Thread by @StefanKertesz

1/There is one upcoming Supreme Court Case to follow for anyone who cares about criminal prosecutions of doctors for prescriptions of opioid medicine - specifically Rx where intentions were to deliver appropriate medical care: Ruan v. USA supremecourt.gov/docket/docketf…

2/The central question comes down to whether it is a federal crime for a physician to prescribe opioids, in a way where the government’s experts contend it was imprudent or unwise, when that physician intended and reasonably believed they were acting within standard of care

3/Most prosecutions of non-MDs under the Controlled Substance Act require “mens rea” criminal intent.

If I sell you a PlayStation, believing it is a PlayStation, which turns out to have cocaine inside, I can’t be convicted of a criminal violation of CSA. No criminal intent

4/when it comes to prosecuting doctors, the federal circuits have split in regard to what instructions are given to juries. Some have effectively gutted the matter of intention and resolved it down to “standard of care”. What that means is as follows#

5/A higher than ordinary prescriber- perhaps unwise but well intended, or perhaps the only one left who won’t abandon legacy patients- is evaluated by the government’s paid experts for anything they can call a “red flag”.

6/The experts are often highly paid docs who lack training in addiction or pain but who avow black & white approaches. ie Never combine Opiods and Benzos. Always order GC/MS urine tests. A doc who didn’t hold to those rules is adjudicated as, in effect, not acting like a doctor

7/In the Ruan case the jury instruction made good faith intentions of the docs immaterial. But that meant doctors can be convicted even if they were attempting to protect the patient. Mens rea doesnt apply. Different federal circuits disagree

8/under this legal standard of prosecution, which is favored by DEA, a doctor who abruptly cuts off all prescriptions, even if that causes deaths and contravenes guidance from HHS, is not liable to any risk of criminal prosecution, and only rarely at civil risk

9/I note that among the prosecutions & investigations that come to my attention, often Boards working in tandem with DEA, cases come down to often just a few Rx’s, where the expert paid by the DEA feels like they would have taken a different decision. Pill mills are long gone.

10/For people who care about this, watch the filings (link below)

No one can predict the outcome. But it will influence the safety of patients who are currently on chronic opioids and being cut off abruptly, as several studies now show /fin

supremecourt.gov/docket/docketf…