Marijuana, Alcohol, and Controlled Substances Categorization: What You Should Know

Andrew Siegel MD    4/30/2022

Controlled Substances Act

The Controlled Substances Act (CSA) was signed into law by President Nixon in 1970.  This legislation created five classes of drugs with the DEA (Drug Enforcement Agency) determining the placement of any given substance into one of five categories (schedules). This placement is based upon the substance’s accepted medical use, its potential for abuse, and liability for safety and dependence. The Act also provided the mechanism for a substance to be added, removed, or transferred to a different schedule.

The meaning of “accepted medical use” is obvious in most cases. However, the term “potential for abuse” is not clearly defined in this Act and the following are clues for a drug having the potential to be abused:

  • Use of a substance independent of advice from a medical practitioner
  • Use of a substance in amounts that are hazardous to one’s health
  • When there is a significant diversion of the substance from legitimate drug channels because of illegitimate use
  • When the substance is new but similar to other substances having abuse potential

“Physical dependence” is defined as the development of tolerance (increasing doses necessary to achieve the same effect) and withdrawal (symptoms occurring with the cessation of use of the substance). “Psychological dependence” is defined as the craving that occurs when one becomes physically addicted. 

The cornerstone of the Controlled Substances Act is the registration of anyone authorized by the DEA to handle controlled substances. A unique DEA number is assigned to anyone involved in the handling of these substances, including the importer, exporter, manufacturer, distributor, hospital, pharmacy, practitioner, and researcher. Every physician has a unique DEA number.

Substance Categorization

The categorizations of controlled substances range from Schedule I (high potential for psychological and physical dependence and abuse) to Schedule V (low potential). 

Schedule I

Heroin, LSD, marijuana, MDMA (ecstasy), peyote, quaaludes, psilocybin (psychedelic mushrooms)

Schedule II

Vicodin, cocaine, methamphetamine, methadone, Dilaudid, Demerol, OxyContin, Percocet, fentanyl, Dexedrine, Adderal, Ritalin, PCP (angel dust), Opium

Schedule II prescriptions must be written and signed by the practitioner using a prescription pad and cannot be phoned in except in an emergency and cannot be refilled.

As a urologist, I occasionally prescribe Vicodin or Percocet for post-operative pain or pain related to a kidney stone.

Schedule III

Tylenol with codeine, ketamine, anabolic steroids, testosterone

As a urologist, I occasionally prescribe Tylenol with codeine for post-operative pain and often prescribe testosterone for men with symptomatic hypogonadism.

Schedule IV

Xanax, Valium, Librium, Klonopin, Ativan, Soma, Darvon, Darvocet, Talwin, Tramadol, Ambien, Lunesta, Provigil

Schedule III and IV drugs may be prescribed by phone or written prescription and may be refilled up to five times within the six-month period dating from the time of the prescription.

As a urologist, I occasionally prescribe Tramadol for post-operative pain and occasionally prescribe Xanax or Valium for pre-procedure or pre-imaging anxiety or for insomnia.

Schedule V

Anti-diarrheal medications, analgesics, anti-cough medicines: Robitussin A-C, Lomotil, Motofen, Lyrica, Parepectolin

Schedule V drugs face restrictions above and beyond over-the-counter medications, including the requirement that the patient must be at least 18 years of age, must have identification, and must have their name entered into a special pharmacy log.

Why Isn’t Alcohol on the Schedule?

Interestingly, alcohol is not regulated under the Controlled Substances Act. Alcohol is so deeply ingrained (no pun intended) into our society that it gets a pass.  Clearly, alcohol has limited medical use, a high potential for abuse, and concerns for safety and dependence. The National Institute for Health (NIH) estimates that there are about 15 million Americans with alcohol abuse disorder.

Why is Marijuana on the Schedule?

Marijuana is listed as a schedule I drug — the same category as heroin! — when clearly it has acceptable medical value and a low potential for abuse, and it has been decriminalized or legalized in many states.  Go figure! Currently, medical marijuana is legal in 38 states and recreational marijuana is legal in 18 states. On April 21 New Jersey commenced sales of recreational marijuana.

Map of the USA showing states where medical marijuana is legal (green), recreational marijuana is legal (blue), marijuana is illegal (gray), marijuana is decriminalized (D).

(Attribution: Lokal_Profil, CC BY-SA 2.5 https://creativecommons.org/licenses/by-sa/2.5, via Wikimedia Commons)

Wishing you the best of health,

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro AreaInside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.  He is the co-founder of PelvicRx and Private Gym.  His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families. 

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours). 

Dr. Siegel’s other books:

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health

Video on THE KEGEL FIX

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

PROMISCUOUS EATING— Understanding and Ending O

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