83_FR_51134 83 FR 50938 - International Drug Scheduling; Convention on Psychotropic Substances; Single Convention on Narcotic Drugs; ADB-FUBINACA; ADB-CHMINACA; Cyclopropyl Fentanyl; Methoxyacetyl Fentanyl; para-Fluoro Butyrfentanyl; Tramadol; Pregabalin; Cannabis Plant and Resin; and Eight Additional Substances; Request for Comments

83 FR 50938 - International Drug Scheduling; Convention on Psychotropic Substances; Single Convention on Narcotic Drugs; ADB-FUBINACA; ADB-CHMINACA; Cyclopropyl Fentanyl; Methoxyacetyl Fentanyl; para-Fluoro Butyrfentanyl; Tramadol; Pregabalin; Cannabis Plant and Resin; and Eight Additional Substances; Request for Comments

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 83, Issue 196 (October 10, 2018)

Page Range50938-50942
FR Document2018-21954

The Food and Drug Administration (FDA) is requesting interested persons to submit comments concerning abuse potential, actual abuse, medical usefulness, trafficking, and impact of scheduling changes on availability for medical use of 16 drug substances. These comments will be considered in preparing a response from the United States to the World Health Organization (WHO) regarding the abuse liability and diversion of these drugs. WHO will use this information to consider whether to recommend that certain international restrictions be placed on these drugs. This notice requesting comments is required by the Controlled Substances Act (the CSA).

Federal Register, Volume 83 Issue 196 (Wednesday, October 10, 2018)
[Federal Register Volume 83, Number 196 (Wednesday, October 10, 2018)]
[Notices]
[Pages 50938-50942]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-21954]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

[Docket No. FDA-2018-N-3685]


International Drug Scheduling; Convention on Psychotropic 
Substances; Single Convention on Narcotic Drugs; ADB-FUBINACA; ADB-
CHMINACA; Cyclopropyl Fentanyl; Methoxyacetyl Fentanyl; para-Fluoro 
Butyrfentanyl; Tramadol; Pregabalin; Cannabis Plant and Resin; and 
Eight Additional Substances; Request for Comments

AGENCY: Food and Drug Administration, HHS.

ACTION: Notice; request for comments.

-----------------------------------------------------------------------

SUMMARY: The Food and Drug Administration (FDA) is requesting 
interested persons to submit comments concerning abuse potential, 
actual abuse, medical usefulness, trafficking, and impact of scheduling 
changes on availability for medical use of 16 drug substances. These 
comments will be considered in preparing a response from the United 
States to the World Health Organization (WHO) regarding the abuse 
liability and diversion of these drugs. WHO will use this information 
to consider whether to recommend that certain international 
restrictions be placed on these drugs. This notice requesting comments 
is required by the Controlled Substances Act (the CSA).

DATES: Submit either electronic or written comments by October 31, 
2018.

ADDRESSES: You may submit comments as follows. Please note that late, 
untimely filed comments will not be considered. Electronic comments 
must be submitted on or before (enter date), 2018. The https://www.regulations.gov electronic filing system will accept comments until 
11:59 p.m. Eastern Time at the end of October 31, 2018. Comments 
received by mail/hand delivery/courier (for written/paper submissions) 
will be considered timely if they are postmarked or the delivery 
service acceptance receipt is on or before that date.

Electronic Submissions

    Submit electronic comments in the following way:
     Federal eRulemaking Portal: https://www.regulations.gov. 
Follow the instructions for submitting comments. Comments submitted 
electronically, including attachments, to https://www.regulations.gov 
will be posted to the docket unchanged. Because your comment will be 
made public, you are solely responsible for ensuring that your comment 
does not include any

[[Page 50939]]

confidential information that you or a third party may not wish to be 
posted, such as medical information, your or anyone else's Social 
Security number, or confidential business information, such as a 
manufacturing process. Please note that if you include your name, 
contact information, or other information that identifies you in the 
body of your comments, that information will be posted on https://www.regulations.gov.
     If you want to submit a comment with confidential 
information that you do not wish to be made available to the public, 
submit the comment as a written/paper submission and in the manner 
detailed (see ``Written/Paper Submissions'' and ``Instructions'').

Written/Paper Submissions

    Submit written/paper submissions as follows:
     Mail/Hand delivery/Courier (for written/paper 
submissions): Dockets Management Staff (HFA-305), Food and Drug 
Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852.
     For written/paper comments submitted to the Dockets 
Management Staff, FDA will post your comment, as well as any 
attachments, except for information submitted, marked and identified, 
as confidential, if submitted as detailed in ``Instructions.''
    Instructions: All submissions received must include the Docket No. 
FDA-2018-N-3685 for ``International Drug Scheduling; Convention on 
Psychotropic Substances; Single Convention on Narcotic Drugs; ADB-
FUBINACA; FUB-AMB(MMB-FUBINACA_AMB-FUBINACA); ADB-CHMINACA; CUMYL-4CN-
BINACA; Cyclopropyl Fentanyl; Methoxyacetyl Fentanyl; Ortho-
Fluorofentanyl; Para-Fluoro Butyrfentanyl; Para-Methoxybutyrfentanyl; 
N-Ethylnorpentylone; Tramadol; Pregabalin; Cannabis Plant and Resin; 
Extracts and Tinctures of Cannabis; Delta-9-Tetrahydrocannabinol; 
Stereoisomers of Tetrahydrocannabinol; Request for Comments.'' Received 
comments, those filed in a timely manner (see ADDRESSES), will be 
placed in the docket and, except for those submitted as ``Confidential 
Submissions,'' publicly viewable at https://www.regulations.gov or at 
the Dockets Management Staff between 9 a.m. and 4 p.m., Monday through 
Friday.
     Confidential Submissions--To submit a comment with 
confidential information that you do not wish to be made publicly 
available, submit your comments only as a written/paper submission. You 
should submit two copies total. One copy will include the information 
you claim to be confidential with a heading or cover note that states 
``THIS DOCUMENT CONTAINS CONFIDENTIAL INFORMATION.'' The Agency will 
review this copy, including the claimed confidential information, in 
its consideration of comments. The second copy, which will have the 
claimed confidential information redacted/blacked out, will be 
available for public viewing and posted on https://www.regulations.gov. 
Submit both copies to the Dockets Management Staff. If you do not wish 
your name and contact information to be made publicly available, you 
can provide this information on the cover sheet and not in the body of 
your comments and you must identify this information as 
``confidential.'' Any information marked as ``confidential'' will not 
be disclosed except in accordance with 21 CFR 10.20 and other 
applicable disclosure law. For more information about FDA's posting of 
comments to public dockets, see 80 FR 56469, September 18, 2015, or 
access the information at: https://www.thefederalregister.org/fdsys/pkg/FR-2015-09-18/pdf/2015-23389.pdf.
    Docket: For access to the docket to read background documents or 
the electronic and written/paper comments received, go to https://www.regulations.gov and insert the docket number, found in brackets in 
the heading of this document, into the ``Search'' box and follow the 
prompts and/or go to the Dockets Management Staff, 5630 Fishers Lane, 
Rm. 1061, Rockville, MD 20852.

FOR FURTHER INFORMATION CONTACT: James R. Hunter, Center for Drug 
Evaluation and Research, Controlled Substance Staff, Food and Drug 
Administration, 10903 New Hampshire Ave., Bldg. 51, Rm. 5150, Silver 
Spring, MD 20993-0002, 301-796-3156, email: [email protected].

SUPPLEMENTARY INFORMATION: 

I. Background

    The United States is a party to the 1971 Convention on Psychotropic 
Substances (Psychotropic Convention). Article 2 of the Psychotropic 
Convention provides that if a party to the convention or WHO has 
information about a substance, which in its opinion may require 
international control or change in such control, it shall so notify the 
Secretary-General of the United Nations (the U.N. Secretary-General) 
and provide the U.N. Secretary-General with information in support of 
its opinion.
    Paragraph (d)(2)(A) of the CSA (21 U.S.C. 811) (Title II of the 
Comprehensive Drug Abuse Prevention and Control Act of 1970) provides 
that when WHO notifies the United States under Article 2 of the 
Psychotropic Convention that it has information that may justify adding 
a drug or other substances to one of the schedules of the Psychotropic 
Convention, transferring a drug or substance from one schedule to 
another, or deleting it from the schedules, the Secretary of State must 
transmit the notice to the Secretary of Health and Human Services 
(Secretary of HHS). The Secretary of HHS must then publish the notice 
in the Federal Register and provide opportunity for interested persons 
to submit comments that will be considered by HHS in its preparation of 
the scientific and medical evaluations of the drug or substance.

II. WHO Notification

    The Secretary of HHS received the following notice from WHO (non-
relevant text removed):

Ref.: C.L.26.2018

    The World Health Organization (WHO) presents its compliments to 
Member States and Associate Members and has the pleasure of 
informing that the 41th Expert Committee on Drug Dependence (ECDD) 
will meet in Geneva from 12 to 16 November 2018. The 41th ECDD will 
convene to review psychoactive substances on their potential to 
cause dependence, abuse and harm to health, and their potential 
therapeutic applications. WHO will make recommendations to the UN 
Secretary-General on the need for and level of international control 
of these substances.
    Member States are invited to collaborate, as in the past, in 
this process by providing pertinent information as requested in the 
questionnaire and concerning substances under review. At its 126th 
session in January 2010, the Executive Board approved the 
publication ``Guidance on the WHO review of psychoactive substances 
for international control'' (EB126/2010/REC1, Annex 6) which 
requires the Secretariat to request relevant information from 
Ministers of Health in Member States to prepare a report for 
submission to the ECDD.
    For this purpose, a questionnaire was designed to gather 
information on the legitimate use, harmful use, status of national 
control and potential impact of international control for each 
substance under evaluation. A list of substances for which Member 
States will receive questionnaires is attached.
    Kindly note that Member States who submitted questionnaire 
responses that were reviewed at the 40th ECDD on cannabis and 
cannabis-related substances will not be requested to re-submit 
questionnaires for those substances for the 41st ECDD. However, if 
Member States would like to amend their responses or submit 
additional information on cannabis and cannabis-related substances, 
it is requested that they inform the Secretariat.
    It would be appreciated if a person from the Ministry of Health 
could be designated as the focal point responsible for coordinating 
answers to the questionnaires. A list of focal

[[Page 50940]]

points designated by Member States for the 40th ECDD in June 2018 is 
attached. It is requested that if a focal point's contact details 
including email address are to be added or amended, that Member 
States inform the Secretariat by 17 September 2018. Any additions or 
amendments to focal point designations should be emailed to 
[email protected].
    If no additions or amendments to focal point details are made by 
this date, the focal point from 2018 will be approached by the 
Secretariat for questionnaire completion. Where there is a competent 
National Authority under the International Drug Control Treaties, it 
is kindly requested that the questionnaires be completed in 
collaboration with such body.
    Once the Secretariat has received the contact details, focal 
points will be given further instructions and direct access to an 
online questionnaire. The questionnaires will be analysed by the 
Secretariat and prepared as a report that will be shared with the 
Committee for review.
    Member States are also encouraged to provide any additional 
relevant information (unpublished or published) that is available on 
these substances to: [email protected]. This information will 
be an invaluable contribution to the ECDD and all submissions will 
be treated as confidential.
    The WHO takes this opportunity to renew to Member States and 
Associate Members the assurance of its highest consideration.
GENEVA, 21 August 2018

Attachment:

41st WHO Expert Committee on Drug Dependence

Member State Questionnaire Substances

SYNTHETIC CANNABINOIDS

ADB-FUBINACA
FUB-AMB (MMB-FUBINACA, AMB-FUBINACA)
ADB-CHMINACA
CUMYL-4CN-BINACA

FENTANYLS

Cyclopropyl Fentanyl
Methoxyacetyl Fentanyl
Ortho-Fluorofentanyl
Para-Fluoro Butyrfentanyl
Para-Methoxybutyrfentanyl

(METH)CATHINONE

N-Ethylnorpentylone

MEDICINES

Tramadol
Pregabalin

    FDA has verified the website addresses contained in the WHO notice, 
as of the date this document publishes in the Federal Register, but 
websites are subject to change over time. Access to view the WHO 
questionnaire can be found at http://www.who.int/medicines/access/controlled-substances/ecdd_41_meeting/en/.

III. Substances Under WHO Review

    ADB-FUBINACA (chemical name: N-[1-(aminocarbonyl)-2,2-
dimethylpropyl]-1-[(4-fluorophenyl)methyl]-1H-indazole-3-carboxamide) 
is an indazole-based synthetic cannabinoid that is a potent, full 
agonist at CB1 receptors. This substance functionally (biologically) 
mimics the effects of the structurally unrelated delta-9-
tetrahydrocannabinol (THC), a Schedule I substance, and the main 
psychoactive chemical constituent in the cannabis (marijuana) plant. 
Synthetic cannabinoids have been marketed under the guise of ``herbal 
incense,'' and promoted by drug traffickers as legal alternatives to 
marijuana. ADB-FUBINACA use has been associated with serious adverse 
events including death in the United States. There are no commercial or 
approved medical uses for ADB-FUBINACA. On April 10, 2017, ADB-FUBINACA 
was temporarily controlled as a Schedule I substance under the CSA.
    FUB-AMB (other names: MMB-FUBINACA; AMB-FUBINACA; chemical name: 
methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3-
methylbutanoate) is an indazole-based synthetic cannabinoid that is a 
potent full agonist at CB1 receptors. This substance functionally 
(biologically) mimics the effects of the structurally unrelated THC, a 
Schedule I substance, and the main psychoactive chemical constituent in 
marijuana. Synthetic cannabinoids have been marketed under the guise of 
``herbal incense,'' and promoted by drug traffickers as legal 
alternatives to marijuana. FUB-AMB use has been associated with serious 
adverse events including death in the United States. There are no 
commercial or approved medical uses for FUB-AMB. On November 3, 2017, 
FUB-AMB was temporarily controlled as a Schedule I substance under the 
CSA.
    ADB-CHMINACA (other name: MAB-CHMINACA; chemical name: N-(1-amino-
3,3-dimethyl-1-oxobutan-2-yl)-1-(cyclohexylmethyl)-1H-indole-3-
carboxamide) is an indazole-based synthetic cannabinoid that is a 
potent full agonist at CB1 receptors. This substance functionally 
(biologically) mimics the effects of the structurally THC, a Schedule I 
substance, and the main psychoactive chemical constituent in marijuana. 
Synthetic cannabinoids have been marketed under the guise of ``herbal 
incense,'' and promoted by drug traffickers as legal alternatives to 
marijuana. ADB-CHMINACA use has been associated with serious adverse 
events including death in the United States. There are no commercial or 
approved medical uses for ADB-CHMINACA. On February 5, 2016, ADB-
CHMINACA was temporarily controlled as a Schedule I substance under the 
CSA.
    CUMYL-4CN-BINACA (chemical name: 1-(4-cyanobutyl)-N-(2-
phenylpropan-2-yl)-1 H-indazole-3-carboxamide) is a clandestinely 
produced indazole-3-carboxamide based synthetic cannabinoid that has 
been sold online and used to mimic the biological effects of THC, the 
main psychoactive chemical constituent in marijuana. Synthetic 
cannabinoids have been marketed under the guise of ``herbal incense,'' 
and promoted by drug traffickers as legal alternatives to marijuana. 
Hospital, scientific publications and law enforcement reports show that 
CUMYL-4CN-BINACA is abused for its psychoactive properties. CUMYL-4CN-
BINACA has been associated with serious adverse events in the United 
States, in addition to multiple deaths in Europe. CUMYL-4CN-BINACA has 
no commercial or medical uses. On July 10, 2018, CUMYL-4CN-BINACA was 
temporarily controlled as a Schedule I substance under the CSA.
    Cyclopropyl fentanyl is a synthetic opioid that has a 
pharmacological profile similar to other Schedule I and II controlled 
opioid substances such as acetyl fentanyl, fentanyl, and other related 
mu-opioid receptor agonist substances. This clandestinely produced 
analog of fentanyl is associated with adverse events typically 
associated with opioid use such as respiratory depression, anxiety, 
constipation, tiredness, hallucinations, and withdrawal. Cyclopropyl 
fentanyl has been associated with numerous fatalities. At least 115 
confirmed overdose deaths involving cyclopropyl fentanyl abuse have 
been reported in the United States. Cyclopropyl fentanyl has no 
commercial or currently accepted medical uses in the United States. On 
January 4, 2018, cyclopropyl fentanyl was temporarily placed into 
Schedule I of the CSA.
    Methoxyacetyl fentanyl has a pharmacological profile similar to 
other Schedule I and II opioid substances such as acetyl fentanyl, 
fentanyl, and other related mu-opioid receptor agonist substances. 
Evidence suggests that the pattern of abuse of fentanyl analogues, 
including methoxyacetyl fentanyl is similar to heroin and prescription 
opioid analgesics. Law enforcement and public health reports 
demonstrate that methoxyacetyl fentanyl is being illicitly distributed 
and abused. The Drug Enforcement Administration (DEA) is aware of at 
least two overdose deaths associated with the abuse of methoxyacetyl 
fentanyl in the United

[[Page 50941]]

States. Methoxyacetyl fentanyl has no currently accepted medical use in 
treatment in the United States. On October 26, 2017, methoxyacetyl 
fentanyl was temporarily placed into Schedule I of the CSA.
    Ortho-fluorofentanyl has a pharmacological profile similar to 
fentanyl and other related mu-opioid receptor agonist. Ortho-
fluorofentanyl has no currently accepted medical use in treatment in 
the United States. Ortho-fluorofentanyl has been encountered by law 
enforcement and public health officials. The DEA has received reports 
for at least 13 confirmed overdose deaths involving ortho-
fluorofentanyl abuse in the United States. On October 26, 2017, ortho-
fluorofentanyl was temporarily placed into Schedule I of the CSA.
    Para-fluorobutyrfentanyl shares pharmacological profile with other 
Schedule I (e.g., butyryl fentanyl) and II (e.g., fentanyl) opioid 
substances. Para-fluorobutyrfentanyl has no currently accepted medical 
use in treatment in the United States. The abuse of para-
fluorobutyrfentanyl carries public health risks similar to that of 
heroin, fentanyl, and prescription opioid analgesics. On February 1, 
2018, para-fluorobutyrfentanyl was temporarily placed into Schedule I 
of the CSA.
    Para-methoxybutyrfentanyl shares pharmacological profile with other 
Schedule I (e.g., butyryl fentanyl) and II (e.g., fentanyl) opioid 
substances. Para-methoxybutyrfentanyl has no currently accepted medical 
use in treatment in the United States. The abuse of para-
methoxybutyrfentanyl carries public health risks similar to that of 
heroin, fentanyl, and prescription opioid analgesics. On February 1, 
2018, para-methoxybutyrfentanyl was temporarily placed into Schedule I 
of the CSA.
    N-ethylnorpentylone (other name: N-ethylpentylone) is a synthetic 
cathinone with stimulant and psychoactive properties similar to 
cathinone, a Schedule I substance. N-ethylpentylone abuse has been 
associated with adverse health effects leading to emergency department 
admissions, and deaths. N-ethylpentylone has no currently accepted 
medical use in treatment in the United States. On August 31, 2018, N-
ethylnorpentylone was temporarily controlled as a Schedule I substance 
under the CSA.
    Tramadol, an opioid analgesic, was first approved by the FDA for 
medical use in March of 1995 for the treatment of moderate to 
moderately severe pain. It is available as immediate-release, extended-
release, and combination products containing acetaminophen. Tramadol 
has been abused alone or in combination with other psychoactive 
substances. On July 2, 2014, the DEA issued a Final Rule controlling 
tramadol as a Schedule IV substance under the CSA with effective date 
of August 18, 2014.
    The ECDD pre-reviewed tramadol at its 39th meeting in November 2017 
noting growing evidence of abuse of tramadol in many countries, in some 
cases serious, accompanied by adverse reactions and tramadol-associated 
deaths and recommending that tramadol be subject to a critical review 
at a subsequent meeting.
    Pregabalin is an FDA-approved medication in the United States and 
is available as an oral capsule and oral solution and approved for the 
management of neuropathic pain associated with diabetic peripheral 
neuropathy, postherpetic neuralgia, and adjunctive therapy for partial 
onset seizures, fibromyalgia, and neuropathic pain associated with 
spinal cord injury. Although the mechanism of action of pregabalin is 
unknown, pregabalin is thought to produce its therapeutic effects on 
neuropathic pain via binding with high affinity to the alpha 2-delta 
receptor site (a subunit of voltage gated calcium channels) within the 
central nervous system. Reports indicate that patients are self-
administering higher than recommended doses to achieve euphoria, 
especially patients who have a history of substance abuse, particularly 
opioids. While effects of excessively high doses are generally non-
lethal, gabapentinoids such as pregabalin are increasingly being 
identified in postmortem toxicology analyses. Pregabalin is a Schedule 
V controlled substance in the United States under the CSA. At its 39th 
meeting in November 2017, the WHO Expert Committee on Drug Dependence 
(ECDD) pre-reviewed pregabalin and, noting increasing evidence of 
misuse and abuse in many countries, the ECDD recommended that 
pregabalin be subject to a future critical review.
    Cannabis, also known as marijuana, is a plant known by biological 
names Cannabis sativa or Cannabis indica. It is a complex plant 
substance containing multiple cannabinoids and other compounds, 
including the psychoactive chemical THC and other structurally similar 
compounds. Cannabinoids are defined as having activity at cannabinoid 1 
and 2 (CB1 and CB2 respectively) receptors. Agonists of CB1 receptors 
are widely abused and are known to modulate motor coordination, memory 
processing, pain, and inflammation, and have anxiolytic effects.
    The principal cannabinoids in the cannabis plant include THC, 
cannabidiol (CBD), and cannabinol. These substances are controlled in 
Schedule I under the CSA. The synthetically derived single pure 
stereoisomer, (-)-trans-delta-9-THC (also known as dronabinol) is the 
active ingredient in two approved drug products in the United States, 
MARINOL (dronabinol) capsules (and generics) and SYNDROS (dronabinol) 
oral solution. MARINOL is controlled in Schedule III, while SYNDROS is 
controlled in Schedule II under the CSA. Both MARINOL and SYNDROS are 
approved to treat anorexia associated with weight loss in patients with 
acquired immunodeficiency syndrome (AIDS), and nausea and vomiting 
associated with cancer chemotherapy in patients who have failed to 
respond adequately to conventional treatment.
    CBD is another cannabinoid constituent of the cannabis plant. In 
the United States, one CBD-containing product, Epidiolex oral solution, 
has received marketing approval by FDA for the treatment of seizures 
associated with two rare and severe forms of epilepsy, Lennox-Gastaut 
syndrome and Dravet syndrome, in patients 2 years of age and older. The 
CBD in Epidiolex is extracted and purified from the cannabis plant. 
Currently, CBD is controlled generally as a Schedule I substance under 
the CSA. However, the recent scheduling action on September 28, 2018, 
by the DEA for Epidiolex, and any future, similar formulations of CBD 
that become FDA-approved medications, places these FDA-approved CBD 
formulations in Schedule V under the CSA.\1\ CBD is not specifically 
listed in the schedules of the 1961, 1971, or 1988 International Drug 
Control conventions.
---------------------------------------------------------------------------

    \1\ https://www.ecfr.gov/cgi-bin/text-idx?SID=f43ff6b6883b0b81774fab03dcea8fa5&mc=true&node=pt21.9.1308&rgn=div5#se21.9.1308_115.
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    At the 40th (2018) meeting of the ECDD, the committee critically-
reviewed CBD and pre-reviews of cannabis plant and resin; extracts and 
tinctures of cannabis; THC; and isomers of THC. The 40th ECDD 
recommended that preparations considered to be pure CBD should not be 
scheduled within the International Drug Control Conventions, and that 
cannabis plant and resin; extracts and tinctures of cannabis; THC; and 
isomers of THC proceed to a Critical Review.

IV. Opportunity To Submit Domestic Information

    As required by paragraph (d)(2)(A) of the CSA, FDA, on behalf of 
HHS, invites

[[Page 50942]]

interested persons to submit comments regarding the 16 drug substances. 
Any comments received will be considered by HHS when it prepares a 
scientific and medical evaluation for drug substances that is 
responsive to the WHO Questionnaire for these drug substances. HHS will 
forward such evaluation of these drug substances to WHO, for WHO's 
consideration in deciding whether to recommend international control/
decontrol of any of these drug substances. Such control could limit, 
among other things, the manufacture and distribution (import/export) of 
these drug substances and could impose certain recordkeeping 
requirements on them.
    Although FDA is, through this notice, requesting comments from 
interested persons, which will be considered by HHS when it prepares an 
evaluation of these drug substances, HHS will not now make any 
recommendations to WHO regarding whether any of these drugs should be 
subjected to international controls. Instead, HHS will defer such 
consideration until WHO has made official recommendations to the 
Commission on Narcotic Drugs, which are expected to be made in mid-
2018. Any HHS position regarding international control of these drug 
substances will be preceded by another Federal Register notice 
soliciting public comments, as required by paragraph (d)(2)(B) of the 
CSA.

    Dated: October 3, 2018.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2018-21954 Filed 10-9-18; 8:45 am]
 BILLING CODE 4164-01-P



                                              50938                             Federal Register / Vol. 83, No. 196 / Wednesday, October 10, 2018 / Notices

                                                                                    RPG CROSS-SITE EVALUATION ANNUALIZED BURDEN ESTIMATES—Continued
                                                                                                                                                                     Number of                   Average
                                                                                                                                           Total                                                                         Estimated          Total
                                                                                                                                                                  responses per               burden hours
                                                                        Data collection activity                                         number of                                                                          total          annual
                                                                                                                                                                    respondent                per response
                                                                                                                                        respondents                                                                     burden hours    burden hours
                                                                                                                                                                    (each year)                 (in hours)

                                              Partner survey ......................................................................                     135                          .33                      0.42              56.3            18.8

                                                                                                                            Enrollment, client and service data

                                              Semi-annual progress reports .............................................                                  27                         2                      16.5                2,673            891
                                              Case enrollment data ...........................................................                            81                        43                      0.25              2,612.3          870.8
                                              Case closure ........................................................................                       81                        43                     0.017                174.2           58.1
                                              Case closure—prenatal .......................................................                               81                        33                     0.017                133.7           44.6
                                              Service log entries ...............................................................                        162                     2,288                      0.03               37,065         12,355

                                                                                                                                      Outcome and impact data

                                              Administrative Data:
                                                  Obtain access to administrative data ...........................                                         27                           1                     42.6            3,450.6         1150.2
                                                  Report administrative data ............................................                                  27                           2                      144             23,328          7,776
                                              Standardized instruments:
                                                  Review and adopt reporting templates .........................                                           27                       .33                         8                216               72
                                                  Data entry for standardized instruments ......................                                           27                       130                      1.25           13,162.5          4,387.5
                                              Review records and submit .................................................                                  27                         2                        25              4,050            1,350

                                              Data entry for comparison study sites (22 grantees) ..........                                               22                       130                       1.25            10,725           3,575

                                                    Estimated Total Burden Hours .....................................                 ........................   ........................   ........................         97,827          32,609



                                                In compliance with the requirements                                  comments and suggestions within 60                                          Organization (WHO) regarding the abuse
                                              of Section 3506(c)(2)(A) of the                                        days of this publication.                                                   liability and diversion of these drugs.
                                              Paperwork Reduction Act of 1995, the                                                                                                               WHO will use this information to
                                                                                                                     Robert Sargis,
                                              Children’s Bureau within the                                                                                                                       consider whether to recommend that
                                                                                                                     Reports Clearance Officer.                                                  certain international restrictions be
                                              Administration for Children and
                                                                                                                     [FR Doc. 2018–22020 Filed 10–9–18; 8:45 am]                                 placed on these drugs. This notice
                                              Families is soliciting public comment
                                              on the specific aspects of the                                         BILLING CODE 4184–29–P                                                      requesting comments is required by the
                                              information collection described above.                                                                                                            Controlled Substances Act (the CSA).
                                              Copies of the proposed collection of                                                                                                               DATES: Submit either electronic or
                                                                                                                     DEPARTMENT OF HEALTH AND
                                              information can be obtained and                                        HUMAN SERVICES                                                              written comments by October 31, 2018.
                                              comments may be forwarded by writing                                                                                                               ADDRESSES: You may submit comments
                                              to Administration for Children and                                     Food and Drug Administration                                                as follows. Please note that late,
                                              Families, Office of Administration,                                                                                                                untimely filed comments will not be
                                                                                                                     [Docket No. FDA–2018–N–3685]
                                              Office of Planning, Research and                                                                                                                   considered. Electronic comments must
                                              Evaluation, 330 C Street SW,                                           International Drug Scheduling;                                              be submitted on or before (enter date),
                                              Washington, DC 20201, Attn: ACF                                        Convention on Psychotropic                                                  2018. The https://www.regulations.gov
                                              Reports Clearance Officer. Email                                       Substances; Single Convention on                                            electronic filing system will accept
                                              address: infocollection@acf.hhs.gov. All                               Narcotic Drugs; ADB–FUBINACA;                                               comments until 11:59 p.m. Eastern Time
                                              requests should be identified by the title                             ADB–CHMINACA; Cyclopropyl                                                   at the end of October 31, 2018.
                                              of the information collection.                                         Fentanyl; Methoxyacetyl Fentanyl;                                           Comments received by mail/hand
                                                                                                                     para-Fluoro Butyrfentanyl; Tramadol;                                        delivery/courier (for written/paper
                                                The Department specifically requests                                                                                                             submissions) will be considered timely
                                              comments on: (a) Whether the proposed                                  Pregabalin; Cannabis Plant and Resin;
                                                                                                                     and Eight Additional Substances;                                            if they are postmarked or the delivery
                                              collection of information is necessary                                                                                                             service acceptance receipt is on or
                                              for the proper performance of the                                      Request for Comments
                                                                                                                                                                                                 before that date.
                                              function of the agency, including                                      AGENCY:          Food and Drug Administration,
                                              whether the information shall have                                                                                                                 Electronic Submissions
                                                                                                                     HHS.
                                              practical utility; (b) the accuracy of the                             ACTION:      Notice; request for comments.                                    Submit electronic comments in the
                                              agency’s estimate of the burden of the                                                                                                             following way:
                                              proposed collection of information; (c)                                SUMMARY:   The Food and Drug                                                  • Federal eRulemaking Portal:
                                              the quality, utility, and clarity of the                               Administration (FDA) is requesting                                          https://www.regulations.gov. Follow the
                                              information to be collected; and (d)                                   interested persons to submit comments                                       instructions for submitting comments.
amozie on DSK3GDR082PROD with NOTICES1




                                              ways to minimize the burden of the                                     concerning abuse potential, actual                                          Comments submitted electronically,
                                              collection of information on                                           abuse, medical usefulness, trafficking,                                     including attachments, to https://
                                              respondents, including through the use                                 and impact of scheduling changes on                                         www.regulations.gov will be posted to
                                              of automated collection techniques or                                  availability for medical use of 16 drug                                     the docket unchanged. Because your
                                              other forms of information technology.                                 substances. These comments will be                                          comment will be made public, you are
                                              Consideration will be given to                                         considered in preparing a response from                                     solely responsible for ensuring that your
                                                                                                                     the United States to the World Health                                       comment does not include any


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                                                                        Federal Register / Vol. 83, No. 196 / Wednesday, October 10, 2018 / Notices                                               50939

                                              confidential information that you or a                  information you claim to be confidential              and Control Act of 1970) provides that
                                              third party may not wish to be posted,                  with a heading or cover note that states              when WHO notifies the United States
                                              such as medical information, your or                    ‘‘THIS DOCUMENT CONTAINS                              under Article 2 of the Psychotropic
                                              anyone else’s Social Security number, or                CONFIDENTIAL INFORMATION.’’ The                       Convention that it has information that
                                              confidential business information, such                 Agency will review this copy, including               may justify adding a drug or other
                                              as a manufacturing process. Please note                 the claimed confidential information, in              substances to one of the schedules of the
                                              that if you include your name, contact                  its consideration of comments. The                    Psychotropic Convention, transferring a
                                              information, or other information that                  second copy, which will have the                      drug or substance from one schedule to
                                              identifies you in the body of your                      claimed confidential information                      another, or deleting it from the
                                              comments, that information will be                      redacted/blacked out, will be available               schedules, the Secretary of State must
                                              posted on https://www.regulations.gov.                  for public viewing and posted on                      transmit the notice to the Secretary of
                                                • If you want to submit a comment                     https://www.regulations.gov. Submit                   Health and Human Services (Secretary
                                              with confidential information that you                  both copies to the Dockets Management                 of HHS). The Secretary of HHS must
                                              do not wish to be made available to the                 Staff. If you do not wish your name and               then publish the notice in the Federal
                                              public, submit the comment as a                         contact information to be made publicly               Register and provide opportunity for
                                              written/paper submission and in the                     available, you can provide this                       interested persons to submit comments
                                              manner detailed (see ‘‘Written/Paper                    information on the cover sheet and not                that will be considered by HHS in its
                                              Submissions’’ and ‘‘Instructions’’).                    in the body of your comments and you                  preparation of the scientific and medical
                                              Written/Paper Submissions                               must identify this information as                     evaluations of the drug or substance.
                                                                                                      ‘‘confidential.’’ Any information marked
                                                Submit written/paper submissions as                                                                         II. WHO Notification
                                                                                                      as ‘‘confidential’’ will not be disclosed
                                              follows:                                                except in accordance with 21 CFR 10.20                   The Secretary of HHS received the
                                                • Mail/Hand delivery/Courier (for                                                                           following notice from WHO (non-
                                                                                                      and other applicable disclosure law. For
                                              written/paper submissions): Dockets                                                                           relevant text removed):
                                                                                                      more information about FDA’s posting
                                              Management Staff (HFA–305), Food and
                                              Drug Administration, 5630 Fishers                       of comments to public dockets, see 80                 Ref.: C.L.26.2018
                                              Lane, Rm. 1061, Rockville, MD 20852.                    FR 56469, September 18, 2015, or access                 The World Health Organization (WHO)
                                                • For written/paper comments                          the information at: https://www.gpo.gov/              presents its compliments to Member States
                                              submitted to the Dockets Management                     fdsys/pkg/FR-2015-09-18/pdf/2015-                     and Associate Members and has the pleasure
                                                                                                      23389.pdf.                                            of informing that the 41th Expert Committee
                                              Staff, FDA will post your comment, as                                                                         on Drug Dependence (ECDD) will meet in
                                              well as any attachments, except for                        Docket: For access to the docket to
                                                                                                      read background documents or the                      Geneva from 12 to 16 November 2018. The
                                              information submitted, marked and                                                                             41th ECDD will convene to review
                                              identified, as confidential, if submitted               electronic and written/paper comments                 psychoactive substances on their potential to
                                              as detailed in ‘‘Instructions.’’                        received, go to https://                              cause dependence, abuse and harm to health,
                                                Instructions: All submissions received                www.regulations.gov and insert the                    and their potential therapeutic applications.
                                              must include the Docket No. FDA–                        docket number, found in brackets in the               WHO will make recommendations to the UN
                                              2018–N–3685 for ‘‘International Drug                    heading of this document, into the                    Secretary-General on the need for and level
                                                                                                      ‘‘Search’’ box and follow the prompts                 of international control of these substances.
                                              Scheduling; Convention on
                                                                                                      and/or go to the Dockets Management                     Member States are invited to collaborate, as
                                              Psychotropic Substances; Single                                                                               in the past, in this process by providing
                                              Convention on Narcotic Drugs; ADB–                      Staff, 5630 Fishers Lane, Rm. 1061,
                                                                                                                                                            pertinent information as requested in the
                                              FUBINACA; FUB–AMB(MMB–                                  Rockville, MD 20852.                                  questionnaire and concerning substances
                                              FUBINACA_AMB–FUBINACA); ADB–                            FOR FURTHER INFORMATION CONTACT:                      under review. At its 126th session in January
                                              CHMINACA; CUMYL–4CN–BINACA;                             James R. Hunter, Center for Drug                      2010, the Executive Board approved the
                                              Cyclopropyl Fentanyl; Methoxyacetyl                     Evaluation and Research, Controlled                   publication ‘‘Guidance on the WHO review
                                              Fentanyl; Ortho-Fluorofentanyl; Para-                   Substance Staff, Food and Drug                        of psychoactive substances for international
                                                                                                      Administration, 10903 New Hampshire                   control’’ (EB126/2010/REC1, Annex 6) which
                                              Fluoro Butyrfentanyl; Para-
                                                                                                      Ave., Bldg. 51, Rm. 5150, Silver Spring,              requires the Secretariat to request relevant
                                              Methoxybutyrfentanyl; N-                                                                                      information from Ministers of Health in
                                              Ethylnorpentylone; Tramadol;                            MD 20993–0002, 301–796–3156, email:                   Member States to prepare a report for
                                              Pregabalin; Cannabis Plant and Resin;                   james.hunter@fda.hhs.gov.                             submission to the ECDD.
                                              Extracts and Tinctures of Cannabis;                     SUPPLEMENTARY INFORMATION:                              For this purpose, a questionnaire was
                                              Delta-9-Tetrahydrocannabinol;                                                                                 designed to gather information on the
                                              Stereoisomers of Tetrahydrocannabinol;                  I. Background                                         legitimate use, harmful use, status of national
                                              Request for Comments.’’ Received                          The United States is a party to the                 control and potential impact of international
                                              comments, those filed in a timely                       1971 Convention on Psychotropic                       control for each substance under evaluation.
                                                                                                                                                            A list of substances for which Member States
                                              manner (see ADDRESSES), will be placed                  Substances (Psychotropic Convention).
                                                                                                                                                            will receive questionnaires is attached.
                                              in the docket and, except for those                     Article 2 of the Psychotropic                           Kindly note that Member States who
                                              submitted as ‘‘Confidential                             Convention provides that if a party to                submitted questionnaire responses that were
                                              Submissions,’’ publicly viewable at                     the convention or WHO has information                 reviewed at the 40th ECDD on cannabis and
                                              https://www.regulations.gov or at the                   about a substance, which in its opinion               cannabis-related substances will not be
                                              Dockets Management Staff between 9                      may require international control or                  requested to re-submit questionnaires for
                                              a.m. and 4 p.m., Monday through                         change in such control, it shall so notify            those substances for the 41st ECDD.
                                              Friday.                                                 the Secretary-General of the United                   However, if Member States would like to
amozie on DSK3GDR082PROD with NOTICES1




                                                • Confidential Submissions—To                         Nations (the U.N. Secretary-General)                  amend their responses or submit additional
                                                                                                                                                            information on cannabis and cannabis-
                                              submit a comment with confidential                      and provide the U.N. Secretary-General
                                                                                                                                                            related substances, it is requested that they
                                              information that you do not wish to be                  with information in support of its                    inform the Secretariat.
                                              made publicly available, submit your                    opinion.                                                It would be appreciated if a person from
                                              comments only as a written/paper                          Paragraph (d)(2)(A) of the CSA (21                  the Ministry of Health could be designated as
                                              submission. You should submit two                       U.S.C. 811) (Title II of the                          the focal point responsible for coordinating
                                              copies total. One copy will include the                 Comprehensive Drug Abuse Prevention                   answers to the questionnaires. A list of focal



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                                              50940                     Federal Register / Vol. 83, No. 196 / Wednesday, October 10, 2018 / Notices

                                              points designated by Member States for the              dimethylpropyl]-1-[(4-                                ADB–CHMINACA was temporarily
                                              40th ECDD in June 2018 is attached. It is               fluorophenyl)methyl]-1H-indazole-3-                   controlled as a Schedule I substance
                                              requested that if a focal point’s contact               carboxamide) is an indazole-based                     under the CSA.
                                              details including email address are to be                                                                        CUMYL–4CN–BINACA (chemical
                                                                                                      synthetic cannabinoid that is a potent,
                                              added or amended, that Member States
                                                                                                      full agonist at CB1 receptors. This                   name: 1-(4-cyanobutyl)-N-(2-
                                              inform the Secretariat by 17 September 2018.
                                              Any additions or amendments to focal point              substance functionally (biologically)                 phenylpropan-2-yl)-1 H-indazole-3-
                                              designations should be emailed to                       mimics the effects of the structurally                carboxamide) is a clandestinely
                                              ecddsecretariat@who.int.                                unrelated delta-9-tetrahydrocannabinol                produced indazole-3-carboxamide based
                                                If no additions or amendments to focal                (THC), a Schedule I substance, and the                synthetic cannabinoid that has been
                                              point details are made by this date, the focal          main psychoactive chemical constituent                sold online and used to mimic the
                                              point from 2018 will be approached by the               in the cannabis (marijuana) plant.                    biological effects of THC, the main
                                              Secretariat for questionnaire completion.               Synthetic cannabinoids have been                      psychoactive chemical constituent in
                                              Where there is a competent National                                                                           marijuana. Synthetic cannabinoids have
                                                                                                      marketed under the guise of ‘‘herbal
                                              Authority under the International Drug
                                              Control Treaties, it is kindly requested that           incense,’’ and promoted by drug                       been marketed under the guise of
                                              the questionnaires be completed in                      traffickers as legal alternatives to                  ‘‘herbal incense,’’ and promoted by drug
                                              collaboration with such body.                           marijuana. ADB–FUBINACA use has                       traffickers as legal alternatives to
                                                Once the Secretariat has received the                 been associated with serious adverse                  marijuana. Hospital, scientific
                                              contact details, focal points will be given             events including death in the United                  publications and law enforcement
                                              further instructions and direct access to an            States. There are no commercial or                    reports show that CUMYL–4CN–
                                              online questionnaire. The questionnaires will           approved medical uses for ADB–                        BINACA is abused for its psychoactive
                                              be analysed by the Secretariat and prepared             FUBINACA. On April 10, 2017, ADB–                     properties. CUMYL–4CN–BINACA has
                                              as a report that will be shared with the                                                                      been associated with serious adverse
                                                                                                      FUBINACA was temporarily controlled
                                              Committee for review.
                                                Member States are also encouraged to                  as a Schedule I substance under the                   events in the United States, in addition
                                              provide any additional relevant information             CSA.                                                  to multiple deaths in Europe. CUMYL–
                                              (unpublished or published) that is available               FUB–AMB (other names: MMB–                         4CN–BINACA has no commercial or
                                              on these substances to: ecddsecretariat@                FUBINACA; AMB–FUBINACA;                               medical uses. On July 10, 2018,
                                              who.int. This information will be an                    chemical name: methyl 2-(1-(4-                        CUMYL–4CN–BINACA was temporarily
                                              invaluable contribution to the ECDD and all             fluorobenzyl)-1H-indazole-3-                          controlled as a Schedule I substance
                                              submissions will be treated as confidential.            carboxamido)-3-methylbutanoate) is an                 under the CSA.
                                                The WHO takes this opportunity to renew               indazole-based synthetic cannabinoid                     Cyclopropyl fentanyl is a synthetic
                                              to Member States and Associate Members the              that is a potent full agonist at CB1                  opioid that has a pharmacological
                                              assurance of its highest consideration.
                                                                                                      receptors. This substance functionally                profile similar to other Schedule I and
                                              GENEVA, 21 August 2018
                                                                                                      (biologically) mimics the effects of the              II controlled opioid substances such as
                                              Attachment:                                             structurally unrelated THC, a Schedule                acetyl fentanyl, fentanyl, and other
                                              41st WHO Expert Committee on Drug                       I substance, and the main psychoactive                related mu-opioid receptor agonist
                                              Dependence                                              chemical constituent in marijuana.                    substances. This clandestinely produced
                                              Member State Questionnaire Substances                   Synthetic cannabinoids have been                      analog of fentanyl is associated with
                                                                                                      marketed under the guise of ‘‘herbal                  adverse events typically associated with
                                              SYNTHETIC CANNABINOIDS                                                                                        opioid use such as respiratory
                                                                                                      incense,’’ and promoted by drug
                                              ADB–FUBINACA                                            traffickers as legal alternatives to                  depression, anxiety, constipation,
                                              FUB–AMB (MMB–FUBINACA, AMB–                             marijuana. FUB–AMB use has been                       tiredness, hallucinations, and
                                                FUBINACA)                                                                                                   withdrawal. Cyclopropyl fentanyl has
                                              ADB–CHMINACA
                                                                                                      associated with serious adverse events
                                              CUMYL–4CN–BINACA                                        including death in the United States.                 been associated with numerous
                                                                                                      There are no commercial or approved                   fatalities. At least 115 confirmed
                                              FENTANYLS                                               medical uses for FUB–AMB. On                          overdose deaths involving cyclopropyl
                                              Cyclopropyl Fentanyl                                    November 3, 2017, FUB–AMB was                         fentanyl abuse have been reported in the
                                              Methoxyacetyl Fentanyl                                  temporarily controlled as a Schedule I                United States. Cyclopropyl fentanyl has
                                              Ortho-Fluorofentanyl                                    substance under the CSA.                              no commercial or currently accepted
                                              Para-Fluoro Butyrfentanyl                                  ADB–CHMINACA (other name:                          medical uses in the United States. On
                                              Para-Methoxybutyrfentanyl                               MAB–CHMINACA; chemical name:                          January 4, 2018, cyclopropyl fentanyl
                                              (METH)CATHINONE                                         N-(1-amino-3,3-dimethyl-1-oxobutan-2-                 was temporarily placed into Schedule I
                                              N-Ethylnorpentylone                                     yl)-1-(cyclohexylmethyl)-1H-indole-3-                 of the CSA.
                                                                                                      carboxamide) is an indazole-based                        Methoxyacetyl fentanyl has a
                                              MEDICINES                                               synthetic cannabinoid that is a potent                pharmacological profile similar to other
                                              Tramadol                                                full agonist at CB1 receptors. This                   Schedule I and II opioid substances
                                              Pregabalin                                              substance functionally (biologically)                 such as acetyl fentanyl, fentanyl, and
                                                FDA has verified the website                          mimics the effects of the structurally                other related mu-opioid receptor agonist
                                              addresses contained in the WHO notice,                  THC, a Schedule I substance, and the                  substances. Evidence suggests that the
                                              as of the date this document publishes                  main psychoactive chemical constituent                pattern of abuse of fentanyl analogues,
                                              in the Federal Register, but websites are               in marijuana. Synthetic cannabinoids                  including methoxyacetyl fentanyl is
                                              subject to change over time. Access to                  have been marketed under the guise of                 similar to heroin and prescription
                                              view the WHO questionnaire can be                       ‘‘herbal incense,’’ and promoted by drug              opioid analgesics. Law enforcement and
amozie on DSK3GDR082PROD with NOTICES1




                                              found at http://www.who.int/medicines/                  traffickers as legal alternatives to                  public health reports demonstrate that
                                              access/controlled-substances/ecdd_41_                   marijuana. ADB–CHMINACA use has                       methoxyacetyl fentanyl is being illicitly
                                              meeting/en/.                                            been associated with serious adverse                  distributed and abused. The Drug
                                                                                                      events including death in the United                  Enforcement Administration (DEA) is
                                              III. Substances Under WHO Review                        States. There are no commercial or                    aware of at least two overdose deaths
                                                 ADB–FUBINACA (chemical name:                         approved medical uses for ADB–                        associated with the abuse of
                                              N-[1-(aminocarbonyl)-2,2-                               CHMINACA. On February 5, 2016,                        methoxyacetyl fentanyl in the United


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                                                                        Federal Register / Vol. 83, No. 196 / Wednesday, October 10, 2018 / Notices                                                   50941

                                              States. Methoxyacetyl fentanyl has no                   combination with other psychoactive                      The principal cannabinoids in the
                                              currently accepted medical use in                       substances. On July 2, 2014, the DEA                  cannabis plant include THC,
                                              treatment in the United States. On                      issued a Final Rule controlling tramadol              cannabidiol (CBD), and cannabinol.
                                              October 26, 2017, methoxyacetyl                         as a Schedule IV substance under the                  These substances are controlled in
                                              fentanyl was temporarily placed into                    CSA with effective date of August 18,                 Schedule I under the CSA. The
                                              Schedule I of the CSA.                                  2014.                                                 synthetically derived single pure
                                                 Ortho-fluorofentanyl has a                              The ECDD pre-reviewed tramadol at                  stereoisomer, (¥)-trans-delta-9-THC
                                              pharmacological profile similar to                      its 39th meeting in November 2017                     (also known as dronabinol) is the active
                                              fentanyl and other related mu-opioid                    noting growing evidence of abuse of                   ingredient in two approved drug
                                              receptor agonist. Ortho-fluorofentanyl                  tramadol in many countries, in some                   products in the United States,
                                              has no currently accepted medical use                   cases serious, accompanied by adverse                 MARINOL (dronabinol) capsules (and
                                              in treatment in the United States. Ortho-               reactions and tramadol-associated                     generics) and SYNDROS (dronabinol)
                                              fluorofentanyl has been encountered by                  deaths and recommending that tramadol                 oral solution. MARINOL is controlled in
                                              law enforcement and public health                       be subject to a critical review at a                  Schedule III, while SYNDROS is
                                              officials. The DEA has received reports                 subsequent meeting.                                   controlled in Schedule II under the
                                              for at least 13 confirmed overdose                         Pregabalin is an FDA-approved                      CSA. Both MARINOL and SYNDROS
                                              deaths involving ortho-fluorofentanyl                   medication in the United States and is                are approved to treat anorexia
                                              abuse in the United States. On October                  available as an oral capsule and oral                 associated with weight loss in patients
                                              26, 2017, ortho-fluorofentanyl was                      solution and approved for the                         with acquired immunodeficiency
                                              temporarily placed into Schedule I of                   management of neuropathic pain                        syndrome (AIDS), and nausea and
                                              the CSA.                                                associated with diabetic peripheral                   vomiting associated with cancer
                                                 Para-fluorobutyrfentanyl shares                                                                            chemotherapy in patients who have
                                                                                                      neuropathy, postherpetic neuralgia, and
                                              pharmacological profile with other                                                                            failed to respond adequately to
                                                                                                      adjunctive therapy for partial onset
                                              Schedule I (e.g., butyryl fentanyl) and II                                                                    conventional treatment.
                                                                                                      seizures, fibromyalgia, and neuropathic
                                              (e.g., fentanyl) opioid substances. Para-                                                                        CBD is another cannabinoid
                                                                                                      pain associated with spinal cord injury.
                                              fluorobutyrfentanyl has no currently                                                                          constituent of the cannabis plant. In the
                                                                                                      Although the mechanism of action of
                                              accepted medical use in treatment in the                                                                      United States, one CBD-containing
                                                                                                      pregabalin is unknown, pregabalin is
                                              United States. The abuse of para-                                                                             product, Epidiolex oral solution, has
                                              fluorobutyrfentanyl carries public                      thought to produce its therapeutic
                                                                                                      effects on neuropathic pain via binding               received marketing approval by FDA for
                                              health risks similar to that of heroin,                                                                       the treatment of seizures associated with
                                              fentanyl, and prescription opioid                       with high affinity to the alpha 2-delta
                                                                                                      receptor site (a subunit of voltage gated             two rare and severe forms of epilepsy,
                                              analgesics. On February 1, 2018, para-                                                                        Lennox-Gastaut syndrome and Dravet
                                              fluorobutyrfentanyl was temporarily                     calcium channels) within the central
                                                                                                      nervous system. Reports indicate that                 syndrome, in patients 2 years of age and
                                              placed into Schedule I of the CSA.                                                                            older. The CBD in Epidiolex is extracted
                                                 Para-methoxybutyrfentanyl shares                     patients are self-administering higher
                                                                                                      than recommended doses to achieve                     and purified from the cannabis plant.
                                              pharmacological profile with other
                                                                                                      euphoria, especially patients who have                Currently, CBD is controlled generally
                                              Schedule I (e.g., butyryl fentanyl) and II
                                                                                                      a history of substance abuse,                         as a Schedule I substance under the
                                              (e.g., fentanyl) opioid substances. Para-
                                                                                                      particularly opioids. While effects of                CSA. However, the recent scheduling
                                              methoxybutyrfentanyl has no currently
                                                                                                      excessively high doses are generally                  action on September 28, 2018, by the
                                              accepted medical use in treatment in the
                                                                                                      non-lethal, gabapentinoids such as                    DEA for Epidiolex, and any future,
                                              United States. The abuse of para-
                                                                                                      pregabalin are increasingly being                     similar formulations of CBD that
                                              methoxybutyrfentanyl carries public
                                                                                                      identified in postmortem toxicology                   become FDA-approved medications,
                                              health risks similar to that of heroin,
                                                                                                      analyses. Pregabalin is a Schedule V                  places these FDA-approved CBD
                                              fentanyl, and prescription opioid
                                                                                                      controlled substance in the United                    formulations in Schedule V under the
                                              analgesics. On February 1, 2018, para-
                                                                                                      States under the CSA. At its 39th                     CSA.1 CBD is not specifically listed in
                                              methoxybutyrfentanyl was temporarily
                                              placed into Schedule I of the CSA.                      meeting in November 2017, the WHO                     the schedules of the 1961, 1971, or 1988
                                                 N-ethylnorpentylone (other name: N-                  Expert Committee on Drug Dependence                   International Drug Control conventions.
                                              ethylpentylone) is a synthetic cathinone                (ECDD) pre-reviewed pregabalin and,                      At the 40th (2018) meeting of the
                                              with stimulant and psychoactive                         noting increasing evidence of misuse                  ECDD, the committee critically-
                                              properties similar to cathinone, a                      and abuse in many countries, the ECDD                 reviewed CBD and pre-reviews of
                                              Schedule I substance. N-ethylpentylone                  recommended that pregabalin be subject                cannabis plant and resin; extracts and
                                              abuse has been associated with adverse                  to a future critical review.                          tinctures of cannabis; THC; and isomers
                                              health effects leading to emergency                        Cannabis, also known as marijuana, is              of THC. The 40th ECDD recommended
                                              department admissions, and deaths. N-                   a plant known by biological names                     that preparations considered to be pure
                                              ethylpentylone has no currently                         Cannabis sativa or Cannabis indica. It is             CBD should not be scheduled within the
                                              accepted medical use in treatment in the                a complex plant substance containing                  International Drug Control Conventions,
                                              United States. On August 31, 2018, N-                   multiple cannabinoids and other                       and that cannabis plant and resin;
                                              ethylnorpentylone was temporarily                       compounds, including the psychoactive                 extracts and tinctures of cannabis; THC;
                                              controlled as a Schedule I substance                    chemical THC and other structurally                   and isomers of THC proceed to a Critical
                                              under the CSA.                                          similar compounds. Cannabinoids are                   Review.
                                                 Tramadol, an opioid analgesic, was                   defined as having activity at                         IV. Opportunity To Submit Domestic
amozie on DSK3GDR082PROD with NOTICES1




                                              first approved by the FDA for medical                   cannabinoid 1 and 2 (CB1 and CB2                      Information
                                              use in March of 1995 for the treatment                  respectively) receptors. Agonists of CB1
                                                                                                                                                              As required by paragraph (d)(2)(A) of
                                              of moderate to moderately severe pain.                  receptors are widely abused and are
                                                                                                                                                            the CSA, FDA, on behalf of HHS, invites
                                              It is available as immediate-release,                   known to modulate motor coordination,
                                              extended-release, and combination                       memory processing, pain, and                            1 https://www.ecfr.gov/cgi-bin/text-idx?SID=f43ff6
                                              products containing acetaminophen.                      inflammation, and have anxiolytic                     b6883b0b81774fab03dcea8fa5&mc=true&node=
                                              Tramadol has been abused alone or in                    effects.                                              pt21.9.1308&rgn=div5#se21.9.1308_115.



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                                              50942                     Federal Register / Vol. 83, No. 196 / Wednesday, October 10, 2018 / Notices

                                              interested persons to submit comments                   ‘‘Assessing Adhesion with Transdermal                    • Mail/Hand delivery/Courier (for
                                              regarding the 16 drug substances. Any                   Delivery Systems and Topical Patches                  written/paper submissions): Dockets
                                              comments received will be considered                    for ANDAs,’’ which was announced in                   Management Staff (HFA–305), Food and
                                              by HHS when it prepares a scientific                    the Federal Register on June 1, 2016.                 Drug Administration, 5630 Fishers
                                              and medical evaluation for drug                         This revised draft guidance provides                  Lane, Rm. 1061, Rockville, MD 20852.
                                              substances that is responsive to the                    recommendations for the design and                       • For written/paper comments
                                              WHO Questionnaire for these drug                        conduct of studies evaluating the                     submitted to the Dockets Management
                                              substances. HHS will forward such                       adhesive performance of a transdermal                 Staff, FDA will post your comment, as
                                              evaluation of these drug substances to                  or a topical delivery system (collectively            well as any attachments, except for
                                              WHO, for WHO’s consideration in                         referred to as TDS). Depending on the                 information submitted, marked and
                                              deciding whether to recommend                           objectives of a TDS product                           identified, as confidential, if submitted
                                              international control/decontrol of any of               development program, applicants may                   as detailed in ‘‘Instructions.’’
                                              these drug substances. Such control                     choose to evaluate TDS adhesion in                       Instructions: All submissions received
                                              could limit, among other things, the                    clinical studies performed to evaluate                must include the Docket No. FDA 2016–
                                              manufacture and distribution (import/                   TDS adhesion only or in clinical studies              D–1254 for ‘‘Assessing Adhesion With
                                              export) of these drug substances and                    performed with a combined purpose                     Transdermal and Topical Delivery
                                              could impose certain recordkeeping                      (e.g., for the simultaneous evaluation of             Systems for ANDAs.’’ Received
                                              requirements on them.                                   adhesion and bioequivalence (BE) with                 comments will be placed in the docket
                                                Although FDA is, through this notice,                 pharmacokinetic (PK) endpoints). The                  and, except for those submitted as
                                              requesting comments from interested                     recommendations in this revised draft                 ‘‘Confidential Submissions,’’ publicly
                                              persons, which will be considered by                    guidance relate exclusively to studies                viewable at https://www.regulations.gov
                                              HHS when it prepares an evaluation of                   submitted in support of an abbreviated                or at the Dockets Management Staff
                                              these drug substances, HHS will not                     new drug application (ANDA).                          between 9 a.m. and 4 p.m., Monday
                                              now make any recommendations to                                                                               through Friday.
                                                                                                      DATES: Submit either electronic or                       • Confidential Submissions—To
                                              WHO regarding whether any of these                      written comments on the revised draft                 submit a comment with confidential
                                              drugs should be subjected to                            guidance by December 10, 2018 to                      information that you do not wish to be
                                              international controls. Instead, HHS will               ensure that the Agency considers your                 made publicly available, submit your
                                              defer such consideration until WHO has                  comment on this revised draft guidance                comments only as a written/paper
                                              made official recommendations to the                    before it begins work on the final                    submission. You should submit two
                                              Commission on Narcotic Drugs, which                     version of the guidance.                              copies total. One copy will include the
                                              are expected to be made in mid-2018.                    ADDRESSES: You may submit comments                    information you claim to be confidential
                                              Any HHS position regarding                              on any guidance at any time as follows:               with a heading or cover note that states
                                              international control of these drug
                                                                                                      Electronic Submissions                                ‘‘THIS DOCUMENT CONTAINS
                                              substances will be preceded by another
                                                                                                                                                            CONFIDENTIAL INFORMATION.’’ The
                                              Federal Register notice soliciting public                 Submit electronic comments in the                   Agency will review this copy, including
                                              comments, as required by paragraph                      following way:                                        the claimed confidential information, in
                                              (d)(2)(B) of the CSA.                                     • Federal eRulemaking Portal:                       its consideration of comments. The
                                                Dated: October 3, 2018.                               https://www.regulations.gov. Follow the               second copy, which will have the
                                              Leslie Kux,                                             instructions for submitting comments.                 claimed confidential information
                                              Associate Commissioner for Policy.                      Comments submitted electronically,                    redacted/blacked out, will be available
                                              [FR Doc. 2018–21954 Filed 10–9–18; 8:45 am]             including attachments, to https://                    for public viewing and posted on
                                              BILLING CODE 4164–01–P
                                                                                                      www.regulations.gov will be posted to                 https://www.regulations.gov. Submit
                                                                                                      the docket unchanged. Because your                    both copies to the Dockets Management
                                                                                                      comment will be made public, you are                  Staff. If you do not wish your name and
                                              DEPARTMENT OF HEALTH AND                                solely responsible for ensuring that your             contact information to be made publicly
                                              HUMAN SERVICES                                          comment does not include any                          available, you can provide this
                                                                                                      confidential information that you or a                information on the cover sheet and not
                                              Food and Drug Administration                            third party may not wish to be posted,                in the body of your comments and you
                                                                                                      such as medical information, your or                  must identify this information as
                                              [Docket No. FDA 2016–D–1254]
                                                                                                      anyone else’s Social Security number, or              ‘‘confidential.’’
                                              Assessing Adhesion With Transdermal                     confidential business information, such                  Any information marked as
                                              and Topical Delivery Systems for                        as a manufacturing process. Please note               ‘‘confidential’’ will not be disclosed
                                              Abbreviated New Drug Applications;                      that if you include your name, contact                except in accordance with 21 CFR 10.20
                                              Revised Draft Guidance for Industry;                    information, or other information that                and other applicable disclosure law. For
                                              Availability                                            identifies you in the body of your                    more information about FDA’s posting
                                                                                                      comments, that information will be                    of comments to public dockets, see 80
                                              AGENCY:    Food and Drug Administration,                posted on https://www.regulations.gov.                FR 56469, September 18, 2015, or access
                                              HHS.                                                      • If you want to submit a comment                   the information at: https://www.gpo.gov/
                                              ACTION:   Notice of availability.                       with confidential information that you                fdsys/pkg/FR-2015-09-18/pdf/2015-
                                                                                                      do not wish to be made available to the               23389.pdf.
                                              SUMMARY:  The Food and Drug                             public, submit the comment as a                          Docket: For access to the docket to
amozie on DSK3GDR082PROD with NOTICES1




                                              Administration (FDA or Agency) is                       written/paper submission and in the                   read background documents or the
                                              announcing the availability of a revised                manner detailed (see ‘‘Written/Paper                  electronic and written/paper comments
                                              draft guidance for industry entitled                    Submissions’’ and ‘‘Instructions’’).                  received, go to https://
                                              ‘‘Assessing Adhesion With Transdermal                                                                         www.regulations.gov and insert the
                                              and Topical Delivery Systems for                        Written/Paper Submissions                             docket number, found in brackets in the
                                              ANDAs.’’ This revised draft guidance                      Submit written/paper submissions as                 heading of this document, into the
                                              supersedes the draft guidance entitled                  follows:                                              ‘‘Search’’ box and follow the prompts


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Document Created: 2018-10-10 17:39:16
Document Modified: 2018-10-10 17:39:16
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice; request for comments.
DatesSubmit either electronic or written comments by October 31, 2018.
ContactJames R. Hunter, Center for Drug Evaluation and Research, Controlled Substance Staff, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 51, Rm. 5150, Silver Spring, MD 20993-0002, 301-796-3156, email: [email protected]
FR Citation83 FR 50938 

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