who has the ability to add delete or reschedule a drug
Controlled Substances Act The legislation created five Schedules (classifications), with varying qualifications for a substance to be included in each. Two federal agencies, the Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA), determine which substances are added to or removed from the various schedules, although the statute passed by Congress created the initial listing. Congress has sometimes scheduled other substances through legislation such as the Hillory J. Farias and Samantha Reid Date-Rape Prevention Act of 2000, which placed gamma hydroxybutyrate (GHB) in Schedule I and sodium oxybate (the ISOLATED sodium salt in GHB) in Schedule III.[2][3] Classification decisions are required to be made on criteria including potential for abuse (an undefined term),[4][5] currently accepted medical use in treatment in the United States, and international treaties.
Rectal administration A drug that is administered rectally will in general (depending on the drug) have a faster onset, higher bioavailability, shorter peak, and shorter duration than the oral route.[1][2] Another advantage of administering a drug rectally, is that it tends to produce less nausea compared to the oral route and prevents any amount of the drug from being lost due to emesis (vomiting). In addition, the rectal route bypasses around two thirds of the first-pass metabolism as the rectum's venous drainage is two thirds systemic (middle and inferior rectal vein) and one third hepatic portal system (superior rectal vein). This means the drug will reach the circulatory system with significantly less alteration and in greater concentrations.[Note 3] Finally, rectal administration can allow patients to remain in the home setting when the oral route is compromised. Unlike intravenous lines, which usually need to be placed in an inpatient environment and require special formulation of sterile medications,[3] a specialized rectal catheter can be placed by a clinician, such as a hospice nurse or home health nurse, in the home. Many oral forms of medications can be crushed and suspended in water to be given via a rectal catheter.