Published on: Wednesday, March 2, 2022

For nearly 90 minutes on Tuesday, the high court grappled with the question of whether good faith is a defense for doctors criminally prosecuted for unlawful distribution of controlled substances (coverage available here).

The court probed both sides intensely, struggling with the grammar of the Controlled Substances Act, the clarity of the relevant regulation, and the proposition that a doctor who lacked subjective criminal intent could nevertheless be jailed for a substantial period of time.

The case, Ruan v. United States, is a challenge to jury instructions in two prosecutions of doctors accused of operating opioids “pill mills,” and otherwise prescribing outside the bounds of ordinary medical practice.

The government argues the intent standard is an objective one — an “honest effort” to comply with professional norms. The doctors argue that the standard must be subjective — did the doctor subjectively believe she was not prescribing for a legitimate medical purpose — in order to differentiate a criminal offense from a mere regulatory violation.