In the United States the result has been a blend of science and law called "scheduling," set up in 1970 by the federal Comprehensive Drug Abuse Prevention and Control Act, which replaced all previous federal narcotics laws. (The legal definition of "narcotics" includes stimulants such as cocaine and hallucinogens such as LSD.) Scheduling is an ongoing process affected by the same influences that shape other laws. Sometimes Congress or a state legislature puts a drug in a particular schedule. Sometimes a federal or state official does so. Like all law, scheduling has an element of arbitrariness, enhanced as federal statutes interact with state laws and local ordinances. Nonetheless, even though results can be puzzling, basic principles in scheduling are clear.
In the United States drugs are either scheduled or unscheduled. Unscheduled drugs may be benign or highly dangerous, available over the counter or by prescription only, perhaps even available to children through a plant growing wild in the woods. A hospital emergency room may deal with someone who uses an unscheduled drug, but the U.S. Drug Enforcement Administration probably will not. Almost all drugs are unscheduled, whether they be pharmaceutical creations from a laboratory or natural products harvested from the soil.
Scheduled drugs are theoretically ranked by their potential for abuse. Not all abuse is addictive, but the rankings imply that some drugs are more of an addiction hazard than others. At the time this book was written, five schedules existed. Generally drugs in a lower-numbered schedule are considered more prone to abuse than those in higher-numbered schedules. Heroin is a Schedule I drug. A cough medicine available without prescription might be in Schedule V. Schedule I is also used for abused drugs having no medical use approved by regulatory agencies in the United States. Thus Schedule I includes marijuana even though decades of research have shown it to be more benign than most drugs listed in other schedules. Schedule I also includes some drugs (dextromoramide, dipipanone, phenoperidine, and others) used routinely by doctors in other countries but that lack approval from U.S. authorities. So although Schedule I is often viewed as a list of the most dangerous drugs, relatively harmless ones are listed if they are unapproved for medical use in the United States, while drugs that can easily kill even when administered in a hospital setting are listed in schedules indicating less danger of abuse. Still, the general rule is that drugs are scheduled according to their abuse potential, with drugs in lower-numbered schedules having more abuse potential than drugs in higher-numbered schedules. Some illicit drug makers try to avoid scheduling regulations altogether by tweaking the chemical composition of a substance just enough that it is no longer the molecule defined in a schedule. Such "designer drugs" remain legal until schedules are updated again.
Schedule I is for drugs ruled as being most prone to abuse, lacking generally accepted use in the American health care system, and being so dangerous that health practitioners cannot safely administer these drugs to patients. Except for specially authorized scientific studies, possession of a Schedule I substance is illegal under any circumstance. No physician can authorize a patient to use a Schedule I item. Schedule II is for drugs ruled as being most prone to abuse but in use in the American health care system and carrying the potential to cause major physical or mental dependence upon continued usage. Schedule III is for drugs ruled as being less prone to abuse; these are generally accepted by the American health care system but pose risks of "moderate or low" physical dependence or "high" psychological dependence. Schedule IV is for drugs ruled as being still less prone to abuse; these are generally accepted by the American health care system and are less likely to result in physical or psychological dependence than Schedule III substances. Schedule V is for drugs least prone to abuse; they are generally accepted by the American health care system and are less likely to result in physical or psychological dependence than Schedule IV compounds.
This book's alphabetical listings give each drug's federal schedule status. States also have schedules. At times, state and federal schedules may not "match" for a particular drug. For example, under international treaty the U.S. government put flunitrazepam in Schedule IV, but federal authorities believed it should be Schedule I. So states have been encouraged to put the substance in Schedule I. Sometimes federal authorities change a drug's schedule, and states may lag behind in conforming. For practical purposes, federal and state schedules have equal legal standing. A drug user who runs afoul of a state schedule can be punished as severely as a person who runs afoul of a federal schedule. A further complication is that although a drug that is unlisted in any schedule is presumed to be unscheduled, official pages of schedules do not necessarily specify all scheduled substances. Sometimes the official pages have not caught up with official decisions; sometimes a chemical is covered if it is derived from a scheduled substance, without a separate listing for the chemical being required. The list of sources at the end of this book tells how to find the official pages of schedules.
For many years, stimulants, depressants, and hallucinogens basically comprised the entire contents of schedules. In the 1990s another type of drug was added, anabolic steroids. Various types of steroids exist. The anabolics can be used to build muscle mass and have long been popular among athletes seeking an edge in competitions. Anabolic steroids can have other effects as well, effects particularly harmful to young persons whose bodies are still developing. Attainment of adult height can be thwarted, and sexual organs can be damaged. Rising concern about injury to younger athletes caused the strict regulations of scheduling to be applied to these drugs, although other types of control (requiring prescriptions and suppressing nonmedical sales) had long been in place.
Scheduling is an element of law enforcement. Penalties for illegal use or possession of a drug depend partly upon its schedule. A related purpose of scheduling involves control of scheduled substances through tracking prescriptions written by health care practitioners and by tracking inventory records of pharmacies.
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