A 4-credit online continuing education course with exam, based on content from The Complete Practitioner: Mental Health Applications, our monthly, 8-page publication, is available at our Web site [http://www.completepractitioner.com].

Course title: Treatment of Substance Abuse and Dependence (4 CE credits)

(At our Web site, click on "Continuing Education," and then click on "CE information.")

QUICK REFERENCE #53: How are drugs classified, based on the 5 "schedules" of the Controlled Substances Act?

The Controlled Substances Act mandates that certain substances be controlled (as defined by 5 "schedules") because of their potential for abuse, leading to possible physical or psychological dependence. The US Drug Enforcement Administration (DEA) is responsible for enforcing the Controlled Substances Act. The most stringent controls are placed on Schedule I substances, which, in the United States, have no generally accepted medical use for treatment and are not available by prescription. Controls are incrementally less stringent for Schedules II through V substances. The controls described below pertain to nonelectronic prescribing. There are many other controls, not described below, such as the regulation of the import and export of controlled substances.

Schedule I [Examples: heroin; marijuana; mescaline; methcathinone]

(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.

• In most cases, these substances are not legally available. [Note: Although some states have legalized medical use of marijuana, federal law prohibiting its use overrides state law. State law cannot be used as a defense if a person is charged by the DEA with marijuana possession.]

Schedule II [Examples: amphetamine (eg, Adderall); codeine; fentanyl (eg, Duragesic); hydromorphone (eg, Dilaudid); meperidine (eg, Demerol); methadone; methylphenidate (eg, Ritalin); morphine; oxycodone (eg, Oxycontin)]

(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.

• A written prescription is required for the initial and additional quantities. (Refills are NOT permitted.)

Schedule III [Examples: anabolic steroids; buprenorphine/naloxone (Suboxone); products that contain small quantities of certain schedule II controlled substances , such as codeine, in combination with noncontrolled ingredients, such as aspirin]

(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.

• Prescriptions and refills may be communicated to the pharmacist in writing, orally (eg, by telephone), or by fax.
• A maximum of 5 refills are permitted.
• Refills are permitted within 6 months of the original prescription.
• To obtain additional quantities beyond the 5-refill, 6-month limitations, a new prescription is required.

Schedule IV [Examples: alprazolam (eg, Xanax); chlordiazepoxide (eg, Librium); diazepam (eg, Valium); lorazepam (Ativan)]

(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.

• The rules pertaining to prescriptions and refills are the same as in Schedule III.

Schedule V [Examples: many cough preparations that contain a limited amount of codeine]

(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.

• Prescriptions and refills may be communicated to the pharmacist in writing, orally (eg, by telephone), or by fax.
• Prescriptions may be refilled as authorized by the practitioner.

SOURCE: This article originally appeared in the November 2006 issue of The Complete Practitioner [http://www.completepractitioner.com].

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