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What is the Controlled Substances Act?

SingleCare Logo for author page By | December 21, 2017

According to the DEA website, The Controlled Substances Act (CSA) places all substances that are regulated (in some manner) under existing federal law, into one of five schedules.  “This schedule placement is based on the substance’s medical use, potential for abuse, and safety or dependence liability. Its goal is to prevent drug misuse, abuse and death from a drug overdose.”  

Overview

The Controlled Substances Act (CSA) is a federal, U.S. drug policy, under which the manufacture, importation, possession, use, and distribution of certain substances is regulated.

What kinds of drugs are included in the CSA?

Some prescription medications, as well as illegal drugs, are part of the CSA. Prescription drugs that have a high likelihood of misuse are included for this purpose. The drugs are classified into five schedules based upon their abuse potential, medical applications, and safety. According to the DEA website, they are classified in the following ways:

Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. You may be surprised at some of the drugs included in this schedule. Some examples of Schedule I drugs are heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote.

Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of Schedule II drugs are combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin.

Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples of Schedule III drugs are products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone.

Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence. Some examples of Schedule IV drugs are Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol.

Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are usually used for antidiarrheal, antitussive, and analgesic purposes. Some examples of Schedule V drugs include cough-preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin.

When was the Controlled Substances Act Passed?

The CSA was signed into law by President Richard Nixon on October 27, 1970. The Controlled Substances Act was passed by the 91st United States Congress, as Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970.

Who decides which drugs are included in the Controlled Substances Act?

According to the Drug Enforcement Agency (DEA) website, “The DEA implements the CSA and may prosecute violators of these laws at both the domestic and international level. Within the CSA there are five schedules (I-V) that are used to classify drugs based upon their abuse potential, medical applications, and safety. Individuals who order, handle, store, and distribute controlled substances must be registered with the DEA to perform these functions. They must maintain accurate inventories, records and security of the controlled substances. The addition, deletion or change of schedule of a medicine or substance may be requested by the U.S. Drug Enforcement Agency (DEA), the Department of Health and Human Services (DHHS), the U.S. Food and Drug Administration (FDA), or from any other party via petition to the DEA. The DEA implements the CSA and may prosecute violators of these laws at both the domestic and international level”, per drugs.com.

How do I fill prescriptions for controlled substances?

State limits for refills

To check restrictions for your State, use this Center for Disease Control reference as a starting point.

In the past several years, the U.S. has had an unprecedented number of prescription drug overdose deaths. The majority of these deaths were from a prescription opioid pain reliever, specifically oxycodone, hydrocodone, or methadone. Not all states were affected the same by the prescription drug overdose death epidemic. As a result, different states have different regulations on these controlled substances.

According to the CDC website “States have the primary responsibility to regulate and enforce prescription drug practice. To combat the prescription drug overdose epidemic, many states have enacted laws that set time or dosage limits on the prescribing or dispensing of controlled substances.”

The CDC elaborates on two primary types of limitations: time limitations and dosage limitations. They state, “One main category of prescription drug limit laws sets forth time limits (hours’ or days’ supply) to the supply of prescription drugs. These time limit laws can be further classified by their applicability to certain drugs, certain populations or certain situations. Another category of prescription drug limit laws limit the dosage amounts of prescription drugs.” These limitations are made to try and prevent drug misuse.  

States differ slightly. For example, Texas prohibits a doctor from authorizing a prescription to be refilled indefinitely. The length of time a prescription may repeat for depends on the drug – it may range from 6 months to a year from date of first issue. After that, the patient should contact their doctor again to renew the prescription. A pharmacist may refuse to fill your subscription if, among other reasons, they are concerned that too high a dose has been prescribed.

Drug and Substance Abuse

Is substance abuse the same as substance dependence?

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), no longer uses the terms substance abuse and substance dependence, rather it refers to substance use disorders, which are defined as mild, moderate, or severe to indicate the level of severity, which is determined by the number of diagnostic criteria met by an individual.”  

What is considered substance abuse? How do I know if I am abusing a substance?

According to the Substance Abuse and Mental Health Services Administration, (SAMHSA) a substance use disorder impacts a person across many areas of their life and can significantly, negatively affect their family and career. Types of substance use disorders are Alcohol Use Disorder (AUD), Tobacco Use Disorder, Cannabis Use Disorder, Stimulant Use Disorder, Hallucinogen Use Disorder and Opioid Use Disorder.  

“Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. According to the DSM-5, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.

Signs of Substance Abuse

It’s important to recognize signs of abuse in yourself or others early, so that you can seek treatment as soon as possible. Symptoms of drug or alcohol abuse should not be taken lightly. According to the National Council on Alcoholism and Drug Dependence, here are symptoms associated with alcohol use disorder:

  • Temporary blackouts or memory loss
  • Mood swings or irritability
  • Drinking alone or in secret
  • Continued use of alcohol to feel normal or happy or to solve problems
  • Flushed skin and broken capillaries on the face
  • Headache, insomnia, nausea, when one stops drinking

Symptoms may not always be physical. It’s necessary to recognize lifestyle changes as well. Look for these possible signs of addiction in yourself or your loved one:

Change in appearance– You don’t seem to care about your physical appearance any longer and have improper hygiene habits.

Problems with interpersonal relationships– You have a hard time getting along with co-workers, friends, and family, who say you’ve changed or are acting differently.

Secrecy- You’ve begun to go out of your way to hide the amount and/or frequency of your drug or alcohol use.

Risk-taking– You will do something potentially dangerous to obtain a substance. You drive or operate heavy machinery while under the influence.

Change in Interests– You don’t have interest in the same activities you once did. You seek out activities or friend groups you know will have available substances for you to consume or use.

Tolerance- Your body has adapted to the substance, and you find you need more and more of it to get the same effect you once had.  

How do I get help?

If you are concerned that you or a loved one may have a substance use disorder, help is available. SAMHSA’s help resource page has many options to treat this serious medical condition. The first step in getting help is determining which course of treatment is best for you.

Inpatient and outpatient programs are two resources for anyone struggling and seeking outside assistance. An inpatient program is an intensive, residential treatment program that is designed to treat severe substance abuse.  An outpatient program is a part-time program that still allows you to work or go to school if necessary.  During inpatient care, patients have access to 24-hour medical care as physicians and specialists monitor their condition. Generally, in an outpatient program, patients spend 10-12 hours a week attending a local treatment center and undergoing counseling and drug education. Both treatments have benefits depending on your condition, financial status, and location.  Often, recovering addicts choose to attend an outpatient program after completing an inpatient residential one.  

For many people, getting help can feel overwhelming. SAMHSA’s National Helpline is available 24 hours a day at 1-800-662-HELP (4357) if you’d like to talk to someone about treatment options and information.

What are the most abused drugs in America?

According to SAMHSA’s National Survey on Drug Use and Health, “Among Americans aged 12 or older, the use of illicit drugs has increased over the last decade from 8.3% of the population using illicit drugs in the past month in 2002 to 10.2% (27 million people) in 2014. Of those, 7.1 million people met criteria for an illicit drug use disorder in the past year.”

Schedule I drugs:

The most commonly abused Schedule I drugs in the U.S. are marijuana (cannabis), medicinal marijuana, heroin, LSD, MDMA, GHB, Ecstasy. The National Institute on Drug Abuse (NIDA) reports that marijuana is the most commonly abused illegal drug in the United States.

Why is Marijuana a Schedule I Drug?

Many people are surprised to see marijuana listed as a Schedule I drug, especially among deadly drugs such as heroin and LSD. Even cocaine and methamphetamine are classified as Schedule II drugs and thus considered less likely to be abused. Congress categorized marijuana as a Schedule I drug in 1970 with the Controlled Substance Act, and it has remained on that list ever since. Since 1972 and as recently as July 2017, various petitions have been filed to reschedule marijuana, but have been continuously denied. Proponents of rescheduling the drug argue that marijuana’s Schedule I classification makes it nearly impossible to conduct meaningful scientific research on its potential medical uses. Currently, 29 states and the District of Columbia have laws legalizing the use of marijuana in some form. According to a national survey done by the Substance Abuse and Mental Health Services Administration (SAMHSA), “Across the nation, 28.50 percent of people aged 12 or older perceived a great risk of harm from monthly marijuana use.”

Schedule II

The most commonly abused Schedule II drugs in the U.S. are Opioids, methadone, meperidine, oxycodone, Percocet, fentanyl.

Opioid Crisis

According to the National Institute on Drug Abuse (NIDA), “Every day, more than 90 Americans die after overdosing on opioids.” Opioids are a broad group of pain-relieving drugs that interact with opioid receptors in your brain cells to muffle your perception of pain and increase your sensation of pleasure. Opioids include the illegal drug, heroin, but also are legally available as prescribed by doctors in the form of oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. Because they produce euphoria, it is easy to become dependent on them. It is important to reduce your risk of side effects and dependence by taking opioids only as prescribed and following your doctor’s explicit instructions.

Schedule III

The most commonly abused Schedule III drugs in the U.S. are low dose codeine and hydrocodone-based opioids.  

Monitoring the Future

Each year, NIDA anonymously surveys 8th, 10th, and 12th graders about their attitudes towards substance abuse and their use of illicit substances. The “Monitoring the Future” Survey is conducted by NIDA funded researchers at the University of Michigan at Ann Arbor and gives insights into substance abuse trends among young people in America. For example, according to this year’s survey, “In 2017, 16.6 percent of 12th graders reported binge drinking (consuming 5 or more drinks on a single occasion) in the previous two weeks, which was not significantly different from 2016.”

What are some effects of abusing controlled substances?

Abusing controlled substances can have severe effects on both the user and their loved ones.

Health effects

There are many detrimental health effects of abusing a controlled substance. According to drugabuse.gov, “Most drugs of abuse can alter a person’s thinking and judgment, leading to health risks, including addiction, drugged driving and infectious disease. Most drugs could potentially harm an unborn baby.” There is also the risk of an overdose or sudden death.  

Social/economic effects

Many people who start abusing controlled substances begin to see other areas of their life suffer. They may frequently miss work or underperform on tasks. This could lead to losing their job and possibly their home. They may also start spending more and more money on the substance, which may lead to economic hardship. There may also be problems socially with family or friends. Parents may neglect their children. Spouses and other family members may feel the stress of having a loved one whose life is no longer under control. It can ultimately lead to the breakdown of a marriage.  

Conclusion

Many illegal and prescription drugs are considered controlled substances and carefully monitored by the CSA. These substances are controlled to avoid misuse, abuse and to ensure that they are used safely.