In March, the Supreme Court heard a case about whether doctors should be held liable for prescribing opioids in good faith. Ruan v. United States is about where sound medical judgment ends and criminal liability begins. In a nation with an opioid crisis and doctors running what are known as “pill mills,” doctors in Alabama were convicted of a crime based on a ruling that did not allow them to claim a defense of “good‐faith” if they were prescribing opioids under the belief that it was medically the right thing to do.

The Petitioner, Dr. Xiulu Ruan, owned and operated a pain clinic and pharmacy with his partner Dr. John Couch. Over a four-year period beginning in 2011, Drs. Ruan and Couch prescribed Transmucosal Immediate-Release Fentanyl Medicines, a type of opioid, to patients at rates which often doubled the next highest prescriber in the entire nation. The lower courts noted that both doctors regularly signed prescriptions for patients they had never met or had met only once. After being convicted in federal court in Alabama, the U.S. Court of Appeals for the Eleventh Circuit affirmed.