Topic Resources
Medications and other substances, whether used for legitimate medical purposes, as a habit (for example, caffeine), or recreationally, are an integral part of everyday life for many people (see table Medications and other substances, whether used for legitimate medical purposes, as a habit (for example, caffeine), or recreationally, are an integral part of everyday life for many people (see tableDrugs with Both Medical and Recreational Uses).
Substance misuse and other substance-related disorders can arise when drugs that directly activate the brain's reward system are taken for the feelings of pleasure they induce. The pleasurable sensations vary with the drug. The drugs are divided into 10 different classes based on the different effects they produce in the body:
CaffeineCaffeine
Cannabis (including marijuana and synthetic cannabinoids)
Hallucinogens (including LSD, phencyclidine, psilocybin, 3,4-methylenedioxymethamphetamine [MDMA])(including LSD, phencyclidine, psilocybin, 3,4-methylenedioxymethamphetamine [MDMA])
Inhalants (such as paint thinner and certain glues)
Opioids (including fentanyl, morphine, and oxycodone)(including fentanyl, morphine, and oxycodone)
Stimulants (including amphetamines and cocainecocaine)
Other (including anabolic steroids and other commonly abused substances)
Substance-related disorders can develop whether or not a drug is legal, is socially acceptable, or has an accepted medical use (with or without a prescription). Details about specific drugs and their effects are discussed elsewhere in THE MANUAL.
In discussions about controlled substances and drug use, the term "narcotics" is often used. This term refers to drugs that cause loss of feeling, a sense of numbness, and drowsiness, specifically opioids (drugs that bind to opiate receptors on cells). However, the term "narcotics" is also used in a broader (and inaccurate) sense to include any drug that is illegal or used illegitimately.
Drugs With Both Medical and Illicit Uses
Drug | Medical Use |
|---|---|
To numb surfaces of the body (as a topical anesthetic) | |
To provide anesthesia | |
To treat nausea due to advanced cancer, and certain types of childhood seizures | |
To relieve pain and provide anesthesia |
Substance use disorders generally involve behavior patterns in which people continue to use a substance despite having problems caused by its use. There may also be physiologic manifestations, including changes in brain circuitry. The common terms "addiction," "abuse," and "dependence" are too loosely and variably defined to be very useful in systematic diagnosis; "substance use disorder" is more comprehensive and has fewer negative connotations.
Drugs in the 10 classes vary in how likely they are to cause a substance use disorder. The likelihood is termed addiction liability and depends upon a combination of factors including
How the drug is used
How strongly the drug stimulates the brain's reward pathway
How quickly the drug works
The drug's ability to induce tolerance and/or symptoms of withdrawal
Scheduled Drugs
The Comprehensive Drug Abuse Prevention and Control Act (Controlled Substances Act) was implemented in the United States in 1970 and modified over the years to regulate the manufacture and distribution of certain classes of drugs, or controlled substances (see table Some Examples of Controlled Substances).
Controlled substances are divided into 5 schedules (or classes) based on their potential for abuse, how accepted they are for medical use, and how safe they are when used under medical supervision. Schedule I drugs are considered the most harmful and therefore have the tightest controls. Schedule V drugs are considered the least harmful and are widely available. State and federal schedules may differ (see also US Drug Enforcement Administration Drug Schedules).
Some Examples of Controlled Substances
Schedule | Examples |
|---|---|
I* | Cathinone (khat) and methcathinone, GHB, heroin (and some other opioids), LSD, marijuana, MDMA, psilocybin, synthetic cannabinoids |
II | Amphetamines, barbiturates (short-acting), cocainecocaine, hydrocodone (including hydrocodone combination products), hydromorphone, methadone, methylphenidate, morphine and other strong opioid agonists, oxycodone, hydrocodone, , hydrocodone (including hydrocodone combination products), hydromorphone, methadone, methylphenidate, morphine and other strong opioid agonists, oxycodone, hydrocodone,phencyclidine |
III | Anabolic steroids, barbiturates (intermediate-acting), buprenorphine, dihydrocodeine, dronabinol, , barbiturates (intermediate-acting), buprenorphine, dihydrocodeine, dronabinol,ketamineketamine, paregoric |
IV | Barbiturates (long-acting), benzodiazepines, chloral hydrate, modafinil, meprobamate, pentazocine, propoxyphene, zolpidemBarbiturates (long-acting), benzodiazepines, chloral hydrate, modafinil, meprobamate, pentazocine, propoxyphene, zolpidem |
V | Cough suppressants containing small amounts of codeine, pregabalinCough suppressants containing small amounts of codeine, pregabalin |
* Cannot be prescribed. GHB = gamma hydroxybutyrate; LSD = lysergic acid diethylamide; MDMA = methylenedioxymethamphetamine. | |
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Drug Enforcement Administration (DEA) Diversion Control Division: Home page of the main US government agency responsible for oversight of legal and illegal use of controlled substances. Contains links to a variety of information, including specific drug information, regulations and requirements, and various forms and applications.
United States Drug Enforcement Administration (DEA), Drug Scheduling: This link leads to further detail on the examples of controlled substances mentioned in this section.
