Complete Your CE Test Online - Click Here Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition. ©2018: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Elite Professional Education, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Elite Professional Education, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Elite Professional Education, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. Introduction Every day in the United States, about 7600 people aged 12 or older illegally consume a drug for the first time. In 2013, an estimated 21.6 million persons (8.7% of the population aged 12 or older) were classified with substance dependence or abuse. Of these, 4.3 million were dependent on illicit drugs alone, and another 2.6 million were dependent on both illicit drugs and alcohol [1,2,3]. To be maximally effective in reducing the use of controlled substances by unauthorized users, health care providers must have a thorough understanding of both the regulatory frameworks surrounding controlled substances and an appreciation for the current acceptable medical practices for prescribing controlled substances in clinical situations. This course will review both of these broad areas, although the focus will be on the non-opioid classes of controlled substances, since guidelines and practices for the responsible prescribing of opioid medications is covered in significant detail in other monographs that are part of this overall CME program. EBP Alert! Research shows that 8.7% of the U. S. population aged 12 or older were classified with substance dependence or abuse in 2013.This makes it imperative that nurses comprehend regulatory frameworks surrounding controlled substances as well as acquire the knowledge necessary to help prevent substance abuse and facilitate treatment for those who are abusers[1,2,3]. The Controlled Substances Act The Controlled Substances Act (CSA), signed into law in 1970, is the fundamental statutory framework for the manufacture, distribution, prescription, and use of controlled substances in the United States. The CSA addresses problems associated with the manufacture, distribution, and abuse of substances with no recognized medical use in the United States, as well as those with currently accepted medical uses. Since controlled drugs are important resources for the clinician, the CSA attempts to balance two competing needs: to maintain an adequate and uninterrupted supply of controlled substances for legitimate purposes, while simultaneously reducing their diversion and abuse [4]. Nursing consideration: Nurses need to stay up-to-date regarding legislation that impacts the administration of controlled substances. This is important because their ability to practice within legal parameters depends, in part, on their knowledge of laws that govern all facets of their practice. Schedules of controlled substances The drugs and other substances that are considered controlled substances under the CSA are divided into five schedules. A controlled substance is placed in its respective schedule based on whether it has a currently accepted medical use in the United States, and on its relative abuse potential and likelihood of causing dependence. Some examples of controlled substances in each schedule are outlined below [5]. Schedule I Substances Substances in this schedule have a high potential for abuse and have been determined to have no currently accepted medical use in the United States. There is a lack of accepted safety for use of the drug or other substance under medical supervision. Some examples of substances listed in Schedule I are heroin, LSD, peyote, and MDMA (ecstasy). Schedule II Substances Substances in this schedule have a high potential for abuse, which may lead to severe psychological or physical dependence. These medications do have a currently accepted medical use in the United States. Examples include many opioid pain medications such as hydrocodone and oxycodone, as well as stimulants such as amphetamine, methamphetamine, methylphenidate, and cocaine. Schedule III Substances Substances in this schedule have less potential for abuse than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence. These substances also have currently accepted medical uses in the United States. Examples include combination products containing not more than 90 mg of codeine per dosage unit (i.e., Tylenol with codeine®). Examples of Schedule III non-opioid drugs include benzphetamine, ketamine, and anabolic steroids such as oxandrolone. Schedule IV Substances Substances in this schedule have a lower potential for abuse than substances in Schedule III, and have currently accepted medical uses in the United States. Examples include alprazolam, clonazepam, diazepam, lorazepam, temazepam, and triazolam. Schedule V Substances Substances in this schedule have a lower potential for abuse than substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics. These are generally used for antitussive, antidiarrheal, and analgesic purposes. Examples include cough preparations containing not more than 200 mg of codeine per 100 milliliters (ml) or per 100 grams (g). Nursing consideration: Nurses must be able to differentiate among the various schedules and know what drugs “belong” to which schedule. This helps to identify potential for abuse as well as improves patient/family education [5]. Registration requirements for prescription of controlled substances The CSA attempts to create a closed system of distribution for controlled substances. A key feature of this system is the registration of all individuals and firms who handle controlled substances. Registration allows for accountability at all levels and includes a host of requirements related to maintaining complete and accurate inventories, records of all transactions involving controlled substances, and secure storage of controlled substances. DEA registration grants practitioners federal authority to handle controlled substances within their scope of practice; however, practitioners may be limited to only those activities that are authorized under state law for the jurisdiction in which their practice is located. When federal law or regulations differ from state law or regulations, the practitioner is required to abide by the more stringent aspects of either the federal or state requirements [6]. In many cases, state law is more stringent than federal law, and must be complied with in addition to Page 2