Schedules of Controlled Substances: Removal of Naloxegol From Control, 64349-64353 [2014-25685]
Download as PDF
Federal Register / Vol. 79, No. 209 / Wednesday, October 29, 2014 / Proposed Rules
service information related to this AD,
contact Costruzioni Aeronautiche Tecnam
Airworthiness Office, Via Maiorise–81043
Capua (CE) Italy; telephone: +39 0823
997538; fax: +39 0823 622899; email:
technical.support@tecnam.com; Internet:
https://www.tecnam.com/Customer-Care/
Service-Bulletins.aspx. You may review this
referenced service information at the FAA,
Small Airplane Directorate, 901 Locust,
Kansas City, Missouri 64106. For information
on the availability of this material at the
FAA, call (816) 329–4148.
Issued in Kansas City, Missouri, on
October 22, 2014.
Earl Lawrence,
Manager, Small Airplane Directorate, Aircraft
Certification Service.
[FR Doc. 2014–25740 Filed 10–28–14; 8:45 am]
BILLING CODE 4910–13–P
DEPARTMENT OF JUSTICE
Drug Enforcement Admininstration
21 CFR Part 1308
[Docket No. DEA–400]
Schedules of Controlled Substances:
Removal of Naloxegol From Control
Drug Enforcement
Administration, Department of Justice.
ACTION: Notice of proposed rulemaking.
AGENCY:
The Drug Enforcement
Administration (DEA) proposes to
remove naloxegol ((5a,6 a)-17-allyl-6((20-hydroxy-3,6,9,12,15,18hexaoxaicos-1-yl)oxy)-4,5epoxymorphinon-3,14-diol) and its salts
from the schedules of the Controlled
Substances Act (CSA). This scheduling
action is pursuant to the CSA which
requires that such actions be made on
the record after opportunity for a
hearing through formal rulemaking.
Naloxegol is currently a schedule II
controlled substance because it can be
derived from opium alkaloids. This
action would remove the regulatory
controls and administrative, civil, and
criminal sanctions applicable to
controlled substances, including those
specific to schedule II controlled
substances, on persons who handle
(manufacture, distribute, reverse
distribute, dispense, conduct research,
import, export, or conduct chemical
analysis) or propose to handle
naloxegol.
DATES: Interested persons may file
written comments on this proposal in
accordance with 21 CFR 1308.43(g).
Electronic comments must be
submitted, and written comments must
be postmarked, on or before November
28, 2014. Commenters should be aware
rmajette on DSK2TPTVN1PROD with PROPOSALS
SUMMARY:
VerDate Sep<11>2014
13:59 Oct 28, 2014
Jkt 235001
that the electronic Federal Docket
Management System will not accept
comments after 11:59 p.m. Eastern Time
on the last day of the comment period.
Interested persons, defined at 21 CFR
1300.01 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)’’, may file a request
for hearing or waiver of participation
pursuant to 21 CFR 1308.44 and in
accordance with 21 CFR 1316.45,
1316.47, 1316.48, or 1316.49, as
applicable. Requests for hearing, notices
of appearance, and waivers of an
opportunity for a hearing or to
participate in a hearing must be
received on or before November 28,
2014.
ADDRESSES: To ensure proper handling
of comments, please reference ‘‘Docket
No. DEA–400’’ on all correspondence,
including any attachments.
• Electronic comments: The DEA
encourages that all comments be
submitted through the Federal
eRulemaking Portal, which provides the
ability to type short comments directly
into the comment field on the Web page
or to attach a file for lengthier
comments. Please go to https://
www.regulations.gov and follow the
online instructions at that site for
submitting comments. Upon completion
of your submission you will receive a
Comment Tracking Number for your
comment. Please be aware that
submitted comments are not
instantaneously available for public
view on Regulations.gov. If you have
received a comment tracking number,
your comment has been successfully
submitted and there is no need to
resubmit the same comment.
• Paper comments: Paper comments
that duplicate an electronic submission
are not necessary and are discouraged.
Should you wish to mail a comment in
lieu of an electronic format, it should be
sent via regular or express mail to: Drug
Enforcement Administration, Attention:
DEA Federal Register Representative/
ODXL, 8701 Morrissette Drive,
Springfield, Virginia 22152.
• Hearing requests: All requests for
hearing and waivers of participation
must be sent to: Drug Enforcement
Administration, Attn: Hearing Clerk/LJ,
8701 Morrissette Drive, Springfield,
Virginia 22152.
FOR FURTHER INFORMATION CONTACT:
Imelda L. Paredes, Office of Diversion
Control, Drug Enforcement
Administration; Mailing Address:
8701Morrissette Drive, Springfield,
Virginia 22152; Telephone: (202) 598–
6812.
SUPPLEMENTARY INFORMATION:
PO 00000
Frm 00015
Fmt 4702
Sfmt 4702
64349
Posting of Public Comments
Please note that all comments
received in response to this docket are
considered part of the public record.
They will, unless reasonable cause is
given, be made available by the DEA 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. The Freedom of
Information Act (FOIA) applies to all
comments received. 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 made publicly available, you
must include the phrase ‘‘PERSONAL
IDENTIFYING INFORMATION’’ in the
first paragraph of your comment. You
must also place the personal identifying
information you do not want made
publicly available 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 made
publicly available, 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.
Comments containing personal
identifying information and confidential
business information identified as
directed above will generally be made
publicly available in redacted form. If a
comment has so much confidential
business information or personal
identifying information that it cannot be
effectively redacted, all or part of that
comment may not be made publicly
available. Comments posted to https://
www.regulations.gov may include any
personal identifying information (such
as name, address, and phone number)
included in the text of your electronic
submission that is not identified as
directed above as confidential.
An electronic copy of this document
and supplemental information to this
proposed rule are available at https://
www.regulations.gov for easy reference.
The DEA specifically solicits written
comments regarding the DEA’s
economic analysis of the impact of these
proposed changes. The DEA requests
that commenters provide detailed
descriptions in their comments of any
expected economic impacts, especially
to small entities. Commenters should
provide empirical data to illustrate the
nature and scope of such impact.
E:\FR\FM\29OCP1.SGM
29OCP1
64350
Federal Register / Vol. 79, No. 209 / Wednesday, October 29, 2014 / Proposed Rules
Request for Hearing, Notice of
Appearance at or Waiver of
Participation in Hearing
Pursuant to 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 (APA) (5
U.S.C. 551–559). 21 CFR 1308.41–
1308.45, and 21 CFR part 1316 subpart
D. In accordance with 21 CFR 1308.44
(a)–(c), requests for hearing, notices of
appearance, and waivers of an
opportunity for a hearing or to
participate in a hearing 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).’’ 21 CFR 1300.01.
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, and include a statement of
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) and 1316.49, including a
written statement regarding the
interested 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 a 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 * * *.’’
All requests for hearing and waivers of
participation must be sent to the DEA
using the address information above, on
or before the date specified above.
rmajette on DSK2TPTVN1PROD with PROPOSALS
Legal Authority
The Drug Enforcement
Administration (DEA) implements and
enforces titles II and III of the
Comprehensive Drug Abuse Prevention
and Control Act of 1970, as amended. 21
U.S.C. 801–971. Titles II and III are
referred to as the ‘‘Controlled
Substances Act’’ and the ‘‘Controlled
Substances Import and Export Act,’’
respectively, but they are collectively
referred to as the ‘‘Controlled
Substances Act’’ or the ‘‘CSA’’ for the
purposes of this action. The DEA
publishes the implementing regulations
for these statutes in title 21 of the Code
of Federal Regulations (CFR), parts 1300
to 1321. The CSA and its implementing
VerDate Sep<11>2014
13:59 Oct 28, 2014
Jkt 235001
regulations are designed to prevent,
detect, and eliminate the diversion of
controlled substances and listed
chemicals into the illicit market while
providing for the legitimate medical,
scientific, research, and industrial needs
of the United States. Controlled
substances have the potential for abuse
and dependence and are controlled to
protect the public health and safety.
Under the CSA, each controlled
substance is classified into one of five
schedules based upon its potential for
abuse, its currently accepted medical
use in treatment in the United States,
and the degree of dependence the drug
or other substance may cause. 21 U.S.C.
812. The initial schedules of controlled
substances established by Congress are
found at 21 U.S.C. 812(c) and the
current list of scheduled substances is
published at 21 CFR part 1308. 21
U.S.C. 812(a).
Pursuant to 21 U.S.C. 811(a)(2), the
Attorney General may, by rule, ‘‘remove
any drug or other substance from the
schedules if he finds that the drug or
other substance does not meet the
requirements for inclusion in any
schedule.’’ The Attorney General has
delegated scheduling authority under 21
U.S.C. 811 to the Administrator of the
DEA, 28 CFR 0.100, who in turn has
redelegated that authority to the Deputy
Administrator of the DEA, 28 CFR part
0, appendix to subpart R.
The CSA provides that proceedings
for the issuance, amendment, or repeal
of the 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 the
Department of Health and Human
Services (HHS),1 or (3) on the petition
of any interested party. 21 U.S.C. 811(a).
This action was initiated by a petition
to remove naloxegol from the list of
scheduled controlled substances of the
CSA, and is supported by, inter alia, a
recommendation from the Assistant
Secretary of the HHS and an evaluation
of all relevant data by the DEA. This
action would remove the regulatory
controls and administrative, civil, and
criminal sanctions applicable to
controlled substances, including those
specific to schedule II controlled
1 As discussed in a memorandum of
understanding entered into by the Food and Drug
Administration (FDA) and the National Institute on
Drug Abuse (NIDA), the FDA acts as the lead agency
within the HHS in carrying out the Secretary’s
scheduling responsibilities under the CSA, with the
concurrence of NIDA. 50 FR 9518, Mar. 8, 1985.
The Secretary of the HHS has delegated to the
Assistant Secretary for Health of the HHS the
authority to make domestic drug scheduling
recommendations. 58 FR 35460, July 1, 1993.
PO 00000
Frm 00016
Fmt 4702
Sfmt 4702
substances, on persons who handle or
propose to handle naloxegol.
Background
Naloxegol, or PEG-naloxol, is a new
molecular entity and is a polyethylene
glycolyated (PEGylated) derivative of
naloxone. Its chemical names are (5a,6
a)-17-allyl-6-((20-hydroxy3,6,9,12,15,18-hexaoxaicos-1-yl)oxy)4,5-epoxymorphinon-3,14-diol or alpha6mPEG7–O-naloxol. Naloxegol is an
antagonist predominantly of peripheral
mu opioid receptors. The Food and
Drug Administration (FDA) approved
naloxegol for marketing on September
16, 2014, under the brand name
MovantikTM.2 It is indicated for the
treatment of opioid-induced
constipation (OIC) in adults with
chronic non-cancer pain.
Gastrointestinal adverse events (AEs)
effects are commonly experienced by
chronic users of opioid analgesics.
Opioids delay gastric emptying and
intestinal transport, which over time
leads to debilitating constipation. OIC is
caused by activation of the mu opioid
receptor in the GI tract.
Proposed Determination To Decontrol
Naloxegol
Pursuant to 21 U.S.C. 811(a),
proceedings to issue, amend, or repeal
scheduling actions may be initiated on
the petition of any interested party. In
accordance with 21 CFR 1308.43, the
DEA received a petition from the drug
sponsor dated March 22, 2012,
requesting that the DEA amend 21 CFR
1308.12(b)(1) to exclude naloxegol as a
schedule II controlled substance. The
petitioner stated that naloxegol is a mu
opioid receptor antagonist without mu
opioid agonist or partial agonist
properties. In accordance with 21 CFR
1308.43(c), the DEA accepted the
petition for filing on October 1, 2012.
Pursuant to 21 U.S.C. 811(b), the DEA
gathered the necessary data on
naloxegol and on February 7, 2013,
forwarded to the HHS the data with the
sponsor’s petition along with a request
for a scientific and medical evaluation
and the HHS’s recommendation as to
whether or not naloxegol should be
removed from the list of controlled
substances. According to the HHS, the
sponsor submitted a New Drug
Application (NDA) for naloxegol on
September 16, 2013. Based on the NDA,
the HHS summarized that naloxegol is
an antagonist of peripheral opioid
receptors for the treatment of OIC.
2 https://www.accessdata.fda.gov/scripts/cder/
drugsatfda/index.cfm?fuseaction=Search
.DrugDetails (last accessed Sept. 26, 2014).
E:\FR\FM\29OCP1.SGM
29OCP1
Federal Register / Vol. 79, No. 209 / Wednesday, October 29, 2014 / Proposed Rules
On August 8, 2014, the HHS provided
to the DEA a scientific and medical
evaluation document prepared by the
FDA entitled ‘‘Basis for the
Recommendation to Decontrol
Naloxegol and its Salts from Schedule II
of the Controlled Substances Act.’’
Pursuant to 21 U.S.C. 811(b), this
document contained an eight-factor
analysis of naloxegol as a new drug,
along with the HHS’s recommendation
to remove naloxegol from the schedules
of the CSA.
In response, the DEA reviewed the
scientific and medical evaluation and
scheduling recommendation provided
by the HHS, and all other relevant data,
and completed its own eight-factor
review document on naloxegol pursuant
to 21 U.S.C. 811(c). Included below is a
brief summary of each factor as
analyzed by the HHS and DEA, and as
considered by the DEA in this proposal
to remove naloxegol from the schedules
of the CSA. 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 https://
www.regulations.gov under docket
number DEA–400.
rmajette on DSK2TPTVN1PROD with PROPOSALS
1. The Drug’s Actual or Relative
Potential for Abuse
Naloxegol is a new molecular entity
that has not been marketed in the
United States or in any other country.
As such, there is no information
available regarding actual abuse of
naloxegol. However, scientific studies
show that naloxegol does not
demonstrate a potential for abuse.
Naloxegol is a conjugation of
polyethylene glycol (PEG) to naloxone.
Naloxegol binds to mu, delta, and kappa
opioid receptors and acts as an
antagonist at these receptors.
PEGylation of naloxone decreases the
capacity of the substance to cross the
blood-brain barrier, limiting the
availability of naloxegol to peripheral
opioid receptors (Diego et al., 2011;
HHS review). Due to naloxegol being an
antagonist at the three opioid receptors,
mu, delta, and kappa, the HHS asserts
that naloxegol does not have opioid
agonist properties. Further, in abuse
liability studies in animals, naloxegol
did not produce responses seen with
morphine administration. In clinical
studies, the reports show that naloxegol
does not produce euphoria or abuse
potential related AEs. For example, the
HHS stated that ‘‘[n]aloxegol (30 to
1,000 mg/kg) produced less than 20%
morphine-appropriate responding at any
dose, which meets criteria for a ‘no-
VerDate Sep<11>2014
13:59 Oct 28, 2014
Jkt 235001
drug’ interoceptive cue.’’ 3 Therefore,
naloxegol does not demonstrate a
potential for abuse.
2. Scientific Evidence of the Drug’s
Pharmacological Effects, if Known
Binding studies showed that
naloxegol does not bind significantly
(>50% inhibition) to other molecular
central nervous system (CNS) receptors,
including dopamine, serotonin,
glutamate, a-aminobutyric acid (GABA),
sigma, acetylcholine, norepinephrine,
cannabinoid, histamine, and
monoamine transporters. Toxicological
studies in rats and dogs did not produce
behavioral signs of abuse potential, e.g.
increased or decreased motor behavior,
decreased body weight, or food intake.
In two analgesia models in rodents,
naloxegol did not produce any analgesic
effects, demonstrating the lack of mu
opioid receptor activation. Naloxegol
was also tested in both analgesia models
for its potency in reversing morphineinduced (subcutaneous or intravenous,
1–32 mg/kg) analgesia. Naloxegol did
not fully reverse the analgesia produced
by morphine, demonstrating that
antagonistic actions of naloxegol were
predominantly at the peripheral opioid
receptor and not at the opioid receptors
in the CNS. According to the HHS, oral
naloxegol (12.5 and 25 mg/day) did
precipitate opioid withdrawal in
patients receiving opioids for pain
management in the Phase 2/3 clinical
trials. The incidence of withdrawal was
low, the symptoms of opioid
withdrawals occurred in patients taking
naloxegol (2%) compared to placebo
(<1%). It occurred with a higher
incidence in patients receiving
naloxegol (3%) at the higher dose (25
mg/day) than those receiving the 12.5
mg/day dose (1%). The HHS asserts that
the withdrawal symptoms reported did
not always meet the criteria of a
clinically meaningful opioid withdrawal
syndrome.
3. The State of Current Scientific
Knowledge Regarding the Drug or Other
Substance
Naloxegol is known as (5a,6a)-17allyl-6-((20-hydroxy-3,6,9,12,15,18hexaoxaicos-1-yl)oxy)-4,5epoxymorphinon-3,14-diol and also as
alpha-6mPEG7–O-naloxol. The CAS
number is 854601–70–0. The molecular
formula of naloxegol is C34H53NO11
and the molecular weight is 651.8 g/
mol. It is a white to off-white powder
and is soluble in aqueous solvents over
3 U.S. Food and Drug Administration, Department
of Health and Human Services, Basis for the
Recommendation to Decontrol Naloxegol and Its
Salts from Schedule II of the Controlled Substances
Act (2014), p. 6.
PO 00000
Frm 00017
Fmt 4702
Sfmt 4702
64351
a pH range of 1 to 7.5. Naloxegol is
synthesized in a five-step process from
naloxone hydrochloride, an opioid
antagonist derived from thebaine.
Naloxegol (25 mg/day) is rapidly
absorbed following oral administration
in healthy volunteers. Maximum plasma
concentrations were reached in 1.5 to 2
hours. The plasma half-life (t 1⁄2) is 7 to
9 hours, with a maximal plasma
concentration (Cmax) of 45 ng/ml. In a
drug distribution study in humans with
radiolabeled naloxegol, the highest
levels of radioactivity were in the liver
and kidneys. The elimination t 1⁄2 of
naloxegol is rapid, with majority being
eliminated within 24-hours post-dose.
4. Its History and Current Pattern of
Abuse
According to HHS, there has been no
evidence of abuse-related signals from
the human clinical trials. Naloxegol is a
mu opioid antagonist, which as a class
does not have abuse potential.
5. The Scope, Duration, and
Significance of Abuse
There have been no reports of abuse
of naloxegol. According to the National
Forensic Laboratory Information System
(NFLIS) 4 and the System to Retrieve
Information from Drug Evidence
(STRIDE),5 there have been no reports of
naloxegol seizures from 2010 to the
present.
6. What, if Any, Risk There Is to the
Public Health
According to the HHS, naloxegol is
well-tolerated and safe at the
therapeutic doses of 12.5 mg and 25 mg.
Preclinical and clinical studies showed
no evidence of potential for abuse of
naloxegol and thus there is little public
health risk from naloxegol.
4 The National Forensic Laboratory Information
System (NFLIS) is a program of the DEA, Office of
Diversion Control. NFLIS systematically collects
drug identification results and associated
information from drug cases submitted to and
analyzed by State and local forensic laboratories.
NFLIS represents an important resource in
monitoring illicit drug abuse and trafficking,
including the diversion of legally manufactured
pharmaceuticals into illegal markets. NFLIS is a
comprehensive information system that includes
data from forensic laboratories that handle
approximately 90% of an estimated 1.0 million
distinct annual State and local drug analysis cases.
NFLIS includes drug chemistry results from
completed analyses only. While NFLIS data is not
direct evidence of abuse, it can lead to an inference
that a drug has been diverted and abused. See 76
FR 77330, 77332, Dec. 12, 2011.
5 The System to Retrieve Information from Drug
Evidence (STRIDE) is a database of drug exhibits
sent to DEA laboratories for analysis. Exhibits from
the database are from the DEA, other federal
agencies, and local law enforcement agencies.
E:\FR\FM\29OCP1.SGM
29OCP1
64352
Federal Register / Vol. 79, No. 209 / Wednesday, October 29, 2014 / Proposed Rules
7. Its Psychic or Physiological
Dependence Liability
responsibilities among the various
levels of government.
There were no symptoms of physical
dependence in a naloxegol physical
dependence liability study in rats. The
HHS also mentioned that the lack of
naloxegol self-administration by
animals is consistent with a lack of
psychic dependence liability.
Executive Order 13175
This rule does not have tribal
implications warranting the application
of Executive Order 13175. This rule
does not have substantial direct effects
on one or more Indian tribes, on the
relationship between the Federal
Government and Indian tribes, or on the
distribution of power and
responsibilities between the Federal
Government and Indian tribes.
8. Whether the Substance is an
Immediate Precursor of a Substance
Already Controlled Under the CSA
Naloxegol is not considered an
immediate precursor of any controlled
substance.
Conclusion
Based on consideration of the
scientific and medical evaluation and
accompanying recommendation of the
HHS, and based on the DEA’s
consideration of its own eight-factor
analysis, the DEA finds that these facts
and all relevant data demonstrate that
naloxegol does not possess abuse or
dependence potential. Accordingly, the
DEA finds that naloxegol does not meet
the requirements for inclusion in any
schedule, and should be removed from
control under the CSA.
Regulatory Analyses
Executive Orders 12866 and 15363
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
(OMB) 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 drafting
errors and ambiguity, minimize
litigation, provide a clear legal standard
for affected conduct, and promote
simplification and burden reduction.
rmajette on DSK2TPTVN1PROD with PROPOSALS
Executive Order 13132
This rulemaking does not have
federalism implications warranting the
application of Executive Order 13132.
The rule does not have substantial
direct effects on the States, on the
relationship between the Federal
Government and the States, or the
distribution of power and
VerDate Sep<11>2014
13:59 Oct 28, 2014
Jkt 235001
Regulatory Flexibility Act
The Deputy Administrator, in
accordance with the Regulatory
Flexibility Act (5 U.S.C. 601–612)
(RFA), has reviewed this proposed rule
and by approving it certifies that it will
not have a significant economic impact
on a substantial number of small
entities. The purpose of this rule is to
remove naloxegol from the list of
schedules of the CSA. This action will
remove regulatory controls and
administrative, civil, and criminal
sanctions applicable to controlled
substances for handlers and proposed
handlers of naloxegol. Accordingly, it
has the potential for some economic
impact in the form of cost savings.
Naloxegol is a new molecular entity
and is not currently available or
marketed in any country. According to
publicly available information reviewed
by the DEA, naloxegol is anticipated to
enjoy patent protection for an extended
period of time before generic
equivalents may be manufactured and
marketed in the United States. Although
the number of manufacturers of
naloxegol may initially be limited, there
is potential for numerous handlers in
various business activities, e.g.,
distributors, hospitals/clinics,
pharmacies, practitioners, etc.
If finalized, the proposed rule will
affect all persons who would handle, or
propose to handle, naloxegol. Due to the
wide variety of unidentifiable and
unquantifiable variables that potentially
could influence the distribution and
dispensing rates of new molecular
entities, the DEA is unable to determine
the number of entities and small entities
which might handle naloxegol.
However, the DEA estimates that all
persons who would handle, or propose
to handle naloxegol, are currently
registered with the DEA to handle
schedule II controlled substances.
Therefore, the 1.5 million (1,469,418 as
of September 2014) controlled substance
registrations, representing
approximately 426,714 entities, would
be the maximum number of entities
affected by this rule. The DEA estimates
PO 00000
Frm 00018
Fmt 4702
Sfmt 4702
that 417,302 (97.8%) of 426,714 affected
entities are ‘‘small entities’’ in
accordance with the RFA and Small
Business Administration size standards.
The DEA estimates all controlled
substances registrants handle both
controlled and non-controlled
substances and these registrants are
expected to continue to handle
naloxegol if the proposed rule were
finalized. Additionally, since
prospective naloxegol handlers are
likely to handle other schedule II
controlled substances, the cost savings
they would receive as a result of the decontrol of naloxegol would be nominal.
As naloxegol handlers continue to
handle other scheduled II controlled
substances, they will need to maintain
their DEA registration and keep the
same security and recordkeeping
processes, equipment, and facilities in
place and would experience only a
nominal reduction in security,
inventory, recordkeeping, and labeling
costs.
While the DEA does not have a basis
to estimate the number of affected
entities, the DEA estimates that the
maximum number of affected entities is
426,714 of which 417,302 are estimated
to be small entities. Since the affected
entities are expected to handle other
schedule II controlled substances and
maintain security and recordkeeping
facilities and processes consistent with
schedule II controlled substances
handling requirements, the DEA
estimates any economic impact (cost
savings) will be nominal. Because of
these facts, this rule will not result in a
significant economic impact on a
substantial number of small entities.
Unfunded Mandates Reform Act of 1995
On the basis of information contained
in the ‘‘Regulatory Flexibility Act’’
section above, the DEA has determined
and certifies pursuant to the Unfunded
Mandates Reform Act of 1995 (UMRA),
2 U.S.C. 1501 et seq., that this action
would not result in any federal mandate
that may result ‘‘in the expenditure by
State, local, and tribal governments, in
the aggregate, or by the private sector, of
$100,000,000 or more (adjusted for
inflation) in any one year * * *.’’
Therefore, neither a Small Government
Agency Plan nor any other action is
required under provisions of UMRA.
Paperwork Reduction Act
This action does not impose a new
collection of information requirement
under the Paperwork Reduction Act, 44
U.S.C. 3501–3521. This action would
not impose recordkeeping or reporting
requirements on State or local
governments, individuals, businesses, or
E:\FR\FM\29OCP1.SGM
29OCP1
Federal Register / Vol. 79, No. 209 / Wednesday, October 29, 2014 / Proposed Rules
organizations. An agency may not
conduct or sponsor, and a person is not
required to respond to, a collection of
information unless it displays a
currently valid OMB control number.
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. In § 1308.12, amend the
introductory text of paragraph (b)(1) by
adding the word ‘‘naloxegol,’’ between
‘‘nalmefene,’’ and ‘‘naloxone,’’ to read
as follows:
■
§ 1308.12
Schedule II.
(a) * * *
(b) * * *
(1) Opium and opiate, and any salt,
compound, derivative, or preparation of
opium or opiate excluding
apomorphine, thebaine-derived
butorphanol, dextrorphan, nalbuphine,
nalmefene, naloxegol, naloxone, and
naltrexone, and their respective salts,
but including the following:
*
*
*
*
*
Dated: October 23, 2014.
Thomas M. Harrigan,
Deputy Administrator.
[FR Doc. 2014–25685 Filed 10–28–14; 8:45 am]
BILLING CODE 4410–09–P
ENVIRONMENTAL PROTECTION
AGENCY
40 CFR Part 52
[EPA–R09–OAR–2014–0696; FRL–9918–58–
Region 9]
Revisions to the California State
Implementation Plan, Ventura County
Air Pollution Control District
Environmental Protection
Agency (EPA).
rmajette on DSK2TPTVN1PROD with PROPOSALS
AGENCY:
ACTION:
Proposed rule.
The Environmental Protection
Agency (EPA) is proposing to approve a
State Implementation Plan (SIP)
revision submitted by California for the
Ventura County Air Pollution Control
District (VCAPCD or ‘‘the District’’)
portion of the California SIP. The
submitted SIP revision contains the
District’s demonstration regarding
Reasonably Available Control
Technology (RACT) requirements for
the 2008 8-hour ozone National
Ambient Air Quality Standards
(NAAQS). We are proposing to approve
the submitted SIP revision under the
Clean Air Act as amended in 1990 (CAA
or the Act). We are taking comments on
this proposal and plan to follow with a
final action.
DATES: Any comments must arrive by
November 28, 2014.
ADDRESSES: Submit comments,
identified by docket number EPA–R09–
OAR–2014–0696, by one of the
following methods:
1. Federal eRulemaking Portal:
www.regulations.gov. Follow the on-line
instructions.
2. Email: steckel.andrew@epa.gov.
3. Mail or deliver: Andrew Steckel
(Air-4), U.S. Environmental Protection
Agency Region IX, 75 Hawthorne Street,
San Francisco, CA 94105–3901.
Instructions: All comments will be
included in the public docket without
change and may be made available
online at www.regulations.gov,
including any personal information
provided, unless the comment includes
Confidential Business Information (CBI)
or other information whose disclosure is
restricted by statute. Information that
you consider CBI or otherwise protected
should be clearly identified as such and
should not be submitted through
www.regulations.gov or email.
www.regulations.gov is an ‘‘anonymous
access’’ system, and EPA will not know
your identity or contact information
unless you provide it in the body of
your comment. If you send email
directly to EPA, your email address will
be automatically captured and included
as part of the public comment. If EPA
cannot read your comment due to
technical difficulties and cannot contact
you for clarification, EPA may not be
able to consider your comment.
SUMMARY:
64353
Electronic files should avoid the use of
special characters, any form of
encryption, and be free of any defects or
viruses.
Docket: Generally, documents in the
docket for this action are available
electronically at www.regulations.gov
and in hard copy at EPA Region IX, 75
Hawthorne Street, San Francisco,
California. While all documents in the
docket are listed at
www.regulations.gov, some information
may be publicly available only at the
hard copy location (e.g., copyrighted
material, large maps), and some may not
be publicly available in either location
(e.g., CBI). To inspect the hard copy
materials, please schedule an
appointment during normal business
hours with the contact listed in the FOR
FURTHER INFORMATION CONTACT section.
FOR FURTHER INFORMATION CONTACT:
Stanley Tong, EPA Region IX, (415)
947–4122, tong.stanley@epa.gov.
SUPPLEMENTARY INFORMATION:
Throughout this document, ‘‘we,’’ ‘‘us’’
and ‘‘our’’ refer to EPA.
Table of Contents
I. The State’s Submittal
A. What document did the State submit?
B. Are there other versions of document?
C. What is the purpose of the RACT SIP
submission?
II. EPA’s Evaluation and Proposed Action
A. How is EPA evaluating the RACT SIP
submission?
B. Does the RACT SIP submission meet the
evaluation criteria?
C. EPA’s Recommendation To Strengthen
the RACT SIP
D. Proposed Action and Public Comment
III. Statutory and Executive Order Reviews
I. The State’s Submittal
A. What document did the State submit?
Table 1 lists the document addressed
by this proposal with the date that it
was adopted by the local air agency and
submitted by the California Air
Resources Board.
TABLE 1—SUBMITTED DOCUMENT
Local agency
Document
VCAPCD ...................
2014 Reasonably Available Control Technology (RACT) State Implementation Plan
(SIP) Revision (‘‘2014 RACT SIP’’).
VerDate Sep<11>2014
13:59 Oct 28, 2014
Jkt 235001
PO 00000
Frm 00019
Fmt 4702
Adopted
Sfmt 4702
E:\FR\FM\29OCP1.SGM
29OCP1
6/10/14
Submitted
7/18/14
Agencies
- Department of Justice
- Drug Enforcement Admininstration
[Federal Register Volume 79, Number 209 (Wednesday, October 29, 2014)]
[Proposed Rules]
[Pages 64349-64353]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-25685]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF JUSTICE
Drug Enforcement Admininstration
21 CFR Part 1308
[Docket No. DEA-400]
Schedules of Controlled Substances: Removal of Naloxegol From
Control
AGENCY: Drug Enforcement Administration, Department of Justice.
ACTION: Notice of proposed rulemaking.
-----------------------------------------------------------------------
SUMMARY: The Drug Enforcement Administration (DEA) proposes to remove
naloxegol ((5[alpha],6 [alpha])-17-allyl-6-((20-hydroxy-3,6,9,12,15,18-
hexaoxaicos-1-yl)oxy)-4,5-epoxymorphinon-3,14-diol) and its salts from
the schedules of the Controlled Substances Act (CSA). This scheduling
action is pursuant to the CSA which requires that such actions be made
on the record after opportunity for a hearing through formal
rulemaking. Naloxegol is currently a schedule II controlled substance
because it can be derived from opium alkaloids. This action would
remove the regulatory controls and administrative, civil, and criminal
sanctions applicable to controlled substances, including those specific
to schedule II controlled substances, on persons who handle
(manufacture, distribute, reverse distribute, dispense, conduct
research, import, export, or conduct chemical analysis) or propose to
handle naloxegol.
DATES: Interested persons may file written comments on this proposal in
accordance with 21 CFR 1308.43(g). Electronic comments must be
submitted, and written comments must be postmarked, on or before
November 28, 2014. Commenters should be aware that the electronic
Federal Docket Management System will not accept comments after 11:59
p.m. Eastern Time on the last day of the comment period.
Interested persons, defined at 21 CFR 1300.01 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)'', may file a request for
hearing or waiver of participation pursuant to 21 CFR 1308.44 and in
accordance with 21 CFR 1316.45, 1316.47, 1316.48, or 1316.49, as
applicable. Requests for hearing, notices of appearance, and waivers of
an opportunity for a hearing or to participate in a hearing must be
received on or before November 28, 2014.
ADDRESSES: To ensure proper handling of comments, please reference
``Docket No. DEA-400'' on all correspondence, including any
attachments.
Electronic comments: The DEA encourages that all comments
be submitted through the Federal eRulemaking Portal, which provides the
ability to type short comments directly into the comment field on the
Web page or to attach a file for lengthier comments. Please go to
https://www.regulations.gov and follow the online instructions at that
site for submitting comments. Upon completion of your submission you
will receive a Comment Tracking Number for your comment. Please be
aware that submitted comments are not instantaneously available for
public view on Regulations.gov. If you have received a comment tracking
number, your comment has been successfully submitted and there is no
need to resubmit the same comment.
Paper comments: Paper comments that duplicate an
electronic submission are not necessary and are discouraged. Should you
wish to mail a comment in lieu of an electronic format, it should be
sent via regular or express mail to: Drug Enforcement Administration,
Attention: DEA Federal Register Representative/ODXL, 8701 Morrissette
Drive, Springfield, Virginia 22152.
Hearing requests: All requests for hearing and waivers of
participation must be sent to: Drug Enforcement Administration, Attn:
Hearing Clerk/LJ, 8701 Morrissette Drive, Springfield, Virginia 22152.
FOR FURTHER INFORMATION CONTACT: Imelda L. Paredes, Office of Diversion
Control, Drug Enforcement Administration; Mailing Address:
8701Morrissette Drive, Springfield, Virginia 22152; Telephone: (202)
598-6812.
SUPPLEMENTARY INFORMATION:
Posting of Public Comments
Please note that all comments received in response to this docket
are considered part of the public record. They will, unless reasonable
cause is given, be made available by the DEA 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. The Freedom of Information Act
(FOIA) applies to all comments received. 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 made publicly available, you
must include the phrase ``PERSONAL IDENTIFYING INFORMATION'' in the
first paragraph of your comment. You must also place the personal
identifying information you do not want made publicly available 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 made publicly available, 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.
Comments containing personal identifying information and
confidential business information identified as directed above will
generally be made publicly available in redacted form. If a comment has
so much confidential business information or personal identifying
information that it cannot be effectively redacted, all or part of that
comment may not be made publicly available. Comments posted to https://www.regulations.gov may include any personal identifying information
(such as name, address, and phone number) included in the text of your
electronic submission that is not identified as directed above as
confidential.
An electronic copy of this document and supplemental information to
this proposed rule are available at https://www.regulations.gov for easy
reference. The DEA specifically solicits written comments regarding the
DEA's economic analysis of the impact of these proposed changes. The
DEA requests that commenters provide detailed descriptions in their
comments of any expected economic impacts, especially to small
entities. Commenters should provide empirical data to illustrate the
nature and scope of such impact.
[[Page 64350]]
Request for Hearing, Notice of Appearance at or Waiver of Participation
in Hearing
Pursuant to 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 (APA) (5 U.S.C. 551-559). 21 CFR 1308.41-1308.45, and 21 CFR part
1316 subpart D. In accordance with 21 CFR 1308.44 (a)-(c), requests for
hearing, notices of appearance, and waivers of an opportunity for a
hearing or to participate in a hearing 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).'' 21 CFR 1300.01. 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, and include a statement of 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) and 1316.49, including
a written statement regarding the interested 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 a 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 * * *.'' All requests for hearing and waivers
of participation must be sent to the DEA using the address information
above, on or before the date specified above.
Legal Authority
The Drug Enforcement Administration (DEA) implements and enforces
titles II and III of the Comprehensive Drug Abuse Prevention and
Control Act of 1970, as amended. 21 U.S.C. 801-971. Titles II and III
are referred to as the ``Controlled Substances Act'' and the
``Controlled Substances Import and Export Act,'' respectively, but they
are collectively referred to as the ``Controlled Substances Act'' or
the ``CSA'' for the purposes of this action. The DEA publishes the
implementing regulations for these statutes in title 21 of the Code of
Federal Regulations (CFR), parts 1300 to 1321. The CSA and its
implementing regulations are designed to prevent, detect, and eliminate
the diversion of controlled substances and listed chemicals into the
illicit market while providing for the legitimate medical, scientific,
research, and industrial needs of the United States. Controlled
substances have the potential for abuse and dependence and are
controlled to protect the public health and safety.
Under the CSA, each controlled substance is classified into one of
five schedules based upon its potential for abuse, its currently
accepted medical use in treatment in the United States, and the degree
of dependence the drug or other substance may cause. 21 U.S.C. 812. The
initial schedules of controlled substances established by Congress are
found at 21 U.S.C. 812(c) and the current list of scheduled substances
is published at 21 CFR part 1308. 21 U.S.C. 812(a).
Pursuant to 21 U.S.C. 811(a)(2), the Attorney General may, by rule,
``remove any drug or other substance from the schedules if he finds
that the drug or other substance does not meet the requirements for
inclusion in any schedule.'' The Attorney General has delegated
scheduling authority under 21 U.S.C. 811 to the Administrator of the
DEA, 28 CFR 0.100, who in turn has redelegated that authority to the
Deputy Administrator of the DEA, 28 CFR part 0, appendix to subpart R.
The CSA provides that proceedings for the issuance, amendment, or
repeal of the 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 the Department of Health and Human Services
(HHS),\1\ or (3) on the petition of any interested party. 21 U.S.C.
811(a). This action was initiated by a petition to remove naloxegol
from the list of scheduled controlled substances of the CSA, and is
supported by, inter alia, a recommendation from the Assistant Secretary
of the HHS and an evaluation of all relevant data by the DEA. This
action would remove the regulatory controls and administrative, civil,
and criminal sanctions applicable to controlled substances, including
those specific to schedule II controlled substances, on persons who
handle or propose to handle naloxegol.
---------------------------------------------------------------------------
\1\ As discussed in a memorandum of understanding entered into
by the Food and Drug Administration (FDA) and the National Institute
on Drug Abuse (NIDA), the FDA acts as the lead agency within the HHS
in carrying out the Secretary's scheduling responsibilities under
the CSA, with the concurrence of NIDA. 50 FR 9518, Mar. 8, 1985. The
Secretary of the HHS has delegated to the Assistant Secretary for
Health of the HHS the authority to make domestic drug scheduling
recommendations. 58 FR 35460, July 1, 1993.
---------------------------------------------------------------------------
Background
Naloxegol, or PEG-naloxol, is a new molecular entity and is a
polyethylene glycolyated (PEGylated) derivative of naloxone. Its
chemical names are (5[alpha],6 [alpha])-17-allyl-6-((20-hydroxy-
3,6,9,12,15,18-hexaoxaicos-1-yl)oxy)-4,5-epoxymorphinon-3,14-diol or
alpha-6mPEG7-O-naloxol. Naloxegol is an antagonist predominantly of
peripheral mu opioid receptors. The Food and Drug Administration (FDA)
approved naloxegol for marketing on September 16, 2014, under the brand
name MovantikTM.\2\ It is indicated for the treatment of
opioid-induced constipation (OIC) in adults with chronic non-cancer
pain. Gastrointestinal adverse events (AEs) effects are commonly
experienced by chronic users of opioid analgesics. Opioids delay
gastric emptying and intestinal transport, which over time leads to
debilitating constipation. OIC is caused by activation of the mu opioid
receptor in the GI tract.
---------------------------------------------------------------------------
\2\ https://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search .DrugDetails (last accessed Sept. 26,
2014).
---------------------------------------------------------------------------
Proposed Determination To Decontrol Naloxegol
Pursuant to 21 U.S.C. 811(a), proceedings to issue, amend, or
repeal scheduling actions may be initiated on the petition of any
interested party. In accordance with 21 CFR 1308.43, the DEA received a
petition from the drug sponsor dated March 22, 2012, requesting that
the DEA amend 21 CFR 1308.12(b)(1) to exclude naloxegol as a schedule
II controlled substance. The petitioner stated that naloxegol is a mu
opioid receptor antagonist without mu opioid agonist or partial agonist
properties. In accordance with 21 CFR 1308.43(c), the DEA accepted the
petition for filing on October 1, 2012.
Pursuant to 21 U.S.C. 811(b), the DEA gathered the necessary data
on naloxegol and on February 7, 2013, forwarded to the HHS the data
with the sponsor's petition along with a request for a scientific and
medical evaluation and the HHS's recommendation as to whether or not
naloxegol should be removed from the list of controlled substances.
According to the HHS, the sponsor submitted a New Drug Application
(NDA) for naloxegol on September 16, 2013. Based on the NDA, the HHS
summarized that naloxegol is an antagonist of peripheral opioid
receptors for the treatment of OIC.
[[Page 64351]]
On August 8, 2014, the HHS provided to the DEA a scientific and
medical evaluation document prepared by the FDA entitled ``Basis for
the Recommendation to Decontrol Naloxegol and its Salts from Schedule
II of the Controlled Substances Act.'' Pursuant to 21 U.S.C. 811(b),
this document contained an eight-factor analysis of naloxegol as a new
drug, along with the HHS's recommendation to remove naloxegol from the
schedules of the CSA.
In response, the DEA reviewed the scientific and medical evaluation
and scheduling recommendation provided by the HHS, and all other
relevant data, and completed its own eight-factor review document on
naloxegol pursuant to 21 U.S.C. 811(c). Included below is a brief
summary of each factor as analyzed by the HHS and DEA, and as
considered by the DEA in this proposal to remove naloxegol from the
schedules of the CSA. 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 https://www.regulations.gov under docket number DEA-400.
1. The Drug's Actual or Relative Potential for Abuse
Naloxegol is a new molecular entity that has not been marketed in
the United States or in any other country. As such, there is no
information available regarding actual abuse of naloxegol. However,
scientific studies show that naloxegol does not demonstrate a potential
for abuse.
Naloxegol is a conjugation of polyethylene glycol (PEG) to
naloxone. Naloxegol binds to mu, delta, and kappa opioid receptors and
acts as an antagonist at these receptors. PEGylation of naloxone
decreases the capacity of the substance to cross the blood-brain
barrier, limiting the availability of naloxegol to peripheral opioid
receptors (Diego et al., 2011; HHS review). Due to naloxegol being an
antagonist at the three opioid receptors, mu, delta, and kappa, the HHS
asserts that naloxegol does not have opioid agonist properties.
Further, in abuse liability studies in animals, naloxegol did not
produce responses seen with morphine administration. In clinical
studies, the reports show that naloxegol does not produce euphoria or
abuse potential related AEs. For example, the HHS stated that
``[n]aloxegol (30 to 1,000 mg/kg) produced less than 20% morphine-
appropriate responding at any dose, which meets criteria for a `no-
drug' interoceptive cue.'' \3\ Therefore, naloxegol does not
demonstrate a potential for abuse.
---------------------------------------------------------------------------
\3\ U.S. Food and Drug Administration, Department of Health and
Human Services, Basis for the Recommendation to Decontrol Naloxegol
and Its Salts from Schedule II of the Controlled Substances Act
(2014), p. 6.
---------------------------------------------------------------------------
2. Scientific Evidence of the Drug's Pharmacological Effects, if Known
Binding studies showed that naloxegol does not bind significantly
(>50% inhibition) to other molecular central nervous system (CNS)
receptors, including dopamine, serotonin, glutamate, [alpha]-
aminobutyric acid (GABA), sigma, acetylcholine, norepinephrine,
cannabinoid, histamine, and monoamine transporters. Toxicological
studies in rats and dogs did not produce behavioral signs of abuse
potential, e.g. increased or decreased motor behavior, decreased body
weight, or food intake. In two analgesia models in rodents, naloxegol
did not produce any analgesic effects, demonstrating the lack of mu
opioid receptor activation. Naloxegol was also tested in both analgesia
models for its potency in reversing morphine-induced (subcutaneous or
intravenous, 1-32 mg/kg) analgesia. Naloxegol did not fully reverse the
analgesia produced by morphine, demonstrating that antagonistic actions
of naloxegol were predominantly at the peripheral opioid receptor and
not at the opioid receptors in the CNS. According to the HHS, oral
naloxegol (12.5 and 25 mg/day) did precipitate opioid withdrawal in
patients receiving opioids for pain management in the Phase 2/3
clinical trials. The incidence of withdrawal was low, the symptoms of
opioid withdrawals occurred in patients taking naloxegol (2%) compared
to placebo (<1%). It occurred with a higher incidence in patients
receiving naloxegol (3%) at the higher dose (25 mg/day) than those
receiving the 12.5 mg/day dose (1%). The HHS asserts that the
withdrawal symptoms reported did not always meet the criteria of a
clinically meaningful opioid withdrawal syndrome.
3. The State of Current Scientific Knowledge Regarding the Drug or
Other Substance
Naloxegol is known as (5[alpha],6[alpha])-17-allyl-6-((20-hydroxy-
3,6,9,12,15,18-hexaoxaicos-1-yl)oxy)-4,5-epoxymorphinon-3,14-diol and
also as alpha-6mPEG7-O-naloxol. The CAS number is 854601-70-0. The
molecular formula of naloxegol is C34H53NO11 and the molecular weight
is 651.8 g/mol. It is a white to off-white powder and is soluble in
aqueous solvents over a pH range of 1 to 7.5. Naloxegol is synthesized
in a five-step process from naloxone hydrochloride, an opioid
antagonist derived from thebaine. Naloxegol (25 mg/day) is rapidly
absorbed following oral administration in healthy volunteers. Maximum
plasma concentrations were reached in 1.5 to 2 hours. The plasma half-
life (t \1/2\) is 7 to 9 hours, with a maximal plasma concentration
(Cmax) of 45 ng/ml. In a drug distribution study in humans with
radiolabeled naloxegol, the highest levels of radioactivity were in the
liver and kidneys. The elimination t \1/2\ of naloxegol is rapid, with
majority being eliminated within 24-hours post-dose.
4. Its History and Current Pattern of Abuse
According to HHS, there has been no evidence of abuse-related
signals from the human clinical trials. Naloxegol is a mu opioid
antagonist, which as a class does not have abuse potential.
5. The Scope, Duration, and Significance of Abuse
There have been no reports of abuse of naloxegol. According to the
National Forensic Laboratory Information System (NFLIS) \4\ and the
System to Retrieve Information from Drug Evidence (STRIDE),\5\ there
have been no reports of naloxegol seizures from 2010 to the present.
---------------------------------------------------------------------------
\4\ The National Forensic Laboratory Information System (NFLIS)
is a program of the DEA, Office of Diversion Control. NFLIS
systematically collects drug identification results and associated
information from drug cases submitted to and analyzed by State and
local forensic laboratories. NFLIS represents an important resource
in monitoring illicit drug abuse and trafficking, including the
diversion of legally manufactured pharmaceuticals into illegal
markets. NFLIS is a comprehensive information system that includes
data from forensic laboratories that handle approximately 90% of an
estimated 1.0 million distinct annual State and local drug analysis
cases. NFLIS includes drug chemistry results from completed analyses
only. While NFLIS data is not direct evidence of abuse, it can lead
to an inference that a drug has been diverted and abused. See 76 FR
77330, 77332, Dec. 12, 2011.
\5\ The System to Retrieve Information from Drug Evidence
(STRIDE) is a database of drug exhibits sent to DEA laboratories for
analysis. Exhibits from the database are from the DEA, other federal
agencies, and local law enforcement agencies.
---------------------------------------------------------------------------
6. What, if Any, Risk There Is to the Public Health
According to the HHS, naloxegol is well-tolerated and safe at the
therapeutic doses of 12.5 mg and 25 mg. Preclinical and clinical
studies showed no evidence of potential for abuse of naloxegol and thus
there is little public health risk from naloxegol.
[[Page 64352]]
7. Its Psychic or Physiological Dependence Liability
There were no symptoms of physical dependence in a naloxegol
physical dependence liability study in rats. The HHS also mentioned
that the lack of naloxegol self-administration by animals is consistent
with a lack of psychic dependence liability.
8. Whether the Substance is an Immediate Precursor of a Substance
Already Controlled Under the CSA
Naloxegol is not considered an immediate precursor of any
controlled substance.
Conclusion
Based on consideration of the scientific and medical evaluation and
accompanying recommendation of the HHS, and based on the DEA's
consideration of its own eight-factor analysis, the DEA finds that
these facts and all relevant data demonstrate that naloxegol does not
possess abuse or dependence potential. Accordingly, the DEA finds that
naloxegol does not meet the requirements for inclusion in any schedule,
and should be removed from control under the CSA.
Regulatory Analyses
Executive Orders 12866 and 15363
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 (OMB) 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 drafting errors and ambiguity, minimize litigation,
provide a clear legal standard for affected conduct, and promote
simplification and burden reduction.
Executive Order 13132
This rulemaking does not have federalism implications warranting
the application of Executive Order 13132. The rule does not have
substantial direct effects on the States, on the relationship between
the Federal Government and the States, or the distribution of power and
responsibilities among the various levels of government.
Executive Order 13175
This rule does not have tribal implications warranting the
application of Executive Order 13175. This rule does not have
substantial direct effects on one or more Indian tribes, on the
relationship between the Federal Government and Indian tribes, or on
the distribution of power and responsibilities between the Federal
Government and Indian tribes.
Regulatory Flexibility Act
The Deputy Administrator, in accordance with the Regulatory
Flexibility Act (5 U.S.C. 601-612) (RFA), has reviewed this proposed
rule and by approving it certifies that it will not have a significant
economic impact on a substantial number of small entities. The purpose
of this rule is to remove naloxegol from the list of schedules of the
CSA. This action will remove regulatory controls and administrative,
civil, and criminal sanctions applicable to controlled substances for
handlers and proposed handlers of naloxegol. Accordingly, it has the
potential for some economic impact in the form of cost savings.
Naloxegol is a new molecular entity and is not currently available
or marketed in any country. According to publicly available information
reviewed by the DEA, naloxegol is anticipated to enjoy patent
protection for an extended period of time before generic equivalents
may be manufactured and marketed in the United States. Although the
number of manufacturers of naloxegol may initially be limited, there is
potential for numerous handlers in various business activities, e.g.,
distributors, hospitals/clinics, pharmacies, practitioners, etc.
If finalized, the proposed rule will affect all persons who would
handle, or propose to handle, naloxegol. Due to the wide variety of
unidentifiable and unquantifiable variables that potentially could
influence the distribution and dispensing rates of new molecular
entities, the DEA is unable to determine the number of entities and
small entities which might handle naloxegol. However, the DEA estimates
that all persons who would handle, or propose to handle naloxegol, are
currently registered with the DEA to handle schedule II controlled
substances. Therefore, the 1.5 million (1,469,418 as of September 2014)
controlled substance registrations, representing approximately 426,714
entities, would be the maximum number of entities affected by this
rule. The DEA estimates that 417,302 (97.8%) of 426,714 affected
entities are ``small entities'' in accordance with the RFA and Small
Business Administration size standards.
The DEA estimates all controlled substances registrants handle both
controlled and non-controlled substances and these registrants are
expected to continue to handle naloxegol if the proposed rule were
finalized. Additionally, since prospective naloxegol handlers are
likely to handle other schedule II controlled substances, the cost
savings they would receive as a result of the de-control of naloxegol
would be nominal. As naloxegol handlers continue to handle other
scheduled II controlled substances, they will need to maintain their
DEA registration and keep the same security and recordkeeping
processes, equipment, and facilities in place and would experience only
a nominal reduction in security, inventory, recordkeeping, and labeling
costs.
While the DEA does not have a basis to estimate the number of
affected entities, the DEA estimates that the maximum number of
affected entities is 426,714 of which 417,302 are estimated to be small
entities. Since the affected entities are expected to handle other
schedule II controlled substances and maintain security and
recordkeeping facilities and processes consistent with schedule II
controlled substances handling requirements, the DEA estimates any
economic impact (cost savings) will be nominal. Because of these facts,
this rule will not result in a significant economic impact on a
substantial number of small entities.
Unfunded Mandates Reform Act of 1995
On the basis of information contained in the ``Regulatory
Flexibility Act'' section above, the DEA has determined and certifies
pursuant to the Unfunded Mandates Reform Act of 1995 (UMRA), 2 U.S.C.
1501 et seq., that this action would not result in any federal mandate
that may result ``in the expenditure by State, local, and tribal
governments, in the aggregate, or by the private sector, of
$100,000,000 or more (adjusted for inflation) in any one year * * *.''
Therefore, neither a Small Government Agency Plan nor any other action
is required under provisions of UMRA.
Paperwork Reduction Act
This action does not impose a new collection of information
requirement under the Paperwork Reduction Act, 44 U.S.C. 3501-3521.
This action would not impose recordkeeping or reporting requirements on
State or local governments, individuals, businesses, or
[[Page 64353]]
organizations. An agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information unless it
displays a currently valid OMB control number.
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
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. In Sec. 1308.12, amend the introductory text of paragraph (b)(1) by
adding the word ``naloxegol,'' between ``nalmefene,'' and ``naloxone,''
to read as follows:
Sec. 1308.12 Schedule II.
(a) * * *
(b) * * *
(1) Opium and opiate, and any salt, compound, derivative, or
preparation of opium or opiate excluding apomorphine, thebaine-derived
butorphanol, dextrorphan, nalbuphine, nalmefene, naloxegol, naloxone,
and naltrexone, and their respective salts, but including the
following:
* * * * *
Dated: October 23, 2014.
Thomas M. Harrigan,
Deputy Administrator.
[FR Doc. 2014-25685 Filed 10-28-14; 8:45 am]
BILLING CODE 4410-09-P