The Failure of the Narcotic Scheduling System

Written by Adekunle O. Adejare PharmD'19
Published on October 26, 2017

The Drug Enforcement Agency’s (DEA) Drug Scheduling System is a way for the federal government to acknowledge that not all medications have the same risk for abuse. While some can only have therapeutic purposes, others can be used, or even abused, recreationally. To protect the public from the intrinsic danger that comes from abusing opioids, these medications are generally scheduled. So, to gain a more accurate view of the opioid epidemic, it is important to know how the scheduling system works as well as how it has succeeded and failed to protect the public.

The scheduling system has five levels. The theory behind the scheduling system is that every drug should be classified by the evidence that supports its potential for use and abuse. Schedule I drugs are known for high abuse potential with no medical benefit. Schedule V medications, may be difficult to abuse but still carry some risk. For example, heroin is a Schedule I medication, while cough medications containing codeine are generally placed in Schedule V. Most opiates that are used for pain are categorized as Schedule II. The scheduling system, along with other changes, has had an intrinsic impact as it has removed the ability of an individual to simply purchase highly abusable medications such as heroin in a pharmacy. This has added deterrence by making it harder to procure the drug. Yet the system has many flaws. The most notable flaw is when people realize a drug can be abused, the methodology for changing a drug’s scheduled level is too arbitrary. An example would be the scheduling of the drug kratom. Among the general public, most individuals use the opiate effects for the purpose of pain relief without any problems. However, after a sudden surge in illicit use, the DEA decided to change the schedule of kratom from an unscheduled drug to a Schedule I drug. The uproar over the sudden inaccessibility of the drug caused an incredible stir amongst its small, but benign community. The result, kratom was not scheduled. While the argument for the DEA to control kratom was based on sound logic, the overreaction of turning the drug into a Schedule I drug shows how the system, while well intentioned, can end with unintended consequences.

The current system of scheduling drugs has proven itself as particularly political in nature. The fact that drugs can move up and down the scheduling system is not helpful to prescribers or the general public. Since the current system is so mercurial in nature, the medical field is essentially tied to an arbitrary system that cannot accurately determine the patient’s needs and the risks associated with the chosen treatment regimen. In the grand scheme of the opioid epidemic the DEA’s willingness to push marijuana to Schedule I has limited the amount of research that has been conducted. It can be argued that it might have helped create the problem by over scheduling marijuana. Years later, with too little data to support its current placement, many states have begun allowing its usage for recreational or medical use with generally positive results. When the system has failed, it has done so in a particularly worrisome fashion. In acknowledging the failures of the current system, one can easily understand the negative ramifications that can come from poor scheduling of medications.

In summary, while the nation’s current scheduling system is adequate, the above examples highlight the intrinsic flaws that currently exist in the system. The fact that kratom was almost turned into a Schedule I drug but was not due to public backlash shows that the current system is as much evidence-based as it is politics-based. In the future, the nation may need to re-evaluate the current system. When this happens, an update to the current systematic scheduling process could yield benefits for any new drugs that may make their way onto the market.

Categories:  Mayes College of Healthcare and Business PolicyPublic HealthOpioidsPharmaceutical and Healthcare BusinessDepartment of Pharmaceutical and Healthcare BusinessHealth PolicyDepartment of Health Policy and Public HealthSubstance Use Disorders Institute