Bloomberg Law
June 27, 2022, 2:39 PMUpdated: June 27, 2022, 3:25 PM

Supreme Court Rules for Doctors on ‘Pill Mill’ Prosecution Proof (1)

Lydia Wheeler
Lydia Wheeler
Senior Reporter
Jordan S. Rubin
Jordan S. Rubin

The US Supreme Court sided with doctors seeking a higher burden of proof in prosecutions for distributing controlled substances like opioids.

In a unanimous decision on Monday, the justices rejected the government’s attempt to make it easier to convict physicians it alleged acted more like drug dealers in prescribing pain killers.

The ruling stemmed from two separate cases prosecuted under the federal Controlled Substances Act for unlawfully prescribing opioids and other controlled substances. Registered professionals are exempt if they prescribe drugs for legitimate medical purposes in the usual course of practice.

The justices vacated the appeals court decisions affirming the convictions and sent the cases back for further review.

The issue was what the government has to prove when it comes to criminal intent. The defendants argued they subjectively believed they were prescribing in good faith. The Justice Department said it should be an objective standard, not up to each doctor’s whim.

In delivering the opinion of the court, Justice Stephen Breyer said the government must prove beyond a reasonable doubt that the defendant knew that he or she was acting in an unauthorized manner, or intended to do so, after a defendant produces evidence that he or she was authorized to dispense controlled substances.

“Defendants who produce evidence that they are ‘authorized”’ to dispense controlled substances are often doctors dispensing drugs via prescription,” he said. “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.”

Xiulu Ruan, 59, was convicted in Alabama and sentenced to 21 years in prison for running what the government called a “massive pill mill” with a co-defendant in Mobile. Shakeel Kahn, 55, was convicted in Wyoming and sentenced to 25 years for running an enterprise with his brother that the government said targeted addicts and resulted in a patient’s death.

Justice Samuel Alito filed a concurring opinion, which Justice Clarence Thomas joined and Justice Amy Coney Barrett joined in part. While Alito said he would toss out the lower courts’ decisions and remand the case for further proceedings, he said the Controlled Substances Act should be read to preserve a traditional preponderance-of-the-evidence standard.

The case is Ruan v. United States, Kahn v. United States, U.S., Nos. 20-1410, 21-5261, 3/1/22.

(Updates with additional details from decision.)

To contact the reporter on this story: Lydia Wheeler in Washington at; Jordan S. Rubin in Washington at

To contact the editors responsible for this story: Seth Stern at; John Crawley at