Opioids And The Mysteries of DEA Schedule V

Read on

I was reviewing the official Federal government Schedules for Controlled Substances the other day, and found some information that astounded me: Schedule V- the most lenient of all prescription regimes- includes the following drugs:

Narcotic drugs. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation containing any of the following narcotic drugs and their salts, as set forth below:

(1) [Reserved]

(2) [Reserved]

(c) Narcotic drugs containing non-narcotic active medicinal ingredients. Any compound, mixture, or preparation containing any of the following narcotic drugs, or their salts calculated as the free anhydrous base or alkaloid, in limited quantities as set forth below, which shall include one or more non-narcotic active medicinal ingredients in sufficient proportion to confer upon the compound, mixture, or preparation valuable medicinal qualities other than those possessed by narcotic drugs alone:

(1) Not more than 200 milligrams of codeine per 100 milliliters or per 100 grams.

(2) Not more than 100 milligrams of dihydrocodeine per 100 milliliters or per 100 grams.

(3) Not more than 100 milligrams of ethylmorphine per 100 milliliters or per 100 grams.

(4) Not more than 2.5 milligrams of diphenoxylate and not less than 25 micrograms of atropine sulfate per dosage unit.

(5) Not more than 100 milligrams of opium per 100 milliliters or per 100 grams.

(6) Not more than 0.5 milligram of difenoxin and not less than 25 micrograms of atropine sulfate per dosage unit.

After all these years, it’s still possible to legally obtain opium and codeine in liquid elixir form with a refillable prescription. (and a new one on me, ethylmorphine. According to one review I read online, “typical opiate high.”)

Only just now have I realized that what the youngers call “Lean” has always been “more legal” than Weed, which President Trump (?) just shifted from Schedule I to Schedule III. Which is still more restrictive than Schedule V.

Technically, Trump (or any other presidential administration) could officially ordain cannabis as strictly Schedule III, prescription-only, and direct that non-prescription sources of cannabis a/o “unauthorized use” be made a “law enforcement priority”. (This would be the domestic policy equivalent of invading China. But observing the world c.2026, all bets are off. I mean, someone might actually want that level of disaster.) From the link supplied below for Schedule III: “No prescription for a controlled substance listed in Schedule III or IV shall be filled or refilled more than six months after the date on which such prescription was issued. No prescription for a controlled substance listed in Schedule III or IV authorized to be refilled may be refilled more than five times…”

Meanwhile, Schedule V is, from a legal standpoint, comparatively cool. Let’s get into the tall weeds of it:

§ 1306.26 Dispensing without prescription.

A controlled substance listed in Schedules II, III, IV, or V which is not a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act, may be dispensed by a pharmacist without a prescription to a purchaser at retail [italics mine], provided that:

(a) Such dispensing is made only by a pharmacist (as defined in part 1300 of this chapter), and not by a nonpharmacist employee even if under the supervision of a pharmacist (although after the pharmacist has fulfilled his professional and legal responsibilities set forth in this section, the actual cash, credit transaction, or delivery, may be completed by a nonpharmacist);

(b) Not more than 240 cc. (8 ounces) of any such controlled substance containing opium, nor more than 120 cc. (4 ounces) of any other such controlled substance nor more than 48 dosage units of any such controlled substance containing opium, nor more than 24 dosage units of any other such controlled substance may be dispensed at retail to the same purchaser in any given 48-hour period;

(c) The purchaser is at least 18 years of age;

(d) The pharmacist requires every purchaser of a controlled substance under this section not known to him to furnish suitable identification (including proof of age where appropriate);

(e) A bound record book for dispensing of controlled substances under this section is maintained by the pharmacist, which book shall contain the name and address of the purchaser, the name and quantity of controlled substance purchased, the date of each purchase, and the name or initials of the pharmacist who dispensed the substance to the purchaser (the book shall be maintained in accordance with the recordkeeping requirement of § 1304.04 of this chapter); and

(f) A prescription is not required for distribution or dispensing of the substance pursuant to any other Federal, State or local law.

(g) Central fill pharmacies may not dispense controlled substances to a purchaser at retail pursuant to this section.

[36 FR 7799, Apr. 24, 1971, as amended at 36 FR 18733, Sept. 21, 1971. Redesignated at 38 FR 26609, Sept. 24, 1973, and further redesignated and amended at 62 FR 13966, Mar. 24, 1997; 68 FR 37411, June 24, 2003]

This situation, which is already written into the letter of the law, does not appear to me to be terribly different from ideas I’ve brought up in my earlier posts, about allowing opioid addicts to have over-the-counter access to mild opioids in restricted quantities with ID accountability and proof of age. I find some of the language unclear. But it certainly doesn’t rule it out.

I have to mention that I haven’t yet looked into the States and their separate provisions for regulating or prohibiting these Schedule V substances. But as I continue to learn more, I’m realizing that at least some localities and physicians are already prescribing Schedule III and Schedule IV opioids for the purpose of drugs maintenance with Telemedicine.

Abridged and copied verbatim from from the original source, complicated lawyer shit and all:

1306.51 Telemedicine prescribing of schedule III-V medications for the treatment of Opioid Use Disorder.

(1) Prescription drug monitoring program review. The prescribing practitioner must be authorized to access the applicable prescription drug monitoring program (PDMP) data of the state in which the patient is located at the time of the telemedicine encounter. The prescribing practitioner shall review such data regarding any controlled substance prescriptions issued to the patient in the last year, or, if less than one year of data is available, in the entire available period. The prescribing practitioner shall ensure the date and time of such a review is annotated in the patient’s electronic health record (EHR) or paper record. This review, or attempted review, must be conducted prior to issuing a prescription in a manner authorized under this section.

(2) Time limit. The practitioner may issue prescriptions to the patient pursuant to this section for a period not to exceed six calendar months beginning on the date the first prescription is issued. The practitioner may issue additional prescriptions to the patient for schedule III-V controlled substances approved by the FDA for use in the treatment of OUD [italics mine.] either:

(i) After the prescribing practitioner has conducted at least one in-person medical evaluation of the patient, as defined in 21 U.S.C. 829(e)(2)(B); or

(ii) As otherwise authorized by 21 U.S.C. 829(e), including pursuant to any other form of telemedicine as defined in 21 U.S.C. 802(54) or pursuant to practices as determined by regulation issued pursuant to 21 U.S.C. 829(e)(3)(B).

This ease of opioid prescription- and even possibly “controlled nonprescription” access- is news to me. Some of the provisions are a quite recent amendment.

But can it really be true that daily clinic appointments to receive opioids (chiefly methadone) are no longer mandated for people seeking to step off of their opioid addictions

How come this isn’t more widely known by the public?