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Any discussion on narcotics, prescription drugs, or other controlled substances is usually peppered with the word schedule. One substance may be Schedule I, while another is Schedule II, III, or IV. For an individual who is not familiar with controlled substances, the word may simply pass through the conversation without a second glance.
To those who understand the drug industry, however, these phrases are paramount to understanding the type of substance being discussed. These terms are called drug classifications. Per the (DEA), medical professionals and law enforcement officials use drug classifications to delineate a substance’s legality, based on “the drug’s acceptable medical use and the drug’s abuse or dependency potential.” Simply put, classifications help to categorize current and developing drugs, which in turn helps lawmakers, law enforcers, and medical experts understand how best to handle a particular substance. In this way, scheduling narcotics, prescription medications, and other drugs makes the industry safer for everyone.
A History of the CSA Drug classifications have officially been in place since the 1970s, when President Nixon signed the (CSA) into law. However, the CSA is merely a chapter in the United States’ long and complicated history with addictive substances. The US has been striving to safely and effectively control drug use since the Pure Food and Drug Act of 1906.
This act required food and drug manufactures to clearly label any product that contains dangerous substances – substances that included alcohol, morphine, opium, and cannabis. The act was amended numerous times over the six decades that followed, but the greatest change took effect in the early 1970s with the CSA. A companion to Nixon’s War on Drugs, the Controlled Substances Act gave the DEA and the Food and Drug Administration (FDA) the power to determine which substances are fit for medical use.
The Classifications The drugs that are considered the most dangerous by the DEA are known as Schedule I substances. These are drugs with no current medical use, per analysis by the DEA and FDA.
These substances also carry a high potential for abuse and addiction. How Scheduling Works How does the DEA and FDA know which drugs are safe and which aren’t? According to a report in, various studies on the drug’s effectiveness and risks are required and reviewed. Any drug entering the market must be analyzed, whether it is a new pharmaceutical or a street drug rising in popularity.
First, the DEA determines whether the drug can be abused. If the answer is “yes,” regardless of how low the probability may be, the drug moves forward in the scheduling system. At this stage, classification can become a little murky. While any drug that is scheduled under the CSA has some potential for abuse, the probability for addiction is so vaguely defined that where a drug is scheduled depends largely on the evidence that research on the drug can yield. Drugs require large-scale clinical trials to showcase their medical merit and keep them out of Schedule I classification.
If the evidence is strong enough, the DEA designates the drug in a lower schedule, which deems it acceptable for use. Classification Controversies.
Some drugs have been reclassified over the years. For example, in 2014, the reclassified the drug hydrocodone, moving it from Schedule III to Schedule II. But on the whole, reclassification or unscheduling a substance is rather rare, and this has led to many controversies surrounding the Controlled Substances Act. The most well-known controversy surrounds marijuana, a Schedule I substance that many experts believe has only a low to moderate risk for addiction and could possess great medical benefits for individuals suffering from cancer and other serious conditions. Despite a growing body of evidence in support of reclassification, the DEA decided that marijuana would retain its Schedule I status in 2016.
To many, this decision was considered a holdover from the War on Drugs mentality, in which any substance once deemed illicit can find no saving grace. Another CSA controversy surrounds specific language the act uses to exempt alcohol and cigarettes. Of the United States Code reads, “The term ‘controlled substance’ means a drug or other substance, or immediate precursor, included in Schedule I, II, III, IV, or V of part B of this subchapter. The term does not include distilled spirits, wine, malt beverages, or tobacco.” To critics, this decision seems careless; the dangers of alcohol and tobacco are well documented, and some experts argue that were it not for this exemption, these substances would be Schedule I. Despite its flaws, the drug classification system is an efficient way to help medical professionals, lawmakers, other officials, and laypeople across the country assess the benefits and dangers of various drugs and medications.
Controlled Drugs What is a controlled (scheduled) drug? A controlled ( scheduled) drug is one whose use and distribution is tightly controlled because of its abuse potential or risk. Controlled drugs are rated in the order of their abuse risk and placed in Schedules by the Federal Drug Enforcement Administration (DEA). The drugs with the highest abuse potential are placed in Schedule I, and those with the lowest abuse potential are in Schedule V.
These schedules are commonly shown as C-I, C-II, C-III, C-IV, and C-V. Some examples of drugs in these Schedules are as follows:. Schedule I drugs with a high abuse risk. These drugs have NO safe, accepted medical use in the United States.
Some examples are heroin, marijuana, LSD, PCP, and crack cocaine. Schedule II drugs with a high abuse risk, but also have safe and accepted medical uses in the United States.
These drugs can cause severe psychological or physical dependence. Schedule II drugs include certain narcotic, stimulant, and depressant drugs.
Some examples are morphine, cocaine, oxycodone (Percodan®), methylphenidate (Ritalin®), and dextroamphetamine (Dexedrine®). Schedule III, IV, or V drugs with an abuse risk less than Schedule II. These drugs also have safe and accepted medical uses in the United States.
Schedule III, IV, or V drugs include those containing smaller amounts of certain narcotic and non-narcotic drugs, anti-anxiety drugs, tranquilizers, sedatives, stimulants, and non-narcotic analgesics. Some examples are acetaminophen with codeine (Tylenol® No.3), paregoric, diazepam (Valium®), alprazolam (Xanax®), propoxyphene (Darvon®), and pentazocine (Talwin®). In 1981, the Texas Legislature passed a law which required doctors to write all prescriptions for Schedule II drugs on a special three‑part or triplicate form. Effective September 1, 1999, the triplicate prescription form was replaced by an official prescription form. Any triplicate prescriptions that are in use are still valid prescriptions and may be used until the supply is depleted.
Prescription Drugs A-z
The new official forms are issued by the Texas Department of Public Safety to prescribers. Pharmacies electronically transmit prescription information to the DPS. The information is used by licensing boards to identify doctors, dentists, and/or pharmacists who may be inappropriately prescribing or dispensing these highly abusable drugs.
In addition, the DPS can identify potential abusers much more quickly and stop any abuse, misuse, or diversion in a more timely manner. The program has been very effective in reducing abuse, misuse, and diversion of Schedule II drugs in Texas.
This second article of a 4-part series on key components of the Federal Controlled Substances Act will discuss the requirements for controlled substances prescriptions. For a prescription for a controlled substance to be considered valid, it must be “issued for a legitimate medical purpose by a registered practitioner acting in the usual course of sound professional practice.” Registered practitioner refers to any health care professional who is authorized to prescribe controlled substances within the area in which he or she is licensed to practice and who is registered with the Drug Enforcement Agency (DEA) or is exempt from registration. All of the following must be included in a prescription for a controlled substance:. Isohunt. Manual signature of the prescriber Schedule II prescriptions must be presented to the pharmacy in written form and signed by the prescriber.
There are no federal quantity limits on Schedule II prescriptions. In addition, there is no federal time limit on when a Schedule II prescription must be filled after being signed by a prescriber.
That being said, the pharmacist must ensure that the controlled substance is being prescribed for a legitimate medical purpose; the quantity of the medication prescribed and the time between signing and filling of a prescription may play a role in this decision. Note that state laws may have stricter rules.
A prescription for a Schedule II medication may be phoned into the pharmacy in an emergency situation. The prescriber must follow-up the phone prescription with a written prescription to the pharmacy within 7 days. Faxed Schedule II prescriptions are generally permitted, however, the pharmacist must receive the original, signed written prescription before dispensing the Schedule II controlled substance to the patient.
There are 3 scenarios in which a facsimile Schedule II prescription may serve as an original written prescription. These include the following:. The provider is prescribing Schedule II medications to a patient in hospice care as certified by Medicare or licensed by the state.
Prescriptions for Schedules III to V controlled substances may be written, orally communicated, or faxed to the pharmacy. Not all prescriptions for controlled substances can be refilled. Schedule II medications may not be refilled; a new prescription must be written every time. Medications classified as Schedule III or IV controlled substances may be refilled up to 5 times in a 6-month period. Schedule V medications may be refilled as authorized by the prescriber. For refills of any controlled substance, the dispensing pharmacist’s initials, date of refill, and amount dispensed must be written on the back of the prescription. One mechanism to verify the validity of a controlled substance prescription is through the DEA registration number provided by the practitioner.
DEA registration numbers contain 2 letters followed by a computer-generated sequence of 7 numbers. The first letter in the DEA registration is generally an A, B, or M.
Prior to October 1, 1985, DEA registration numbers began with the letter A. Saint seiya anime chronological order. Registration numbers issued after this date start with the letter B. Mid-level practitioners, such as advanced nurse practitioners and physician assistants, have registration numbers beginning with the letter M.
The second letter in the registration number is the first letter of the practitioner’s last name (ie, J for Jackson or W for White). The computer-generated sequence of numbers can be verified using the following formula: add the sum of the first, third, and fifth digits to twice the sum of the second, fourth, and sixth digits. The total should be a number whose last digit is the same as the last digit of the DEA number on the prescription. Health care providers with prescribing authority, when acting within the usual course of business at a hospital or other health care institution, may prescribe controlled substances under the DEA registration number of the hospital or institution. Examples of practitioners who may use a hospital’s DEA registration number include physician interns and residents as well as medical house staff or mid-level practitioners such as physician assistants or advanced nurse practitioners. The hospital or other institution must authorize the health care provider to prescribe under its registration number.
A specific internal code number must be assigned to each authorized practitioner. The health care institution must keep an up-to-date list of all internal codes with the corresponding practitioner. If the pharmacy has any doubt regarding a controlled substance prescription from a provider using a health care institution’s DEA number, the pharmacist may contact the institution to verify the legitimacy of the prescription. As mentioned previously, mid-level practitioners such as nurse midwives, nurse practitioners, nurse anesthetists, clinical nurse specialists, physician assistants, and optometrists may be granted DEA registration numbers and may prescribe controlled substances. However, registration is contingent upon authority granted by the state in which they are licensed. Pharmacists must be familiar with the controlled substances act in their state to determine which health care providers may or may not prescribe any controlled substances and, if so, which schedules may be prescribed. On December 19, 2007, a DEA regulation came into effect that allows a prescriber to issue multiple prescriptions authorizing an individual patient to receive a total of up to a 90-day supply of a Schedule II controlled substance.
However, this is allowable only under the following conditions:.
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Schedule 3 Drugs
Schedule 3 (III) Drugs The drug has a potential for abuse less than the drugs in schedules 1 and 2. The drug has a currently accepted medical use in treatment in the United States. Abuse of the drug may lead to moderate or low physical dependence or high psychological dependence. The following drugs are listed as Schedule 3 (III) Drugs. by the Controlled Substances Act (CSA): The Controlled Substances Act (CSA) schedule information displayed applies to substances regulated under federal law.
There may be variations in CSA schedules between individual states.
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