In a ruling on June 27, 2022, the U.S. Supreme Court said prosecutions for cases involving excessive prescribing of opioids must show the prescriber knew they lacked a legitimate medical purpose.

The ruling nominally involves CSA convictions of “pill mill” prescribers in the Tenth and Eleventh circuits, but it carries nationwide implications for criminal and civil cases related to sales and distribution of prescription narcotics for recreational use. Monday’s ruling held that the DOJ “must prove beyond a reasonable doubt that the defendant knew that he or she was acting in an unauthorized manner, or intended to do so,” in order to secure a conviction for improper prescribing.