As a physician, you will likely, or have already, prescribed medications that fall under a drug classification schedule. These classification schedules were created by the Government, around 1970, when they realized there was a major drug epidemic going on in the United States.
The Drug Enforcement Administration was tasked with classifying all dangerous drugs into five different schedules.
How is a Drug Evaluated for Scheduling?
Evaluating a drug for scheduling is not an easy job. There are many factors that help determine just how dangerous a drug can be and which schedule it should fall under.
One factor focuses on whether the drug has a potential for abuse. Another factor is safety and third, how addictive the drug may be. Finally, they determine if the drug has any medical applications.
Once evaluated, drugs are placed into schedules, starting from 1, or the worst, to schedule 5, the least problematic.
Schedule 1 classification means the drug in question is very dangerous and, in some cases, can be fatal. It means the drug has a high potential for abuse and addiction and it does not have a medical application.
One of the drugs that fall under schedule 1 is marijuana. There are many fighting to take marijuana, or cannabis, out of schedule 1 simply because marijuana is showing that it can be beneficial in treating illnesses.
This is the reason several states have legalized it for medical use. Some have even legalized it for recreational use.
On the federal level, however, it is still considered a schedule 1 substance and if caught with it, can bring considerable consequences.
The drugs that fall under schedule 1, other than marijuana, include heroin, LSD, Peyote, MDMA, GHB, ecstasy, psilocybin, synthetic marijuana, Quaaludes, Khat, and Bath Salts.
Schedule 1 drugs can lead to serious consequences when abused. Aside from fines and jail time, they can do bodily damage and can even be fatal.
Drugs listed in this category are considered to have a high risk for physical and mental dependence, leading to addiction and abuse. Narcotics such as morphine, opium, codeine, and hydrocodone.
Narcotics can be stimulants and relaxants. They all fall under schedule two classification. For instance, schedule two stimulants include cocaine, amphetamine and methamphetamine. Non-stimulating narcotics include methadone, hydromorphone, Demerol, oxycodone, oxycontin, and fentanyl.
This classification of drugs can lead to severe addictive tendencies which can lead to respiratory problems and even death.
The potential for abuse and addiction with schedule 3 drugs are less than that of schedule one and two. In fact, schedule 3 chemicals have a moderate to low potential for physical and psychological dependence.
Drugs in this classification Xanax, Klonipin and Soma. Also included are valium, Ativan and Restoril. Vicodin is also on this list, if the dose is less than 15 milligrams, and less than 90 milligrams of codeine.
Other drugs associated with schedule 3 classification include anabolic steroids, testosterone and ketamine.
With this schedule, dosage becomes a determinant. The lower the dose, the less damage it can do.
Schedule 4 drugs are not considered as dangerous, with less potential for physical and psychological dependence. While these drugs can also appear in other schedules, the dosage provides the difference as to why some are more harmful than others.
All the schedule 4 drugs are at the lowest doses. The drugs are Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin and Ambien.
The legal penalties are much smaller than the higher scheduled drug classifications but can still include both jail time and hefty fines, if someone is caught having them illegally in their possession.
Drugs in this classification have very limited amounts of narcotics and are typically used for preparations of medicines to address issues such as analgesic purposes.
Drugs such as anti-diarrheal, anti-tussive and minor pain medicines are examples. Specifically, cough medicines with less than 200 milligrams of codeine, Lomotil, Lyrica, moto fen, and parapectolin.
Abuse of these medicines can still occur and can lead to legal problems. However, the potential for physical or psychological dependence is extremely low.
Dispensing Controlled Substances
You can dispense schedule II through V class of drugs only and you must follow all Drug Enforcement Administration rules strictly.
Each schedule of drugs has specific and detailed prescription filling regulations.
Schedule II drugs include morphine and amphetamines. Physicians cannot fax or email prescriptions. Schedule II prescriptions are only valid for 90 days. They cannot be refilled and are limited to a 30-day supply.
Schedule III drugs are valid for 180 days or up to five refills. A maximum of 30-day supply. This class of drugs can be faxed but not emailed.
Schedule IV and V drugs can be faxed and given orally. You may dispense up to a 90-day supply for drugs that fall under this category. These are also valid for 180 days or up to five refills.
Repackaged medicines are the best way to dispense controlled substances to your patients. Repackaging of narcotics and other controlled substances has very strict quality control processes. Controlled substances are coded and labeled. Meaning, they are traceable all the way back to the manufacturer.
This provides you and your patients with the reassurance that if a medication is stolen or misused, it can be tracked to verify where the medicine originated and for whom or what it was intended.
Because of the many quality control processes of repackaging facilities, you can feel confident prescribing repackaged medication to your patients because they go above and beyond ordinary standards.
Governments have established programs called the prescription drug monitoring program to help physicians verify whether or not a patient has been listed as an abuser of certain drugs. This monitoring system has been a terrific way to prevent patients from doctor shopping.
If you want to dispense controlled substances, there are many rules and regulations you must follow. But providing this type of service to your patients is well worth the efforts needed to implement the program.