Supreme Court Rules in Favor of Doctors Challenging Opioid Convictions

This picture shows 5-mg pills of Oxycodone on June 17, 2019. Keith Srakocic/AP Photo File

The Supreme Court of the United States (SCOTUS) ruled in favor of two doctors challenging convictions on drug distribution charges for over-prescribing controlled opioids on the rationale that their actions may have been in “good faith.”

The justices ruled 9–0 on June 27 (pdf), siding with Dr. Xiulu Ruan and Dr. Shakeel Khan.

Justice Stephen Breyer argued that their trials were unfair because jurors were not required to consider whether the two convicted doctors had “good faith” reasons to prescribe numerous off-label opioid prescriptions.

Both doctors were registered under the Controlled Substances Act, allowing them to prescribe controlled substances to patients.

However, prosecutors at their trials argued that the prescriptions were unauthorized, meaning the drugs were prescribed not for a legitimate, medical reason.

Breyer, who is retiring at noon on June 30, the end of the court’s current term, wrote that for doctors with evidence that they have authority to prescribe controlled substances, prosecutors would need to prove they knowingly or intentionally acted in an unauthorized manner.

He wrote that the CSA registered doctors intentionally prescribing addictive drugs in an unauthorized way is illegal, but not the drugs themselves.

“We normally would not view such dispensations as inherently illegitimate; we expect, and indeed usually want, doctors to prescribe the medications that their patients need,” Breyer wrote.

Justice Samuel Alito, writing on behalf of himself and fellow conservative Justices Clarence Thomas and Amy Coney Barrett, said he agreed with the decisions but said the reasoning could result in “confusion.”

The two cases have been returned for further proceedings in lower courts.

The Defendants’ Cases

The remanded cases come as the country has faced a growing opioid crisis for over 20 years, with the death toll continuing to grow.

According to statements from the U.S. Department of Justice (DOJ), Ruan practiced medicine in Alabama and Khan practiced in Arizona and Wyoming. The two were sentenced to 21 and 25 years in prison respectively, in separate criminal cases.

Ruan and his business partner were convicted for running a clinic that issued nearly 300,000 controlled drugs from 2011 to 2015 (pdf). Of particular importance was the prosecutors finding him to almost exclusively prescribe Subsys and Abstral—two brand-name instant-release fentanyl drugs—for off-label neck, back, and joint pain, even though it was indicated as a prescription for breakthrough cancer pain in opioid-tolerant patients.

Ruan and his partner also received kickbacks from the manufacturer of Subsys in exchange for prescribing great quantities of the drug, putting him as one of the top prescribers of Subsys in the United States, according to DOJ statements.

The two also purchased around $1.6 million worth of stocks in Galena Biopharma, the manufacturer of Abstral. From 2013 to 2014, he and his partner were the number one and two prescribers of Abstral in the United States respectively. the statements said.

Kahn and his brother were convicted for unlawfully prescribing large quantities of opioids in single transactions and often with other potentially toxic drugs, resulting in at least one patient dying of an overdose.

The two were convicted as doctors running “pill mills,” though both argue that they did in good faith.