Xiulu Ruan, a board-certified Alabama pain specialist, was sentenced to 21 years in federal prison for prescribing opioid analgesics “outside the usual course of professional medical practice.” According to the appeals court that upheld his 2017 conviction, it did not matter whether he sincerely believed he was doing what a physician is supposed to do.
That ruling, which is the focus of a case the Supreme Court heard in March, conflates negligence with criminal liability, invites the Drug Enforcement Administration (DEA) to usurp state medical regulators, and encourages prosecutions that have a chilling effect on pain treatment. If it is allowed to stand, doctors who already face intense pressure to curtail opioid prescriptions will be even more inclined to elevate drug control above pain control.
Ruan’s trial featured the usual battle of experts. Defense witnesses portrayed him as a conscientious physician doing his best to serve patients in dire need,
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