The Federal Controlled Substances Act (CSA)
In 1970, the U.S. Congress passed the Controlled Substances Act, organizing federally regulated substances into five schedules. The Drug Enforcement Administration (DEA) enforces the CSA and schedules substances based on their abuse potential, medical use, and dependence risk. Schedule I has the highest abuse potential with no accepted medical use, while Schedule V has the lowest. Schedule III falls in the middle.
Defining What is Considered a Level 3 Drug
A Schedule III controlled substance, or "level 3 drug," is defined by specific CSA criteria. To be classified as Schedule III, a substance must meet the following conditions:
Key Criteria for Schedule III Classification
- Potential for Abuse: Lower than Schedule I and II substances. The abuse risk exists but is less than drugs like heroin or fentanyl.
- Accepted Medical Use: Has a currently accepted medical use in treatment in the United States. These drugs are prescribed for various conditions.
- Dependence Liability: Abuse may lead to moderate or low physical dependence or high psychological dependence. This differs from the severe dependence potential of Schedule I and II drugs.
Prescribing and Dispensing Regulations
Prescription rules for Schedule III substances are less strict than for Schedule II drugs. A prescription is required and can be verbal or electronic. Pharmacies can refill these prescriptions up to five times within six months.
Common Examples of Schedule III Controlled Substances
Schedule III includes various drugs with accepted medical uses and moderate abuse potential. Examples include:
- Products Containing Limited Quantities of Codeine: Such as Tylenol with codeine, used for pain and cough.
- Buprenorphine: Used to treat opioid addiction.
- Ketamine: An anesthetic used for anesthesia and depression. Its abuse potential is linked to its dissociative effects.
- Anabolic Steroids: Related to testosterone, prescribed for conditions like delayed puberty but often abused for performance enhancement, potentially causing high psychological dependence.
- Vicodin (Hydrocodone Products): While previously Schedule III, these were moved to Schedule II in 2014 due to high abuse potential. This shows classifications can change based on new evidence.
Comparison of Controlled Substance Schedules
The table below compares the key features of the controlled substance schedules:
| Feature | Schedule I | Schedule II | Schedule III | Schedule IV | Schedule V |
|---|---|---|---|---|---|
| Accepted Medical Use | No | Yes, but with severe restrictions | Yes | Yes | Yes |
| Abuse Potential | High | High | Moderate to low | Low | Lower than Schedule IV |
| Dependence Risk | Severe physical or psychological | Severe physical or psychological | Moderate to low physical, high psychological | Limited physical or psychological | Limited physical or psychological relative to Schedule IV |
| Examples | Heroin, LSD, Ecstasy | Fentanyl, OxyContin, Adderall | Ketamine, Anabolic Steroids, Tylenol with Codeine | Xanax, Valium, Ambien | Robitussin AC, Lomotil |
Understanding the Implications of Schedule III
Schedule III classification has implications for patients and healthcare providers. Patients need careful management to prevent misuse. Providers face regulatory requirements, including record-keeping and specific prescription protocols. Unauthorized possession or distribution carries substantial legal penalties, though typically less severe than for Schedule I or II substances. Federal trafficking penalties can include fines and imprisonment.
The Evolving Nature of Drug Scheduling
Drug classifications can change with new scientific evidence on medical value and abuse potential. Rescheduling can be initiated by the DEA, HHS, or public petition. An example is the 2023 HHS recommendation to move marijuana to Schedule III. This highlights the dynamic nature of drug policy. For an official list of controlled substances, consult the DEA's website DEA.gov.
Conclusion
To summarize, what is considered a level 3 drug is a Schedule III substance under the CSA. These drugs have accepted medical uses but moderate to low physical dependence and high psychological dependence potential. Examples include anabolic steroids, ketamine, and certain codeine combinations, subject to specific regulations to manage risks. While their abuse potential is less than Schedule I and II drugs, healthcare professionals must monitor their use to ensure safety and prevent misuse.
