On June 27, the U.S. Supreme Court ruled that, in a case considering whether doctors should be punished for prescribing drugs in a way that amounts to unlawful distribution, a knowing intent is required. The court decided prosecutors must prove that a doctor “knew that he or she was acting in an unauthorized manner, or intended to do so,” stated the opinion, which was written by Justice Stephen Breyer. It comes amid the ongoing opioid epidemic and concern for pain patients not getting the relief they need.

The unanimous ruling follows the cases of Xiulu Ruan of Alabama, who was sentenced to 21 years in prison in 2017 after being found guilty of running what the Justice Department called a pill mill, and Shakeel Kahn of Wyoming, who was sentenced to 25 years in prison in 2019 for crimes including drug distribution resulting in death. The court’s decision comes as a blow to the U.S. DOJ’s efforts to prosecute physicians and other prescribers for similar conduct in light of the country’s opioid crisis.