Analyzing the Impact of Ruan v. United States (2022) on Opioid Prescription Practices: A Closer Look at the Supreme Court’s Landmark Decision

In 2022, the Supreme Court decided Ruan v. United States, 597 U.S. __ (2022). From 2011 to 2015, Dr. Xiulu Ruan operated a clinic, where over 400,000 opioid prescriptions were allegedly prescribed to patients for no legitimate medical purpose. Both doctors were indicted in 2016 pursuant to 21 U.S.C. § 841(a)(1) under the Controlled Substances Act. This statute discusses unlawful distribution of a controlled substance. More specifically, under 21 U.S.C. § 841, it is a criminal act to distribute or dispense controlled substances unless the prescription is authorized. The wording of the statute is of importance to the Supreme Court’s decision. The statute states “except as authorized, it is a criminal act to knowingly or intentionally distribute or dispense a controlled substance.” (emphasis added). The United States argued that Ruan prescribed the medication with no legitimate medical purpose. The defense requested the judge to inform the jury that they had acted in good faith that they should not be guilty under 21 U.S.C. § 841(a)(1). The district court judge disagreed and informed the jury that the doctors could be held guilty if their prescribing practices were outside of medical norms to the extent they were unrecognizable as medicine. The jury ultimately found both doctors guilty. On appeal, the United States Court of Appeals for the Eleventh Circuit affirmed the lower court’s decision.

The Supreme Court held that the United States must prove beyond a reasonable doubt that a defendant “knowingly or intentionally” acted in an unauthorized manner once the defendant meets their burden of producing evidence that their conduct was authorized. In other words, the defendant has the burden of production and the government carries the burden of proof. Before this decision the government needed only to prove that the defendant intentionally and knowingly distributed a scheduled substance and if that prescription later turned out to be unauthorized, the criminal elements were met. The government must now prove that the doctor or medical professional knew that the prescription was not authorized. The decision in Ruan provides broader protection to physicians who regularly prescribe opioids.

When under investigation it is important to follow the advice of your attorney and not speak about the alleged crimes over social media. LGR Law, LLC’s federal criminal defense attorneys have the essential skills to protect your legal rights. Should you or a loved one receive any indication that you are a target of a federal investigation, contact Lorraine Gauli-Rufo, and the attorneys at LGR Law immediately. (973) 239-4300,, [email protected]

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