Controlled vs. Non-Controlled Drugs: What Parents & Young Adults Need To Know

Over-the-counter and prescription medications can support your health, but they can also pose risks when not used as directed, especially in homes with adolescents and teens. By practicing safe habits and discussing the risks of misuse with your teens, you can minimize the potential harm. 

What are controlled vs. non-controlled drugs?

There are two different types of drugs: controlled and non-controlled. 

• A non-controlled substance is a medication (or chemical) that is not regulated under the Controlled Substances Act (CSA) because it has a low potential for dependence or abuse. Many prescription and over-the-counter drugs fall into this category, including antibiotics, blood pressure medications, and cholesterol medications.
• A controlled substance is regulated by the Drug Enforcement Administration (DEA). These substances have a potential for dependence or abuse. Their production, possession, and use are highly controlled, and refills are limited and subject to specific requirements. 

How the DEA scheduling system works

The Drug Enforcement Administration uses a scheduling system to control the manufacturing, distribution, and use of specific drugs. These groupings are based on whether there's accepted medical use, their safety profile, and their potential for abuse and dependence. States can add substances to the schedule list, reclassify and de-classify some drugs as long as they cannot declassify federally prohibited drugs outright.

Schedule I

In the U.S., a Schedule I drug is very likely to be abused with no approved medicinal purpose. These drugs are considered unsafe and carry a strong risk for addiction and other harm. Examples include heroin, ecstasy, and LSD. 

Schedule II

Schedule II drugs have accepted medical uses, but they also carry the risk for significant physical or mental dependence. As a result, these drugs are very tightly monitored with an online system, refills are not authorized, and prescription requires written prescription. These drugs include opioids like fentanyl, stimulants like Adderall, and some barbiturates like pentobarbital. These drugs are only available under strict federal regulation and with a (monitored) prescription. 

Schedule III

Schedule III drugs have accepted medical uses. They have a low to moderate risk of physical addiction but have a high risk of psychological addiction. These drugs require a prescription, but the rules for prescribing them are not as strict as those for Schedule II drugs. Examples include Tylenol with codeine, anabolic steroids, and certain barbiturates. 

Schedule IV

Medications in Schedule IV have a lower potential for abuse or dependence compared to those in Schedules I-III. However, there is some risk of dependence. They can be prescribed via written or faxed prescriptions. Examples of drugs in this category include anxiety medications (benzodiazepines) like diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin). 

The opioid pain reliever Tramadol is also in this category, and so is the sleep aid zolpidem (Ambien). 

Schedule V

A Schedule V drug has a low risk of abuse, and has a lower risk of dependence than other controlled substances. These drugs are subject to the least strict regulations.

Some can be refilled or found over the counter in limited quantities at pharmacies. However, the government still monitors them. Buyers typically have to show ID and sign a logbook. Some examples include some cough syrups containing codeine and certain antidiarrheal medications (such as Lomotil).

Defining non-controlled substances

Non-controlled substances are not included in the federal Controlled Substances Act. This means they’re less regulated and less likely to be abused. This includes both prescription and non-prescription drugs.

The FDA determines whether a drug can be sold without a prescription. This choice is based on how safe the medicine is, taking into account things like the risk of overdose, interactions with other drugs, and major adverse effects.

Prescription medications usually carry higher safety risks than over-the-counter (OTC) medications, so they require medical oversight. They may interact with certain foods and other medications. In contrast, OTC medications generally have a low risk of serious side effects and low toxicity. They also have labels with detailed instructions for use.

The rules for refills for prescription medications depend on your doctor’s approval, state laws, and your insurance policies. Your doctor can determine how many refills are needed. While some pharmacies may allow refills a week early, some insurance plans do not. Once you’ve used your authorized refills, you will need a new prescription.

Key differences in prescription and dispensing

There are significant differences in how controlled substances and non-controlled substances are prescribed and dispensed.

Controlled substances 

Pharmacies and pharmacists must register with the DEA to handle and dispense controlled substances. They have a responsibility to ensure that prescriptions for these substances are issued for authorized medical reasons by an authorized prescriber. In many states, prescribers and pharmacists must also check the patient’s controlled substance dispensing history by using a prescription drug monitoring program (PDMP).

There are certain rules for filling a prescription for a controlled substance. For instance, Schedule II drugs cannot be refilled, while Schedule III and IV drugs can only be refilled within six months. In emergencies, a verbal prescription for a Schedule II drug is allowed, but with strict procedures attached.

Many states require tamper-resistant prescription pads for written prescriptions for controlled substances. Additionally, more states are adopting electronic prescribing for controlled substances, although this is not a federal requirement.

Regulated vs. non-regulated drug testing in schools and employment 

Laws at the federal, state, and local levels regulate drug toxicology testing for some controlled substances. Some academic institutions and employers can choose to do additional testing on their students or employees  as authorized by state laws. The main differences between these testing types are the substances they test for, the stringency of their procedures, and the level of legal oversight.

Some jobs, such as commercial drivers, pilots, and nuclear power workers, require drug testing for safety reasons. In schools, random testing usually only applies to athletes or students involved in certain extracurricular activities.

Non-regulated drug testing is mostly handled by employers who follow varying state and local laws. It can also be used in different industries for pre-employment checks, post-accident investigations, or if there’s reasonable suspicion of drug-induced impairment.

Safe use and disposal tips for teens and young adults

The Centers for Disease Control offer helpful guidance on how to use prescribed controlled substances safely. When used correctly, they can help your child or teen live a better life. However, if they are misused or fall into the wrong hands, they can lead to abuse or addiction. Here are some tips for safe use for parents and teens: 

• Use one pharmacy for your prescriptions and refills. When everything is filled at the same place, it's easier for your pharmacist to check for potential interactions. Using a single pharmacy can also streamline communication between your pharmacist and your doctors, allowing them to clarify your dosages or receive other specific instructions.
• When beginning a prescription for a controlled substance, it's important to follow all of your doctor's guidance. Take your medication exactly as prescribed. Never take a larger dose or more frequently than your doctor instructed. Taking more than you should can increase your risk of serious side effects or health problems. For example, schedule III opioid medications like buprenorphine come with a risk of overdose if they are misused. Abrupt discontinuation of benzodiazepines, especially if previously taking higher doses, can be life-threatening.,
• Know the signs of an opioid overdose. Signs include extreme sleepiness, slowed breathing, or blue (or pale) lips and fingernails. Naloxone (also known as Narcan) is a life-saving medication that can reverse the effects of an opioid overdose. It is available as a nasal spray or an injection, and programs are available to teach you how to administer it properly.
• Dispose of drugs properly. Permanent drug disposal sites are available through the DEA's "Take Back" program. These collection sites are located at hospitals, pharmacies, and police departments. They provide a safe way to dispose of any unused and expired prescription medications.

Special considerations for young people

When it comes to prescribing drugs to children and teenagers, special considerations must be taken into account. Misusing prescription medications can cause harm to their developing brains.

Children also face unique social and emotional pressures that adults may not face, which can increase their risk of misuse and abuse.

Parents play an important part in decreasing these risks. Talk to your children about the dangers of prescription drug abuse. When parents are open and regularly discuss these dangers with them, they are less likely to misuse drugs.

If your child is prescribed medication, keep track of how much is in the bottle as well as refill dates. For prescriptions for controlled substances, consider keeping them in a lock box and using a pill box to monitor use. Dispose of any unused medications properly and never leave them in the house where they may be misused.

If you take medication, set a good example. Parents who model healthy habits and use their medication responsibly can serve as positive role models for their children.

Bottom line: empowering informed medication choices

Alongside professional therapy, medication plays an important role in many people's treatment process. It's important for you, as your child's caregiver, to play an active role in treatment, and this means making informed medication choices that will improve their quality of life.

Be sure to ask questions about the medication options available to your child and learn everything you can about the potential benefits and risks of each. 

Once your child starts a new medication, be sure to regularly re-evaluate the treatment plan and bring up any concerns (such as side effects) with your child's provider. They can help address your concerns and, if necessary, make modifications to their dosage or treatment plan.

How Emora Health can help

If your child or teen is struggling with their mental health, we can help. For many mental health concerns, a clinician may recommend the use of psychotropic medication to relieve symptoms. Most medications are needed only for a period of time.

Our psychiatric providers who specialize in caring for children and teens use a variety of treatment approaches, which often include therapy, medication management, or both. If medications are not warranted, they are careful not to initiate medications and instead provide thorough education on non-medication treatment options. 

Once you sign up for care, we will schedule an initial evaluation to understand your child’s needs and goals. In addition to professional counseling, our providers may prescribe a safe, age-appropriate, evidence-based medication to address their symptoms. Ongoing check-ins are also regularly scheduled to monitor your child's progress and make any necessary adjustments to their medication or dosage. As a parent, you are always involved, and we will provide you with care and guidance every step of the way. 

If you're ready to get your child started with high-quality virtual therapy with a vetted specialist in as little as two days, contact Emora Health. Start by checking your insurance for a real-time cost estimate.