Schedules of Controlled Substances: Placement of Ezogabine Into Schedule V, 77895-77899 [2011-32172]

Download as PDF 77895 Rules and Regulations Federal Register Vol. 76, No. 241 Thursday, December 15, 2011 This section of the FEDERAL REGISTER contains regulatory documents having general applicability and legal effect, most of which are keyed to and codified in the Code of Federal Regulations, which is published under 50 titles pursuant to 44 U.S.C. 1510. The Code of Federal Regulations is sold by the Superintendent of Documents. Prices of new books are listed in the first FEDERAL REGISTER issue of each week. 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: Final rule. AGENCY: With the issuance of this final rule, the Administrator of the Drug Enforcement Administration (DEA) places 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 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: Effective date: December 15, 2011. SUMMARY: 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: pmangrum on DSK3VPTVN1PROD with RULES Legal Authority The DEA implements and enforces Titles II and III of the Comprehensive Drug Abuse Prevention and Control Act of 1970, often referred to as the Controlled Substances Act and the Controlled Substances Import and Export Act (21 U.S.C. 801–971), as amended (hereinafter, ‘‘CSA’’). The implementing regulations for these statutes are found in Title 21 of the Code of Federal Regulations (CFR), parts VerDate Mar<15>2010 14:52 Dec 14, 2011 Jkt 226001 1300 to 1321. 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 is 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 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. This action imposes the regulatory controls and criminal sanctions of Schedule V on the manufacture, distribution, dispensing, importation, and exportation of ezogabine and products containing ezogabine. Pursuant to 21 CFR 1308.44(e), the Administrator of DEA may issue her final order ‘‘[I]f all interested persons waive or are deemed to waive their opportunity for the hearing or to participate in the hearing.’’ As no requests for a hearing were filed on this proposed scheduling action, all interested persons are deemed to have waived their opportunity for a hearing pursuant to 21 CFR 1308.44(d), and the Administrator may issue her final order without a hearing. Ezogabine is a new drug with a novel mechanism of action for the treatment of partial onset seizures. Because ezogabine is a new drug with possible immediate medical application to a life- PO 00000 Frm 00001 Fmt 4700 Sfmt 4700 threatening illness not always treatable with medications currently available and because it may not be prescribed in the United States until this final rulemaking action is in effect and the subsequent requirements that result from this final action are satisfied, the Administrator hereby finds that it is in the interest of public health to forego the 30 day period prior to this final rule taking effect. This will impose no hardship on any interested party and is responsive to comments intended to facilitate the availability of ezogabine as soon as possible for that population of people suffering from seizures that may benefit from treatment with ezogabine. Therefore, in accordance with this finding of conditions of public health and of good cause to waive the 30 day period and pursuant to 21 CFR 1308.45 and 5 U.S.C. 553(d)(3), this final rule is effective upon publication. Background Ezogabine, known chemically as N-[2amino-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®.1 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 1 https://www.accessdata.fda.gov/ drugsatfda_docs/nda/2011/ 022345Orig1s000TOC.cfm; as of July 21, 2011. E:\FR\FM\15DER1.SGM 15DER1 77896 Federal Register / Vol. 76, No. 241 / Thursday, December 15, 2011 / Rules and Regulations 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). Following analysis, the Administrator of DEA published a Notice of Proposed Rulemaking entitled ‘‘Schedules of Controlled Substances: Placement of Ezogabine into Schedule V’’ on October 21, 2011 (76 FR 65424), which proposed placement of ezogabine into Schedule V of the CSA. The proposed rule provided an opportunity for all interested persons to request a hearing or to submit comments on or before November 21, 2011. 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 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. 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: pmangrum on DSK3VPTVN1PROD with RULES 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.2 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%. 2 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. VerDate Mar<15>2010 14:52 Dec 14, 2011 Jkt 226001 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: 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 PO 00000 Frm 00002 Fmt 4700 Sfmt 4700 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 ARCILSD (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 file 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-(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 140–143 °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 E:\FR\FM\15DER1.SGM 15DER1 pmangrum on DSK3VPTVN1PROD with RULES Federal Register / Vol. 76, No. 241 / Thursday, December 15, 2011 / Rules and Regulations 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 yet been marketed, 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 file 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 file similar to the data generated by pregabalin, it is likely that ezogabine VerDate Mar<15>2010 14:52 Dec 14, 2011 Jkt 226001 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, 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. PO 00000 Frm 00003 Fmt 4700 Sfmt 4700 77897 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. Requests for a Hearing and Comments DEA received no requests for a hearing on this scheduling action. DEA received two comments on the NPRM to schedule ezogabine. Comment: The first comment requested that ezogabine be placed into Schedule IV of the CSA instead of Schedule V as proposed. While the commenter stated that ezogabine may help those who have not had success with current epilepsy treatments, the commenter believed that ezogabine’s new mechanism of action, including its effect on the central nervous system as an anticonvulsant and the potential side effects of the drug therein, warrant closer scrutiny and supervision under Schedule IV. DEA Response: DEA disagrees. That ezogabine has an effect on the central nervous system is alone not enough to merit its inclusion into Schedule IV of the CSA, nor is the possibility that persons to whom ezogabine is prescribed would need to monitor their medications closely. Instead, as detailed in the HHS and DEA analyses and the HHS recommendation, studies indicate that the abuse potential and likely effects of ezogabine are similar to those of the Schedule V drugs pregabalin and lacosamide, and, therefore, merit ezogabine’s inclusion into Schedule V of the CSA. Comment: The second comment stated that because epilepsy is a serious and potentially life-threatening illness that may not be adequately treated with currently available medicines, conditions of public health necessitate an early effective date for the final rule pursuant to 21 CFR 1308.45. As such, the commenter requested an effective date for the rule concurrent with its publication in the Federal Register. DEA Response: As stated under ‘‘Legal Authority,’’ DEA agrees that this rule should become effective upon publication. Ezogabine, unlike the currently available anticonvulsant E:\FR\FM\15DER1.SGM 15DER1 77898 Federal Register / Vol. 76, No. 241 / Thursday, December 15, 2011 / Rules and Regulations medications, may act as an anticonvulsant through a novel mechanism of action. Because some patients with epilepsy do not achieve satisfactory seizure control from treatments currently in use, the availability of ezogabine becomes an important and potentially life-saving option for such patients. Thus, for public health reasons pursuant to 21 CFR 1308.45 and based on finding good cause pursuant to 5 U.S.C. 553(d)(3) as outlined, this final rule is effective upon publication in the Federal Register. pmangrum on DSK3VPTVN1PROD with RULES Scheduling 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 will schedule ezogabine as a controlled substance under the CSA. 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 Upon the effective date of this final rule, ezogabine is subject to the CSA VerDate Mar<15>2010 14:52 Dec 14, 2011 Jkt 226001 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, must be registered to conduct such activities pursuant to 21 U.S.C. 822 and in accordance with 21 CFR Part 1301. Security. Ezogabine is subject to Schedules III–V security requirements and must 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 the effective date of this final rule must 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 must 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 must conduct an inventory of all stocks of the substance on hand at the time of registration. Records. All registrants must 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 must 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 must 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 the effective date of this final rule is unlawful. PO 00000 Frm 00004 Fmt 4700 Sfmt 4700 Regulatory Analyses Executive Orders 12866 and 13563 In accordance with 21 U.S.C. 811(a), this 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 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 rulemaking does not preempt or modify any provision of state law or impose enforcement responsibilities on any state or 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. Executive Order 13175 This 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. Congressional Review Act This rule is not a major rule as defined by § 804 of the Small Business Regulatory Enforcement Fairness Act of 1996 (Congressional Review Act). This rule will not result in an annual effect on the economy of $100,000,000 or more, a major increase in costs or prices, or significant adverse effects on competition, employment, investment, productivity, innovation, or on the ability of United States-based companies to compete with foreign based companies in domestic and export markets. List of Subjects in 21 CFR Part 1308 Administrative practice and procedure, Drug traffic control, Reporting and recordkeeping requirements. E:\FR\FM\15DER1.SGM 15DER1 Federal Register / Vol. 76, No. 241 / Thursday, December 15, 2011 / Rules and Regulations For the reasons set out above, 21 CFR Part 1308 is amended 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 [N-[2-amino-4-(4fluorobenzylamino)-phenyl]-carbamic acid ethyl ester]–2779 * * * * * Dated: December 8, 2011. Michele M. Leonhart, Administrator. BILLING CODE 4410–09–P DEPARTMENT OF TRANSPORTATION Federal Aviation Administration 14 CFR Part 71 [Docket No. FAA–2011–0893; Airspace Docket No. 11–ANM–18] Modification of Class E Airspace; The Dalles, OR Federal Aviation Administration (FAA), DOT. ACTION: Final rule. AGENCY: This action modifies Class E airspace at The Dalles, OR. Controlled airspace is necessary to accommodate aircraft using Area Navigation (RNAV) Global Positioning System (GPS) standard instrument approach procedures at Columbia Gorge Regional/ The Dalles Municipal Airport. This action also changes the airport name. This improves the safety and management of Instrument Flight Rules (IFR) operations at the airport. DATES: Effective date, 0901 UTC, April 5, 2012. The Director of the Federal Register approves this incorporation by reference action under 1 CFR part 51, subject to the annual revision of FAA Order 7400.9 and publication of conforming amendments. FOR FURTHER INFORMATION CONTACT: Eldon Taylor, Federal Aviation pmangrum on DSK3VPTVN1PROD with RULES SUMMARY: 18:12 Dec 14, 2011 History On October 12, 2011, the FAA published in the Federal Register a notice of proposed rulemaking to modify controlled airspace at The Dalles, OR (76 FR 63235). Interested parties were invited to participate in this rulemaking effort by submitting written comments on the proposal to the FAA. No comments were received. Class E airspace designations are published in paragraph 6005, of FAA Order 7400.9V dated August 9, 2011, and effective September 15, 2011, which is incorporated by reference in 14 CFR 71.1. The Class E airspace designations listed in this document will be published subsequently in that Order. The Rule [FR Doc. 2011–32172 Filed 12–14–11; 8:45 am] VerDate Mar<15>2010 Administration, Operations Support Group, Western Service Center, 1601 Lind Avenue SW., Renton, WA 98057; telephone (425) 203–4537. SUPPLEMENTARY INFORMATION: Jkt 226001 This action amends Title 14 Code of Federal Regulations (14 CFR) Part 71 by modifying Class E airspace extending upward from 700 feet above the surface, at Columbia Gorge Regional/The Dalles Municipal Airport, to accommodate IFR aircraft executing RNAV (GPS) standard instrument approach procedures at the airport. This also notes the airport’s name change from The Dalles Municipal Airport to Columbia Gorge Regional/The Dalles Municipal Airport. This action is necessary for the safety and management of IFR operations. The FAA has determined this regulation only involves an established body of technical regulations for which frequent and routine amendments are necessary to keep them operationally current. Therefore, this regulation: (1) Is not a ‘‘significant regulatory action’’ under Executive Order 12866; (2) is not a ‘‘significant rule’’ under DOT Regulatory Policies and Procedures (44 FR 11034; February 26, 1979); and (3) does not warrant preparation of a regulatory evaluation as the anticipated impact is so minimal. Since this is a routine matter that will only affect air traffic procedures and air navigation, it is certified this rule, when promulgated, will not have a significant economic impact on a substantial number of small entities under the criteria of the Regulatory Flexibility Act. The FAA’s authority to issue rules regarding aviation safety is found in Title 49 of the U.S. Code. Subtitle 1, Section 106 discusses the authority of the FAA Administrator. Subtitle VII, Aviation Programs, describes in more detail the scope of the agency’s authority. This PO 00000 Frm 00005 Fmt 4700 Sfmt 4700 77899 rulemaking is promulgated under the authority described in Subtitle VII, Part A, Subpart I, Section 40103. Under that section, the FAA is charged with prescribing regulations to assign the use of airspace necessary to ensure the safety of aircraft and the efficient use of airspace. This regulation is within the scope of that authority as it creates additional controlled airspace at Columbia Gorge Regional/The Dalles Municipal Airport, The Dalles, OR. List of Subjects in 14 CFR Part 71 Airspace, Incorporation by reference, Navigation (air). Adoption of the Amendment In consideration of the foregoing, the Federal Aviation Administration amends 14 CFR part 71 as follows: PART 71—DESIGNATION OF CLASS A, B, C, D AND E AIRSPACE AREAS; AIR TRAFFIC SERVICE ROUTES; AND REPORTING POINTS 1. The authority citation for 14 CFR part 71 continues to read as follows: ■ Authority: 49 U.S.C. 106(g), 40103, 40113, 40120; E.O. 10854, 24 FR 9565, 3 CFR, 1959– 1963 Comp., p. 389. § 71.1 [Amended] 2. The incorporation by reference in 14 CFR 71.1 of the Federal Aviation Administration Order 7400.9V, Airspace Designations and Reporting Points, dated August 9, 2011, and effective September 15, 2011 is amended as follows: ■ Paragraph 6005 Class E airspace areas extending upward from 700 feet or more above the surface of the earth. * * * ANM OR E5 * * The Dalles, OR [Modified] Columbia Gorge Regional/The Dalles Municipal Airport, OR (Lat. 45°37′07″ N., long. 121°10′02″ W.) Klickitat VOR/DME (Lat. 45°42′49″ N., long. 121°06′03″ W.) That airspace extending upward from 700 feet above the surface within a 12.9-mile radius of Columbia Gorge Regional/The Dalles Municipal Airport; that airspace extending upward from 1,200 feet above the surface within a 20.1-mile radius of the VOR/ DME extending clockwise from the 088° radial to the 272° radial. Issued in Seattle, Washington, on December 6, 2011. Johanna Forkner, Acting Manager, Operations Support Group, Western Service Center. [FR Doc. 2011–32043 Filed 12–14–11; 8:45 am] BILLING CODE 4910–13–P E:\FR\FM\15DER1.SGM 15DER1

Agencies

[Federal Register Volume 76, Number 241 (Thursday, December 15, 2011)]
[Rules and Regulations]
[Pages 77895-77899]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-32172]



========================================================================
Rules and Regulations
                                                Federal Register
________________________________________________________________________

This section of the FEDERAL REGISTER contains regulatory documents 
having general applicability and legal effect, most of which are keyed 
to and codified in the Code of Federal Regulations, which is published 
under 50 titles pursuant to 44 U.S.C. 1510.

The Code of Federal Regulations is sold by the Superintendent of Documents. 
Prices of new books are listed in the first FEDERAL REGISTER issue of each 
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Federal Register / Vol. 76, No. 241 / Thursday, December 15, 2011 / 
Rules and Regulations

[[Page 77895]]



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: Final rule.

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

SUMMARY: With the issuance of this final rule, the Administrator of the 
Drug Enforcement Administration (DEA) places 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 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: Effective date: December 15, 2011.

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:

Legal Authority

    The DEA implements and enforces Titles II and III of the 
Comprehensive Drug Abuse Prevention and Control Act of 1970, often 
referred to as the Controlled Substances Act and the Controlled 
Substances Import and Export Act (21 U.S.C. 801-971), as amended 
(hereinafter, ``CSA''). The implementing regulations for these statutes 
are found in Title 21 of the Code of Federal Regulations (CFR), parts 
1300 to 1321. 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 is 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 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. This action imposes the regulatory 
controls and criminal sanctions of Schedule V on the manufacture, 
distribution, dispensing, importation, and exportation of ezogabine and 
products containing ezogabine.
    Pursuant to 21 CFR 1308.44(e), the Administrator of DEA may issue 
her final order ``[I]f all interested persons waive or are deemed to 
waive their opportunity for the hearing or to participate in the 
hearing.'' As no requests for a hearing were filed on this proposed 
scheduling action, all interested persons are deemed to have waived 
their opportunity for a hearing pursuant to 21 CFR 1308.44(d), and the 
Administrator may issue her final order without a hearing.
    Ezogabine is a new drug with a novel mechanism of action for the 
treatment of partial onset seizures. Because ezogabine is a new drug 
with possible immediate medical application to a life-threatening 
illness not always treatable with medications currently available and 
because it may not be prescribed in the United States until this final 
rulemaking action is in effect and the subsequent requirements that 
result from this final action are satisfied, the Administrator hereby 
finds that it is in the interest of public health to forego the 30 day 
period prior to this final rule taking effect. This will impose no 
hardship on any interested party and is responsive to comments intended 
to facilitate the availability of ezogabine as soon as possible for 
that population of people suffering from seizures that may benefit from 
treatment with ezogabine. Therefore, in accordance with this finding of 
conditions of public health and of good cause to waive the 30 day 
period and pursuant to 21 CFR 1308.45 and 5 U.S.C. 553(d)(3), this 
final rule is effective upon publication.

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[supreg].\1\
---------------------------------------------------------------------------

    \1\ https://www.accessdata.fda.gov/drugsatfda_docs/nda/2011/022345Orig1s000TOC.cfm; as of July 21, 2011.
---------------------------------------------------------------------------

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

[[Page 77896]]

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).
    Following analysis, the Administrator of DEA published a Notice of 
Proposed Rulemaking entitled ``Schedules of Controlled Substances: 
Placement of Ezogabine into Schedule V'' on October 21, 2011 (76 FR 
65424), which proposed placement of ezogabine into Schedule V of the 
CSA. The proposed rule provided an opportunity for all interested 
persons to request a hearing or to submit comments on or before 
November 21, 2011.
    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 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. 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.\2\
---------------------------------------------------------------------------

    \2\ 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: 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 file 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 [deg]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

[[Page 77897]]

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 yet been marketed, 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 file 
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 file 
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, 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.

Requests for a Hearing and Comments

    DEA received no requests for a hearing on this scheduling action. 
DEA received two comments on the NPRM to schedule ezogabine.
    Comment: The first comment requested that ezogabine be placed into 
Schedule IV of the CSA instead of Schedule V as proposed. While the 
commenter stated that ezogabine may help those who have not had success 
with current epilepsy treatments, the commenter believed that 
ezogabine's new mechanism of action, including its effect on the 
central nervous system as an anticonvulsant and the potential side 
effects of the drug therein, warrant closer scrutiny and supervision 
under Schedule IV.
    DEA Response: DEA disagrees. That ezogabine has an effect on the 
central nervous system is alone not enough to merit its inclusion into 
Schedule IV of the CSA, nor is the possibility that persons to whom 
ezogabine is prescribed would need to monitor their medications 
closely. Instead, as detailed in the HHS and DEA analyses and the HHS 
recommendation, studies indicate that the abuse potential and likely 
effects of ezogabine are similar to those of the Schedule V drugs 
pregabalin and lacosamide, and, therefore, merit ezogabine's inclusion 
into Schedule V of the CSA.
    Comment: The second comment stated that because epilepsy is a 
serious and potentially life-threatening illness that may not be 
adequately treated with currently available medicines, conditions of 
public health necessitate an early effective date for the final rule 
pursuant to 21 CFR 1308.45. As such, the commenter requested an 
effective date for the rule concurrent with its publication in the 
Federal Register.
    DEA Response: As stated under ``Legal Authority,'' DEA agrees that 
this rule should become effective upon publication. Ezogabine, unlike 
the currently available anticonvulsant

[[Page 77898]]

medications, may act as an anticonvulsant through a novel mechanism of 
action. Because some patients with epilepsy do not achieve satisfactory 
seizure control from treatments currently in use, the availability of 
ezogabine becomes an important and potentially life-saving option for 
such patients. Thus, for public health reasons pursuant to 21 CFR 
1308.45 and based on finding good cause pursuant to 5 U.S.C. 553(d)(3) 
as outlined, this final rule is effective upon publication in the 
Federal Register.

Scheduling 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 will schedule ezogabine as a controlled 
substance under the CSA.

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

    Upon the effective date of this final rule, ezogabine is 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, must be registered to conduct such 
activities pursuant to 21 U.S.C. 822 and in accordance with 21 CFR Part 
1301.
    Security. Ezogabine is subject to Schedules III-V security 
requirements and must 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 the effective 
date of this final rule must 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 must 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 must conduct an inventory of 
all stocks of the substance on hand at the time of registration.
    Records. All registrants must 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 must 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 must 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 the effective date of this final rule 
is unlawful.

Regulatory Analyses

Executive Orders 12866 and 13563

    In accordance with 21 U.S.C. 811(a), this 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 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 rulemaking does not preempt or modify any provision of state 
law or impose enforcement responsibilities on any state or 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.

Executive Order 13175

    This 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.

Congressional Review Act

    This rule is not a major rule as defined by Sec.  804 of the Small 
Business Regulatory Enforcement Fairness Act of 1996 (Congressional 
Review Act). This rule will not result in an annual effect on the 
economy of $100,000,000 or more, a major increase in costs or prices, 
or significant adverse effects on competition, employment, investment, 
productivity, innovation, or on the ability of United States-based 
companies to compete with foreign based companies in domestic and 
export markets.

List of Subjects in 21 CFR Part 1308

    Administrative practice and procedure, Drug traffic control, 
Reporting and recordkeeping requirements.


[[Page 77899]]


    For the reasons set out above, 21 CFR Part 1308 is amended as 
follows:

PART 1308--SCHEDULES OF CONTROLLED SUBSTANCES

0
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.


0
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 [N-[2-amino-4-(4-fluorobenzylamino)-phenyl]-
carbamic acid ethyl ester]-2779
* * * * *

    Dated: December 8, 2011.
Michele M. Leonhart,
Administrator.
[FR Doc. 2011-32172 Filed 12-14-11; 8:45 am]
BILLING CODE 4410-09-P
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