Understanding The Controlled Substances Act

The Controlled Substances Act (CSA) is a federal law that regulates the manufacture, importation, possession, use, and distribution of certain narcotics, stimulants, depressants, hallucinogens, anabolic steroids, and other chemicals in the United States. It was passed by the 91st US Congress as Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970 and applies to both legal and illegal substances. The CSA created 5 schedules, also known as classifications, which have varying degrees of qualifications for a substance to be included in each.

The scheduling created by the CSA is governed by both the Drug Enforcement Agency (DEA) and the Food and Drug Administration (FDA), who are granted the power to classify or remove substances under the CSA. Classifications under the CSA must include criteria such as potential for abuse, currently accepted medical use, and international treaties.

The Controlled Substances Act outlines the drug scheduling system, which lays out 5 classes of drugs each with different levels of regulation.

Currently, alcohol and tobacco products are not regulated under the CSA.

Understanding The CSA

There are 5 different scheduling categories under the CSA, the highest being I (1) and the lowest being V (5). Drugs and other substances are scheduled based on three major factors: the potential for abuse, accepted medical use, and potential for addiction. Using these, the DEA and FDA can place drugs in their corresponding categories to help guide legislation and other federal guidelines.

Below is a table that breaks down how drugs are scheduled according to criteria that both the FDA and DEA oversee.

Potential For Abuse Accepted Medical Use Potential For Addiction
Schedule I High None Very high, no safe use
Schedule II High Some High if abused
Schedule III Medium Yes Moderate addiction if abused
Schedule IV Moderate Yes Possible if abused
Schedule V Low Yes Possible mild addiction if abused

Drug Scheduling In The US

The DEA uses drug scheduling as a rating system to determine which drugs have a higher potential for abuse. The agency also uses scheduling to determine the charges brought upon those in possession of drugs.

Schedule I Controlled Substances

Schedule I controlled substances are defined as those having no specified medicinal purposes, lacking accepted safety for use under medical supervision, and having the highest potential for abuse. Drugs in this category may under no circumstances be prescribed by a doctor or medical professional and are subject to strict production quotas by the DEA.

According to criteria set forth by the DEA, a substance does not need to have a similar “high potential for abuse” as a drug like Heroin, for example, to be considered a schedule I drug. This is if its “undisputed” that a certain drug “has no currently accepted medical use in treatment in the United States and a lack of accepted safety for use under medical supervision, […], the drug must remain in schedule I.”

Schedule I Drugs Include:

Schedule II Controlled Substances

The key difference between schedule I and II drugs is that the latter have some accepted medicinal use in certain circumstances. Although schedule II substances have a high potential for abuse, most of these drugs have strict guidelines regarding their medicinal purposes when prescribed. Outside of the direct prescription by a practitioner, schedule II drugs may not be dispensed, taken, or distributed for any reason.

Schedule II Drugs Include:

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Schedule III Controlled Substances

Drugs under this schedule are those with a moderate to low abuse potential (lower than schedule I and II), a currently accepted medical use, and a low to moderate potential for physical or psychological dependence. Without the direct guidance of a practitioner or healthcare provider, no schedule III drug may be possessed, taken, or distributed for any reason.

Additionally, prescriptions involving schedule III controlled substances may not be filled more than 6 months after the date, or more than 5 times total unless renewed by your practitioner.

Anabolic Steroids and testosterone are among some of the more common drugs that fall in this category. Other examples include:

  • Xyrem
  • Marinol
  • Ergine

Schedule IV Controlled Substances

These drugs are considered by the DEA to have an accepted medical use and a lower potential of abuse compared to Schedule III substances.

Schedule IV Drugs Include:

Schedule V Controlled Substances

These substances have the lowest potential for abuse according to the DEA. Prescriptions to control conditions like irritable bowel syndrome and fibromyalgia are among those considered to fall under schedule V. Robitussin AC, a cough suppressant with very low amounts of Codeine, is also a Schedule V substance. Other examples of schedule V controlled substances include:

  • Diuretics containing diphenoxylate
  • Anticonvulsants
  • Purovalerone (used to treat chronic fatigue)
  • Cannabioil (only in certain circumstances, CBD formulations remain schedule I except for those derived from hemp)

Proposed Changes To The CSA

Advocates of drug safety debate whether the CSA classifications truly prevent drug use, or if they simply put barriers in place that make it harder for those who need specific drugs to get them. Furthermore, critics of the CSA state that the law lacks a concrete definition of “drug abuse,” which they believe can make it hard to properly schedule drugs. Opioid Painkillers and Marijuana are the most frequently discussed drugs in the CSA debate.

Rescheduling Painkillers

Many people advocate for either increasing or decreasing the schedule of Painkillers. Some groups are concerned about the powerfully addictive nature of Painkillers and others are concerned it may be too hard for people who need pain relief to get the drug.

Advocates of increasing the schedule of drugs like Hydrocodone often point to the epidemic of Painkiller addictions and the rise in ‘pill mills’ throughout the 2000s. Considering that nearly 46% of all American adults reported using a prescription painkiller, legally or illegally, in 2022, many advocates say that rescheduling them could make them harder to get, and, in turn, harder to abuse.

That same group of advocates were successful in lobbying for Hydrocodone to move from a Schedule III to a Schedule II substance in 2014.

Rescheduling Marijuana

There have been many attempts to remove Marijuana’s Schedule I status since the 1970s. Those advocating to reduce Marijuana’s schedule level say that Marijuana is not as dangerous as drugs in the same, or lower, schedules.

For example, Fentanyl, which is a schedule II drug, was responsible for more than 80,000 overdose deaths in 2021. While Marijuana does have a potential for addiction, from 1999 to 2014 there have been just 78 poisoning deaths due to Marijuana alone. In fact, there have been more fatal overdoses of over-the-counter drugs such as Tylenol since 1999 then there have been Marijuana.

Additionally, Schedule I drugs are considered to have no medical purpose; however, Marijuana is used medicinally in most states. To date, 37 states including the District of Columbia and four US territories have laws permitting the use of Marijuana for medical use.

Despite the debates, it is important to recognize the addictive quality of Marijuana.

Although it’s often touted as a ‘non-habit forming’ substance, Marijuana can take a psychological hold over some people, similar to how some people develop food or gambling addictions.

The CSA And Addiction Treatment

Because the CSA designates some drugs as illegal, some people may not seek treatment for their addiction for fear of being arrested for possession. But having an addiction is not illegal. Getting treatment can help turn your life around.

If you have an addiction, there are people available to help you find a treatment center and discuss financial options. Contact a treatment provider to get help.