more than just classification. The DEA requires registration for anyone handling controlled substances, including pharmacists and doctors.
Additional regulations include:
- Security requirements: Strict measures to prevent theft, varying by schedule.
- Prescription rules: Specific information required, with limits on refills, especially for Schedule II drugs which have no refills.
- Record-keeping: Accurate inventory and dispensing records are mandatory.
- State vs. Federal laws: States have their own controlled substance laws, often similar to federal schedules but with potential variations.
Comparison of drug schedules
| Feature | Schedule I | Schedule II | Schedule III | Schedule IV | Schedule V |
|---|---|---|---|---|---|
| Abuse Potential | High | High | Moderate to Low | Low | Lowest |
| Accepted Medical Use | None | Yes, with severe restrictions | Yes | Yes | Yes |
| Dependence Risk | Severe physical/psychological | Severe physical/psychological | Moderate physical or high psychological | Limited physical/psychological | Limited physical/psychological relative to Schedule IV |
| Refill Limitations | Not applicable | No refills allowed | Max 5 refills in 6 months | Max 5 refills in 6 months | Max 5 refills in 6 months, or as permitted by state law |
Conclusion
What are considered controlled drugs is defined by the Controlled Substances Act's five-tier scheduling system. The DEA uses this system to classify substances based on abuse potential, medical utility, and dependence risk. These classifications determine the regulations for each substance, covering everything from prescribing to storage. This system is crucial for managing the risks of potentially harmful substances while ensuring access to necessary medical treatments.
For more detailed information, consult the DEA Diversion Control Division website.
