By ruling in favor of two doctors accused of running pill mills, SCOTUS is clarifying opioid prescription practices
Days after the Supreme Court overturned Roe v. Wade, it made a much less publicized ruling on prescription opioids—one that was far more welcome in the medical community. In a rare 9–0 decision in Ruan v. United States, the court ruled in favor of several doctors who were criminally convicted of acting as drug dealers by overprescribing pain medications.
In the face of a decades-long overdose crisis that continues to escalate, doctors have become terrified that authorities will decide that their practice is out of line and throw them in prison for drug trafficking. Hundreds of doctors have been prosecuted—and thousands more simply decided to stop prescribing opioids, even when they thought the benefits would outweigh the risks.
Lower courts had split on a key question in these criminal cases: should the government be required to prove that accused doctors are aware that they have crossed the line from medicine into drug dealing—or should prosecutors only have to demonstrate that their prescribing so deviated from the standard of care for pain management that it was obviously criminal?
Not surprisingly, when the Centers for Disease Control and Prevention published opioid prescribing guidelines in 2016, they were adopted as hard mandates. Afraid that standing out would paint a target on their backs, doctors have reduced or eliminated opioid doses used for chronic pain to conform to the guidelines—and have even prescribed lower doses to end-of-life patients because of fears of prosecution.
Health care workers who are afraid that patients’ pleas for pain relief will result in legal trouble for them also tend to become callous and cruel. Earlier this year, former nurse Bill Kinkle says HE was dumped out of a wheelchair onto a hospital floor because staff assumed that since he had wounds linked to IV drug use, he must be faking his inability to move to get sympathy so he could get drugs.
The decision is already starting to have an effect on physician prosecutions. The U.S. Department of Justice has dropped at least one case involving opioid prescriptions. And an attorney for one of the defendants associated with the Ruan decision, Ronald Chapman, said that in the case of David Lewis, who he was also representing, the judge had to adjust jury instructions just as the decision was about to be read.
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