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Supreme Court Ruling On Prescription Opioids - Prescribing Opioids Is Not Criminal Intent

Days after overturning Roe v. Wade, a considerably less well-publicized Supreme Court ruling on prescription opioids was much more well-received by the medical community.

In the unusual 9-0 ruling in Ruan v. United States, the court sided with six doctors who had been found guilty of trafficking drugs by overprescribing painkillers.

The ruling offers doctors accused of illegally prescribing opioids a chance to defend themselves against law enforcement since it requires that prosecutors show that the doctors had criminal intent rather than just that their prescribing did not follow accepted practices.

The ruling may thereby increase the likelihood that people with pain or addiction will receive the right medical care by making the legislation more clear, particularly if they have complex circumstances that may need for exceptional doses.

Doctors are scared that the government would find their practice to be improper and imprison them for drug trafficking in the face of an overdose catastrophe that has been escalating for decades.

While thousands more simply elected to cease prescribing opioids, even when they believed the advantages would outweigh the risks, hundreds of doctors have been charged.

Justice Samuel Alito stated in his concurring opinion:

A doctor who makes negligent or even reckless mistakes in prescribing drugs is still ‘acting as a doctor’ — he or she is simply acting as a bad doctor. The same cannot be said, however, when a doctor knowingly or purposefully issues a prescription to facilitate ‘addiction and recreational abuse.’

In other words, criminal prosecution should only be used for deliberate drug sales; civil malpractice legislation is the appropriate remedy for poor medical care.

Lower courts disagreed on a crucial issue in these criminal cases: should the prosecution only have to show that the accused doctors' prescribing for pain relief clearly deviated from the accepted standard of care, rather than having to show that they were aware they had crossed the line from medicine into drug dealing?

Prosecutors said, for instance, that Dr. Ruan started prescribing huge doses of a certain brand of fentanyl after investing $1.6 million in the business that produced it in the Ruan case.

The government claimed that there was enough evidence to convict him of drug dealing, but the Court heard his case when his attorneys argued that the jury instructions prevented him from effectively defending himself as an appropriate prescriber. (The Court did not reverse his conviction; rather, it remanded the case to the appellate level so that the lower court might decide whether to order a new trial in light of its decision.)

“For a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice,” according to ambiguous federal law. However, it doesn't specify what a valid medical reason is.

It is understandable why these recommendations, which the Centers for Disease Control and Prevention announced in 2016, were turned into strict regulations.

Doctors have lowered or removed opioid doses used for chronic pain in order to comply with the guidelines because they are worried that standing out would make them targets for prosecution. They have even prescribed lower doses to end-of-life patients out of fear of being prosecuted.

Final Thought

Thousands of people are currently being forced to endure senseless suffering. Prescription rates are now lower than they were in the middle of the 1990s, before pharmaceutical marketing caused a significant spike.

The number of opioid prescriptions written for cancer patients between 2013 and 2017, who were expressly exempt from the CDC recommendations, decreased by 21%, and the decline grew after the publication of the recommendations.

Even the CDC, including the writers of its guidelines, claims that physicians have erroneously used the advice and caused injury; the guidelines are currently being updated. During this time, the number of overdose deaths is soaring.

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