Pill Mills Keep Churning: Courts Raise the Bar for Convicting Doctors Accused of Fueling Opioid Epidemic

A federal appeals court recently overturned Shakeel Kahn’s 2019 conviction—which sentenced him to 25 years after he was found guilty on several counts related to illegally prescribing powerful drugs—after a ruling by the Supreme Court raised the bar for what prosecutors have to prove in cases like these [1]. Kahn and his brother operated a medical practice in Arizona. After local pharmacies began to refuse Kahn’s requests to fill prescriptions in 2012, Kahn opened a second practice in Casper, Wyoming while continuing to operate in Arizona and keeping many of his patients[2]. After a government investigation beginning in 2016, Kahn was convicted of illegally prescribing various prescription drugs, particularly oxycodone, in exchange for money and without adequate examination of patient needs. Kahn defended himself by saying that he had a “good faith” reason to believe the prescriptions were valid. A jury in Wyoming convicted him on various charges related to these allegations [2]. After appealing to the Supreme Court, Justice Breyer wrote in a unanimous opinion that “once defendants produce evidence that they were authorized to dispense controlled substances like opioids, prosecutors must prove they knew they were acting in an unauthorized manner” [3]. The Court said that jurors were wrongly instructed as to the mens rea standard—or knowledge and intent requirement—necessary to convict Kahn in violation of the Controlled Substances Act. On remand, the 10th circuit ruled that this error was not harmless beyond a reasonable doubt to the jury’s rationale for their decision, and thus Kahn is entitled to a new trial [2]. The Court’s clarification of the grounds necessary to convict doctors accused of violating the Controlled Substances Act will effectively make it more difficult to prove that operators of America’s “pill mills”—which help fuel the nation’s opioid epidemic—are violating the law [1].