Table 1. Drug Schedules I-V Established by the Controlled Substances Act (Continued)
IV
Low potential for SUD and misuse relative to Schedule III**
Currently accepted medical use
Paper Electronically transmitted Phone, fax
Up to 5 refills within 6 months
Benzodiazepines: Alprazolam Clonazepam Diazepam
Lorazepam Midazolam Temazepam Triazolam Carisoprodol
V
Low potential for SUD and misuse relative to Schedule IV
Currently accepted medical use
Paper Electronically transmitted Phone, fax
No limits, except partial refills must occur within 6 months of issue date
Cough preparations with codeine Ezogabine
SUD = Substance-use disorder LSD = Lysergic acid diethylamide MDMA = Methylenedioxymethamphetamine ACET = Acetaminophen *See exceptions under “Federal Restrictions Regarding Refills” **Benzodiazepines carry risks of substance dependence and respiratory depression, particularly in combination with other substances that also depress respiration. 21,22
Schedule II medications do have accepted medical uses (some with restrictions), including opioids for acute or chronic pain severe enough to warrant an opioid prescription and stimulants used to treat attention deficit hyperactivity disorder (ADHD). Use of Schedule II drugs may lead to severe psychological or physical dependence. The medications in Schedule III may lead to a moderate or low degree of physical dependence or “high.” Schedule III opioids include products containing not more than 90 mgs of codeine per dosage unit. This is also the schedule that contains stimulants and anabolic steroids. Although Schedule IV drugs are considered to have low potential for SUD and misuse relative to Schedule III, cautions do apply. This schedule contains medications that are frequently prescribed for insomnia and anxiety disorders. These drugs, which include alprazolam, diazepam, and lorazepam, are frequently mentioned in overdose statistics involving opioids, and
expert guidance urges caution in their use and taper and particularly discourages the combination with opioids unless deemed necessary. 13,20,21 Schedule V contains drugs with limited quantities of opioids that include cough preparations, containing no more than 200 milligrams of codeine per 100 milliliters or per 100 grams. Although this lower schedule has less misuse danger relative to other schedules, patients prescribed any CS still must be managed with care. Part of the role of the DEA is to ensure medications are not diverted for misuse. Table 2 contains common terms associated with the use and misuse of opioids and other prescription drugs that are categorized under CS schedules. 5 The DEA provides manuals for HCPs and other practitioners to keep abreast of federal requirements in implementing the CSA. 22 As of this writing, the DEA Diversion Control Division is currently updating all manuals but did issue an updated pharmacist’s manual as of 2020.
Book Code: TN24CME
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