SCOTUS: Doctors who prescribe in good faith cannot so easily be convicted of trafficking

When a majority SCOTUS opinion is written by Justice Stephen Breyer, and joined by Chief Justice John Roberts and Justices Sonia Sotomayor, Elena Kagan, Neil Gorsuch, and Brett Kavanaugh, you know its an odd decision:

The Supreme Court today unanimously sided with two physicians who were convicted of drug trafficking based on opioid prescriptions that federal prosecutors portrayed as medically inappropriate. Six justices said the government is required to prove that a doctor “knowingly or intentionally” exceeded the authorization for medical use of controlled substances. Three justices disagreed with the majority’s legal analysis but concluded that a doctor cannot be convicted of drug trafficking if he acted in “good faith.”

The decision in Ruan v. United States sends both cases back to the lower courts so they can assess the defendants’ arguments that the instructions received by the juries that convicted them misstated the law seriously enough that they are entitled to new trials. But whether or not they prevail on those claims, the ruling represents an important limit on prosecutions that have long had a chilling effect on pain treatment. Physicians who prescribe opioids based on an honest belief that they are practicing good medicine now have less reason to fear that they will nevertheless face federal charges that could send them to prison for decades.

Kate Nicholson, executive director of the National Pain Advocacy Center, is “thrilled with the ruling,” which she says “entirely tracked the argument we made in our amicus curiae brief.” Under Ruan, she notes in an email, “doctors authorized to prescribe controlled substances can only be convicted for violating the Controlled Substances Act when they intend or know that they are prescribing in an unauthorized manner.” That requirement, she says, is especially important for “doctors treating patients in pain, who might otherwise be deterred from meeting the needs of their patients by the fear that disagreement with their medical judgment would subject them to serious criminal liability.”

The fact is that some very wise and learned doctors were becoming skittish about prescribing legitimate pain killers because they were afraid of the government coming after them if patients end up abusing them.

I’m willing to tolerate a few pill mills in exchange for cancer patients in unimaginable (for most of us) pain getting the meds they need to make their often short lives bearable.

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