For the Defense - Vol. 7, Issue 3 - 30

Do No (Intentional)
Harm: How A Pill Mill
and The Supreme
Court May Help Curb
The Opioid Crisis
Jonathan Fodi
and Margaret McIlroy
I
n its 2021-2022 term, the United States Supreme Court
had more than one thing to say about the healthcare
decisions of the country's medical practitioners. A
unanimous opinion released just three days after the
Dobbs bombshell is certain to have an immediate
chilling effect on Department of Justice prosecutions of
doctors and nurses nationwide-most notably for those
practicing in pain management.
The consolidated case of Ruan v. United States1
examined
the language and legislative intent of Section 841 of the
Controlled Substance Act ( " CSA " ).2
More specifically,
the Court scrutinized the opening clause of the statute,
which prohibits medical practitioners from dispensing
or prescribing narcotics " except as authorized. " At issue
was the government's burden of proof as applied to that
phrase. To convict, must the government prove that a
prescriber intended to break the law? Or was it sufficient
to show that the relevant medical community would not
condone the defendant's practices?
The ultimate holding in Ruan hardly seems earthshattering.
The U.S. Supreme Court ruled that the CSA,
a statute which imposes criminal liability on medical
practitioners, criminalizes only intentional violations of the
law. For decades, prosecutors, trial judges, and appellate
courts had been operating under a flawed and relaxed
interpretation, allowing convictions to stand on a quasinegligence
standard. Indeed, in upholding Dr. Ruan's
conviction, the Eleventh Circuit cited a 1975 decision as
30 For The Defense l Vol. 7, Issue 3
The Controlled Substance Act - 21 U.S.C.S. § 841
(a) Unlawful acts. Except as authorized by
this title, it shall be unlawful for any person
knowingly or intentionally-
(1) to manufacture, distribute, or dispense, or
possess with intent to manufacture, distribute,
or dispense, a controlled substance...
On appeal in Ruan, the parties agreed that the test for
whether a prescription was " authorized " flowed through
a federal regulation. Per the regulation, an authorized
prescription is one that is " issued for a legitimate medical
purpose by an individual practitioner acting in the usual
course of his professional practice. " 4
There was also no
dispute on the general interpretation derived from that
regulatory language: A medical practitioner must act in
good faith when issuing a prescription.
precedent for an objective standard of reasonable medical
practice.3
In striking down past practices that endured for nearly
fifty
years, Ruan merged longstanding doctrines of
common law with basic canons of statutory construction
and legislative intent. Justice Breyer's opinion, written
with such commonsensical analysis that it feels virtually
irrefutable, reads like a page out of a 1L textbook. But if
the rationale and holding in Ruan now seem so obvious,
what took so long to get here?
For the Defense - Vol. 7, Issue 3

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