Modifying the DEA Controlled Substance Schedules

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The Drug Enforcement Administration (DEA) has established five categories of controlled drugs based upon the criteria defined below.   This article discusses the drugs listed in each category and suggests modifications to the lists to comply with the mission statement below.

DEA statement on how drugs are classified is based on the following:

“Substances are placed in their respective schedules based on whether they have a currently accepted medical use in treatment in the United States, their relative abuse potential, and the likelihood of causing dependence when abused.”

These schedules were established with some major deviations from the above statement as to how drugs are classified into one of the five schedules.  There should be a major review of these schedules based upon the consequences of making some drugs unavailable that are useful, and some drugs that have created drug overdose epidemics that should be in more restrictive categories.  The Schedule of drugs is defined by the DEA into five categories, I to V.

Schedule I drugs

Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are:

heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote

With the exception of heroin, none of the drugs in Schedule I should be in that classification according to the DEA summary statement on how drugs are classified.  Methaqualone is used for sleeping, and is much less addicting than drugs in Schedule II.  Ecstasy has been carefully reviewed by the NIH.  It is similar to mescaline, with the amphetamine base structure altered to produce several neurotransmitters commonly associated with pleasure.

The following statement was provided regarding Ecstasy by American Addiction Centers, which provides drug abuse treatment programs.

(Alexander) Shulgin and David Nichols from Perdue University published the first report on the subjective effects of MDMA in humans in 1978 and compared the drug to marijuana or magic mushrooms without hallucinations.

Their description of ecstasy’s disinhibiting effects soon caught the interest of psychotherapists who viewed the drug as a potential tool to overcome patients’ fears and increase their insight into their own emotions; however, MDMA was never approved by the Food and Drug Administration (FDA) or subjected to clinical trials.

The reason that Ecstasy is included in this article is to illustrate the lack of investigation into the medical uses of the majority of the Schedule I drugs by the FDA or other research organizations.  In general, hallucinogens are not addicting and rarely create any long-lasting physical effects. Hallucinogens are not for everyone, and this article does not endorse the use of hallucinogens or any other drug that is discussed.  The FDA specifically prohibited the investigation of marijuana and other Schedule I drugs until recently.

Marijuana was criminalized on the national level in 1937 in what was largely a racist law that targeted non-whites and resulted in millions of people going to jail.  Marijuana and LSD have both been shown to have significant medical value.  LSD has been shown to have therapeutic value in treating PTSD and other forms of mental illness.  Peyote and other hallucinogens have been used for centuries by Native American and other indigenous cultures around the world.  The DEA has an LSD fact sheet that states that overdoses of LSD can be fatal.  This is a link to a video that discusses whether LSD can cause death.  The short answer is “no”.

With the exception of heroin, all Schedule I drugs should be moved to Schedule IV. 

Schedule II drugs

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 II drugs are all major causes of addiction and are frequent causes of death.  More information on the definition of addiction and actions by addicts that cause death are provided in a previous article.  Death is often caused by combining Schedule II drugs with alcohol or other drugs.  The Schedule II drugs need to have extremely tight controls in terms of tracking each patient’s use and a system to prevent multiple doctors from prescribing the drugs to the same client.  The combination of heroin (Sch I) with fentanyl (Sch II) has led to an epidemic of drug overdoses.

Schedule II drugs should be reassigned to Schedule I. 

Schedule III drugs are classified into two subcategories, i.e. narcotic and non-narcotic drugs.  The lower classification is based upon smaller amounts of addictive components allowed in these drugs.  If addicts do not follow the recommended dosages, drugs in Schedule III are also highly addictive and potentially fatal, especially if mixed with alcohol or other CNS depressants.

Schedule III/IIIN Controlled Substances (3/3N)

Substances in this schedule have a potential for abuse less than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence.

Examples of Schedule III narcotics include combination products containing less than 15 milligrams of hydrocodone per dosage unit (Vicodin), products containing not more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine), and buprenorphine (Suboxone).

Examples of Schedule IIIN non-narcotics include benzphetamine (Didrex), phendimetrazine, ketamine, and anabolic steroids such as Depo-Testosterone.

The Schedule III narcotic drugs are all addictive with serious to deadly effects if combined with alcohol.  Schedule III defines the reduced dosages of highly addictive drugs.  These drugs are abused by addicts by simply increasing the quantity of the drug being used.  Like the drugs in Schedule II, there needs to be tighter control of the prescribing of these drugs, and stringent tracking by patient name and doctor(s) to prevent multiple prescriptions by multiple doctors.

The Schedule IIIN drugs are non-narcotic, but have the potential for addiction.   The first two drugs listed are used in weight control and have many characteristics of amphetamines.  Ketamine is used as an anesthesia, which means it can be lethal if combined with alcohol.  The FDA box warnings list the adverse effects of depo-testosterone include cardiac disease, coronary artery disease, heart failure, hypertension, myocardial infarction, and thromboembolism.

Schedule III drugs should have black box warnings that they are addicting and potentially fatal if combined with alcohol or other drugs.

Schedule IV drugs are considered to be safer than any of the Schedule I, Schedule II or Schedule III drugs.

Schedule IV Controlled Substances

Substances in this schedule have a low potential for abuse relative to substances in Schedule III.
Examples of Schedule IV substances include: alprazolam (Xanax), carisoprodol (Soma), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril), and triazolam (Halcion).

Schedule IV drugs include several categories of drugs that include tranquilizers, anti-depressants, sleep disorders, and anesthesia.  These drugs are often combined with heroin (Sch I), other drugs or alcohol.  These combinations lead to multiple overdoses because they are central nervous system (CNS) depressants.  The result of combining these drugs multiples the effects of individual drugs and leads to respiratory failure.

Schedule IV drugs should have black box warnings that they are addicting and potentially fatal is combined with alcohol or other drugs.

Schedule V drugs.

Schedule V Controlled Substances

Substances in this schedule have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics.

Examples of Schedule V substances include cough preparations containing not more than 200 milligrams of codeine per 100 milliliters or per 100 grams (Robitussin AC, Phenergan with Codeine), and ezogabine.

The Schedule V drugs depend upon low doses of addicting drugs to be allowed in the lowest category of controlled drugs.  The Schedule V drug classification defines the amounts of codeine that is permitted in each dose.  Classification of drugs as being lower risk of addiction or side effects based on the allowed amount of the addicting substance is ineffective.  Black box labels should be required for these products as being potentially addictive, and they may have serious adverse side-effects if combined with alcohol or other drugs.

Summary of recommended reclassifications:

  1. With the exception of heroin, all current drugs in Schedule I should be reclassified to Schedule IV based upon the failure to cause addiction or proven medicinal value.
  2. All current Schedule II drugs should be moved to Schedule I classification based upon their extremely high addictive nature, and potentially fatal consequences of misuse. Tight monitoring of prescription issuers, prescription users, and multiple prescription applications by users should be nationally monitored.
  3. All Schedule III, Schedule IV, and Schedule V drugs should have black box labels warning of addiction potential and potentially fatal consequences of using the drugs with other drugs or alcohol.

Social commentary on consequences of current FDA drug classifications.

There are millions of people in jail because of drug charges.  Most of these incarcerations are for users of drugs, not of dealers or manufacturers.  Those in jail for using drugs should be released and their convictions expunged so that they can return to being normal citizens.  Those with addictions should be rehabilitated, with the cost being shared among the drug manufacturers and taxes on the foreign manufacturing source of the drugs.

The people that produced and promoted drugs like OxyCotin should be jailed, as well as the people at the FDA that cooperated in promoting the Schedule II drugs as being safe.  Those put into jail for selling heroin and Schedule II drugs should have their sentences reevaluated and restored to prior sentencing guidelines before the War on Drugs policies were implemented.  Putting cartel suppliers and legitimate or illegal manufacturers of addictive drugs should result in extensive prison terms and forfeiture of assets.

 

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