Schedule III/IIIN controlled substances Substances in this schedule have less potential for abuse than substances in Schedules I and II, and abuse may lead to low to moderate physical dependence and high psychological dependence (DEA, 2018b). Examples of Schedule III narcotics include: ● Products containing no more than 90 mg of codeine (Tylenol with Codeine). ● Buprenorphine (Suboxone). Schedule IV controlled substances Substances in this schedule have a low potential for abuse relative to substances in Schedules I, II, and III (DEA, 2018b). Examples of Schedule IV controlled substances include:
Examples of Schedule IIIN non-narcotics include: ● Benzphetamine (Didrex).
● Butalbital (Fiorinal). ● Dronabinol (Marinol). ● Ketamine. ● Anabolic steroids. ● Testosterone (Androderm).
● Lorazepam (Ativan). ● Midazolam (Versed). ● Modafinil (Provigil). ● Phentermine (Adipex-P). ● Temazepam (Restoril). ● Triazolam (Halcion). ● Zaleplon (Sonata). ● Zolpidem (Ambien).
● Alprazolam (Xanax). ● Carisoprodol (Soma). ● Clonazepam (Klonopin). ● Clorazepate (Tranxene). ● Diazepam (Valium). ● Eszopiclone (Lunesta).
Schedule V controlled substances Substances in this schedule have a low potential for abuse relative to substances in Schedule IV and primarily include preparations containing limited quantities of certain narcotics (DEA, 2018b). Examples of Schedule V controlled substances include: ● Cough preparations containing no more than codeine 200 mg/100 mL or codeine 200 mg/100 g (Robitussin AC, Phenergan with Codeine). ● Diphenoxylate (Lomotil).
Self-Assessment Quiz Question #1 If there is accidental ingestion of a known or unknown substance with no respiratory distress, whom should you call? a. Poison Control (1-800-222-1222). b. Emergency Services (911). c. American Medical and Lawyer Referral Service (411-PAIN). d. CVS or local pharmacist.
● Lacosamide (Vimpat). ● Opium preparations. ● Pregabalin (Lyrica).
MEDICAL MARIJUANA LEGISLATION
Medical marijuana involves using the whole unprocessed marijuana plant or its essential extracts to treat symptoms of illness and other conditions. The FDA has neither recognized nor approved the marijuana plant as a medicine. The DEA considers marijuana a Schedule I controlled substance due to the lack of scientific research. However, a growing body of literature (scientific and anecdotal) has led to the increasing use of medical marijuana to address various conditions, including pain, seizures, and posttraumatic stress disorder (PTSD). The DEA considered rescheduling marijuana to Schedule II in August 2017 but decided against it (LaBruyere, 2022). The DEA has agreed to support additional research on marijuana and make the process easier for researchers. However, despite the lack of scientific confirmation, more than half of U.S. states and the District of Columbia have legalized marijuana, while other states restrict access. In 2013, the federal government took a lenient approach to federal law enforcement regarding marijuana and provided guidance that allows states to legalize medical marijuana. However, in January 2018, this memo was rescinded (U.S. Department of Justice [DOJ], 2018), and now the status of state-level medical marijuana legalization is uncertain. The medical marijuana debate has highlighted the issue of state rights versus those of the federal government. Since 2018, another 19 states have legalized recreational marijuana, and 39 states have legalized medical marijuana. Medical marijuana is the same as or similar to the plant used for recreational purposes but is prescribed by an authorized clinician. Each state has regulations regarding qualified practitioners who can recommend medical marijuana and discuss the types of legal medical marijuana with individuals. In addition, states may require individuals to obtain a medical
marijuana card that allows them to purchase medical marijuana from a dispensary. Medical marijuana products vary from plants to extracted oils and edible products (e.g., cookies, butters, lozenges). It is important to note that the FDA does not oversee or regulate medical marijuana as it does prescription medications. Therefore, the quality of medical marijuana, including purity, strength, and ingredients, may vary significantly depending on where and when it is purchased. The FDA has approved marijuana-derived prescription medications (see Table 1). Two products are synthetic derivatives: Dronabinol is synthetic delta-9-tetrahydrocannabinol, while nabilone is a derivative of cannabinol, one of the many chemical constituents of marijuana. The FDA approved Epidiolex, which contains cannabidiol (CBD) purified from marijuana plants, in 2018 as a Schedule V drug. While Epidiolex is FDA-approved for treating seizures related to Lennox–Gastaut syndrome and Dravet syndrome, it is also used to treat other off-label conditions. In 2020, Epidiolex was approved to treat seizures associated with tuberous sclerosis complex (TSC) in patients age 1 year and older. Under the CSA, CBD is currently a Schedule I controlled substance because it is a chemical component of the cannabis plant. The FDA has submitted a medical and scientific analysis of CBD, including data from studies to assess its abuse potential, to the DEA in an effort to change the scheduling of CBD. In 2020, the DEA removed Epidiolex from a downgraded Schedule V and descheduled it entirely, meaning Epidiolex is no longer subject to the CSA and its tracking and monitoring requirements (HB6095, 2021).
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