The government acceleration of actions against opioid “pill mills” has produced a reluctance to prescribe at levels that actually diminish patients’ pain, and patients often feel that doctors are viewing them presumptively as drug-seekers. On June 27, however, the Supreme Court unanimously sided with doctors, in the appeals of Drs. Xiulu Ruan and Shakeel Kahn, who had been convicted of unlawfully dispensing opioid painkillers.
In their arguments at the Supreme Court, the doctors urged adopting a subjective good-faith standard so that a medical practitioner who sincerely believed their prescriptions were within the usual course of professional practice could not be convicted of violating the law—that a doctor who is mistaken or even negligent is different from one who is mis-prescribing on purpose, which is what the law is directed toward.
The government argued that a subjective goodfaith standard would be no standard at all in a setting in which dangerous drugs were involved, and it urged the Court to instead adopt an objective good-faith standard based on what a “reasonable doctor” would do. Consistent with concerns expressed by several justices during oral arguments that the objective standard left open too many chances for close calls that could result in prison time, the Court held that the subjective standard was appropriate.
Writing for the majority, Justice Breyer held that once a doctor produced evidence that they were authorized to prescribe opioids, prosecutors needed to prove beyond a reasonable doubt that they knowingly or intentionally acted in an unauthorized manner. That does not mean that the actual convictions were reversed in the actual cases. Those cases were instead sent back to be reviewed on appeal under this requirement.
However, there is a significant implication for doctors who follow proper rules and only resort to the strongest drugs after other methods and lower doses have failed and who have records that substantiate all of that, proving their belief that the treatment was medically valid. They are now entitled to have jurors determine if the prescribing was within authorized guidelines by virtue of them believing that it was necessary.
Admittedly, this is still not protection against an investigation or case. However, it is hoped that with this constraint on prosecutors, doctors may now be more willing to properly prescribe controlled medications to the patients who truly need them.
