SCOTUSblog by Abbe R. Gluck 2/28/2022
Amid overdose crisis, court will weigh physician intent in “pill mill” prosecutions and more under the Controlled Substances Act
In the midst of a national opioid crisis that claimed more than 100,000 lives in this country over the past year, the Supreme Court will hear a case on Tuesday about the relevance of doctors’ subjective intentions in criminal prosecutions for unlawful distribution of controlled substances. While on the surface, the case, Ruan v. United States, may appear to be an ordinary “pill mill” case, the decision could have a much broader impact on the practice of medicine as well as doctrines of criminal intent.
The Controlled Substances Act makes it unlawful for “any person knowingly or intentionally … to manufacture, distribute, or dispense” a controlled substance, “[e]xcept as authorized by this subchapter.” One of those exceptions is for physicians who operate under the statute’s registration scheme; registered doctors may prescribe controlled substances in accordance with rules promulgated by the attorney general. The rule at issue in this case allows doctors to dispense a controlled substance that is “issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.” The question is whether a doctor’s subjective intent — namely, whether she prescribed in good faith — is relevant to applying that standard. Two doctors who were convicted of violating the CSA say subjective intent is critical. The United States, in contrast, argues for an objective standard, on the ground that the act “does not permit a physician to simply decide for himself that any manner or volume of drug distribution is ‘medicine.’”
Dr. Xiulu Ruan, one of the petitioners, was a board-certified interventional pain specialist who the government alleges operated an Alabama “pill mill” — a term used to describe doctors, clinics, or pharmacies that prescribe or dispense high volumes of powerful narcotics inappropriately. Ruan’s clinic, the government says, improperly issued more than 300,000 prescriptions for controlled substances over a four-year period. Ruan is also alleged to have been one of the top prescribers in the nation of a type of fentanyl, an extremely potent synthetic opioid approved to treat breakthrough pain in cancer patients, and to have tied his prescribing practices to his own financial interests, including to manufacturers in whose companies he had purchased stock and to the drugs available in the pharmacy he and his partner owned. The other petitioner, Dr. Shakeel Kahn is alleged to have sold controlled substances in exchange for cash and even firearms in Arizona and Wyoming, sometimes without performing any exam and documenting the encounters with falsified notes.
More:
https://www.scotusblog.com/2022/02/amid-overdose-crisis-court-will-weigh-physician-intent-in-pill-mill-prosecutions-and-more-under-the-controlled-substances-act/
