The DEA is not authorized to establish medical standards or practice medicine. The Ruan case, to be discussed in this session, reinforces that concept and makes clear “the crucial role ‘authorization’ plays in distinguishing morally blameworthy conduct from socially necessary conduct.” Physicians have been at the center of government prosecutions for “illegal” prescribing of controlled substances for a very long time. Since 1975, when the US Supreme Court decided physicians could be held criminally liable under the federal drug trafficking statute, the DEA and federal prosecutors and a stable of medical experts have applied their own memories and understandings as to what constitutes a valid controlled substance prescription. Sometimes, the government pursues defendant-physicians who were indeed acting as physicians, resulting in a courtroom battle played out over the applicable medical standards and how one should practice medicine instead of whether the defendant-physician had the legally required “knowledge or intent” to prescribe in an “unauthorized” fashion—to act not as a physician but as a drug dealer. The Ruan decision is a victory, but only time will tell whether it will impact DEA decision-making and memories. Regardless, one thing is clear: Ruan reinforces the need for Main Street Practitioner to not only understand what is meant by the subject intent of a physician who prescribes controlled substances, but also to continue to push licensing boards, professional societies, and educational groups for clarity on the objective standards associated with “authorized” prescribing: legitimate medical purpose and usual course of professional practice. Additional Reading List