In the United States, a controlled substance is any drug or chemical that federal law regulates because of its potential for misuse or dependence. The Controlled Substances Act places these substances into five “schedules” based on accepted medical use and potential for abuse. Understanding how scheduling works helps patients, families, and clinicians in Massachusetts make safe choices and follow the rules that apply to prescribing, storing, and disposing of medications.
This guide explains the five schedules in plain language, how federal and Massachusetts law interact, what scheduling means for refills and prescriptions, and what to do if a controlled medication has become a problem. If you or a loved one needs help, Swift River in Cummington provides medical detox and inpatient treatment for people across Massachusetts.
Controlled Substances Under Federal Law
Congress enacted the Controlled Substances Act to organize certain medicines and chemicals into schedules that the Drug Enforcement Administration enforces. Schedules range from I through V. The Food and Drug Administration and the Department of Health and Human Services provide scientific review, and the DEA finalizes scheduling decisions.
At a high level, Schedule I substances have no currently accepted medical use and a high potential for abuse. Schedule II substances have accepted medical uses but also high abuse potential and strict controls. Schedules III through V have decreasing abuse potential and more flexible prescribing rules. You can read the government’s plain-English overview on the DEA website for more detail.
The Five Schedules At A Glance
Below are examples to illustrate the differences. Examples are not complete lists and scheduling can change as the DEA updates regulations.
- Schedule I: Substances without accepted medical use under federal law and with a high potential for abuse.
- Schedule II: Medications with accepted use and high abuse potential. Typical examples include certain opioids and stimulants used for ADHD.
- Schedule III: Medications with moderate to low physical dependence or high psychological dependence risk, such as some combination products containing lower doses of opioids.
- Schedule IV: Medications with lower abuse potential, including many benzodiazepines and certain sleep medicines.
- Schedule V: Medications with the lowest abuse potential in this system, such as certain cough or antidiarrheal preparations when they meet specific limits.
For the official lists and updates, see the DEA’s controlled substance schedules and the Code of Federal Regulations.
DEA: Controlled Substance Schedules
Federal Versus Massachusetts Law On Controlled Substances
Federal law sets the baseline, and Massachusetts law layers on additional requirements. Massachusetts General Laws Chapter 94C governs controlled substances in the Commonwealth. The Department of Public Health’s Drug Control Program oversees the Prescription Monitoring Program and other safeguards statewide.
Prescribers and pharmacists in Massachusetts use the Massachusetts Prescription Awareness Tool, known as MassPAT, to check a patient’s recent controlled-substance prescription history. The goal is to support safe, appropriate prescribing and reduce duplicate or overlapping prescriptions.
M.G.L. c.94C: Massachusetts Controlled Substances Act
Massachusetts Prescription Monitoring Program (PMP) | MassPAT Guide
Is Cannabis A Controlled Substance?
Under federal law, marijuana remains in the schedules of the Controlled Substances Act. The U.S. Department of Justice has proposed moving marijuana to Schedule III, and that process involves rulemaking steps like public comment and hearings. A proposal does not change the law until a final rule is issued and takes effect. States set their own marijuana policies that can differ from federal law. If you have questions about how these rules apply to you in Massachusetts, speak with your prescriber, pharmacist, or an attorney.
What Scheduling Means For Prescriptions & Refills
Scheduling affects how a clinician can prescribe a medicine, how many refills are allowed, and the documentation a pharmacy must keep. These are general federal rules and Massachusetts can impose stricter requirements.
- Schedule II: No refills are allowed. A prescriber can issue separate prescriptions with future fill dates within federal limits when appropriate. Pharmacies follow strict verification and recordkeeping rules.
- Schedules III and IV: Up to five refills are allowed within six months from the date the prescription is issued. After six months or five refills, whichever comes first, a new prescription is required.
- Schedule V: Refills are permitted as authorized by the prescriber. State law and plan policies may set additional limits.
For authoritative language, see the eCFR sections on refills and prescriptions.
21 CFR §1306.12: Refilling Schedule II Prescriptions | 21 CFR §1306.22: Refills for Schedules III–IV
Controlled, Prescription, Or Over-The-Counter: What Is The Difference?
Not all prescriptions are controlled substances. Antibiotics, many antidepressants, and most blood pressure medicines are prescriptions that are not scheduled under the Controlled Substances Act. Over-the-counter medicines do not require a prescription and most are not scheduled either. A drug becomes a “controlled substance” when it appears in one of the five schedules and then special federal and state rules apply to prescribing, dispensing, storage, and documentation.
Safe Storage & Disposal In Massachusetts
Store controlled medications in a locked or secure place and keep them out of reach of children and pets. Never share prescriptions. When you no longer need a controlled medicine, the FDA recommends using a take-back program when available. If you cannot access a take-back site, follow FDA guidance for safe household disposal and use the agency’s “flush list” only when directed.
FDA: Disposal of Unused Medicines | FDA Flush List | DEA Drug Disposal Resources
FAQ: Common Questions We Hear In Massachusetts
Why did my prescriber check MassPAT?
Massachusetts requires prescribers to consult the prescription monitoring database before certain prescriptions. This safety step helps your care team select the safest dose and avoid duplicate therapies or dangerous interactions.
My insurer limited my refill. Is that the law?
Insurers can set utilization rules that are stricter than federal or state law. Your pharmacist can explain your plan’s limits and coordinate with your prescriber on alternatives if needed.
Can I travel with a controlled medication?
Keep medications in original labeled containers and carry only the amount you need. If traveling across state or international borders, rules vary. Ask your prescriber and review destination requirements before you go.
If A Controlled Medication Has Become A Problem
Warning signs include taking more than prescribed, seeking early refills, changing how you take the medicine, or using someone else’s prescription. If you recognize these issues, you are not alone and help is available in Massachusetts. Call the statewide Behavioral Health Help Line for real-time support, contact the 988 Suicide and Crisis Lifeline for any mental health or substance use crisis, or reach out to Swift River for a confidential assessment.
What To Expect At Swift River
Most people begin with medically supervised detox to manage withdrawal safely and to stabilize. Our team then creates a personalized residential treatment plan that can include individual therapy, group therapy, and medications for opioid or alcohol use disorder when appropriate. You will also learn relapse prevention skills and build a discharge plan that connects you with local supports in Massachusetts.
Drug and Alcohol Detox | Inpatient Treatment Program | Medication-Assisted Treatment
Length & Continuum Of Care At Swift River
Detox addresses the acute phase and usually lasts days, not weeks. Residential treatment often follows for several weeks depending on clinical need. Discharge planning links you to outpatient counseling, peer support, recovery housing, and community resources close to home. Our goal is to step your care down responsibly and keep you connected to support that fits your life in Massachusetts.
Insurance & Costs
Most health plans cover medically necessary addiction treatment, including detox and inpatient care, subject to your individual benefits. We verify your benefits quickly and explain your options. If Swift River is out of network for your plan, we can still explore affordable pathways.
Verify Your Insurance | Insurances We Accept | Frequently Asked Questions
Aftercare & Community Resources In Massachusetts
Recovery strengthens when you combine professional care with peer support and practical tools. Use these statewide and national resources to locate ongoing help near you.
- Massachusetts Bureau of Substance Addiction Services
- SAMHSA Treatment Locator
- Alcoholics Anonymous: Find A.A. Near You
- Narcotics Anonymous: Find NA
- SMART Recovery Meetings
Why People From Across Massachusetts Choose Swift River
Swift River sits in the Berkshires in Cummington and serves individuals from Boston, Worcester, Springfield, Pittsfield, and beyond. Our campus setting supports focus and stability. People choose us for 24/7 medical care during detox, evidence-based residential treatment, and thoughtful aftercare planning that connects you back to your community supports in Massachusetts.
How To Start
If you are ready to talk about treatment, call our team or complete a quick insurance verification. We will confirm benefits, answer your questions, and schedule an assessment.
Contact Swift River | Verify Benefits Online
Our Location
Swift River is located in Cummington in Western Massachusetts. Many people from across the Commonwealth choose residential care outside their home city because a change of setting can reduce triggers and support focus on recovery. Our team helps coordinate travel and a smooth transition back to your local providers and supports.
Important Safety Note
If you or someone you know is in immediate danger or experiencing a life-threatening emergency, call 911. For a mental health or substance use crisis, call or text 988 for 24/7 support. This article offers general information and is not legal or medical advice. Always consult your prescriber or pharmacist about your specific medications and the laws that apply to you.
Resources & Further Reading
- DEA: Drug Scheduling
- DEA Diversion Control: Controlled Substance Schedules
- eCFR: 21 CFR §1306.12 and 21 CFR §1306.22
- Massachusetts General Laws c.94C
- Massachusetts Prescription Monitoring Program and MassPAT
- DOJ Proposed Rule: Rescheduling Marijuana
- FDA: Disposal of Unused Medicines
- FindTreatment.gov (SAMHSA) and 988 Suicide & Crisis Lifeline
