What Are Schedule I Drugs?

Medically reviewed by Alex Yampolsky, PharmD

The U.S. Drug Enforcement Administration (DEA) sets national standards for controlled substances per the Title 21 U.S. Code (USC) Controlled Substances Act (CSA). Controlled substances are subjected to high levels of government regulation.

The DEA maintains a list of controlled medications and illicit substances categorized from Schedules I to V (1 to 5), depending on the medication's medical use and potential for dependency and abuse. This law provides government oversight over the manufacturing and distribution of these substances.

Prescribers and dispensers must have a DEA license to supply these drugs. Schedule I drugs have the highest risk, while Schedule V drugs have the least potential for abuse.

Schedule I drugs include heroin, LSD (lysergic acid diethylamide), and cannabis (marijuana), among others. These drugs have the most potential for abuse, with the highest levels of dependency, and must not be used when not needed.

This article will provide a detailed analysis of the different categories of controlled substances and discuss the different drugs that comprise these sections.

Understanding Drug Schedules

Drugs, substances, or chemicals used to make medicines are classified into five distinct categories or schedules. Such categories are based on the drug's acceptable medical use, its potential for abuse or dependency, and its tendency to create physical or psychological dependence.

The five schedules, I to V, range from maximum (Schedule I) to least potential for abuse (Schedule V).

The content below defines each category of controlled substances and lists common drugs that comprise each category:

Schedule I

Schedule I drugs have no accepted medical use and safety under medical supervision in the United States, with a high potential for abuse and/or addiction.

Cannabis, for example, is legal in some states but is still classified as a Schedule I drug at the federal level.

In addition to cannabis, Schedule I drugs include heroin, LSD, and Ecstasy (3,4-methylenedioxymethamphetamine).

Schedule II

Schedule II drugs have some medically acceptable uses but a high potential for abuse and/or addiction. They are prescribed to treat severe pain, anxiety, insomnia, and attention deficit hyperactivity disorder (ADHD).

Examples of Schedule II narcotics include Dilaudid (hydromorphone), Percocet (oxycodone/acetaminophen), Demerol (meperidine), OxyContin (oxycodone), and Sublimaze (fentanyl).

Other Schedule II narcotics include codeine, morphine, and opium.

Examples of Schedule II stimulants include Adderall (amphetamine/dextroamphetamine), Desoxyn (methamphetamine), and Ritalin (methylphenidate).

Schedule III

Schedule III drugs have low to moderate potential for abuse and psychological addiction compared to Schedule I or II.

Medications in this category are often used for pain management, anesthesia, or appetite suppression. These drugs are available only on prescription and are generally unavailable over-the-counter (OTC).

Schedule III contains no more than 90 milligrams (mg) of codeine per dosage unit, such as Tylenol #3 (acetaminophen and codeine) and Suboxone (buprenorphine).

Examples of Schedule III nonnarcotics include benzphetamine, Ketalar (ketamine), and anabolic steroids, such as Depo-Testosterone (testosterone cypionate).

Schedule IV

Schedule IV drugs have viable medical use and low potential for use or misuse.

Examples of Schedule IV substances include: Xanax (alprazolam), Soma (carisoprodol), Klonopin (clonazepam), Tranxene (clorazepate), Valium (diazepam), Restoril (temazepam), and Halcion (triazolam).

Schedule V

Schedule V drugs possess lower abuse potential than Schedule IV drugs and above. They consist primarily of preparations containing limited quantities of certain narcotics.

Schedule V substances include cough preparations containing no more than 200 mg of codeine per 100 milliliters (mL) or 100 grams (g), such as Robitussin AC (guaifenesin and codeine) and promethazine with codeine.

Schedule I Drugs: Recreational and Medical Use

It is very challenging to regulate the use of Schedule I drugs.

One reason for this is that many of these drugs have proven health benefits, such as cannabis in the form of medical marijuana, as well as LSD. However, these drugs, while common, are often misused.

Nonetheless, legal restrictions are placed on the recreational use of controlled drugs to prevent drug misuse. For example, prescription drugs labeled as Schedule I, such as methaqualone (commonly known as quaaludes), are abused.

This drug has effects similar to heroin. Research data suggests that 4% to 6% of people who misuse prescription opioids switch to heroin.

What Are Designer Drugs?

A controlled substance analog (also called a "designer drug" or "legal high") is a substance intended for human consumption and is similar to a controlled drug.

A designer drug is a structural or functional analog of a controlled substance. It is made by altering the chemical structure to mimic the effects of the parent compound.

It is structurally or pharmacologically similar to or characterized as being similar to a controlled (Schedule I or Schedule II) substance. Also, it is not an approved medication in the United States.

Medical Marijuana

Cannabis, a Schedule I drug, is derived from the plant Cannabis sativa. However, as of August 2023, the Joe Biden administration has recommended that cannabis be reclassified from a Schedule I substance to Schedule III.

The term "medical marijuana" refers to the role of cannabis in treating medical conditions. In the United States, over one-half of the states have legalized marijuana for medical use.

In states where medical marijuana is legal, a healthcare provider gives a written statement to get the drug. It includes the explanation for using cannabis for a specific condition, with your name, to acquire it from an authorized seller.

Cannabis is sometimes prescribed to treat chronic pain, including nerve damage, nausea, and vomiting caused by chemotherapy for cancer, eating disorders, and human immunodeficiency virus (HIV)/AIDS.

Some studies show that cannabis relieves symptoms of multiple sclerosis (MS), Crohn's disease, inflammatory bowel disease (IBD), glaucoma, and epilepsy.

The Food and Drug Administration (FDA) has approved two artificial derivatives of cannabis, e.g., Marinol (dronabinol) and Cesamet (nabilone). They are available on prescription to treat medical conditions.

Know, however, that laws differ across states for the recreational use of cannabis.

Health Benefits of LSD

The Schedule I drug LSD has been used to treat anxiety, depression, psychosomatic diseases (physical illness caused by stress), and addiction.

However, most of the studies do not meet contemporary standards. It has taken several decades to revive interest in LSD research and its therapeutic potential for psychiatry.

New studies conforming to modern standards are necessary to strengthen the research regarding its use.

Historical Context of Schedule I Drugs

The Controlled Substances Act (CSA) established a federal policy that allowed the federal government to regulate the manufacture, distribution, import, export, and use of regulated substances.

The 91st U.S. Congress legislated the CSA in 1970, and it was signed into law by President Richard Nixon.

This law was an effort to combine all previous federal drug laws. It allows federal law enforcement of controlled substances and serves as the legal foundation in the fight against drug abuse.

The CSA also gives the DEA and the FDA the authority to control which substances are added or removed from drug schedules.

The United States has been striving for the safe and effective use of controlled drugs since the Pure Food and Drug Act of 1906, which required manufacturers to label any product containing dangerous substances such as alcohol, morphine, opium, and cannabis.

The Pure Food and Drug Act of 1906 has been amended several times over the following six decades, but the most significant change occurred in the early 1970s with the adoption of the CSA.

The cornerstone of the CSA is its classification system to regulate controlled substances.

Furthermore, the CSA ensures that a controlled substance prescription must meet several criteria, such as being issued by a healthcare practitioner for a legitimate medical purpose.

The CSA also requires drug prescribers to list their DEA-issued registration number on each controlled substance prescription.

Comparison With Other Drug Schedule

While the drug schedules mainly refer to a drug's medical value and the likelihood of substance misuse, they also classify drugs by their chemical makeup and how they interact with the brain and body, as follows:

• Schedule I contains drugs with little or no therapeutic value and is subjected to the most restrictive control. These drugs cannot be lawfully possessed or prescribed.

• Healthcare practitioners can prescribe drugs in Schedules II and III. These drugs can be legally possessed and supplied lawfully by anyone with a prescription (note that Schedule II drugs cannot be refilled). These are medically acceptable in particular cases for treating chronic pain or addiction. However, it is an offense contrary to the 1971 Act to keep any Schedule II or III drugs without a prescription or lawful authority.

• Substances in Schedule IV have a low potential for abuse relative to drugs in Schedules II and III. These drugs can only be lawfully possessed under prescription.

• Schedule V includes drugs with a limited amount of controlled drugs (narcotics) and are rarely available as OTC medicines.

Sometimes, a drug can be reclassified depending on its change in therapeutic uses. For example, in 2014, the DEA reclassified hydrocodone from Schedule III to Schedule II. However, reclassification is relatively rare.

Potential Legal Ramifications

It is illegal to prescribe, trade, sell, use, or possess Schedule I drugs. These are federally controlled substances under the CSA. There are strict penalties regarding the illegal possession of these drugs. Heavy fines and even jail are the consequences.

A detailed view of the legal penalties for possessing controlled substances from different schedules can be found on the DEA's official website.

The CSA drug scheduling information applies to drugs or substances regulated under federal law. There may be differences in laws between individual states and among state laws and federal law.

For example, there are drugs, specifically cannabis, that fall into Schedule I but have been legalized in many states for recreational or medical use.

Summary

The DEA sets national controlled substance standards and lists the drugs in five schedules. These schedules have been outlined in the Federal Comprehensive Drug Abuse Prevention and Control Act of 1970 guidelines. The legal restrictions on using controlled drugs are to prevent drug misuse.

The drugs are listed into five schedules depending on the drug's acceptable medical use and potential for abuse or dependency. Schedule I contains medications with no medical value and maximum potential for abuse, and Schedule V contains drugs with the least potential for abuse.

Schedule I contains heroin, LSD, cannabis, peyote, and Ecstasy. Certain derivatives of these drugs are FDA-approved for various medical conditions.

Always use the prescribed drug in the recommended dosage to avoid adverse side effects and to lower the risk of dependence on these drugs.

Frequently Asked Questions

How can I safely throw away Scheduled I drugs and substances?

Hospitals, clinics, and organizations using controlled substances must have policies and procedures to dispose of these substances and avoid potential drug diversion and environmental pollution.

Clinics and facilities using controlled substances must maintain adequate and detailed records, but individual healthcare systems impose specific requirements.

Return unused or expired medicines to the community-medicine return-back program or ask your pharmacist.

Where can I find more information on controlled substances?

If you have an addiction or dependence on a controlled drug or need additional information on the controlled drugs, visit government websites for up-to-date, reliable information, including the U.S. Department of Justice/Diversion Control Division for a list of controlled substances.

Read the original article on Verywell Health.