Opinion Piece: After 50 Years of Failure, It’s Time to Rethink the Controlled Substances Act

Written by Trey Brasher ’19 and Elijah Zorro Ullman ‘15, SSDP Scientific Policy Council members

(Written to publish on October 27th, 2020 for the Atlanta Journal-Constitution)

50 years ago today, on Oct 27th, 1970, the federal Controlled Substances Act (CSA) was signed into law. Solidifying treatment of drugs as a criminal issue rather than a medical or societal one, the CSA established the Drug Enforcement Administration (DEA) and categorized drugs as Schedule 1 through 5, with the former being the most restrictive.  The CSA states Schedule 1 drugs:

“By law, if not by science, are declared to have no legitimate medical uses and to have high potential for addiction.”

The CSA placed a moratorium on research with Schedule 1 substances, hampering medical research for decades.  Only recently has research with these compounds been resurrected.  In 2018, the FDA assigned psilocybin and MDMA, both Schedule 1 drugs, “Breakthrough Treatment” designations. This begs the question: How could these drugs simultaneously be breakthrough treatments and have no medical value?  

The CSA effectively bans the study of substances that, if studied, might demonstrate medicinal efficacy, a perennial problem with cannabis. The purely self-serving refusal of the DEA to review new applications to grow research grade cannabis until they faced lawsuits (Miller, 2020), is par for the course; the DEA, with the CSA behind it, consistently denies and ignores scientific evidence. Just this year, they released a statement denying the therapeutic uses of cannabis, but recognizing the medical potential of synthetic THC (DEA, 2020).  

The failure of the CSA’s paradigm, criminal rather than medical treatment of drug abuse, is becoming abundantly clear.  There is lackluster evidence that overall US drug use has decreased since the passage of the CSA while the US prison system has burgeoned to the largest in the world, with around 20% of those incarcerated solely for drug possession (Bureau, 2014, DPA). 

Fentanyl, one of the opioids fueling the opioid epidemic, is a highly potent compound used with high efficacy as a surgical analgesic and, therefore, is a Schedule 2 drug. Its placement ignores the risk of overdose when compared to Schedule I compounds like cannabis and MDMA. Since 1999, opioid overdoses have increased 5-fold and deaths attributable to synthetic opioids increased by over 600% in the last 7 years (CDC, 2020). Anyone else remember when Insys Therapeutics donated $500,000 in 2016 in Arizona to keep cannabis illegal yet was seeking approval for synthetic cannabis? Don’t forget that Insys also manufactures Fentanyl. (Washington Post, 2017)

 According to the Georgia ACLU in 2018, 52% of all drug arrests were for cannabis possession alone. Shifting priorities and budgets away from this type of arrest would allow the funding of social welfare programs providing economic assistance, or to hire social workers to offer addiction treatment services. Furthermore, Georgia received $630 million from the National Institutes of Health and $188 million from the National Science Foundation in 2019 (FASEB, 2020). If we can ease the restrictions on research of compounds, such as MDMA and cannabis, we can vastly increase Georgia’s research grants and push society forward. With world-leading research institutions like Emory University and Georgia Institute of Technology, we have the equipment and expertise necessary to study these compounds. 

The failure of US drug policy is becoming a non-partisan consensus. In 2018, MDMA, a Schedule 1 drug, entered Phase 3 clinical trials for Post-Traumatic Stress Disorder (PTSD) with studies showing clear and significant efficacy in treatment of the disorder (Ot’alora et al, 2018; Marseille et al., 2020). Further driving the need for this efficacious therapeutic is the fact that between 16-20 US veterans commit suicide per day (DVA, 2019). The men and women in uniform in the USA deserve so much better than this. 

There is a clear discrepancy between damages from a drug and its drug schedule. When cannabis, psilocybin, and MDMA are all in Schedule 1 alongside heroin, but fentanyl, cocaine, and methamphetamine are in Schedule 2, it’s clear that there is no meaningful connection between the dangers posed by a drug and its drug schedule (Nutt, 2009). It doesn’t take a pharmacologist to see the mismatch. 

Congress needs to take action to lift barriers to researching these substances. House Majority Leader Steny Hoyer has said the Marijuana Opportunity, Reinvestment, and Expungement (MORE) Act will come to a vote this autumn. The bill would remove marijuana from the CSA, thereby eliminating many of the hurdles that have prevented research that could save lives. Congress would need to take additional action to lift the research barriers to other Schedule 1 substances, but passing the MORE Act is the necessary first step towards fixing our country’s broken laws

Citations

Bureau of Justice Statistics. (2014). Bureau of Justice Statistics.

Department of Veterans Affairs. (2019). National veteran suicide prevention annual report.

Drug Facts Sheet: Marijuana/Cannabis [PDF]. (2020, April). Drug Enforcement Administration (DEA).

Drug War Statistics. (n.d.). Retrieved October 25, 2020, from https://www.drugpolicy.org/issues/drug-war-statistics

Laffiteau, C. (2011). The balloon effect: The failure of supply side strategies in the war on drugs. Academia. edu, 1, 1-18.

Marseille, E., Kahn, J. G., Yazar-Klosinski, B., & Doblin, R. (2020). The cost-effectiveness of MDMA-assisted psychotherapy for the treatment of chronic, treatment-resistant PTSD. PloS one, 15(10), e0239997.

National Institute on Drug Abuse (NIDA)(2020). Overdose Death Rates 

Nutt, D. (2009). Government vs science over drug and alcohol policy. The Lancet, 374(9703), 1731-1733.

Ot’alora G, M., Grigsby, J., Poulter, B., Van Derveer III, J. W., Giron, S. G., Jerome, L., … & Mithoefer, M. C. (2018). 3, 4-Methylenedioxymethamphetamine-assisted psychotherapy for treatment of chronic posttraumatic stress disorder: A randomized phase 2 controlled trial. Journal of Psychopharmacology, 32(12), 1295-1307.

https://www.washingtonpost.com/news/wonk/wp/2017/03/24/a-pharma-company-that-spent-500000-trying-to-keep-pot-illegal-just-got-dea-approval-for-synthetic-marijuana/

New ACLU Report: Black People Still Almost 3 Times More Likely to Get Arrested for Marijuana in Georgia. (2020, April 20). Retrieved October 25, 2020, from https://www.acluga.org/en/press-releases/new-aclu-report-black-people-still-almost-3-times-more-likely-get-arrested-marijuana

Federal Research Funding by State and District. (n.d.). Retrieved October 26, 2020, from https://www.faseb.org/Science-Policy-and-Advocacy/Federal-Funding-Data/Federal-Funding-by-State-District

Disclaimer: These views do not reflect the position of the Emory University Molecular and Systems Pharmacology PhD Program