Supreme Court grapples with drug trafficking convictions against opioid prescribers

The Supreme Court on Tuesday faced convictions of two doctors who operated opioid ‘pill mills’, a case in which judges are asked to find the line between legitimate medical practice and the criminal distribution of drugs that has contributed to a national crisis.

The doctors, both sentenced to more than 20 years in prison, are challenging their convictions, arguing medical professionals should not be tried as drug dealers when they believe they are prescribing drugs for a legitimate medical purpose.

“If it is sufficient to find that a doctor has acted outside the usual course of practice without reference to the purpose of the prescription, then doctors can be condemned for non-compliance with medical standards, even if they do not ‘have ever prescribed for an improper reason,’ Beau Brindley, an attorney representing one of the doctors, told judges on Tuesday.

“This makes it possible to condemn doctors who ignore the extent of their obligations, whether or not they are [they are] drug trafficking in the conventional sense of the term. »

Tuesday’s arguments centered on careful readings of criminal law regarding controlled substances, which prohibit the distribution of such drugs unless prescribed by a licensed physician “acting in the ordinary course of his or her professional practice.”

It is unclear how the court will decide the case, and the judges appeared to be conflicted over where to draw the line between a doctor operating in the usual course of practice and one trafficking narcotics. Some members of the bench questioned the doctors’ lawyers’ insistence that defendants should be protected by a defense that they are acting in good faith when prescribing addictive and often dangerous drugs.

“What if a doctor legitimately believes that legitimate medical practice is to give people who are addicted to drugs the drugs they need to satisfy that addiction,” Justice said. Samuel AlitoSamuel AlitoOvernight Energy & Environment — UN issues dire climate change warning Supreme Court wrestles with EPA’s power to regulate climate change Congress evades Supreme Court MORE. “That’s what the doctor really thinks.”

“The doctor should be acquitted, in your opinion?” Alito asked.

Brindley replied: “If the jury thinks they’re sincere and they believe it’s a legitimate aim, I think it’s true. But I don’t think that’s very likely to happen when all the evidence objectives come to say that it is false.”

Other judges seemed cautious about how to interpret what they see as unclear language in laws and regulations regarding controlled substances and the implications an unclear ruling could have for the medical profession.

Justice Brett KavanaughBrett Michael KavanaughSupreme Court wrestles with EPA’s power to regulate climate change Congress evading Supreme Court Graham on Jackson nomination: ‘The radical left’ has won ‘again’ MORE suggested that regulations to provide more clarity might be needed.

“‘Legitimate medical purpose’ is a very vague thing that reasonable people may disagree about,” Kavanaugh said.

Tuesday’s arguments concerned a pair of cases involving two separate doctors, each facing decades in prison for their prolific prescriptions of opioids and other drugs.

Xiulu Ruan was convicted of illegally distributing controlled substances from a medical clinic in Mobile, Alabama, and sentenced to 21 years in prison. Prosecutors said Ruan and a partner were among the nation’s top opioid prescribers, dispensing more than 300,000 scripts between 2011 and 2015.

The other case involves Shakeel Khan, a doctor who operated a cash-only clinic in a small town in Arizona until local pharmacies stopped filling his prescriptions. Khan opened a new practice in Wyoming, where he was later tried, convicted, and sentenced to 25 years in prison for distribution, one of which resulted in an overdose death.

Eric Feigin, a deputy solicitor general arguing on behalf of the federal prosecutors who brought the cases, told the court that the lawsuits were straightforward and accepting doctors’ legal arguments would invite predatory practices to run rampant in the medical field.

“They’re really asking this court to turn their DEA records, which are based on the idea that they actually practice medicine, into licenses to … violate the general rule that selling drugs is illegal,” Feigin said.

“They want to be free from any obligation, even to undertake the slightest effort to act like doctors when prescribing dangerous, highly addictive and, in one case, fatal doses of drugs to unsuspecting and vulnerable patients.”

The Supreme Court will deliver its decision in early July.

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