Chapter 8: Public Health

📊 What Are Vital Statistics?

Vital statistics are the official records of life events that are essential for understanding population health, growth, and demographics. These statistics are collected by government agencies to track key events in a population over time.

✅ Key Types of Vital Statistics:

Births

Total live births

Birth rates by age, location, marital status

Deaths

Total deaths

Causes of death

Mortality rates (e.g., infant mortality, age-specific death rates)

Marriages

Number of marriages

Marriage rates

Age at marriage

Divorces

Number and rate of divorces

Duration of marriages

Fetal Deaths (Stillbirths)

Deaths of fetuses at 20+ weeks gestation

Abortions (in some jurisdictions)

Voluntary pregnancy terminations

Abortion ratios and rates

🏥 Why Vital Statistics Matter in Healthcare:

Guide public health policy and planning

Track disease trends and health risks

Allocate resources for maternal and child health

Inform epidemiological studies and health research

Support population projections and emergency planning

📦 Sources of Vital Statistics:

Local and state health departments

Vital records offices

Centers for Disease Control and Prevention (CDC) – National Center for Health Statistics (NCHS)

World Health Organization (WHO) for global data

🍼 Birth Records

📋 What They Include:

Full name of child

Date and place of birth

Sex of the child

Parent(s)’ names and addresses

Birth certificate number

Attending physician or midwife

🧾 Uses:

Legal proof of identity, age, and citizenship

Enrollment in school, voting, and passports

Public health tracking (e.g., birth rates, infant health)

Population planning and demographic research

🏛️ Filed By:

Hospital, birthing center, or midwife

Sent to the state vital records office

⚰️ Death Records

📋 What They Include:

Full name of deceased

Date and place of death

Cause(s) of death

Certifying physician or coroner

Age, sex, race, occupation, marital status

🧾 Uses:

Legal proof for wills, insurance, and estates

Public health monitoring (e.g., mortality rates, disease trends)

Epidemiological studies and health planning

Tracking leading causes of death and life expectancy

🏛️ Filed By:

Certifying medical personnel or coroner

Funeral director submits to state vital records office

🗂️ Where Records Are Kept:

State or local vital records offices

Indexed by the National Center for Health Statistics (NCHS)

Access may be restricted for privacy reasons

⚰️ Who Can Sign a Death Certificate?

✅ Authorized to Sign a Death Certificate:

1. 🩺 Attending Physician

Most common certifier if the patient died under medical care

Must have recent knowledge of the patient’s health condition

Signs the cause of death portion of the certificate

2. 🧑‍⚕️ Hospital Medical Officer

In hospitals, hospitalists or medical residents may sign under attending supervision

Must be authorized under hospital policy

3. 🕵️‍♂️ Medical Examiner or Coroner

Required if the death is sudden, unexpected, violent, or suspicious

Also signs in cases of accidents, suicides, homicides, or no recent medical history

May perform autopsies to determine cause of death

4. 🦺 Physician Assistant (PA) or Nurse Practitioner (NP)

(In some states)

May be allowed to complete the certificate under physician delegation

State law and facility policy determine eligibility

⚠️ Special Cases Requiring a Coroner or ME:

No attending physician

Death under unusual, traumatic, or criminal circumstances

Death in custody or public institution

Death occurring at home without medical supervision

📍 Key Notes:

The funeral director completes demographic sections, but only a medical professional can certify the cause of death.

All death certificates must be filed with the state or local vital records office within a legally specified timeframe (often 72 hours).

🌍 Core Public Health Functions

The U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) identify three core functions of public health, each supported by essential services:

🧠 1. Assessment

Involves gathering and analyzing health data to understand community health needs.

🔹 Key Activities:

Monitor health status to identify problems

Diagnose and investigate health hazards

Conduct surveys, screenings, and surveillance (e.g., COVID-19 tracking)

🛠️ 2. Policy Development

Uses data to create public policies and interventions that protect health.

🔹 Key Activities:

Inform, educate, and empower the public

Develop community partnerships

Create laws, guidelines, and health programs

Promote evidence-based solutions (e.g., tobacco restrictions, vaccination plans)

🧰 3. Assurance

Ensures services are available, accessible, and high quality for the population.

🔹 Key Activities:

Enforce health regulations (e.g., restaurant inspections, quarantine laws)

Link people to healthcare services

Train and certify the public health workforce

Evaluate effectiveness and improve health programs

🧱 The 10 Essential Public Health Services (aligned to these core functions):

Assess and monitor health status

Investigate and diagnose health problems

Inform and educate the public

Strengthen community partnerships

Develop policies and plans

Enforce public health laws

Ensure access to care

Maintain a competent workforce

Evaluate health services

Innovate through research

🦠 Reportable Diseases and Injuries

Reportable conditions are diseases, infections, or injuries that healthcare providers, labs, or other authorities are legally required to report to public health agencies.

🎯 Purpose of Reporting:

Detect and control outbreaks

Protect the public from threats (e.g., TB, STIs, COVID-19)

Monitor trends and plan interventions

Comply with state and federal public health laws

📝 Examples of Reportable Diseases and Injuries

🧫 Infectious Diseases:

COVID-19

Tuberculosis (TB)

HIV/AIDS

Hepatitis A, B, and C

Measles, Mumps, Rubella

Meningitis

Gonorrhea, Syphilis, Chlamydia

Pertussis (Whooping Cough)

Salmonella, E. coli (foodborne illnesses)

🧍‍♀️ Occupational and Environmental Exposures:

Lead or mercury poisoning

Pesticide exposure

Work-related illnesses (e.g., asbestosis, silicosis)

🧨 Injuries and Violence:

Gunshot wounds

Stabbings

Burn injuries

Suspected child or elder abuse

Sexual assault or rape

Certain workplace injuries (OSHA-reportable)

🏛️ Who Must Report:

Physicians

Hospitals and clinics

Laboratories

Schools and child care centers

Employers (in some cases)

📍 Reporting is Mandatory and Time-Sensitive

Some diseases (like measles or meningitis) require immediate notification

Others may be reported within 1–7 days depending on jurisdiction

📦 Where to Report:

Local or state public health departments

Some cases go to the CDC or national surveillance systems

💉 National Childhood Vaccine Injury Act of 1986 (NCVIA)

📜 Purpose:

The NCVIA was enacted by the U.S. Congress to:

Compensate individuals harmed by certain vaccines

Protect vaccine manufacturers and providers from liability

Maintain public confidence in vaccination programs

Establish a streamlined system for reporting, reviewing, and responding to vaccine injuries

🧱 Key Components:

1. 🏛️ National Vaccine Injury Compensation Program (VICP)

A no-fault alternative to the traditional legal system

Individuals can file claims for compensation if they believe a vaccine caused injury or death

Funded by a 75¢ tax per vaccine dose

2. 📋 Vaccine Injury Table

Lists covered vaccines and recognized injuries with time frames

If an injury listed occurs within the timeframe, it is presumed to be caused by the vaccine

3. 📝 Vaccine Adverse Event Reporting System (VAERS)

Co-managed by CDC and FDA

Requires healthcare providers to report certain adverse events

Collects national data on vaccine safety and side effects

4. 📄 Informed Consent Requirement

Providers must give patients (or parents) a Vaccine Information Statement (VIS) before each dose of a covered vaccine

VIS includes information about risks, benefits, and what to do in case of adverse effects

⚖️ Legal Protections:

Vaccine manufacturers and providers are shielded from liability in most cases

Civil lawsuits may only proceed if the VICP process is exhausted first

🧒 Vaccines Covered:

Includes routine childhood vaccines such as:

DTaP/Tdap

MMR (Measles, Mumps, Rubella)

Hepatitis B

Polio

Varicella (chickenpox)

HPV, Influenza (injection), and others

💉 National Vaccine Injury Compensation Program (VICP)

📜 Established:

1988, under the National Childhood Vaccine Injury Act of 1986

🎯 Purpose:

To provide a no-fault alternative to traditional legal action for individuals who suffer an injury or death caused by certain covered vaccines.

🏛️ Why It Was Created:

Prevent vaccine shortages caused by lawsuits against manufacturers

Encourage continued vaccine production

Maintain public trust in vaccines

Compensate individuals fairly without needing to prove negligence

🧾 How the VICP Works:

Filing a Petition

Injured party (or their legal guardian) files with the U.S. Court of Federal Claims

Must be filed within 3 years of injury or 2 years of death

Medical Review

Reviewed by medical experts from Health Resources and Services Administration (HRSA)

Hearing and Decision

Special masters determine eligibility and compensation

If criteria are met, compensation is awarded

Funding

Paid from the Vaccine Injury Compensation Trust Fund, funded by a $0.75 tax per vaccine dose

📋 Types of Compensation:

Medical and rehabilitative care

Lost wages

Pain and suffering (up to $250,000)

Death benefits (if applicable)

💉 Covered Vaccines Include:

DTaP / Tdap

MMR (Measles, Mumps, Rubella)

Polio

Hepatitis A and B

HPV

Influenza (injectable)

COVID-19 (currently handled under a separate program, CICP)

✅ Advantages:

No need to prove fault or negligence

Faster, less adversarial than court

Fair compensation and due process

 

🛡️ Smallpox Emergency Personnel Protection Act (SEPPA) of 2003

📜 Purpose:

To provide compensation and protection to healthcare workers and emergency personnel vaccinated against smallpox as part of a national bioterrorism preparedness plan.

⚠️ Why It Was Passed:

In response to the threat of bioterrorism after 9/11

The U.S. government launched a voluntary smallpox vaccination program

Concerns arose over risks to vaccinated individuals and lack of legal protection

🧾 Key Features of SEPPA:

1. 💉 Compensation for Injury or Death

Covers medical expenses, lost income, and death benefits for:

Vaccinated individuals

Their close contacts (who may experience adverse effects)

Claims reviewed by the U.S. Department of Health and Human Services (HHS)

2. 🛑 Legal Liability Protections

Protects healthcare entities and personnel from lawsuits related to smallpox vaccination injuries

Similar to protections in other public health emergency acts

3. 👥 Who Is Eligible?

Healthcare workers

Public health and emergency responders

Volunteers participating in approved vaccination programs

4. 🕒 Time Limits:

Claims must be filed within 1 year of the date the person knew (or should have known) they were injured

🔒 Related Law:

SEPPA complements the Public Readiness and Emergency Preparedness (PREP) Act, which provides broader liability protection for public health emergencies

The American Academy of Pediatrics (AAP) recommends a comprehensive immunization schedule to protect children and adolescents from various preventable diseases. These recommendations are developed in collaboration with the Centers for Disease Control and Prevention (CDC) and are updated annually to reflect current scientific evidence.

📋 Recommended Vaccines for Children and Adolescents

Below is a list of vaccines commonly recommended for individuals from birth through 18 years of age:

Hepatitis B (HepB)

Rotavirus (RV)

Diphtheria, Tetanus, and Acellular Pertussis (DTaP)

Haemophilus influenzae type b (Hib)

Pneumococcal conjugate (PCV13)

Inactivated Poliovirus (IPV)

Influenza (Flu)

Measles, Mumps, and Rubella (MMR)

Varicella (VAR)

Hepatitis A (HepA)

Tetanus, Diphtheria, and Acellular Pertussis (Tdap)

Human Papillomavirus (HPV)

Meningococcal conjugate (MenACWY)

Serogroup B Meningococcal (MenB)

COVID-19

The specific timing and number of doses for each vaccine are outlined in the official immunization schedule. For the most current and detailed information, please refer to the AAP’s official immunization schedule: (publications.aap.org).

🏛️ State-Level Vaccination Laws in the U.S.

While federal agencies like the CDC and AAP provide immunization recommendations, states hold legal authority over most vaccination requirements and policies.

⚖️ What State Vaccination Laws Cover:

1. 🧒 School and Childcare Entry Requirements

States require children to be vaccinated against diseases such as MMR, DTaP, Polio, Varicella, and Hepatitis B to attend:

Public and private K–12 schools

Preschools and childcare facilities

2. 🏥 College and Healthcare Worker Requirements

Many states require college students and healthcare employees to be vaccinated (e.g., MMR, meningococcal, influenza, COVID-19)

Often applies to public universities and licensed facilities

3. 📄 Exemptions Allowed by States

Medical Exemptions (allowed in all 50 states)

Religious Exemptions (allowed in ~44 states)

Philosophical/Personal Belief Exemptions (allowed in fewer than 20 states)

Exemption rules vary greatly by state

4. 🗂️ Documentation and Enforcement

Parents must submit official immunization records or exemption forms

Schools are often required to report immunization compliance rates to state health departments

🔍 Examples of State Differences:

State	Religious Exemption	Philosophical Exemption	Strict Enforcement?
California	❌ No	❌ No	✅ Yes
Texas	✅ Yes	✅ Yes	🚫 Less strict
New York	❌ No	❌ No	✅ Yes
Florida	✅ Yes	❌ No	⚠️ Moderate

🏥 Emergency and Public Health Authority

States can mandate vaccines during emergencies (e.g., outbreaks, pandemics)

May issue temporary vaccination orders for school closures, quarantines, or exclusions

Current events:

According to the Centers for Disease Control (CDC)’s website, as of May 29, 2025, there have been almost 1100 cases of measles reported in the United States. There have been cases reported in 33 of the 50 states. Of those cases, 96% were either unvaccinated or their vaccination status was unknown. There have been 3 confirmed deaths. The epicenter of the outbreak was a community in West Texas where there is a large population of children who are unvaccinated.

When 95% or greater members of a community are vaccinated, most people are protected by herd immunity. In the 2019-2020 school year, 95.2% of incoming kindergarteners were vaccinated with the Measles, Mumps and Rubella (MMR) vaccine. By the 2023-2024 school year, that percentage had dropped to 92.7% of incoming kindergarteners. This means that over 250,000 kindergarteners are susceptible to the measles virus.

🚨 Reportable Injuries in Healthcare and Public Health

Reportable injuries are injuries that, due to their public safety, legal, or public health implications, must be reported to appropriate government or law enforcement agencies.

🔥 Commonly Reportable Injuries Include:

Category	Examples	Reported To
Violent Injuries	Gunshot wounds, stab wounds, blunt force trauma	Law enforcement
Abuse	Suspected child abuse, elder abuse, domestic violence	Child protective services or APS
Burn Injuries	Especially large, suspicious, or caused by explosion/chemicals	Fire marshal, law enforcement
Sexual Assault	Rape, sexual battery, and related trauma	Law enforcement and victim services
Workplace Injuries	Amputations, crush injuries, chemical exposure	OSHA (Occupational Safety & Health Administration)
Infectious Exposure	Needlestick injuries with exposure to HIV/HBV/HCV	Hospital infection control, public health dept
Poisoning or Overdose	Drug overdoses (especially opioids), toxic exposures	Poison control, health departments
Deaths from Injury	Any death due to trauma, suspected crime, or unknown cause	Coroner/medical examiner

⚖️ Why Reporting Is Required:

To ensure public safety and legal accountability

To activate protective services for vulnerable populations

To enable epidemiologic surveillance of violence and occupational hazards

In some states, failure to report is a criminal offense

🧑‍⚕️ Who Must Report:

Physicians and nurses

Hospitals and clinics

Emergency responders

School officials (in child-related cases)

Employers (for OSHA-reportable injuries)

🛡️ Child Abuse Prevention and Treatment Act (CAPTA)

Originally Enacted: 1974
Latest Reauthorization: Most recently amended by the CAPTA Reauthorization Act of 2010 (additional updates ongoing)

🎯 Purpose:

To provide federal funding and guidance to states in support of:

Prevention, identification, and treatment of child abuse and neglect

Development of protective systems, reporting protocols, and data collection

Improvement of child welfare services

🔑 Key Provisions of CAPTA:

1. 📋 Definition of Child Abuse and Neglect

CAPTA defines abuse/neglect broadly as:

“Any recent act or failure to act on the part of a parent or caregiver, which results in death, serious physical or emotional harm, sexual abuse or exploitation.”

2. 📝 Mandatory Reporting Requirements

All states must have laws requiring certain professionals (e.g., healthcare providers, teachers, social workers) to report suspected child abuse

CAPTA mandates states to grant immunity from liability for good-faith reporting

3. 🏛️ State Grant Requirements

To receive CAPTA funding, states must:

Appoint a Child Protective Services (CPS) agency

Establish citizen review panels

Ensure confidentiality protections

Have provisions for investigation and intervention

4. 🧠 Focus on Prevention and Training

Provides grants for community-based prevention programs

Funds education and training for child welfare professionals

Encourages the use of multidisciplinary approaches

5. 📊 Data Collection

Supports national systems like the National Child Abuse and Neglect Data System (NCANDS)

Collects data on reports, investigations, outcomes, and services provided

🔄 Reauthorizations Expanded CAPTA to Include:

Infants affected by prenatal drug exposure

Enhanced services for children with disabilities

Addressing human trafficking of children

👵 Elder Abuse Reporting in Healthcare

📜 What Is Elder Abuse?

Elder abuse is any intentional or negligent act by a caregiver or other person that causes harm or risk of harm to an older adult, typically defined as age 60 or older.

🚨 Types of Elder Abuse:

Type	Examples
Physical abuse	Hitting, pushing, improper restraint
Emotional abuse	Threats, humiliation, isolation
Sexual abuse	Non-consensual sexual contact or harassment
Neglect	Failing to provide food, hygiene, meds
Financial abuse	Stealing money, forging checks
Abandonment	Desertion by caregiver

⚖️ Who Must Report?

Under state mandatory reporting laws, the following healthcare professionals are typically required to report suspected elder abuse:

Physicians and nurses

Medical assistants and caregivers

Social workers

Hospital administrators

Home health aides and long-term care staff

📋 What Must Be Reported?

Any reasonable suspicion or evidence of abuse, neglect, or exploitation of an elderly person. You do not need proof—a good-faith report is sufficient.

🕒 When and How to Report:

Immediately or within 24–48 hours (varies by state)

Contact:

Adult Protective Services (APS)

Long-Term Care Ombudsman (for nursing homes)

Local law enforcement (for immediate danger or criminal behavior)

Some states require written reports in addition to verbal ones

🛡️ Legal Protections:

Reporters are protected by immunity laws if they report in good faith

Failure to report can lead to civil or criminal penalties

🏥 Domestic Abuse Reporting in Healthcare

🛑 What Is Domestic Abuse?

Domestic abuse—also called intimate partner violence (IPV)—includes physical, sexual, emotional, and financial abuse between people in a current or former intimate relationship.

🚨 What Forms Does It Take?

Type	Examples
Physical Abuse	Hitting, slapping, choking, restraining
Emotional Abuse	Threats, intimidation, gaslighting
Sexual Abuse	Forced sex, unwanted touching
Economic Abuse	Controlling money, withholding financial access
Psychological Control	Isolation, constant monitoring, verbal threats

⚖️ Healthcare Providers’ Responsibilities:

✅ Required to Screen:

Many hospitals and clinics follow Joint Commission standards requiring routine IPV screening

Screening should be private, trauma-informed, and non-judgmental

✅ Required to Document:

Document patient statements and observed injuries in medical records

Use objective language and include photos (with consent)

📝 Mandatory Reporting: Varies by State

State Policy	What’s Required
Some states	Mandatory reporting of injuries caused by weapons or abuse
Others	No reporting unless the patient consents
All states	Reporting is required if children, elders, or vulnerable adults are also at risk

🧠 Note: In most states, adult patients have the right to choose whether to involve law enforcement unless their injuries fall under specific reporting laws.

🛡️ Legal and Ethical Duties:

Encourage help: Offer resources like safety planning and hotline info

Maintain confidentiality unless required to report by law

Know your state’s reporting laws (many only require reporting if a deadly weapon is used)

👶 Unborn Victims of Violence Act (UVVA)

Also known as: “Laci and Conner’s Law”
Signed into law: April 1, 2004

🎯 Purpose:

To recognize an unborn child as a separate legal victim when they are injured or killed during the commission of certain federal violent crimes.

⚖️ Key Provisions:

1. Legal Status of the Unborn Child

Defines an “unborn child” as:

“A child in utero, meaning a member of the species Homo sapiens, at any stage of development, who is carried in the womb.”

Grants independent victim status to the unborn child in federal criminal cases.

2. Scope of Application

Applies to federal crimes of violence, including:

Assault, murder, kidnapping

Crimes committed on federal property (e.g., military bases, national parks)

Crimes involving interstate commerce

3. Penalties

Offenders can be charged separately for harm done to the pregnant individual and the unborn child

If the unborn child dies, the charge may be fetal homicide, even if the mother survives

No requirement to prove intent to harm the fetus

4. Exclusions

Does not apply to legal abortion

Does not apply to medical treatment of the pregnant woman or the fetus

Exempts actions by the pregnant person themselves

🧠 Context and Controversy

Sparked national debate about fetal rights vs. reproductive rights

Supported by advocates for victims of violence and unborn children

Opposed by some who argue it could affect abortion access and personhood laws

🛑 Identifying Abuse: A Guide for Professionals

Abuse can affect individuals of any age and often occurs in private settings, making detection and intervention critical. Abuse may be physical, emotional, sexual, financial, or take the form of neglect.

👀 General Signs of Abuse

Type of Abuse	Possible Indicators
Physical	Unexplained bruises, burns, fractures, frequent injuries, patient fearful of touch
Emotional/Psych.	Depression, anxiety, withdrawal, low self-esteem, overly apologetic
Sexual	Genital pain, STIs, inappropriate sexual knowledge (esp. in children), fearful behavior
Neglect	Malnutrition, poor hygiene, unattended medical needs, unsafe living conditions
Financial	Sudden bank changes, missing belongings, unpaid bills, unusual gifts to caregivers

🧑‍⚕️ Clues From Behavior and Interaction

Caregiver speaks for patient or prevents them from answering questions

Patient appears nervous or intimidated around caregiver

Delay in seeking medical care for injuries

Frequent missed appointments or vague explanations

Victim may deny or minimize harm, even under obvious distress

👩‍🏫 At-Risk Populations

Children and teens

Elderly individuals or those with disabilities

Intimate partners (IPV survivors)

Non-English speakers or isolated individuals

Those dependent on others for care or housing

📋 What to Do If You Suspect Abuse:

Document clearly and factually: Use objective terms, note visible injuries, and quote patient when possible

Ask safely and privately: Use trauma-informed, non-judgmental language

Report according to state law:

Mandatory reporters include healthcare providers, teachers, social workers, and others

Report to Adult or Child Protective Services, law enforcement, or appropriate agency

Offer support resources: Provide hotline numbers, safety planning info, or referral to social work

⚖️ Federal Drug Regulations Overview

Federal drug laws are designed to ensure that prescription and non-prescription drugs are safe, effective, and properly used. These laws cover manufacturing, distribution, prescribing, and dispensing.

🧱 1. Food, Drug, and Cosmetic Act (FDCA) – 1938

Administered by: U.S. Food and Drug Administration (FDA)

Requires that all drugs be:

Safe and properly labeled

Approved by the FDA before marketing

Gave FDA authority to recall unsafe drugs and regulate labeling

🧪 2. Controlled Substances Act (CSA) – 1970

Administered by: Drug Enforcement Administration (DEA)

Classifies drugs into five schedules (I–V) based on abuse potential and medical use:

Schedule I: No accepted medical use (e.g., heroin, LSD)

Schedule II: High abuse potential (e.g., opioids, amphetamines)

Schedules III–V: Decreasing abuse risk, more accepted use

Regulates: prescribing, storage, and record-keeping of controlled substances

💊 3. Drug Listing Act – 1972

Requires manufacturers to register all marketed drugs with the FDA

Each drug assigned a unique National Drug Code (NDC)

🛡️ 4. Prescription Drug Marketing Act (PDMA) – 1987

Prohibits re-importation of U.S.-made drugs by anyone other than the manufacturer

Regulates drug samples, hospital repackaging, and wholesaler licensing

🧾 5. Drug Supply Chain Security Act (DSCSA) – 2013

Creates a system to track and trace prescription drugs through the U.S. supply chain

Designed to prevent counterfeit or contaminated drugs from reaching patients

🧬 6. FDA Modernization Act – 1997

Streamlined clinical trials, labeling, and drug approvals

Expanded “off-label” use communications between manufacturers and providers

🧠 Additional Oversight Agencies

FDA (Food and Drug Administration): Safety, approval, labeling, and recalls

DEA (Drug Enforcement Administration): Controlled substances and prescribing laws

FTC (Federal Trade Commission): Advertising of over-the-counter drugs

⚖️ Controlled Substances Act (CSA)

Enacted: 1970
Administered by: U.S. Drug Enforcement Administration (DEA)

🎯 Purpose:

To regulate the manufacture, importation, possession, use, and distribution of certain substances based on their medical use and potential for abuse or dependence.

Drug Scheduling System (Schedules I–V):

Schedule	Examples	Medical Use?	Abuse Potential
I	Heroin, LSD, MDMA, cannabis*	❌ No accepted use	High
II	Oxycodone, fentanyl, Adderall, Ritalin	✅ Severe restrictions	High (severe dependence)
III	Ketamine, anabolic steroids, codeine combo	✅ Accepted use	Moderate to low
IV	Xanax, Ativan, Valium	✅ Accepted use	Low
V	Cough preparations with codeine, Lomotil	✅ Accepted use	Very low

*Marijuana remains a Schedule I drug under federal law but is legal for medical/recreational use in many states.

🧾 Key Provisions:

1. Registration Requirements

Prescribers, pharmacists, manufacturers, and researchers must register with the DEA

Each must follow strict documentation and storage rules

2. Recordkeeping and Inventory

Controlled substances require detailed logs, inventories, and audit trails

Records must be kept for 2 years minimum

3. Prescription Rules

Schedule II: No refills, must be written/e-prescribed (except emergencies)

Schedules III–V: Refillable up to 5 times within 6 months

4. Security Measures

Must store controlled substances in locked, secure cabinets

Regular inspections by the DEA or state boards

🚨 Penalties for Violations:

Civil fines and criminal prosecution for unlawful prescribing, dispensing, or diversion

Penalties vary by schedule and quantity

🌿 Marijuana Legalization in the United States: A 2025 Overview

Marijuana legalization in the U.S. involves a complex and evolving landscape of state laws, federal restrictions, and public policy debates. Here’s a concise summary:

⚖️ Federal Law (Still in Effect)

Marijuana is a Schedule I controlled substance under the Controlled Substances Act (CSA)
→ No accepted medical use and high potential for abuse (federally)

Illegal to possess, distribute, or cultivate marijuana under federal law—even in states where it’s legal

Federal enforcement is limited in legalized states (due to DOJ guidance), but not eliminated

🗺️ State-Level Legalization (as of 2025)

✅ Recreational (Adult-Use) Marijuana Legalized in 24+ States

Including:

California, Colorado, New York, Illinois, Michigan, Arizona, New Mexico, New Jersey, and others

Legal for adults (typically 21+), includes limits on possession and home cultivation

✅ Medical Marijuana Legalized in Over 35 States

Allows use of marijuana with physician recommendation

Conditions include: chronic pain, epilepsy, cancer, PTSD, glaucoma, etc.

⚠️ Some States Still Prohibit Use

A few states maintain full prohibition or allow CBD-only use

🧠 Key Issues in Legalization

Area	Considerations
Public Health	Risk of youth use, impaired driving, cannabis use disorder
Economy	Tax revenue, job creation, cannabis industry growth
Criminal Justice	Reduction in marijuana arrests, efforts to expunge past convictions
Regulation	Licensing, quality control, marketing restrictions, potency limits
Employment	Workplace drug policies still apply in most states

📉 Decriminalization vs. Legalization

Decriminalization: Reduces penalties for possession but does not legalize sale/use

Legalization: Permits possession, use, and regulated sale under state law

🟢 Recreational & Medical Use Legalized (24 States + D.C.)

State	Recreational Use	Medical Use	Notes
Alaska	✅	✅	Legalized recreational use in 2014
Arizona	✅	✅	Legalized recreational use in 2020
California	✅	✅	First state to legalize medical marijuana in 1996
Colorado	✅	✅	Among the first to legalize recreational use in 2012
Connecticut	✅	✅	Recreational sales began in 2022
Delaware	✅	✅	Recreational use legalized in 2023
Illinois	✅	✅	Recreational sales began in 2020
Maine	✅	✅	Recreational use legalized in 2016
Maryland	✅	✅	Recreational use legalized in 2022
Massachusetts	✅	✅	Recreational sales began in 2018
Michigan	✅	✅	Recreational use legalized in 2018
Minnesota	✅	✅	Recreational use legalized in 2023; sales expected to begin in 2025
Missouri	✅	✅	Recreational use legalized in 2022
Montana	✅	✅	Recreational use legalized in 2020
Nevada	✅	✅	Recreational sales began in 2017
New Jersey	✅	✅	Recreational sales began in 2022
New Mexico	✅	✅	Recreational use legalized in 2021
New York	✅	✅	Recreational use legalized in 2021
Ohio	✅	✅	Recreational use legalized in 2023
Oregon	✅	✅	Recreational sales began in 2015
Rhode Island	✅	✅	Recreational use legalized in 2022
Vermont	✅	✅	Recreational sales began in 2022
Virginia	✅	✅	Possession legalized in 2021; retail sales pending
Washington	✅	✅	Among the first to legalize recreational use in 2012
Washington, D.C.	✅	✅	Possession and cultivation legal; sales not permitted

🟡 Medical Use Only (15 States)

State	Recreational Use	Medical Use	Notes
Alabama	❌	✅	Medical use legalized in 2021
Arkansas	❌	✅	Medical use legalized in 2016
Florida	❌	✅	Medical use legalized in 2016; recreational legalization failed in 2024
Georgia	❌	✅	Limited medical use; low-THC oil permitted
Hawaii	❌	✅	Medical use legalized in 2000
Iowa	❌	✅	Limited medical use; low-THC products permitted
Kentucky	❌	✅	Medical use legalized in 2023
Louisiana	❌	✅	Medical use legalized in 2015
Mississippi	❌	✅	Medical use legalized in 2022
Nebraska	❌	✅	Medical use legalized in 2024; implementation pending
New Hampshire	❌	✅	Medical use legalized in 2013
North Dakota	❌	✅	Medical use legalized in 2016
Oklahoma	❌	✅	Medical use legalized in 2018
Pennsylvania	❌	✅	Medical use legalized in 2016; recreational legalization under consideration
South Dakota	❌	✅	Medical use legalized in 2020

🔴 Fully Illegal (No Legal Use) (6 States)

State	Recreational Use	Medical Use	Notes
Idaho	❌	❌	No legal use; strict laws in place
Indiana	❌	❌	No legal use; limited CBD use permitted
Kansas	❌	❌	No legal use; discussions ongoing
North Carolina	❌	❌	No legal use; advisory council formed to consider legalization
South Carolina	❌	❌	No legal use; medical legalization efforts ongoing
Texas	❌	❌	No legal use; limited CBD use permitted

Note: While marijuana remains illegal at the federal level under the Controlled Substances Act, enforcement has been generally limited in states that have enacted legalization measures.