Schedules of Controlled Substances: Placement of Ezogabine Into Schedule V, 65424-65428 [2011-27253]
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[FR Doc. 2011–27267 Filed 10–20–11; 8:45 am]
BILLING CODE 4910–13–P
DEPARTMENT OF JUSTICE
Drug Enforcement Administration
21 CFR Part 1308
[Docket No. DEA–354]
Schedules of Controlled Substances:
Placement of Ezogabine Into Schedule
V
Drug Enforcement
Administration, Department of Justice.
ACTION: Notice of proposed rulemaking.
AGENCY:
The Drug Enforcement
Administration (DEA) proposes placing
the substance ezogabine, including its
salts, isomers, and salts of isomers
whenever the existence of such salts,
isomers, and salts of isomers is possible,
into Schedule V of the Controlled
Substances Act (CSA). This proposed
action is pursuant to the CSA which
requires that such actions be made on
the record after opportunity for a
hearing through formal rulemaking.
DATES: DEA will permit interested
persons to file written comments on this
proposal pursuant to 21 CFR 1308.43(g).
Electronic comments must be submitted
and written comments must be
postmarked on or before November 21,
2011. Commenters should be aware that
the electronic Federal Docket
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SUMMARY:
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Management System will not accept
comments after midnight Eastern Time
on the last day of the comment period.
Interested persons, defined as those
‘‘adversely affected or aggrieved by any
rule or proposed rule issuable pursuant
to section 201 of the Act (21 U.S.C.
811),’’ 1 may file a request for hearing
pursuant to 21 CFR 1308.44 and in
accordance with 21 CFR 1316.45 and
1316.47. Requests for hearing, notices of
appearance, and waivers of
participation must be received on or
before November 21, 2011.
ADDRESSES: To ensure proper handling
of comments, please reference ‘‘Docket
No. DEA–354’’ on all electronic and
written correspondence. DEA
encourages all comments be submitted
electronically through https://
www.regulations.gov using the
electronic comment form provided on
that site. An electronic copy of this
document and supplemental
information to this proposed rule are
also available at the https://
www.regulations.gov Web site for easy
reference. Paper comments that
duplicate the electronic submission are
not necessary as all comments
submitted to https://www.regulations.gov
will be posted for public review and are
part of the official docket record. Should
you, however, wish to submit written
comments via regular or express mail,
they should be sent to the Drug
Enforcement Administration, Attention:
DEA Federal Register Representative/
OD, 8701 Morrissette Drive, Springfield,
VA 22152. All requests for hearing must
be sent to Drug Enforcement
Administration, Attention: Hearing
Clerk/LJ, 8701 Morrissette Drive,
Springfield, VA 22152.
FOR FURTHER INFORMATION CONTACT:
Rhea D. Moore, Office of Diversion
Control, Drug Enforcement
Administration, 8701 Morrissette Drive,
Springfield, Virginia 22152; Telephone
(202) 307–7165.
SUPPLEMENTARY INFORMATION:
Posting of Public Comments: Please
note that all comments received are
considered part of the public record and
made available for public inspection
online at https://www.regulations.gov
and in the DEA’s public docket. Such
information includes personal
identifying information (such as your
name, address, etc.) voluntarily
submitted by the commenter.
If you want to submit personal
identifying information (such as your
name, address, etc.) as part of your
comment, but do not want it to be
posted online or made available in the
1 21
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Frm 00014
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public docket, you must include the
phrase ‘‘PERSONAL IDENTIFYING
INFORMATION’’ in the first paragraph
of your comment. You must also place
all of the personal identifying
information you do not want posted
online or made available in the public
docket in the first paragraph of your
comment and identify what information
you want redacted.
If you want to submit confidential
business information as part of your
comment, but do not want it to be
posted online or made available in the
public docket, you must include the
phrase ‘‘CONFIDENTIAL BUSINESS
INFORMATION’’ in the first paragraph
of your comment. You must also
prominently identify confidential
business information to be redacted
within the comment. If a comment has
so much confidential business
information that it cannot be effectively
redacted, all or part of that comment
may not be posted online or made
available in the public docket.
Personal identifying information and
confidential business information
identified and located as set forth above
will be redacted, and the comment, in
redacted form, will be posted online and
placed in the DEA’s public docket file.
Please note that the Freedom of
Information Act applies to all comments
received. If you wish to inspect the
agency’s public docket file in person by
appointment, please see the ‘‘For
Further Information’’ paragraph.
Request for Hearing, Notice of
Appearance at or Waiver of
Participation in Hearing
In accordance with the provisions of
the CSA (21 U.S.C. 811(a)), this action
is a formal rulemaking ‘‘on the record
after opportunity for a hearing.’’ Such
proceedings are conducted pursuant to
the provisions of the Administrative
Procedure Act (5 U.S.C. 556 and 557)
and 21 CFR 1308.41. Pursuant to 21 CFR
1308.44(a)–(c), requests for hearing,
notices of appearance, and waivers of
participation may be submitted only by
interested persons, defined as those
‘‘adversely affected or aggrieved by any
rule or proposed rule issuable pursuant
to section 201 of the Act (21 U.S.C.
811).’’ Such requests or notices must
conform to the requirements of 21 CFR
1308.44(a) or (b) and 1316.47 or
1316.48, as applicable. A request or
notice should state, with particularity,
the interest of the person in the
proceeding and the objections or issues,
if any, concerning which the person
desires to be heard. Any waiver must
conform to the requirements of 21 CFR
1308.44(c), including a written
statement regarding the interested
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person’s position on the matters of fact
and law involved in any hearing.
Please note that pursuant to 21 U.S.C.
811(a), the purpose and subject matter
of the hearing is restricted to ‘‘(A)
find[ing] that such drug or other
substance has a potential for abuse, and
(B) mak[ing] with respect to such drug
or other substance the findings
prescribed by subsection (b) of section
812 of this title for the schedule in
which such drug is to be placed * * *’’
Requests for hearing, notices of
appearance at the hearing, and waivers
of participation in the hearing should be
submitted to DEA using the address
information provided above.
Legal Authority
Under the CSA, controlled substances
are classified in one of five schedules
based upon their potential for abuse,
their currently accepted medical use,
and the degree of dependence the
substance may cause. 21 U.S.C. 812. The
initial schedules of controlled
substances by statute are found at 21
U.S.C. 812(c) and the current list of
scheduled substances are published at
21 CFR part 1308.
Pursuant to 21 U.S.C. 811(a)(1), the
Attorney General may, by rule, ‘‘add to
such a schedule or transfer between
such schedules any drug or other
substance if he (A) finds that such drug
or other substance has a potential for
abuse, and (B) makes with respect to
such drug or other substance the
findings prescribed by subsection (b) of
section 812 of this title for the schedule
in which such drug is to be placed
* * *’’ Pursuant to 28 CFR 0.100(b), the
Attorney General has delegated this
scheduling authority to the
Administrator of DEA.
The CSA provides that scheduling of
any drug or other substance may be
initiated by the Attorney General (1) on
his own motion; (2) at the request of the
Secretary of HHS, or (3) on the petition
of any interested party. 21 U.S.C. 811(a).
This proposed action is based on a
recommendation from the Assistant
Secretary for Health of the Department
of Health and Human Services (HHS)
and on an evaluation of all other
relevant data by DEA. If finalized, this
action would impose the regulatory
controls and criminal sanctions of
Schedule V on the manufacture,
distribution, dispensing, importation,
and exportation of ezogabine and
products containing ezogabine.
Background
Ezogabine, known chemically as N-[2amino-4-(4-fluorobenzylamino)-phenyl]carbamic acid ethyl ester, is a new
chemical substance with central
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nervous system depressant properties
and is classified as a sedative-hypnotic.
Pharmacological studies indicate that
ezogabine primarily acts as a ligand at
ion-gated channels in the brain to
enhance potassium currents mediated
by neuronal KCNQ (Kv7) channels.
Additionally, ezogabine indirectly
enhances the gamma-aminobutyric acid
(GABA) mediated neurotransmission.
On June 10, 2011, the Food and Drug
Administration (FDA) approved a New
Drug Application (NDA) for ezogabine
as an adjunct treatment of partial onset
seizures, to be marketed under the trade
name Potiga.® 2
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reasonable to assume that there may be
significant diversions from legitimate
channels, significant use contrary to or
without medical advice, or that it has a
substantial capability of creating hazards to
the health of the user or to the safety of the
community.3
The drug or drugs containing such a
substance are new drugs so related in their
action to a drug or drugs already listed as
having a potential for abuse to make it likely
that the drug will have the same potentiality
for abuse as such drugs, thus making it
Ezogabine acts as a ligand at ion-gated
channels in the brain, similar to the
Schedule V substances pregabalin and
lacosamide, and, like those drugs,
ezogabine is indicated for the treatment
of epileptic conditions in humans.
There is strong evidence, described
below, that ezogabine produces
behavioral effects in humans and in
animals that are similar to those
produced by pregabalin and lacosamide.
Phase 1 clinical studies indicate that
the rate of euphoria-related adverse
events (AEs) resulting from
administration of ezogabine was 6–9%.
This is similar to the AE rates for
administration of pregabalin (10%) and
lacosamide (>7%), while Phase 2⁄3
clinical studies indicated similar AE
rates between ezogabine (<1%) and
lacosamide (<2%). Animal studies
involving administration of ezogabine to
animals produced a sedative behavioral
profile similar to that produced from
administration of pregabalin and
lacosamide, including decreased
locomotion, decreased muscle tone, and
an increase in ataxia. Further, in abuse
potential studies conducted with
sedative-hypnotic abusers, ezogabine,
pregabalin, and lacosamide, when
compared to placebos, are similar in
their ability to produce statistically
significant increases in subjective
responses including ‘‘Drug Liking,’’
‘‘Euphoria,’’ ‘‘Overall Drug Liking,’’
‘‘Good Drug Effects,’’ and ‘‘High.’’
Because of the similarities between
ezogabine, pregabalin, and lacosamide,
it is very likely that ezogabine will have
an abuse potential similar to those
Schedule V substances. Currently there
is a lack of evidence regarding the
diversion, illicit manufacturing or
deliberate misuse of ezogabine due to its
commercial unavailability in any
country, but since ezogabine is not
readily synthesized from available
substances, any diversion would be
from legitimate channels. The above
referenced studies, which include
demonstration of the significant
euphoric effects produced by ezogabine
in humans, predict that there will be
significant use of ezogabine contrary to
or without medical advice.
2. Scientific Evidence of the Drug’s
Pharmacological Effects, If Known:
2 https://www.accessdata.fda.gov/
drugsatfda_docs/nda/2011/
022345Orig1s000TOC.cfm; as of July 21, 2011.
3 Comprehensive Drug Abuse Prevention and
Control Act of 1970, H.R. Rep. No. 91–1444, 91st
Cong., Sess. 1 (1970); 1970 U.S.C.C.A.N. 4566, 4601.
Proposed Determination to Schedule
Ezogabine
Pursuant to 21 U.S.C. 811(a),
proceedings to add a drug or substance
to those controlled under the CSA may
be initiated by request of the Secretary
of HHS. On January 12, 2011, HHS
provided DEA with a scientific and
medical evaluation document prepared
by FDA entitled ‘‘Basis for the
Recommendation for Control of
Ezogabine in Schedule V of the
Controlled Substances Act.’’ Pursuant to
21 U.S.C. 811(b), this document
contained an eight-factor analysis of the
abuse potential of ezogabine as a new
drug, along with HHS’ recommendation
to control ezogabine under Schedule V
of the CSA.
In response, DEA conducted an eightfactor analysis of ezogabine’s abuse
potential pursuant to 21 U.S.C. 811(c).
Included below is a brief summary of
each factor as analyzed by HHS and
DEA, and as considered by DEA in the
scheduling decision. Please note that
both the DEA and HHS analyses are
available in their entirety under
‘‘Supporting and Related Material’’ of
the public docket for this rule at
www.regulations.gov under docket
number DEA–354.
1. The Drug’s Actual or Relative
Potential for Abuse: Ezogabine is a new
chemical substance that has not been
marketed in the U.S. or in any other
country. As such, there is no
information available which details
actual abuse of ezogabine. However, the
legislative history of the CSA offers
another methodology for assessing a
drug or substance’s potential for abuse:
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Ezogabine acts to enhance potassium
currents mediated by neuronal KCNQ
(Kv7) channels with a secondary action
through the augmentation of GABAmediated neurotransmission without
direct GABA receptor stimulation. In
individuals with histories of
recreational sedative-hypnotic abuse,
ezogabine (300 and 600 mg orally)
produced increased ratings on the
primary positive subjective scales [VASDrug-liking, VAS-Overall Drug Liking,
ARCI–MBG (Euphoria), VAS-Take Drug
Again] for peak responses (Emax for the
first eight hours after drug
administration) that were significantly
different from the placebo. This effect is
similar to that produced by alprazolam
(1.5 and 3.0 mg orally; Schedule IV). On
secondary positive subjective scales
[VAS-High, VAS-Good Effects, ARCIAmphetamine (Activation)] for peak
responses, both ezogabine and
alprazolam produced significant
increases compared to the placebo,
while there were no differences between
ezogabine and alprazolam on those
measures.
In human abuse potential studies,
ezogabine (300 and 600 mg), upon oral
administration, increased ratings on
negative and sedating subjective
measures [VAS-Bad Effects, ARCI–LSD
(dysphoria) and ARCI–PCAG (sedation)]
compared to the placebo, but these
increases were lower than those
produced by 1.5 and 3.0 mg alprazolam.
These data for ezogabine are similar to
those produced by lacosamide. A 900
mg dose of ezogabine produced VASDrug Liking and VAS-Good Effects that
were higher than those produced by the
two lower doses of ezogabine and either
dose of alprazolam. However, the
changes in VAS-Bad Effects and ARCI–
LSD (dysphoria) following 900 mg
ezogabine were less than or similar to
those produced by lower doses of
ezogabine and either dose of
alprazolam. The adverse events
following 900 mg ezogabine are similar
to those described in the NDA for the
human abuse potential study conducted
with lacosamide. These included
euphoria, somnolence, visual
disturbances, and altered auditory
perception.
In human abuse potential studies,
ezogabine, similar to pregabalin and
lacosamide, also produced ratings on
each of the positive subjective responses
that were statistically similar to those
produced by Schedule IV
benzodiazepines (alprazolam or
diazepam). Although this appears to
suggest that these drugs have an abuse
potential similar to that of Schedule IV
substances, the other data from human
abuse potential studies, the adverse
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effect profile data from safety and
efficacy studies, and the data from the
preclinical animal behavioral studies
demonstrate that ezogabine has abuse
potential less than that of Schedule IV
drugs but similar to that of Schedule V
drugs.
3. The State of Current Scientific
Knowledge Regarding the Drug or Other
Substance: The chemical name of
ezogabine is N-[2-amino-4-(4fluorobenzylamino)-phenyl]-carbamic
acid ethyl ester. It is an achiral molecule
with a molecular formula of
C16H18FN3O2 and a molecular weight of
303.3 g/mol. Ezogabine is a nonhygroscopic white to slightly colored
powder with a melting point of 140–
1430C. It is soluble in 0.9% saline,
methanol, chloroform, but only
sparingly soluble in ethanol and 0.1N
HCL.
Ezogabine in humans has a Tmax (time
required for ezogabine to reach
maximum plasma concentration)
ranging from 1–4 hours following both
acute and multiple dosing, and, without
the involvement of cytochrome P450,
undergoes an extensive and almost
exclusively phase 2 metabolic
biotransformation. Ezogabine is
predominantly metabolized by Nglucuronidation, resulting in the
formation of two distinct Nglucuronides of the unchanged parent
drug and to a lesser extent by Nacetylation to form N-acetyl-retigabine,
the major bioactive metabolite of
ezogabine. The half-life of both
ezogabine and N-acetyl-retigabine is
approximately eight hours and the Cmax
(maximum plasma concentration) of
both components is dose proportional
after both acute and multiple dosing,
suggesting a lack of accumulation with
repeated administration.
4. Its History and Current Pattern of
Abuse: As stated in the summary of
Factor 1, information on ezogabine’s
history and current pattern of abuse is
unavailable as it has not been marketed
in any country. As such, evaluation of
abuse potential for ezogabine derives
from positive indicators in clinical
studies which are believed to be
predictive of drug abuse and which are
discussed in Factors 1 and 2 above.
5. The Scope, Duration, and
Significance of Abuse: Because
ezogabine has not been marketed in any
country, information on the scope,
duration, and significance of abuse of
ezogabine is unavailable. However,
epidemiological data on pregabalin, a
Schedule V drug with an abuse
potential similar to that of ezogabine, is
available from the Drug Abuse Warning
Network (DAWN) database.
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The ‘‘abuse frequency ratio,’’
calculated as the ratio of nonmedical
use related annual emergency
department visits (as reported in
DAWN) to the total number of annual
prescriptions for pregabalin is less than
that for the Schedule IV drug,
alprazolam. Further, because ezogabine
has abuse-related human and animal
data in its NDA similar to data
generated for pregabalin, ezogabine is
likely to have an abuse potential similar
to pregabalin. The ‘‘abuse frequency
ratios’’ for pregabalin range from 29 to
47, while those for alprazolam are
approximately three to six times higher,
ranging from 160 to 235. Thus,
pregabalin was placed into Schedule V
based both on abuse-related human and
animal data submitted in its NDA and
by epidemiological data which justified
placement relative to drugs in Schedule
IV. Given that ezogabine has abuserelated human and animal data in its
NDA similar to the data generated by
pregabalin, it is likely that ezogabine
will have an abuse potential similar to
this Schedule V drug.
6. What, if any, Risk There is to the
Public Health: The data indicates that
ezogabine may present a serious safety
risk to the public health, and the
predicted level of risk is similar to that
observed with pregabalin and
lacosamide but less than that produced
by Schedule IV benzodiazepines. In
Phase 1 clinical safety studies, the
overall adverse event profile following
ezogabine administration was similar to
those from pregabalin and lacosamide
and includes not only euphoria, but also
somnolence, and feeling or thinking
abnormally. Further, the human abuse
potential study showed that the majority
of subjects receiving the 900 mg dose of
ezogabine experienced multiple adverse
events such as euphoria, somnolence,
visual disturbance, amnesia, hypoaesthesia, paranoia, fear, confusion and
hallucination. Although the 900 mg
dose is three times greater than the
recommended therapeutic dose,
individuals who abuse drugs typically
do so at supra-therapeutic doses.
7. Its Psychic or Physiological
Dependence Liability: Ezogabine may
produce limited psychic or
physiological dependence liability
following extended administration.
Since there are no studies detailing
abrupt discontinuation of ezogabine,
there are minimal adequate data to
evaluate the ability of ezogabine to
induce withdrawal symptoms that are
indicative of physical dependence.
Many of the adverse events reported
from the discontinuation of ezogabine
were also reported prior to its
discontinuation, including dizziness,
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somnolence, and a state of confusion.
By comparison, abrupt or rapid
discontinuation of pregabalin in human
studies resulted in patient-reported
symptoms of nausea, headache or
diarrhea, which are suggestive of
physical dependence, while abrupt
termination of lacosamide produced no
signs or symptoms of withdrawal in
diabetic neuropathic pain patients.
Unlike ezogabine and pregabalin, the
withdrawal syndrome following
discontinuation of Schedule IV
substances such as alprazolam can range
from mild dysphoria and insomnia to a
major syndrome including abdominal
pain, muscle cramps, vomiting,
sweating, tremors and convulsions.
These are similar in character to those
associated with other sedativehypnotics.
The study of ezogabine abuse
potential in humans with histories of
recreational abuse of sedative-hypnotics
found that ezogabine produces euphoria
(18–33%) in these individuals.
Additionally, ezogabine produced
euphoria (8.5%) in Phase 1 studies in
healthy individuals. These euphoriarelated adverse events following
administration of ezogabine are
suggestive of its ability to produce
psychic dependence, and the adverse
events appear to be less severe and
occur less frequently than Schedule IV
drugs (diazepam and alprazolam) and
are more similar to those of Schedule V
drugs, pregabalin and lacosamide.
8. Whether the Substance is an
Immediate Precursor of a Substance
Already Controlled Under the CSA:
Ezogabine is not an immediate
precursor of any controlled substance.
Conclusion: Based on consideration of
the scientific and medical evaluation
and accompanying recommendation of
HHS, and based on DEA’s consideration
of its own eight-factor analysis, DEA
finds that these facts and all relevant
data constitute substantial evidence of
potential for abuse of ezogabine. As
such, DEA hereby proposes to schedule
ezogabine as a controlled substance
under the CSA.
Proposed Determination of Appropriate
Schedule
The CSA establishes five schedules of
controlled substances known as
Schedules I, II, III, IV, and V. The statute
outlines the findings required to place a
drug or other substance in any
particular schedule. 21 U.S.C. 812(b).
After consideration of the analysis and
recommendation of the Assistant
Secretary for Health of HHS and review
of all available data, the Administrator
of DEA, pursuant to 21 U.S.C. 812(b)(5),
finds that:
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(1) Ezogabine has a low potential for
abuse relative to the drugs or other
substances in Schedule IV. The overall
abuse potential of ezogabine is
comparable to the Schedule V
substances such as pregabalin and
lacosamide;
(2) Ezogabine has a currently accepted
medical use in treatment in the United
States. Ezogabine was approved for
marketing by FDA as an adjunct
treatment of partial onset seizures; and
(3) Abuse of ezogabine may lead to
limited physical dependence or
psychological dependence relative to
the drugs or other substances in
Schedule IV.
Based on these findings, the
Administrator of DEA concludes that
ezogabine, including its salts, isomers
and salts of isomers, whenever the
existence of such salts, isomers, and
salts of isomers is possible, warrants
control in Schedule V of the CSA (21
U.S.C. 812(b)(5)).
Requirements for Handling Ezogabine
If this rule is finalized as proposed,
ezogabine would be subject to the CSA
and the Controlled Substances Import
and Export Act (CSIEA) regulatory
controls and administrative, civil and
criminal sanctions applicable to the
manufacture, distribution, dispensing,
importing and exporting of a Schedule
V controlled substance, including the
following:
Registration. Any person who
manufactures, distributes, dispenses,
imports, exports, engages in research or
conducts instructional activities with
ezogabine, or who desires to
manufacture, distribute, dispense,
import, export, engage in research or
conduct instructional activities with
ezogabine, would need to be registered
to conduct such activities pursuant to
21 U.S.C. 822 and in accordance with 21
CFR part 1301.
Security. Ezogabine would be subject
to Schedules III–V security
requirements and would need to be
manufactured, distributed, and stored
pursuant to 21 U.S.C. 823 and in
accordance with 21 CFR 1301.71,
1301.72(b), (c), and (d), 1301.73,
1301.74, 1301.75(b) and (c), 1301.76,
and 1301.77.
Labeling and Packaging. All labels
and labeling for commercial containers
of ezogabine which are distributed on or
after finalization of this rule would need
to be in accordance with 21 CFR
1302.03–1302.07, pursuant to 21 U.S.C.
825.
Inventory. Every registrant required to
keep records and who possesses any
quantity of ezogabine would be required
to keep an inventory of all stocks of
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ezogabine on hand pursuant to 21
U.S.C. 827 and in accordance with 21
CFR 1304.03, 1304.04, and 1304.11.
Every registrant who desires registration
in Schedule V for ezogabine would be
required to conduct an inventory of all
stocks of the substance on hand at the
time of registration.
Records. All registrants would be
required to keep records pursuant to 21
U.S.C. 827 and in accordance with 21
CFR 1304.03, 1304.04, 1304.06, 1304.21,
1304.22, and 1304.23.
Prescriptions. Ezogabine or products
containing ezogabine would be required
to be distributed or dispensed pursuant
to 21 U.S.C. 829 and in accordance with
21 CFR 1306.03–1306.06, 1306.08,
1306.21, and 1306.23–1306.27.
Importation and Exportation. All
importation and exportation of
ezogabine would need to be done in
accordance with 21 CFR part 1312,
pursuant to 21 U.S.C. 952, 953, 957, and
958.
Criminal Liability. Any activity with
ezogabine not authorized by, or in
violation of, Subchapter I Part D and
Subchapter II of the CSA or the CSIEA
occurring on or after finalization of this
proposed rule would be unlawful.
Regulatory Analyses
Executive Orders 12866 and 13563
In accordance with 21 U.S.C. 811(a),
this proposed scheduling action is
subject to formal rulemaking procedures
done ‘‘on the record after opportunity
for a hearing,’’ which are conducted
pursuant to the provisions of 5 U.S.C.
556 and 557. The CSA sets forth the
criteria for scheduling a drug or other
substance. Such actions are exempt
from review by the Office of
Management and Budget pursuant to
Section 3(d)(1) of Executive Order
12866 and the principles reaffirmed in
Executive Order 13563.
Executive Order 12988
This proposed regulation meets the
applicable standards set forth in
Sections 3(a) and 3(b)(2) of Executive
Order 12988 Civil Justice Reform to
eliminate ambiguity, minimize
litigation, establish clear legal
standards, and reduce burden.
Executive Order 13132
This proposed rulemaking does not
preempt or modify any provision of
State law; nor does it impose
enforcement responsibilities on any
State; nor does it diminish the power of
any State to enforce its own laws.
Accordingly, this rulemaking does not
have federalism implications warranting
the application of Executive Order
13132.
E:\FR\FM\21OCP1.SGM
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65428
Federal Register / Vol. 76, No. 204 / Friday, October 21, 2011 / Proposed Rules
Executive Order 13175
This proposed rule will not have
Tribal implications and will not impose
substantial direct compliance costs on
Indian Tribal governments.
Paperwork Reduction Act of 1995
This action does not impose a new
collection of information under the
Paperwork Reduction Act of 1995, 44
U.S.C. 3501–3521.
List of Subjects in 21 CFR Part 1308
Administrative practice and
procedure, Drug traffic control,
Reporting and recordkeeping
requirements.
For the reasons set out above, 21 CFR
part 1308 is proposed to be amended to
read as follows:
PART 1308—SCHEDULES OF
CONTROLLED SUBSTANCES
1. The authority citation for 21 CFR
part 1308 continues to read as follows:
Authority: 21 U.S.C. 811, 812, 871(b),
unless otherwise noted.
2. Section 1308.15 is amended by
redesignating paragraphs (e)(1) and (2)
as paragraphs (e)(2) and (3), and adding
a new paragraph (e)(1) to read as
follows:
§ 1308.15
Schedule V.
*
*
*
*
*
(e) * * *
(1) Ezogabine—2779
*
*
*
*
*
Dated: October 14, 2011.
Michele M. Leonhart,
Administrator.
[FR Doc. 2011–27253 Filed 10–20–11; 8:45 am]
new type of review, the ‘‘progress
review.’’ A progress review will be an
abbreviated program review meant to
focus on an inmate’s programming
activities. This shortened version of the
more thorough program review will
facilitate more efficiently-used staff and
inmate time, in that it will primarily
focus on any new or changed aspects of
an inmate’s initial classification and
participation in recommended
programs. Inmates who have 36 months
or more until their projected release
date will receive alternating program
and progress reviews at least once every
180 calendar days, a practice that will
allow the Bureau to more efficiently
utilize staff time and resources. The
process will also allow staff to devote
more time and resources to the reviews
of inmates who are closer to their
release dates, enabling the Bureau to
better fulfill its mission to prepare
inmates for eventual release into
communities within the United States.
DATES: Comments due by December 20,
2011.
ADDRESSES: Comments should be
submitted to the Rules Unit, Office of
General Counsel, Bureau of Prisons, 320
First Street, NW., Washington, DC
20534. You may also comment via the
Internet to BOP at
BOPRULES@BOP.GOV or by using the
https://www.regulations.gov comment
form for this regulation. When
submitting comments electronically you
must include the BOP Docket No. in the
subject box.
FOR FURTHER INFORMATION CONTACT:
Sarah Qureshi, Office of General
Counsel, Bureau of Prisons, phone (202)
307–2105.
SUPPLEMENTARY INFORMATION:
BILLING CODE 4410–09–P
DEPARTMENT OF JUSTICE
Bureau of Prisons
28 CFR Part 524
[BOP–1155–P]
RIN 1120–AB55
Classification and Program Review
Bureau of Prisons, Department
of Justice.
ACTION: Notice of proposed rulemaking.
jlentini on DSK4TPTVN1PROD with PROPOSALS
AGENCY:
In this document, the Bureau
of Prisons (Bureau) proposes to revise
its regulations on classification and
program review to ensure that
classification and program review
procedures adequately address inmate
needs. This proposed rule also adds a
SUMMARY:
VerDate Mar<15>2010
17:43 Oct 20, 2011
Jkt 226001
Posting of Public Comments
Please note that all comments
received are considered part of the
public record and are made available for
public inspection online at https://
www.regulations.gov. Such information
includes personal identifying
information (such as your name,
address, etc.) voluntarily submitted by
the commenter.
If you want to submit personal
identifying information (such as your
name, address, etc.) as part of your
comment, but do not want it to be
posted online, you must include the
phrase ‘‘PERSONAL IDENTIFYING
INFORMATION’’ in the first paragraph
of your comment. You must also locate
all the personal identifying information
you do not want posted online in the
first paragraph of your comment and
identify what information you want
redacted.
PO 00000
Frm 00018
Fmt 4702
Sfmt 4702
If you want to submit confidential
business information as part of your
comment but do not want it to be posted
online, you must include the phrase
‘‘CONFIDENTIAL BUSINESS
INFORMATION’’ in the first paragraph
of your comment. You must also
prominently identify confidential
business information to be redacted
within the comment. If a comment has
so much confidential business
information that it cannot be effectively
redacted, all or part of that comment
may not be posted on https://
www.regulations.gov.
Personal identifying information
identified and located as set forth above
will be placed in the agency’s public
docket file, but not posted online.
Confidential business information
identified and located as set forth above
will not be placed in the public docket
file. If you wish to inspect the agency’s
public docket file in person by
appointment, please see the ‘‘For
Further Information Contact’’ paragraph.
Proposed Rule
In this document, we propose to
revise the regulations which set forth
the classification and program review
rules and to add a new level of review:
progress reviews.
Section 524.10 Purpose
In this proposed section, we explain
that the purpose of this subpart is to
explain the Bureau’s process for
classifying newly committed inmates,
conducting program reviews, and
conducting progress reviews. We have
only revised the introductory paragraph
of this section, to add the concept of
progress reviews (which will be
explained below). The three types of
reviews listed here will be conducted
for all inmates except: (1) Pretrial
inmates, who are covered in 28 CFR part
551; and (2) inmates committed for
study and observation.
Pretrial inmate reviews are not
described in this subpart because they
are specifically covered in 28 CFR
551.107. According to that regulation,
pretrial inmates are scheduled for an
initial review by the unit team within 21
calendar days of the inmate’s arrival at
the institution, and later reviews are
conducted at least once every 90 days.
Inmates committed for study and
observation do not receive the reviews
described because they do not receive
program or work assignments while in
this status. Such inmates are typically
committed to the Bureau to determine
competency to stand trial or for other
mental health or medical assessments,
and are inappropriate for assignment to
work or other Bureau programs.
E:\FR\FM\21OCP1.SGM
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Agencies
[Federal Register Volume 76, Number 204 (Friday, October 21, 2011)]
[Proposed Rules]
[Pages 65424-65428]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-27253]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF JUSTICE
Drug Enforcement Administration
21 CFR Part 1308
[Docket No. DEA-354]
Schedules of Controlled Substances: Placement of Ezogabine Into
Schedule V
AGENCY: Drug Enforcement Administration, Department of Justice.
ACTION: Notice of proposed rulemaking.
-----------------------------------------------------------------------
SUMMARY: The Drug Enforcement Administration (DEA) proposes placing the
substance ezogabine, including its salts, isomers, and salts of isomers
whenever the existence of such salts, isomers, and salts of isomers is
possible, into Schedule V of the Controlled Substances Act (CSA). This
proposed action is pursuant to the CSA which requires that such actions
be made on the record after opportunity for a hearing through formal
rulemaking.
DATES: DEA will permit interested persons to file written comments on
this proposal pursuant to 21 CFR 1308.43(g). Electronic comments must
be submitted and written comments must be postmarked on or before
November 21, 2011. Commenters should be aware that the electronic
Federal Docket Management System will not accept comments after
midnight Eastern Time on the last day of the comment period.
Interested persons, defined as those ``adversely affected or
aggrieved by any rule or proposed rule issuable pursuant to section 201
of the Act (21 U.S.C. 811),'' \1\ may file a request for hearing
pursuant to 21 CFR 1308.44 and in accordance with 21 CFR 1316.45 and
1316.47. Requests for hearing, notices of appearance, and waivers of
participation must be received on or before November 21, 2011.
---------------------------------------------------------------------------
\1\ 21 CFR 1300.01.
ADDRESSES: To ensure proper handling of comments, please reference
``Docket No. DEA-354'' on all electronic and written correspondence.
DEA encourages all comments be submitted electronically through https://www.regulations.gov using the electronic comment form provided on that
site. An electronic copy of this document and supplemental information
to this proposed rule are also available at the https://www.regulations.gov Web site for easy reference. Paper comments that
duplicate the electronic submission are not necessary as all comments
submitted to https://www.regulations.gov will be posted for public
review and are part of the official docket record. Should you, however,
wish to submit written comments via regular or express mail, they
should be sent to the Drug Enforcement Administration, Attention: DEA
Federal Register Representative/OD, 8701 Morrissette Drive,
Springfield, VA 22152. All requests for hearing must be sent to Drug
Enforcement Administration, Attention: Hearing Clerk/LJ, 8701
---------------------------------------------------------------------------
Morrissette Drive, Springfield, VA 22152.
FOR FURTHER INFORMATION CONTACT: Rhea D. Moore, Office of Diversion
Control, Drug Enforcement Administration, 8701 Morrissette Drive,
Springfield, Virginia 22152; Telephone (202) 307-7165.
SUPPLEMENTARY INFORMATION:
Posting of Public Comments: Please note that all comments received
are considered part of the public record and made available for public
inspection online at https://www.regulations.gov and in the DEA's public
docket. Such information includes personal identifying information
(such as your name, address, etc.) voluntarily submitted by the
commenter.
If you want to submit personal identifying information (such as
your name, address, etc.) as part of your comment, but do not want it
to be posted online or made available in the public docket, you must
include the phrase ``PERSONAL IDENTIFYING INFORMATION'' in the first
paragraph of your comment. You must also place all of the personal
identifying information you do not want posted online or made available
in the public docket in the first paragraph of your comment and
identify what information you want redacted.
If you want to submit confidential business information as part of
your comment, but do not want it to be posted online or made available
in the public docket, you must include the phrase ``CONFIDENTIAL
BUSINESS INFORMATION'' in the first paragraph of your comment. You must
also prominently identify confidential business information to be
redacted within the comment. If a comment has so much confidential
business information that it cannot be effectively redacted, all or
part of that comment may not be posted online or made available in the
public docket.
Personal identifying information and confidential business
information identified and located as set forth above will be redacted,
and the comment, in redacted form, will be posted online and placed in
the DEA's public docket file. Please note that the Freedom of
Information Act applies to all comments received. If you wish to
inspect the agency's public docket file in person by appointment,
please see the ``For Further Information'' paragraph.
Request for Hearing, Notice of Appearance at or Waiver of Participation
in Hearing
In accordance with the provisions of the CSA (21 U.S.C. 811(a)),
this action is a formal rulemaking ``on the record after opportunity
for a hearing.'' Such proceedings are conducted pursuant to the
provisions of the Administrative Procedure Act (5 U.S.C. 556 and 557)
and 21 CFR 1308.41. Pursuant to 21 CFR 1308.44(a)-(c), requests for
hearing, notices of appearance, and waivers of participation may be
submitted only by interested persons, defined as those ``adversely
affected or aggrieved by any rule or proposed rule issuable pursuant to
section 201 of the Act (21 U.S.C. 811).'' Such requests or notices must
conform to the requirements of 21 CFR 1308.44(a) or (b) and 1316.47 or
1316.48, as applicable. A request or notice should state, with
particularity, the interest of the person in the proceeding and the
objections or issues, if any, concerning which the person desires to be
heard. Any waiver must conform to the requirements of 21 CFR
1308.44(c), including a written statement regarding the interested
[[Page 65425]]
person's position on the matters of fact and law involved in any
hearing.
Please note that pursuant to 21 U.S.C. 811(a), the purpose and
subject matter of the hearing is restricted to ``(A) find[ing] that
such drug or other substance has a potential for abuse, and (B)
mak[ing] with respect to such drug or other substance the findings
prescribed by subsection (b) of section 812 of this title for the
schedule in which such drug is to be placed * * *'' Requests for
hearing, notices of appearance at the hearing, and waivers of
participation in the hearing should be submitted to DEA using the
address information provided above.
Legal Authority
Under the CSA, controlled substances are classified in one of five
schedules based upon their potential for abuse, their currently
accepted medical use, and the degree of dependence the substance may
cause. 21 U.S.C. 812. The initial schedules of controlled substances by
statute are found at 21 U.S.C. 812(c) and the current list of scheduled
substances are published at 21 CFR part 1308.
Pursuant to 21 U.S.C. 811(a)(1), the Attorney General may, by rule,
``add to such a schedule or transfer between such schedules any drug or
other substance if he (A) finds that such drug or other substance has a
potential for abuse, and (B) makes with respect to such drug or other
substance the findings prescribed by subsection (b) of section 812 of
this title for the schedule in which such drug is to be placed * * *''
Pursuant to 28 CFR 0.100(b), the Attorney General has delegated this
scheduling authority to the Administrator of DEA.
The CSA provides that scheduling of any drug or other substance may
be initiated by the Attorney General (1) on his own motion; (2) at the
request of the Secretary of HHS, or (3) on the petition of any
interested party. 21 U.S.C. 811(a). This proposed action is based on a
recommendation from the Assistant Secretary for Health of the
Department of Health and Human Services (HHS) and on an evaluation of
all other relevant data by DEA. If finalized, this action would impose
the regulatory controls and criminal sanctions of Schedule V on the
manufacture, distribution, dispensing, importation, and exportation of
ezogabine and products containing ezogabine.
Background
Ezogabine, known chemically as N-[2-amino-4-(4-fluorobenzylamino)-
phenyl]-carbamic acid ethyl ester, is a new chemical substance with
central nervous system depressant properties and is classified as a
sedative-hypnotic. Pharmacological studies indicate that ezogabine
primarily acts as a ligand at ion-gated channels in the brain to
enhance potassium currents mediated by neuronal KCNQ (Kv7) channels.
Additionally, ezogabine indirectly enhances the gamma-aminobutyric acid
(GABA) mediated neurotransmission. On June 10, 2011, the Food and Drug
Administration (FDA) approved a New Drug Application (NDA) for
ezogabine as an adjunct treatment of partial onset seizures, to be
marketed under the trade name Potiga.[reg] \2\
---------------------------------------------------------------------------
\2\ https://www.accessdata.fda.gov/drugsatfda_docs/nda/2011/022345Orig1s000TOC.cfm; as of July 21, 2011.
---------------------------------------------------------------------------
Proposed Determination to Schedule Ezogabine
Pursuant to 21 U.S.C. 811(a), proceedings to add a drug or
substance to those controlled under the CSA may be initiated by request
of the Secretary of HHS. On January 12, 2011, HHS provided DEA with a
scientific and medical evaluation document prepared by FDA entitled
``Basis for the Recommendation for Control of Ezogabine in Schedule V
of the Controlled Substances Act.'' Pursuant to 21 U.S.C. 811(b), this
document contained an eight-factor analysis of the abuse potential of
ezogabine as a new drug, along with HHS' recommendation to control
ezogabine under Schedule V of the CSA.
In response, DEA conducted an eight-factor analysis of ezogabine's
abuse potential pursuant to 21 U.S.C. 811(c). Included below is a brief
summary of each factor as analyzed by HHS and DEA, and as considered by
DEA in the scheduling decision. Please note that both the DEA and HHS
analyses are available in their entirety under ``Supporting and Related
Material'' of the public docket for this rule at www.regulations.gov
under docket number DEA-354.
1. The Drug's Actual or Relative Potential for Abuse: Ezogabine is
a new chemical substance that has not been marketed in the U.S. or in
any other country. As such, there is no information available which
details actual abuse of ezogabine. However, the legislative history of
the CSA offers another methodology for assessing a drug or substance's
potential for abuse:
The drug or drugs containing such a substance are new drugs so
related in their action to a drug or drugs already listed as having
a potential for abuse to make it likely that the drug will have the
same potentiality for abuse as such drugs, thus making it reasonable
to assume that there may be significant diversions from legitimate
channels, significant use contrary to or without medical advice, or
that it has a substantial capability of creating hazards to the
health of the user or to the safety of the community.\3\
---------------------------------------------------------------------------
\3\ Comprehensive Drug Abuse Prevention and Control Act of 1970,
H.R. Rep. No. 91-1444, 91st Cong., Sess. 1 (1970); 1970 U.S.C.C.A.N.
4566, 4601.
Ezogabine acts as a ligand at ion-gated channels in the brain,
similar to the Schedule V substances pregabalin and lacosamide, and,
like those drugs, ezogabine is indicated for the treatment of epileptic
conditions in humans. There is strong evidence, described below, that
ezogabine produces behavioral effects in humans and in animals that are
similar to those produced by pregabalin and lacosamide.
Phase 1 clinical studies indicate that the rate of euphoria-related
adverse events (AEs) resulting from administration of ezogabine was 6-
9%. This is similar to the AE rates for administration of pregabalin
(10%) and lacosamide (>7%), while Phase \2/3\ clinical studies
indicated similar AE rates between ezogabine (<1%) and lacosamide
(<2%). Animal studies involving administration of ezogabine to animals
produced a sedative behavioral profile similar to that produced from
administration of pregabalin and lacosamide, including decreased
locomotion, decreased muscle tone, and an increase in ataxia. Further,
in abuse potential studies conducted with sedative-hypnotic abusers,
ezogabine, pregabalin, and lacosamide, when compared to placebos, are
similar in their ability to produce statistically significant increases
in subjective responses including ``Drug Liking,'' ``Euphoria,''
``Overall Drug Liking,'' ``Good Drug Effects,'' and ``High.''
Because of the similarities between ezogabine, pregabalin, and
lacosamide, it is very likely that ezogabine will have an abuse
potential similar to those Schedule V substances. Currently there is a
lack of evidence regarding the diversion, illicit manufacturing or
deliberate misuse of ezogabine due to its commercial unavailability in
any country, but since ezogabine is not readily synthesized from
available substances, any diversion would be from legitimate channels.
The above referenced studies, which include demonstration of the
significant euphoric effects produced by ezogabine in humans, predict
that there will be significant use of ezogabine contrary to or without
medical advice.
2. Scientific Evidence of the Drug's Pharmacological Effects, If
Known:
[[Page 65426]]
Ezogabine acts to enhance potassium currents mediated by neuronal KCNQ
(Kv7) channels with a secondary action through the augmentation of
GABA-mediated neurotransmission without direct GABA receptor
stimulation. In individuals with histories of recreational sedative-
hypnotic abuse, ezogabine (300 and 600 mg orally) produced increased
ratings on the primary positive subjective scales [VAS-Drug-liking,
VAS-Overall Drug Liking, ARCI-MBG (Euphoria), VAS-Take Drug Again] for
peak responses (Emax for the first eight hours after drug
administration) that were significantly different from the placebo.
This effect is similar to that produced by alprazolam (1.5 and 3.0 mg
orally; Schedule IV). On secondary positive subjective scales [VAS-
High, VAS-Good Effects, ARCI-Amphetamine (Activation)] for peak
responses, both ezogabine and alprazolam produced significant increases
compared to the placebo, while there were no differences between
ezogabine and alprazolam on those measures.
In human abuse potential studies, ezogabine (300 and 600 mg), upon
oral administration, increased ratings on negative and sedating
subjective measures [VAS-Bad Effects, ARCI-LSD (dysphoria) and ARCI-
PCAG (sedation)] compared to the placebo, but these increases were
lower than those produced by 1.5 and 3.0 mg alprazolam. These data for
ezogabine are similar to those produced by lacosamide. A 900 mg dose of
ezogabine produced VAS-Drug Liking and VAS-Good Effects that were
higher than those produced by the two lower doses of ezogabine and
either dose of alprazolam. However, the changes in VAS-Bad Effects and
ARCI-LSD (dysphoria) following 900 mg ezogabine were less than or
similar to those produced by lower doses of ezogabine and either dose
of alprazolam. The adverse events following 900 mg ezogabine are
similar to those described in the NDA for the human abuse potential
study conducted with lacosamide. These included euphoria, somnolence,
visual disturbances, and altered auditory perception.
In human abuse potential studies, ezogabine, similar to pregabalin
and lacosamide, also produced ratings on each of the positive
subjective responses that were statistically similar to those produced
by Schedule IV benzodiazepines (alprazolam or diazepam). Although this
appears to suggest that these drugs have an abuse potential similar to
that of Schedule IV substances, the other data from human abuse
potential studies, the adverse effect profile data from safety and
efficacy studies, and the data from the preclinical animal behavioral
studies demonstrate that ezogabine has abuse potential less than that
of Schedule IV drugs but similar to that of Schedule V drugs.
3. The State of Current Scientific Knowledge Regarding the Drug or
Other Substance: The chemical name of ezogabine is N-[2-amino-4-(4-
fluorobenzylamino)-phenyl]-carbamic acid ethyl ester. It is an achiral
molecule with a molecular formula of
C16H18FN3O2 and a molecular
weight of 303.3 g/mol. Ezogabine is a non-hygroscopic white to slightly
colored powder with a melting point of 140-143\0\C. It is soluble in
0.9% saline, methanol, chloroform, but only sparingly soluble in
ethanol and 0.1N HCL.
Ezogabine in humans has a Tmax (time required for
ezogabine to reach maximum plasma concentration) ranging from 1-4 hours
following both acute and multiple dosing, and, without the involvement
of cytochrome P450, undergoes an extensive and almost exclusively phase
2 metabolic biotransformation. Ezogabine is predominantly metabolized
by N-glucuronidation, resulting in the formation of two distinct N-
glucuronides of the unchanged parent drug and to a lesser extent by N-
acetylation to form N-acetyl-retigabine, the major bioactive metabolite
of ezogabine. The half-life of both ezogabine and N-acetyl-retigabine
is approximately eight hours and the Cmax (maximum plasma
concentration) of both components is dose proportional after both acute
and multiple dosing, suggesting a lack of accumulation with repeated
administration.
4. Its History and Current Pattern of Abuse: As stated in the
summary of Factor 1, information on ezogabine's history and current
pattern of abuse is unavailable as it has not been marketed in any
country. As such, evaluation of abuse potential for ezogabine derives
from positive indicators in clinical studies which are believed to be
predictive of drug abuse and which are discussed in Factors 1 and 2
above.
5. The Scope, Duration, and Significance of Abuse: Because
ezogabine has not been marketed in any country, information on the
scope, duration, and significance of abuse of ezogabine is unavailable.
However, epidemiological data on pregabalin, a Schedule V drug with an
abuse potential similar to that of ezogabine, is available from the
Drug Abuse Warning Network (DAWN) database.
The ``abuse frequency ratio,'' calculated as the ratio of
nonmedical use related annual emergency department visits (as reported
in DAWN) to the total number of annual prescriptions for pregabalin is
less than that for the Schedule IV drug, alprazolam. Further, because
ezogabine has abuse-related human and animal data in its NDA similar to
data generated for pregabalin, ezogabine is likely to have an abuse
potential similar to pregabalin. The ``abuse frequency ratios'' for
pregabalin range from 29 to 47, while those for alprazolam are
approximately three to six times higher, ranging from 160 to 235. Thus,
pregabalin was placed into Schedule V based both on abuse-related human
and animal data submitted in its NDA and by epidemiological data which
justified placement relative to drugs in Schedule IV. Given that
ezogabine has abuse-related human and animal data in its NDA similar to
the data generated by pregabalin, it is likely that ezogabine will have
an abuse potential similar to this Schedule V drug.
6. What, if any, Risk There is to the Public Health: The data
indicates that ezogabine may present a serious safety risk to the
public health, and the predicted level of risk is similar to that
observed with pregabalin and lacosamide but less than that produced by
Schedule IV benzodiazepines. In Phase 1 clinical safety studies, the
overall adverse event profile following ezogabine administration was
similar to those from pregabalin and lacosamide and includes not only
euphoria, but also somnolence, and feeling or thinking abnormally.
Further, the human abuse potential study showed that the majority of
subjects receiving the 900 mg dose of ezogabine experienced multiple
adverse events such as euphoria, somnolence, visual disturbance,
amnesia, hypo-aesthesia, paranoia, fear, confusion and hallucination.
Although the 900 mg dose is three times greater than the recommended
therapeutic dose, individuals who abuse drugs typically do so at supra-
therapeutic doses.
7. Its Psychic or Physiological Dependence Liability: Ezogabine may
produce limited psychic or physiological dependence liability following
extended administration. Since there are no studies detailing abrupt
discontinuation of ezogabine, there are minimal adequate data to
evaluate the ability of ezogabine to induce withdrawal symptoms that
are indicative of physical dependence. Many of the adverse events
reported from the discontinuation of ezogabine were also reported prior
to its discontinuation, including dizziness,
[[Page 65427]]
somnolence, and a state of confusion. By comparison, abrupt or rapid
discontinuation of pregabalin in human studies resulted in patient-
reported symptoms of nausea, headache or diarrhea, which are suggestive
of physical dependence, while abrupt termination of lacosamide produced
no signs or symptoms of withdrawal in diabetic neuropathic pain
patients.
Unlike ezogabine and pregabalin, the withdrawal syndrome following
discontinuation of Schedule IV substances such as alprazolam can range
from mild dysphoria and insomnia to a major syndrome including
abdominal pain, muscle cramps, vomiting, sweating, tremors and
convulsions. These are similar in character to those associated with
other sedative-hypnotics.
The study of ezogabine abuse potential in humans with histories of
recreational abuse of sedative-hypnotics found that ezogabine produces
euphoria (18-33%) in these individuals. Additionally, ezogabine
produced euphoria (8.5%) in Phase 1 studies in healthy individuals.
These euphoria-related adverse events following administration of
ezogabine are suggestive of its ability to produce psychic dependence,
and the adverse events appear to be less severe and occur less
frequently than Schedule IV drugs (diazepam and alprazolam) and are
more similar to those of Schedule V drugs, pregabalin and lacosamide.
8. Whether the Substance is an Immediate Precursor of a Substance
Already Controlled Under the CSA: Ezogabine is not an immediate
precursor of any controlled substance.
Conclusion: Based on consideration of the scientific and medical
evaluation and accompanying recommendation of HHS, and based on DEA's
consideration of its own eight-factor analysis, DEA finds that these
facts and all relevant data constitute substantial evidence of
potential for abuse of ezogabine. As such, DEA hereby proposes to
schedule ezogabine as a controlled substance under the CSA.
Proposed Determination of Appropriate Schedule
The CSA establishes five schedules of controlled substances known
as Schedules I, II, III, IV, and V. The statute outlines the findings
required to place a drug or other substance in any particular schedule.
21 U.S.C. 812(b). After consideration of the analysis and
recommendation of the Assistant Secretary for Health of HHS and review
of all available data, the Administrator of DEA, pursuant to 21 U.S.C.
812(b)(5), finds that:
(1) Ezogabine has a low potential for abuse relative to the drugs
or other substances in Schedule IV. The overall abuse potential of
ezogabine is comparable to the Schedule V substances such as pregabalin
and lacosamide;
(2) Ezogabine has a currently accepted medical use in treatment in
the United States. Ezogabine was approved for marketing by FDA as an
adjunct treatment of partial onset seizures; and
(3) Abuse of ezogabine may lead to limited physical dependence or
psychological dependence relative to the drugs or other substances in
Schedule IV.
Based on these findings, the Administrator of DEA concludes that
ezogabine, including its salts, isomers and salts of isomers, whenever
the existence of such salts, isomers, and salts of isomers is possible,
warrants control in Schedule V of the CSA (21 U.S.C. 812(b)(5)).
Requirements for Handling Ezogabine
If this rule is finalized as proposed, ezogabine would be subject
to the CSA and the Controlled Substances Import and Export Act (CSIEA)
regulatory controls and administrative, civil and criminal sanctions
applicable to the manufacture, distribution, dispensing, importing and
exporting of a Schedule V controlled substance, including the
following:
Registration. Any person who manufactures, distributes, dispenses,
imports, exports, engages in research or conducts instructional
activities with ezogabine, or who desires to manufacture, distribute,
dispense, import, export, engage in research or conduct instructional
activities with ezogabine, would need to be registered to conduct such
activities pursuant to 21 U.S.C. 822 and in accordance with 21 CFR part
1301.
Security. Ezogabine would be subject to Schedules III-V security
requirements and would need to be manufactured, distributed, and stored
pursuant to 21 U.S.C. 823 and in accordance with 21 CFR 1301.71,
1301.72(b), (c), and (d), 1301.73, 1301.74, 1301.75(b) and (c),
1301.76, and 1301.77.
Labeling and Packaging. All labels and labeling for commercial
containers of ezogabine which are distributed on or after finalization
of this rule would need to be in accordance with 21 CFR 1302.03-
1302.07, pursuant to 21 U.S.C. 825.
Inventory. Every registrant required to keep records and who
possesses any quantity of ezogabine would be required to keep an
inventory of all stocks of ezogabine on hand pursuant to 21 U.S.C. 827
and in accordance with 21 CFR 1304.03, 1304.04, and 1304.11. Every
registrant who desires registration in Schedule V for ezogabine would
be required to conduct an inventory of all stocks of the substance on
hand at the time of registration.
Records. All registrants would be required to keep records pursuant
to 21 U.S.C. 827 and in accordance with 21 CFR 1304.03, 1304.04,
1304.06, 1304.21, 1304.22, and 1304.23.
Prescriptions. Ezogabine or products containing ezogabine would be
required to be distributed or dispensed pursuant to 21 U.S.C. 829 and
in accordance with 21 CFR 1306.03-1306.06, 1306.08, 1306.21, and
1306.23-1306.27.
Importation and Exportation. All importation and exportation of
ezogabine would need to be done in accordance with 21 CFR part 1312,
pursuant to 21 U.S.C. 952, 953, 957, and 958.
Criminal Liability. Any activity with ezogabine not authorized by,
or in violation of, Subchapter I Part D and Subchapter II of the CSA or
the CSIEA occurring on or after finalization of this proposed rule
would be unlawful.
Regulatory Analyses
Executive Orders 12866 and 13563
In accordance with 21 U.S.C. 811(a), this proposed scheduling
action is subject to formal rulemaking procedures done ``on the record
after opportunity for a hearing,'' which are conducted pursuant to the
provisions of 5 U.S.C. 556 and 557. The CSA sets forth the criteria for
scheduling a drug or other substance. Such actions are exempt from
review by the Office of Management and Budget pursuant to Section
3(d)(1) of Executive Order 12866 and the principles reaffirmed in
Executive Order 13563.
Executive Order 12988
This proposed regulation meets the applicable standards set forth
in Sections 3(a) and 3(b)(2) of Executive Order 12988 Civil Justice
Reform to eliminate ambiguity, minimize litigation, establish clear
legal standards, and reduce burden.
Executive Order 13132
This proposed rulemaking does not preempt or modify any provision
of State law; nor does it impose enforcement responsibilities on any
State; nor does it diminish the power of any State to enforce its own
laws. Accordingly, this rulemaking does not have federalism
implications warranting the application of Executive Order 13132.
[[Page 65428]]
Executive Order 13175
This proposed rule will not have Tribal implications and will not
impose substantial direct compliance costs on Indian Tribal
governments.
Paperwork Reduction Act of 1995
This action does not impose a new collection of information under
the Paperwork Reduction Act of 1995, 44 U.S.C. 3501-3521.
List of Subjects in 21 CFR Part 1308
Administrative practice and procedure, Drug traffic control,
Reporting and recordkeeping requirements.
For the reasons set out above, 21 CFR part 1308 is proposed to be
amended to read as follows:
PART 1308--SCHEDULES OF CONTROLLED SUBSTANCES
1. The authority citation for 21 CFR part 1308 continues to read as
follows:
Authority: 21 U.S.C. 811, 812, 871(b), unless otherwise noted.
2. Section 1308.15 is amended by redesignating paragraphs (e)(1)
and (2) as paragraphs (e)(2) and (3), and adding a new paragraph (e)(1)
to read as follows:
Sec. 1308.15 Schedule V.
* * * * *
(e) * * *
(1) Ezogabine--2779
* * * * *
Dated: October 14, 2011.
Michele M. Leonhart,
Administrator.
[FR Doc. 2011-27253 Filed 10-20-11; 8:45 am]
BILLING CODE 4410-09-P