Ask The Pharmacist: Marijuana and Controlled Substance Classifications
Jonathan Rowell, Pharm. D.
Clinical Pharmacist, Pharmacy Solutions
What are controlled substances and their regulations?
The Controlled Substances Act (CSA) classifies drugs regulated by the government into five schedules, ranging from Schedule I to Schedule V, based on their medical value and potential for abuse.
Recently, the U.S. Department of Justice (DOJ) proposed rescheduling marijuana from a Schedule I to a Schedule III controlled substance. This change follows a review requested by President Biden in 2022 and supported by medical and legal evaluations from the Department of Health and Human Services (HHS) and the Justice Department’s Office of Legal Counsel (OLC). The rulemaking process will include public notice, comments and an administrative hearing before any final decision is made.
Here's an Overview of the Five Schedules:
Schedule I Substances
Schedule I drugs are considered the most dangerous, with no currently accepted medical use and a high potential for abuse. Examples include heroin, LSD and ecstasy. Currently, marijuana is classified under this category, but this proposed change seeks to recognize its medical utility by moving it to Schedule III.
Schedule II Substances
These drugs have a high potential for abuse, which may lead to severe psychological or physical dependence, but they also have accepted medical uses. Examples include cocaine, methamphetamine and prescription painkillers like oxycodone and fentanyl. These substances require strict regulations for their prescription and use.
Schedule III Substances
Schedule III substances have a moderate to low potential for physical and psychological dependence. They have accepted medical uses and include drugs like anabolic steroids, ketamine and certain codeine products. The proposed rescheduling of marijuana to Schedule III reflects its recognized medical use and reduced potential for abuse compared to Schedule I drugs.
Schedule IV Substances
These drugs have a low potential for abuse and a lower risk of dependence. They’re widely accepted for medical use and include medications such as alprazolam (Xanax), diazepam (Valium) and tramadol. These substances are less strictly regulated but still require oversight.
Schedule V Substances
Schedule V substances have the lowest potential for abuse and consist of preparations containing limited quantities of certain narcotics. They’re used for medical purposes and include cough preparations with less than 200 milligrams of codeine per 100 milliliters, like Robitussin AC, and anti-diarrheal medications containing low doses of opium.
Implications of Rescheduling Marijuana and Its Impact on Workers’ Compensation
The proposed change to the marijuana drug schedule marks a significant step towards aligning federal and state policy, potentially transforming the future of marijuana regulation and use in the United States.
Currently, the Schedule I classification often excludes marijuana from workers’ compensation benefits, as it’s not recognized as a legitimate medical treatment under federal law. With rescheduling, marijuana could be more readily prescribed. This shift could lead to increased acceptance of marijuana as a treatment option. Employers, insurers and health care providers would need to adapt to this new landscape should reclassification happen, developing guidelines to manage the prescription and reimbursement of medical marijuana. For further details, you can read the full announcement here.
This information is meant to serve as a general overview, and any specific questions should be more fully reviewed with your health care professional such as the prescribing doctor or dispensing pharmacist.
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