Legal Considerations for Substance Use Disorders

The Controlled Substances Act, established in 1971, is the federal drug policy under which certain drugs are regulated. All drugs are classified into one of five drug schedules based on their medical use, potential for misuse, and likelihood for dependence. Schedule I drugs are considered most dangerous, with no medical use and the highest chance of misuse and dependence (for example, heroin), while Schedule V drugs have low potential for misuse but contain small amounts of controlled substances (for example, cough syrup with codeine). Use of opioids is regulated through the Controlled Substances Act, as is the use and distribution of some medications for treating opioid use disorder (OUD) — specifically methadone (Schedule II) and buprenorphine (Schedule III).

Cannabis is classified as a Schedule I drug under the Controlled Substances Act and prohibited under federal law. Medical cannabis products are not approved by the Food and Drug Administration (FDA) and cannot be prescribed by healthcare providers. However, in states where medical cannabis is legal, healthcare providers can suggest medical cannabis to treat certain conditions as described by state law.

Historically, substance use disorders (SUDs) have been viewed as a crime rather than a chronic health condition. While some drugs like alcohol, tobacco, and prescription drugs may be legally accessed, many commonly misused drugs are illicit, or illegal to purchase or use. Cannabis use has additional challenges as legality differs by jurisdiction and purpose of use. Therefore, screening for SUD is accompanied by various legal implications and raises ethical concerns.

Federal and state laws guide how healthcare providers can treat substance use, including setting requirements for who can provide treatment and how to prescribe controlled substances. Federal and state laws also protect patient health records, including information about individuals' substance misuse and medical and mental health information. States have also enacted Good Samaritan laws, which protect individuals experiencing or witnessing an overdose from arrest or prosecution by law. Laws relating to substance use vary by state and may change over time. States may also have stricter requirements than federal rules, in which case the stricter requirements should be followed. Rural providers should review applicable laws in their region and consult legal counsel as needed to ensure compliance with most up-to-date requirements.

Rural SUD treatment programs can partner with local law enforcement to help people who may be misusing substances. Program planners may need to understand law enforcement's perspective on SUD in order to create a successful, respectful, and sustainable partnership. In Kentucky, for example, the Angel Initiative allows individuals experiencing addiction to go to any Kentucky state police post and ask for help accessing addiction treatment care, without fear of arrest. As part of this initiative, individuals who seek help can turn in any drugs or drug paraphernalia and will not be charged or prosecuted for possession. Engaging with law enforcement allows for a more integrated and holistic approach to helping individuals with SUD.

Resources to Learn More

Laws, Regulations, and Policies
Website
Describes federal laws and regulations related to substance use and mental health services.
Organization(s): Substance Abuse and Mental Health Services Administration

Prescription Drug Abuse Policy System
Website
Tracks and summarizes prescription drug abuse laws across states.
Organization(s): Center for Public Health Law Research, Temple University Beasley School of Law