On June 27, the United States Supreme Court ruled 9-0 that the government cannot rightfully prosecute prescribers for violating the Controlled Substances Act (CSA) unless it can demonstrate that the violation was committed knowingly or intentionally. Coming just days after the rollback of Roe v. Wade, the Ruan v. United States decision represents a significant curtailing of Drug Enforcement Administration (DEA) oversight—and a victory for chronic pain patients and everyone who prescribes or receives controlled substances.
The case involved two doctors, Xiulu Ruan and Shakeel Kahn, who were separately convicted—unlawfully, per the new ruling—of improper opioid prescribing and sentenced to 21 and 25 years in prison, respectively. SCOTUS has now kicked the case back to the lower courts, where the doctors will be able to challenge their convictions. Delivering the court opinion, Justice Stephen Breyer wrote that a doctor issuing a CSA prescription is not acting unlawfully if they believe “in good faith that the prescription is a valid means of pursuing a medical purpose.”
It has been “easier to convict a doctor of a federal felony and send them to prison for the rest of their lives than it is to win a medical malpractice case or action at the state board,” Jennifer Oliva, a law professor at the University of California, Hastings, told Filter. “That’s flipping the law on its head.”
“Under the way this statute was being interpreted, the government can put on some expert [and ask], ‘Do most doctors do this?’ and the expert says ‘No’ … Now you’re going to federal prison.”
Oliva, who co-authored an amicus brief in support of the doctors in the case, said that the DEA has increasingly been given authority to punish providers for whatever it deems to be improper practice, when that should be under the jurisdiction of state medical boards.
“Boards are staffed with medical doctors and bring in experts in the field,” she said. “That’s different than the federal government using a law enforcement statute that was meant to apply to illicit drug distributors … to have this blunt-force instrument where they can come in and suspend a prescriber.”
The chilling effect on prescribers has brought immeasurable suffering for US pain patients and contributed to public demonization of opioids that further fuels the drug war. With the Ruan decision, SCOTUS has clarified in the public record that a prescriber’s state of mind, and the intention behind their actions, is what matters in the context of federal criminal law—not the DEA’s reading of their actions.
“Under the way this statute was being interpreted,” Oliva continued, “the government can put on some expert [and ask], ‘Do most doctors do this?’ and the expert says ‘No’ … and then they say you’re outside the scope of what the ordinary physician is doing here. Now you’re going to federal prison.”
Threatening controlled substance prescribers with incarceration has reduced neither drug use nor overdose. Rather, restricting access to regulated opioids has only pushed people toward the adulterated unregulated supply, increasing overdose risks and deaths.
Photograph via Wyoming Department of Health