Half a century ago, Congress enacted the Controlled Substances Act (CSA), creating a framework that classifies drugs by their “medical use” and by their “potential for abuse.” Yet a recent assessment from the Government Accountability Office (GAO) points out that the statute offers no precise definitions for either standard, opening the door to contentious and variable regulatory judgments with broad criminal-justice consequences.
Schedule I under the CSA is intended for substances deemed to carry a “high potential for abuse,” to have “no currently accepted medical use,” and to lack “accepted safety for use under medical supervision.” Substances in this schedule—such as heroin, LSD, psilocybin, and MDMA—are prohibited except for government-approved research purposes.
Meanwhile, Schedule II includes drugs like cocaine, methamphetamine, fentanyl, morphine, hydrocodone, and oxycodone, which are considered to have a “high potential for abuse” but do have an “accepted” medical use and are legally accessible by prescription.
Similar logic applies to Schedules III, IV, and V, which are intended to cover substances with progressively lower abuse potential, providing for less severe penalties for possession or distribution without authorization. A problem becomes evident immediately: a substance that has abuse potential below “high” yet lacks an accepted medical use does not neatly fit into any of these categories.
The way cannabis has been handled historically illustrates this paradox. When Congress enacted the CSA in 1970, marijuana was placed in Schedule I, and the Drug Enforcement Administration (DEA), which had the authority to reclassify drugs in consultation with the Department of Health and Human Services (HHS), kept it there despite a string of petitions arguing that it did meet the statutory criteria.
Starting in 1992, the GAO notes, the DEA defined “accepted medical use” by a five-element test, including “adequate safety studies” and “adequate and well-controlled studies proving efficacy.” Since those requirements align closely with the evidence the Food and Drug Administration (FDA) demands to authorize a drug for prescription, the DEA effectively equated “accepted medical use” with FDA approval.
Under the Biden administration, HHS embraced an alternate standard for “accepted medical use” that weighs broad clinical experience with a drug (for example in the 41 states where medical marijuana is legal) and requires “some credible scientific support” for at least one application. Based on an FDA assessment, HHS concluded that cannabis satisfied that standard and, after re-evaluating its “potential for abuse,” recommended placing it in Schedule III, which encompasses prescription medications like ketamine, anabolic steroids, and Tylenol with codeine.
Last April, Acting Attorney General Todd Blanche issued a final rule implementing the HHS recommendation, but with a nuance. For now, he indicated, only marijuana products currently sold by state-licensed medical dispensaries or those that may be approved later by the FDA would be eligible for Schedule III.
The scientific and legal reasoning behind that move was hard to discern, given that the products included and those excluded are pharmacologically identical, differing only in their intended use. By contrast, cocaine, fentanyl, and methamphetamine remain Schedule II whether they are dispensed through pharmacies with medical prescription or bought on the black market without authorization.
In any event, the government’s reversal on cannabis revealed how pliable the CSA’s scheduling standards can be. The reclassification hinged more on a shift in attitude than on a fundamental scientific change.
Beyond redefining “accepted medical use,” that shift also involved a fresh evaluation of marijuana’s abuse potential. The CSA “does not include a statutory definition of ‘potential for abuse,'” the GAO notes, and “FDA officials told us that the absence of a written definition… posed challenges for assessing relative abuse potential and for recommending an appropriate schedule for certain substances.”
The GAO urges the FDA to specify the criteria and process for determining a drug’s “potential for abuse.” The opacity highlighted by the report is astonishing given how long Americans have lived under the CSA, a law that criminalizes a broad array of peaceful behavior and imposes penalties based on arbitrary regulatory distinctions.
© Copyright 2026 by Creators Syndicate Inc.
