Schedule II/IIN Controlled Substances Substances in this class have a high potential for abuse that may lead to severe psychological or physical dependence, and they also have accepted medical use (DEA, 2018b). Examples of Schedule II narcotics: ● Codeine. ● Hydrocodone (Vicodin, Zohydro ER). ● Hydromorphone (Dilaudid).
● Clonazepam (Klonopin). ● Clorazepate (Tranxene). ● Diazepam (Valium). ● Eszopiclone (Lunesta). ● Lorazepam (Ativan). ● Midazolam (Versed). ● Modafinil (Provigil). ● Phenteramine (Adipex-P). ● Temazepam (Restoril).
● Methadone (Dolophine). ● Meperidine (Demerol). ● Morphine (MSContin, Roxanol). ● Opium. ● Oxycodone (Roxicodone, OxyContin, Percocet). ● Fentanyl (Sublimaze, Duragesic). Examples of Schedule IIN non-narcotics: ● Amobarbital. ● Amphetamine (Dexedrine, Adderall). ● Nabilone (Cesamet). ● Methamphetamine (Desoxyn). ● Methylphenidate (Ritalin). ● Pentobarbital. Schedule III/IIIN Controlled Substances
● Triazolam (Halcion). ● Zaleplon (Sonata). ● Zolpidem (Ambien). 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: ● Cough preparations containing not more than codeine 200 mg/100 mL or codeine 200 mg/100 mg (Robitussin AC, Phen- ergan with Codeine). ● Diphenoxylate (Lomotil). PAs are authorized to prescribe Schedule II-V in 44 states and DC. Five states allow III-V. However, PAs are not authorized to prescribe in Kentucky. Physicians directly oversee these practitio- ners, but PAs are considered “mid-level” practitioners. This des- ignation allows PAs and other healthcare providers to prescribe controlled substances. State by state requirements can be ac- cessed here https://deadiversion.usdoj.gov/drugreg/practioners/ mlp_by_state.pdf Self-Assessment Quiz Question #1 If there is accidental ingestion of a known or unknown substance with no respiratory distress, who 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). Physician Assistance (PAs)
Substances in this schedule have less of a potential for abuse than substances in Schedules I and II, and abuse may lead to low to moderate physical dependence and high psychological depen- dence (DEA, 2018b). Examples of Schedule III narcotics: ● Products containing no more than 90 mg of codeine (Tylenol with Codeine). ● Buprenorphine (Suboxone). Examples of Schedule IIIN non-narcotics: ● Benzphetamine (Didrex). ● Butalbital (Fiorinal). ● Dronabinol (Marinol). ● Ketamine. ● Anabolic steroids. ● Testosterone (Androderm). Schedule IV Controlled Substances Substances in this schedule have a low potential for abuse relative to substances in Schedule III (DEA, 2018b). Examples of Schedule IV controlled substances:
● Alprazolam (Xanax). ● Carisoprodol (Soma).
MEDICAL MARIJUANA LEGISLATION
Medical marijuana refers to using the whole, unprocessed mari- juana 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 1 controlled substance due to the lack of scientific research. However, a growing body of literature (scientific and an - ecdotal) has led to the increasing use of medical marijuana for various conditions, including pain, seizures, posttraumatic stress disorder (PTSD), and other disorders. 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, over 50% of the states and the District of Columbia have legalized marijuana, while other states maintain restricted access. In 2013, the federal government took a lenient approach to federal law enforcement regarding marijuana and provided guidance allowing states to legalize medical marijuana. However, in January 2018, this memo was rescinded (DOJ, 2018), and now the status of state-level legalization of medical marijuana is uncertain. The medical marijuana debate has highlighted the issue of state rights versus the federal government. Since 2018, another 19 states have legalized recreational marijuana, and 39 states have legalized medical marijuana. Attorney General Mer-
rick Garland has reiterated that the Department of Justice will not prioritize prosecuting marijuana use “given the nation’s ongoing opioid and methamphetamine epidemic[s].” 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 the recommendations for types of legal, medical marijuana. In addition, states may require individuals to obtain a medical marijuana card, allowing them to purchase medical marijuana from a dispensary. Medical marijuana products vary from plant to extracted oils or edible products (e.g., cookies, butters, lozenges, and others). 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 pre- scription 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 I. While Epidiolex is FDA-approved for treating seizures related to Lennox-Gastaut syndrome and Dra-
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