Uses Drugs of Abuse—Origins and Effects - Scheduling Of Drugs

The federal strategy to reduce illicit drug use is based on the Comprehensive Drug Abuse Prevention and Control Act of 1970, Title II (PL 91-513)—commonly called the Controlled Substances Act. This act establishes the criteria for "scheduling," or categorizing, all substances regulated under existing federal law. (See Table 2.1.)

• Schedule I—These drugs have a high potential for abuse and have no currently accepted medical use in treatment in the United States. Included in this class are heroin; most hallucinogens, such as LSD and MDMA (Ecstasy); and the members of the cannabis family, including marijuana and hashish.
• Schedule II—These drugs also have a high potential for abuse but have been accepted for medical use in the United States, with severe restrictions. Abuse of these drugs may lead to severe psychological or physical dependence. Opium, morphine, PCP, methamphetamine, methadone, certain barbiturates, and cocaine are some of the drugs in this schedule. A number of painkillers that were once Schedule III substances, including oxycodone and hydrocodone, were reclassified as Schedule II in 2004.
• Schedule III—The drugs in this class have less potential for abuse than those in the first two schedules. They are currently accepted for medical use in the United States, but abuse may lead to moderate or low physical dependence or high psychological dependence. Included in this category are anabolic steroids and some barbiturates.
• Schedule IV—These drugs have even less potential for abuse than those in Schedule III and are currently accepted for medical use in the United States. Abuse may lead to limited physical and psychological dependence. Darvon, Equanil, Valium, and Xanax are included here.
• Schedule V—These drugs have a lower potential for abuse than those in Schedule IV. They are accepted for medical use, but abuse may lead to limited physical or psychological dependence. Some narcotics used for antidiarrheal or antitussive (cough suppressing) purposes are included here.

While less addictive than Schedule I and II drugs, Schedule III, IV, and V drugs can be very dangerous to an abuser's health. A significant black market has developed for these drugs. Drug abusers visit their doctors complaining of a problem they know will likely be treated by a drug they desire. If the physician is fooled, he or she writes a prescription, which the drug abuser has filled at a pharmacy. The abuser then either uses the drugs personally or sells them to another addict.

Considerations in Determining the Schedule

According to the Drug Enforcement Administration (DEA) (http://www.usdoj.gov/dea/pubs/csa/811.htm#c], in structuring the regulatory requirements shown in Table 2.2, federal agencies must first consider eight specific factors:

• The drug's actual or relative potential for abuse.
• Scientific evidence of its pharmacological effect, if known.
• The state of current scientific knowledge about the drug.
• Its history and current pattern of abuse.
• The scope, duration, and significance of abuse.
• The risk, if any, to public health.
• The drug's psychological or physiological "dependence liability" (the chance that the user may become addicted to it).
• The substance's potential to be a source for a drug already regulated under federal law.

TABLE 2.1
Uses and abuses of controlled substances

Drugs	CSA schedules	Trade or other names	Medical uses	Dependence		Tolerance	Duration (hours)	Usual method	Possible effects	Effects of overdose	Withdrawal syndrome
				Physical	Psychological
Narcotics
Heroin	Substance I	Diamorphine, horse, smack, black tar, chiva, negra (black tar)	None in U.S., Analgesic antitussive	High	High	Yes	3-4	Injected,snorted, smoked	Euphoria, drowsiness, respiratory depression constricted pupils, nausea	Slow and shallow breathing, clammy skin, convulsions, coma, possible death	Watery eyes, runny nose, yawning, loss of appetite, irritability, tremors, panic, cramps, nausea, chills and sweating
Morphine	Substance II	MS-contin, Roxanol, Oramorph SR, MSIR	analgesic,	High	High	Yes	3-12	Oral, injected
Hydrocodone	Substance II, product III, V	Hydrocodone w/Acetaminophen, Vicodin, Vicoprofen, Tussionex, Lortab	Analgesic, antitussive	High	High	Yes	3-6	Oral
Hydromorphone	Substance II	Dilaudid	Analgesic	High	High	Yes	3-4	Oral, injected
Oxycodone	Substance II	Roxicet, Oxycodone w/Acetaminophen, OxyContin, Endocet, Percocet, Percodan	Analgesic	High	High	Yes	3-12	Oral
Codeine	Substance II, products III, V	Acetaminophen, Guaifenesin or Promethazine w/Codeine, Fiorinal, Fioricet or Tylenol w/Codeine	Analgesic, anititussive	Moderate	Moderate	Yes	3-4	Oral, injected
Other narcotics	Substance II, III, IV	Fentanyl, Demerol, Methadone, Darvon, Stadol, Talwin, Paregoric, Buprenex	Analgesic, antidiarrheal, antitussive	High-low	High-low	Yes	Variable	Oral, injected snorted, smoked
Depressants
Gamma hydroxybutyric acid	Sub I, product III	GHB, Liquid Ecstasy, Liquid X, Sodium Oxybate, Xyrem®	None in U.S., anesthetic	Moderate	Moderate	Yes	3-6	Oral	Slurred speech, depression, drunken behavior without odor of alcohol, impaired memory of events, interacts with alcohol	Shallow respiration, clammy skin, dilated pupils, weak and rapid pulse, coma, possible death
Anxiety, insomnia, tremors, delirium, convulsions, possible death	Benzodiazepines	Substance IV	Valium, Xanax, Halcion, Ativan, Restoril, Rohypnol (Roofies, R-2), Klonopin	Antianxiety, sedative, anticonvulsant, hypnotic, muscle relaxant	Moderate	Moderate	Yes	1-8	Oral, injected
Other depressants	Substance I, II, III, IV	Ambien, Sonata, Meprobamate, Chloral Hydrate, Barbiturates, Methaqualone (quaalude)	Antianxiety, sedative, hypnotic	Moderate	Moderat e	Yes	2-6	Oral

TABLE 2.1
Uses and abuses of controlled substances [CONTINUED]

				Dependence
Drugs	CSA schedules	Trade or other names	Medical uses	Physical	Psychological	Tolerance	Duration (hours)	Usual method	Possible effects	Effects of overdose	Withdrawal syndrome
Stimulants
Cocaine	Substance II	Coke, flake, snow, crack, coca, blanca, perico, nieve, soda	Local anesthetic	Possible	High	Yes	1-2	Snorted, smoked, injected	Increased alertness, excitation, euphoria, increased pulse rate & blood pressure, insomnia, loss of appetite	Agitation, increased body temperature, hallucinations, convulsions, possible death	Apathy, long periods of sleep, irritability, depression, disorientation
Amphetamine/ methamphetamine	Sub II	Crank, ice, cristal, krystal meth, speed, Adderall, Dexedrine, Desoxyn	Attention deficit/ hyperactivity disorder, narcolepsy, weight control	Possible	High	Yes	2-4	Oral, injected, smoked
Methylphenidate	Substance II	Ritalin (Illy's), Concerta, Focalin, Metadate	Attention deficit/ hyperactivity disorder, narcolepsy, weight control	Possible	High	Yes	2-4	Oral, injected, snorted, smoked
Other Stimulants	Substance III, IV	Adipex P, Lonamin, Prelu-2, Didrex, Provigil	Vasoconstriction	Possible	Moderate	Yes	2-4	Oral
Hallucinogens
MDMA and analogs	Substance I	(Ecstasy, XTC, Adam), MDA (love drug), MDEA (eve), MBDB	None	None	Moderate	Yes	4-6	Oral, snorted, smoked	Heightened senses, teeth grinding and dehydration	Increased body temperature, electrolyte imbalance, cardiac arrest	Muscle aches, drowsiness, depression, acne	LSD	Substance I	Acid, microdot, sunshine, boomers	None	None	Unknown	Yes	8-12	Oral
z Phencyclidine and analogs	Sub I, II, III	PCP, angel dust, hog, loveboat, Ketamine (special K), PCE, PCPy, TCP	Anesthetic (Ketamine)	Possible	High	Yes	1-12	Smoked, oral, Injected snorted	Illusions and hallucinations, altered perception of time and distance	(LSD) Longer, more intense "trip" episodes	None
Other hallucinogens	Substance I	Psilocybe mushrooms, mescaline, peyote cactus, Ayahausca, DMT, Dextromethorphan* (DXM)	None	None	Possible	4-8	Oral		Unable to direct movement, feel pain, or remember	Drug seeking behavior *Not regulated
Cannabis
Marijuana	Substance I	Pot, grass, sinsemilla, blunts, mota, yerba, grifa	None	Unknown	Moderate	Yes	2-4	Smoked, oral	Euphoria, relaxed inhibitions, increased appetite, disorientation	Fatigue, paranoia, possible psychosis	Occasional reports of insomnia, hyperactivity, decreased appetite
Tetrahydrocannabinol	Sub I, product III	THC, Marinol	Antinauseant, appetite stimulant	Yes	Moderate	Yes	2-4	Smoked, oral
Hashish and hashish oil	Substance I	Hash, hash oil	None	Unknown	Moderate	Yes	2-4	Smoked, oral
Anabolic steroids
Testosterone	Substance III	Depo Testosterone Sustanon, Sten, Cypt	Hypogonadism	Unknown	Unknown	Unknown	14-28 days	Injected	Virilization, edema, testicular atrophy, gynecomastia, acne, aggressive behavior	Unknown	Possible depression
Other anabolic steroids	Substance III	Parabolan, Winstrol, Equipose, Anadrol, Dianabol, Primabolin- Depo, D-Ball	Anemia, breast cancer	Unknown	Yes	Unknown	Variable	Oral, injected

TABLE 2.1
Uses and abuses of controlled substances [CONTINUED]
SOURCE: Donald E. Joseph, ed., "Drugs of Abuse/Uses and Effects," in Drugs of Abuse, 2005 Edition, U.S. Department of Justice, Drug Enforcement Administration, 2005, http://www.usdoj.gov/dea/pubs/abuse/index.htm (accessed February 11, 2005)

				Dependence
Drugs	CSA schedules	Trade or other names	Medical uses	Physical	Psychological	Tolerance	Duration (hours)	Usual method	Possible effects	Effects of overdose	Withdrawal syndrome
Inhalants
Amyl and butyl nitrates		Pearls, poppers, rush, lockerroom	Angina (Amyl)	Unknown	Unknown	No	1	Inhaled	Flushing, hypotension, headache	Methemoglobinemia	Agitation
Nitrous oxide		Laughing gas, baloons, whippets	Anesthetic	Unknown	Low	No	0.5	Inhaled	Impaired memory, slurred speech, drunken behavior, slow onset vitamin deficiency, organ damage	Vomiting, respiratory depression, loss of consciousness, possible death	Trembling, anxiety, insomnia, vitamin deficiency, confusion, hallucinations, convulsions
Other inhalants		Adhesives, spray paint, hair spray, dry cleaning fluid, spot remover, lighter fluid	None	Unknown	High	No	0.5-2	Inhaled
Alcohol		Beer, wine, liquor	None	High	High	Yes	1-3	Oral

TABLE 2.2
Regulatory requirements for controlled substances
SOURCE: Donald E. Joseph, ed., "Regulatory Requirements: Controlled Substances," in Drugs of Abuse, 2005 Edition, U.S. Department of Justice, Drug Enforcement Administration, 2005, http://www.usdoj.gov/dea/pubs/abuse/index.htm (accessed February 11, 2005)

	Schedule I	Schedule II	Schedule III	Schedule IV	Schedule V
Registration	Required	Required	Required	Required	Required
Recordkeeping	Separate	Separate	Readily retrievable	Readily retrievable	Readily retrievable
Distribution restrictions	Order forms	Order forms	Records required	Records required	Records required
Dispensing limits	Research use only	Rx: written; no refills	Rx: written or oral; refills note 1	Rx: written or oral; refills note 1	OTC (Rx drugs limited to M.D.'s order)
Manufacturing
Security	Vault/safe	Vault/safe	Secure storage area	Secure storage area	Secure storage area
Manufacturing
Quotas	Yes	Yes	No, but some drugs limited by schedule II	No, but some drugs limited by schedule II	No, but some drugs limited by schedule II
Import/export
Narcotic	Permit	Permit	Permit	Permit	Permit to import; declaration to export
Import/export
Non-narcotic	Permit	Permit	Note 2	Declaration	Declaration
Reports to DEA by manufacturer/ distributor
Narcotic	Yes	Yes	Yes	Manufacturer only	Manufacturer only
Reports to DEA by manufacturer/ distributor
Non-narcotic	Yes	Yes	Note 3	Note 3	No