DEA Drug Scheduling: How Drug Policies Shaped the Opioid Crisis

News headlines punctuate the impact of the opiate crisis in America on a daily basis – detailing people dying, families impacted, crimes committed, and communities struggling to keep up. With the very tangible impact of opiates in the forefront of people’s minds, sometimes it is difficult to look beyond that and look at the policies and laws that govern drugs and understand how the best laid plans of lawmakers and policymakers may have played a role in the growth of opiate use and the difficulty many people face when trying to access treatment.

Understanding the framework that the federal government looks at drugs through helps explain a piece of how we have gotten to the place of having a rampant opiate epidemic without a clear resolution path in the United States. In 1970, during Richard Nixon’s presidency, the United States Congress passed the Comprehensive Drug Abuse Prevention and Control Act (CDAPCA), which included the Controlled Substances Act (CSA). Nixon then created the Drug Enforcement Agency (DEA) in 1973 to support the CDAPCA and subsequently consolidated several federal agencies into a singular agency that manages how drugs are classified, which guides medical usage and outlines the likelihood of abuse of each substance. The table below shows the structure of the various schedules, along with examples of their current classifications.

This drug scheduling framework provides the guidance to prescribers (doctors, psychiatrists, ARNPs, etc.) on the use (or limitations) of medications, which is also connected to insurance carriers who play a role in lobbying the government on policymaking for coverage for certain drugs and medications. All of the pieces of this puzzle have been designed by a governing body to “protect” the public, but have inadvertently played a substantial role in the opioid epidemic we are living through today. One of the perceived hopes of creating a drug scheduling system was to serve as a built-in warning system for medical providers and consumers alike. Think of it like the warning tags on consumer products like mattresses and hairdryers – Stop! Danger! Don’t Remove This Tag! If people know that a drug has a big risk of abuse or addiction, surely people won’t want to take it!

When I look at this table with the examples of different drugs, I don’t feel a sense of warning. Rather, my mind starts churning on how and why? Why is cannabis, which has a tremendously low chance of death or overdose, classified as having serious safety concerns, whereas fentanyl, which is responsible for thousands and thousands of deaths just last year, is classified as less dangerous? Why are the medication-assisted treatments for opiate addiction (methadone and buprenorphine) in different schedules? Why are medications like Xanax and Ativan (benzodiazepine), which are incredibly addictive and can lead to overdose categorized in Schedule IV? These are just some of the questions that lead many Americans to question the usefulness and accuracy of DEA drug scheduling.

The reality is that since the CSA was passed in 1970, the use of illicit drugs has steadily climbed. Different drugs have been en vogue at different points (for instance, crack and cocaine in the 1980s and opiates in the early 2000s, to name a couple), but overall have continued to trend upward. While the CSA and DEA drug scheduling have stayed relatively stagnant since their passage, there have been various programs by different federal and state agencies to attempt, in parallel, to control, solve, or cure the problem. From the highly publicized “War on Drugs” by Richard Nixon to the “Just Say No” campaign and mandatory minimum sentencing guidelines during Ronald Reagan’s administration, US citizens began experiencing a society that viewed substance use problems as a choice and a highly criminalized activity.

It's clear that the Controlled Substances Act (and all the subsequent departments and programs) were designed with the hope of protecting public health. However, the inherently rigid and potentially outdated framework has contributed to the reality Americans are facing on a daily basis, such as overdose, difficulties in accessing care, appropriate medical interventions, and engagement with the legal and prison-industrial system. The American people would be better served by a more nuanced approach to drug scheduling – one that takes into account the disease model of addiction, care and compassion for the individual, and a focus on treatment and prevention over criminalization.

‍‍**Please note: This post is for educational purposes only. This post does not constitute medical advice and is not intended as a substitute for professional medical advice, diagnosis, or treatment, and readers are advised to consult with a qualified healthcare professional for any medical concerns or conditions. The views expressed may not reflect those of all healthcare professionals

References

Alpert, A., Dykstra, S., & Jacobson, M. (2024). Hassle costs versus information: How do prescription drug monitoring programs reduce opioid prescribing? American Economic Journal: Economic Policy, 16(1), 87–123. https://doi.org/10.1257/pol.20200579

Barnes, M. R., Luo, Y., Parker, J. M. & Shepler, B. M. (2024). Prescribers’ perspectives: The impact of the controlled substance scheduling system on providing optimal patient care. Exploratory Research in Clinical and Social Pharmacy, 16(100511-). https://doi.org/10.1016/j.rcsop.2024.100511

Carroll, C. M. (2025). Controlled Substances Act (CSA). Salem Press Encyclopedia of Health.

Comer, S. D., Pravetoni, M., Coop, A., Baumann, M. H., & Cunningham, C. W. (2021). Potential unintended consequences of class-wide drug scheduling based on chemical structure: A cautionary tale for fentanyl-related compounds. Drug and Alcohol Dependence, 221. https://doi.org/10.1016/j.drugalcdep.2021.108530

Gupta, S., Nguyen, T., Freeman, P. R., & Simon, K. (2023). Competitive effects of federal and state opioid restrictions: Evidence from the controlled substance laws. Journal of Health Economics, 91, N.PAG. https://doi.org/10.1016/j.jhealeco.2023.102772

Wu, A., Phan, C., Nguyen, K. C., Quindoy, M., Lewis, J., & Apollonio, D. E. (2021). Trends in hydrocodone combination product exposures reported to California Poison Control System (CPCS) following DEA rescheduling. Clinical Toxicology (15563650), 59(4), 313–319. https://doi.org/10.1080/15563650.2020.1803350