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VICTORY FOR PAIN CARE IN THE UNITED STATES SUPREME COURT JUNE 27, 2022
Walter F. Wrenn MD, stated March 7, 2022
“The question we have to ask ourselves is how did the DOJ/DEA and state AG’S get away with violating the civil rights of so many healthcare providers.” That question was answered yesterday by a 9-0 decision in the United States Supreme Court.
1.How did they get away with being able to introduce in court ambiguous terms like highly addictive and overprescribing?
2. How were they able to use the 2016 CDC guidelines as laws or rules?
3. How were they able to suspend the medical and DEA licenses of health care providers before trial and on the day charges were filed?
4. What are the providers who have been charged and imprisoned entitled to now?
SUMMARY OF SUPREME COURT RUAN RULING
Justice Stephen Breyer wrote for the court that prosecutors must prove that doctors knew they were illegally prescribing powerful pain drugs in violation of the federal Controlled Substances Act.
The ruling came as the U.S. has been seeing record numbers of drug overdose deaths, many from the highly lethal opioid fentanyl.
Evaluating the convictions of two doctors who are each facing more than two decades in prison, the justices ruled on a subject on which advocates for patients and doctors had urged the court to distinguish between criminal behavior and medical errors made in good faith.
It did so in the ruling. Prosecutors, Breyer wrote, “must prove beyond a reasonable doubt that the defendant knowingly or intentionally acted in an unauthorized manner.” The justices ruled unanimously for the doctors, though only six endorsed Breyer’s standard for conviction.
Fear of aggressive prosecution already has led doctors to avoid prescribing opioids “against their best medical judgment,” the National Pain Advocacy Center told the court in a written filing.
summary of SCOTUS decision by Ron Chapman Esq
“Over the last 46 years of silence from the Supreme Court on the issue of unlawful prescribing, the Federal Government and Circuit Courts have taken some strange turns.
The standard levied against physicians charged with unlawfully prescribing controlled substances shifted from one in which the benefit of the doubt rested with the prescriber to one in which evolving “objective” standards, such as the CDC Guidelines and state medical board regulations, became an ad hoc standard of care.
As the scope of permissible conduct began to narrow, federal prosecutions ramped up and courtrooms across this country became filled with allegations that a physician “failed to do a physical exam” “ignored an inconsistent urine drug test” or didn’t respond to signs of addiction and diversion.
This shift had a profound impact on pain in America. Primary care physicians ceased prescribing, emergency rooms minimized pain complaints and discharged patients in excruciating pain. The epidemic of untreated pain was thrust upon pain management providers who were ill equipped to handle the millions of Americans suffering with chronic pain.
The “deterrent” effect so often sought in federal sentencing had tremendous blowback when coupled with the vague and shifting standards for permissible conduct.
Justice Breyer authored the unanimous decision of the court and Justice Breyer did an amazing job clearing up the mess that has been created by a wide range of conflicting decisions over the last 46 years.
Plainly, he stated that, first the physician must show that he was authorized to prescribe controlled substances. This is as simple as showing a DEA registration to the jury to prove that he or she had permission to prescribe. Next the Government must show that he knowingly and intentionally violated this standard.
This means that the physician must know that he unlawfully prescribed – a violation of an “objective standard” is insufficient to meet this knowledge requirement.”
SUMMARY OF THE ARGUMENT FROM CATO INSTITUTE AMICUS BRIEF
“Prescribing controlled substances for the benefit of patients is everyday and essential practice for physicians and other authorized prescribing practitioners.2 Gonzales v. Oregon, 546 U.S. 243, 254 (2006)
1 Rule 37 statement: The parties were notified and consented to the filing of this brief more than 10 days before its filing. See Sup. Ct. R. 37.2(a). No party’s counsel authored any of this brief; amicus alone funded its preparation and submission. See Sup. Ct. R. 37.6.
2 Although these cases involve physicians, other practitioners—such as advance practice registered nurses and physician as- assistants—have prescribing authority under state law and are authorized to prescribe under the Controlled Substances Act to the extent of their state’s permissions and in compliance with the Drug Enforcement Agency’s requirements of authorization. (explaining that the inability to prescribe controlled substances would constitute a “severe restriction on medical practice”).
Despite dominant public narratives about the harms of prescribed controlled substances, these compounds are neither harmful nor useful absent context. In fact, they are essential to modern medicine;3 a reality acknowledged by Congress in the initial sentences of the CSA. 21 U.S.C. § 801(1) (many of the controlled substances under the statute’s purview “have a useful and legitimate medical purpose and are necessary to maintain the health and general welfare of the American people”). “
LIST OF HEALTH PROVIDERS THAT HAVE BEEN TARGETS OF DOJ-DEA
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