Justice Stephen Breyer wrote for the court that prosecutors must prove that doctors knew they were illegally prescribing powerful pain drugs in violation of the federal Controlled Substances Act.
The ruling came as the U.S. has been seeing record numbers of drug overdose deaths, many from the highly lethal opioid fentanyl.
Evaluating the convictions of two doctors who are each facing more than two decades in prison, the justices ruled on a subject on which advocates for patients and doctors had urged the court to distinguish between criminal behavior and medical errors made in good faith.
It did so in the ruling. Prosecutors, Breyer wrote, “must prove beyond a reasonable doubt that the defendant knowingly or intentionally acted in an unauthorized manner.” The justices ruled unanimously for the doctors, though only six endorsed Breyer’s standard for conviction.
Fear of aggressive prosecution already has led doctors to avoid prescribing opioids “against their best medical judgment,” the National Pain Advocacy Center told the court in a written filing.
But the justices did not throw out the convictions of two doctors whose appeal was heard in February. Instead, it ordered federal appeals courts to take a new look at their cases.
The court ruled on appeals from Xiulu Ruan of Mobile, Alabama, and Shakeel Kahn, who practiced medicine in Ft. Mohave, Arizona, and Casper, Wyoming.
Ruan is serving a 21-year federal prison term. Kahn is in prison for up to 25 years. They will get another chance to argue that their convictions should be overturned.
Ruan and a partner, James Couch, were convicted of overprescribing medications at their Physicians Pain Specialists of Alabama clinic and a pharmacy.
The two doctors “enriched themselves through a long-running scheme of unlawfully issuing prescriptions for addictive and potent controlled substances, in response to their own financial incentives rather than the legitimate medical needs of their patients,” Solicitor General Elizabeth Prelogar, the Biden administration’s top Supreme Court lawyer, told the court in a written filing.
They grossed $20 million between 2012 and a raid in 2015, prosecutors said. In 2014, they wrote 66,892 prescriptions, prosecutors said.
Kahn was convicted of conspiracy to unlawfully distribute and dispense controlled substances resulting in death, including oxycodone, an opioid pain reliever, and fentanyl, a synthetic opioid.
Kahn “routinely performed only a perfunctory examination — or no examination at all — before prescribing controlled substances for a patient,” the Justice Department said in a Supreme Court brief.
Jessica Burch, of Lake Havasu City, Arizona, was a patient of Kahn’s who died from an overdose in 2015.
Kahn wrote nearly 15,000 prescriptions for controlled substances over six years, totaling nearly 2.2 million pills, prosecutors said. Nearly half were oxycodone, they said.