In response to the 1961 Single Convention, the United States Congress passed the Controlled Substances Act (link) and the Controlled Substances Import and Export Act (link) in 1970. Both of these acts categorize prescription drugs into schedules, according to abuse and therapeutic potential, and specify the means to regulate each schedule. Five schedules were established on a scale, beginning with Schedule I containing illegal drugs and ending with Schedule V containing the least regulated drugs. According to the Controlled Substances Act, opioids are categorized under Schedule II and Schedule III.

Drugs listed in Schedule II are described as follows:⁸

• The drug has a high potential for abuse
• The drug has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions
• Abuse of the drug may lead to severe psychological or physical dependence

Drugs listed in Schedule III are described as follows:⁸

• The drug has a potential for abuse less than the drugs in Schedules I or II.
• The drug has a currently accepted medical use in treatment in the United States.
• Abuse of the drug may lead to moderate to low physical dependence or high psychological dependence.

Congress initiated the Drug Enforcement Administration (DEA) as the federal agency responsible for enforcing the Controlled Substances Act. To uphold federal guidelines that stipulate opioids as medically necessary for intractable pain, the DEA states in its regulations that it does not want to "impose any limitations on a physician or authorized hospital staff to administer or dispense narcotic drugs…to persons with intractable pain in which no relief or cure is possible or none has been found after reasonable efforts." ⁹

The DEA also states¹⁰ "A physician is allowed to exercise his medical judgment and to dispense or administer narcotics to an individual for extended periods for the purpose of relieving intractable pain in which no other relief or cure is known. An example of this would be terminal cancer patients or patients with painful chronic disorders."

As you will see in the state laws and regulations section below, the DEA does not uphold their allowance of physicians to exercise their medical judgment for prescribing narcotics for chronic pain for extended periods of time. On the contrary, the DEA works with the state medical boards to monitor opioid prescribing. If the DEA or state medical boards discover any physicians whom they deem to be overprescribing opioids, often they work together during the investigation and prosecution of these physicians as well.