Controlled Substances Act

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In the United States, the Controlled Substances Act (CSA) regulates drugs with abuse potential. It divides drugs into classes called schedules, and establishes rules for the process and enforcement of the schedules. Originally focused on psychoactive drugs with abuse potential, the Act now also controls anabolic steroids.

Drug Schedules

Required findings as followed:

Schedule I.

(A) The drug or other substance has a high potential for abuse.
(B) The drug or other substance has no currently accepted medical use in treatment in the United States.
(C) There is a lack of accepted safety for use of the drug or other substance under medical supervision.

Examples of Schedule I drugs include certain opioids including heroin, MDMA (ecstasy), LSD, marijuana, and mescaline.

Schedule II.

(A) The drug or other substance has a high potential for abuse.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.
(C) Abuse of the drug or other substances may lead to severe psychological or physical dependence.

Schedule II drugs include opium, certain opioids (pain medications such as morphine, oxycodone, fentanyl), cocaine (approved as a topical surgical anesthetic), methamphetamine (Desoxyn), amphetamine (Adderall), methylphenidate (Ritalin) and many barbiturates.

Schedule III.

(A) The drug or other substance has a potential for abuse less than the drugs or other substances in schedules I and II.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.

Anabolic steroids, ketamine, gamma-hydroxybutyric acid, and certain opioid medications (buprenorphine, tramadol, many codeine mixtures) and stimulant medications (modafinil, benzphetamine) are listed on Schedule III.

Schedule IV.

(A) The drug or other substance has a low potential for abuse relative to the drugs or other substances in schedule III.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule III.

Examples of Schedule IV substances include many benzodiazepines (e.g., diazepam, lorazepam, alprazolam, flunitrazepam), benzodiazepine like sleep drugs (e.g., zolpidem), and diet drugs (e.g., phentermine).

Schedule V.

(A) The drug or other substance has a low potential for abuse relative to the drugs or other substances in schedule IV.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule IV.

Substances on Schedule V primarily include medications containing smaller doses of opioids (e.g., cough syrups).

Controlled substances

Drugs and other materials regulated by the Controlled Substances Act are called controlled substances. Some controlled substances are not drugs but are used to make other controlled substances which are. For example, thebaine is used to make hydrocodone, oxymorphone, and other opioid medications. Drugs which are controlled substances use abbreviated markings, such as schedule II controlled substances marked C-II.

Because a CSA schedule includes legal use does not mean that each substance (drug) listed in that schedule is approved and legal in the United States. Rohypnol (flunitrazepam) is a schedule IV drug that is unapproved and illegal in the US; however, it is a benzodiazepine and other members of this drug class are approved and legal, such as diazepam (Valium) and alprozolam (Xanax). An uncontrolled drug may later become a controlled substance, such as tramadol (Ultram) and modafinil (Provigil) being placed in schedule IV. Similarly controlled drugs may be rescheduled, such as hydrocodone (Lortab, Vicodin) moved from schedule III to schedule II, or dronabinol (Marinol) moved from schedule II to schedule III. Some controlled substance may be approved for veterinary but not human use, such as the potent opioid etorphin, used to tranquilize large mammals like elephants.

Some states place controlled drugs into more restricted schedules, that is, reschedule them.

Aside from the United States, many other countries have adopted a similar system regulating drugs by abuse potential.

Constitutionality

The constitutionality of the Controlled Substance Act has been disputed. In 1972, the National Commission on Marijuana and Drug Abuse, commissioned by President Richard Nixon, reported questioned whether the Act has violated various constitutional limitation on federal power. Nixon and the Congress ignored the committee's findings and the Act was implemented anyways. In 2005, the Supreme Court decided in case Gonzales v. Raich, in a 6-3 decision that the Controlled Substance Act did not violate the Commerce Clause in United States Constitution. The decision cited Wickard v. Filburn, an FDR-era case that significantly expanded federal power over intrastate commerce.

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