government continues to focus on drug abuse in general, but has become increasingly aware of the problem of prescription drug abuse in particular. In addition, nongovernmental organizations such as the National Coalition Against Prescription Drug Abuse (NCAPDA), founded in 2010, work to further raise awareness of this growing national problem (NCAPDA, n.d.).
be imposed (U.S. Department of Justice, n.d.). It also provided for the establishment of the Office of National Drug Control Policy, which works to reduce drug use and its consequences by leading and coordinating the development, implementation, and assessment of U.S. drug policy (Executive Office of the President, Office of National Drug Control Strategy [ONDCS], n.d.a). Today, The scope of the problem In 2017, an estimated 6% of U.S. adults older than age 26 had used prescription drugs for nonmedical purposes for the first time within the past year. Also in 2017, statistics showed that as
many as 14% of young adults aged 18 to 25 were currently using prescription psychotherapeutic drugs for reasons other than those intended (NIDA, n.d.f).
Table 1: Definition of Controlled Substance Schedules Drugs and other substances that are considered controlled substances under the Controlled Substances Act (CSA) are divided into five schedules. An updated and complete list of the schedules is published annually in Title 21 Code of Federal Regulations (C.F.R.) §§ 1308.11 through 1308.15 . Substances are placed in their respective schedules based on whether they have a currently accepted medical use in treatment in the United States, their relative abuse potential, and likelihood of causing dependence when abused. Some examples of the drugs in each schedule are listed here.
Schedule I Controlled Substances Schedule II Controlled Substances
● Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse. ● Some examples of substances listed in Schedule I are heroin, lysergic acid diethylamide (LSD), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine (“Ecstasy”). ● Substances in this schedule have a high potential for abuse that may lead to severe psychological or physical dependence. ● Examples of Schedule II narcotics include hydromorphone, methadone, meperidine, oxycodone, and fentanyl. Other Schedule II narcotics include morphine, opium, and codeine. ● Examples of Schedule II stimulants include amphetamine, methamphetamine, and methylphenidate. ● Other Schedule II substances include amobarbital, glutethimide, and pentobarbital. ● Substances in this schedule have less potential for abuse than substances in Schedules I or II, and abuse may lead to moderate or low physical dependence or high psychological dependence. ● Examples of Schedule III narcotics include combination products containing not more than 90 milligrams of codeine per dosage unit and buprenorphine. ● Examples of Schedule III non-narcotics include benzphetamine, phendimetrazine, ketamine, and anabolic steroids. ● Substances in this schedule have a low potential for abuse relative to substances in Schedule III. ● Examples of Schedule IV substances include alprazolam, carisoprodol, clonazepam, clorazepate, diazepam, lorazepam, midazolam, temazepam, and triazolam.
Schedule III Controlled Substances
Schedule IV Controlled Substances Schedule V Controlled Substances
● Substances in this schedule have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics. ● Examples of Schedule V substances include cough preparations containing not more than 200 milligrams of codeine per 100 milliliters or per 100 grams and ezogabine. Note. Adapted from “Controlled Substance Schedules,” by the U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control, n.d.a.. Retrieved from https://www.deadiversion.usdoj.gov/schedules/
United States makes up only 4.6% of the world’s population but uses 80% of the global supply of opioid pain relievers (Institute of Addiction Medicine, n.d.). Drug overdose deaths from opiates rose from 8,048 in 1999 to 47,600 in 2017. Deaths from opioid overdoses alone now outnumber deaths due to heroin and cocaine combined, and have increased six-fold in the past 20 years (NIDA, 2019a). Populations at risk for prescription drug abuse cross all demographic sectors, although the drug of choice may differ. Colleges, for example, have seen abuse of prescription stimulants. Nonmedical use of Adderall increased between 2009 and 2013, but decreased from 2013 to 2017 (NIDA, 2018i). Certain populations may be more at risk than others, including youth, women, and older adults; people between the ages of 18 and 25 have the highest reported rate of abuse of prescription drugs (NIDA, 2018i). Early prescription drug use for nonmedical reasons, particularly prior to age 21, is a predictor of future abuse (McCabe et al., 2007; NIDA, 2018i). Older adults, particularly women, are more likely to abuse prescription pain relievers than any other substances (Hemsing, 2016). The number of pregnant women with opioid use disorder (OUD) at labor and delivery more than quadrupled from 1999 to 2014, according to an analysis by the CDC. The babies born to these
Emergency room visits involving prescription drug abuse have seen alarming increases. Approximately 1.2 million emergency room visits in 2011 were attributed to misuse of prescription drugs. Narcotic pain reliever-related emergency room visits involving nonmedical use increased 117% from 168,379 visits in 2005 to 366,181 visits in 2011 (Crane, 2015). These numbers do not include hospital visits and deaths resulting from the effects of driving while impaired by prescription drug abuse, a number that still remains largely unknown. Admission to treatment facilities for prescription drug abuse and addiction has also increased more than for most other drug admissions. According to the 2017 Treatment Episode Data Sets Annual Report on Admissions to and Discharges from Publicly-Funded Substance Use Treatment, the most frequently reported primary substances abused in 2017 were opiates (34%), alcohol (29%), marijuana/ hashish (13%), stimulants (12%), and cocaine (5%), accounting for 93% of all admissions of patients aged 12 years and older. Additionally, the proportion of admissions aged 12 years or older for primary use of opiates other than heroin increased from 5% in 2007 to 10% in 2011 and 2012, before declining to 7% in 2017 (HHS, 2017). The most frequently abused prescription drugs are those used for the control of pain, particularly opioids (NIDA, 2018b). The
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