Under 21 USC 841, it is a felony for "any person" to "knowingly or intentionally" distribute or dispense a controlled substance "except as authorized by this subchapter." Yesterday the Supreme Court considered how that language from the Controlled Substances Act (CSA) applies to physicians accused of prescribing opioid pain medication "outside the usual course of professional medical practice." That issue is important for patients as well as doctors, because the threat of criminal prosecution for deviating from what the Drug Enforcement Administration (DEA) considers medically appropriate has a chilling effect on pain treatment.
The CSA authorizes physicians with DEA registrations to prescribe controlled substances. But according to a CSA regulation, a valid prescription "must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice." Grammatically speaking, Justice Samuel Alito argued, the phrase "knowingly or intentionally" cannot be read as applying to deviations from that ambiguous standard. Justice Stephen Breyer disagreed.
