Whether juries must be instructed that the government must prove that a physician acted with the mens rea of intent as to issuing a prescription outside the usual course of professional practice or not for a legitimate medical purpose and that that action and intent must mean that a physician has abandoned medical practice and engaged in 'illicit drug dealing and trafficking as conventionally understood' in order to prevent a criminal conviction for malpractice under the CSA?

QUESTION PRESENTED Because prescribing controlled substances is a quintessential part of a physician’s professional life, when those controlled substances have medical uses, the Controlled Substances Act (“CSA”) empowers physicians to do so. But that authority has limits. Specifically, the CSA “bars doctors from using their powers as a means to engage in illicit drug dealing and trafficking as conventionally understood.” Gonzalez v. Oregon, 546 U.S. 248, 270 (2006). A doctor, therefore, is criminally liable for unlawfully distributing a controlled substance when acting as “a drug ‘pusher,” and “not as a physician.” United States v. Moore, 423 U.S. 122, 126, 143 (1975). The practice of instructing juries in the Fourth Circuit, however, strips the CSA, as applied to physicians, of any meaningful mens rea component and blurs this clear line between criminal and merely unprofessional or negligent conduct, and allows medical practitioners to be convicted of felony drug trafficking based on malpractice or other disputes about the standard of care. The question presented is: Whether juries must be instructed that the government must prove that a physician acted with the mens rea of intent as to issuing a prescription outside the usual course of professional practice or not for a legitimate medical purpose and that that action and intent must mean that a physician has abandoned medical practice and engaged in “illicit drug dealing and trafficking as conventionally understood” in order to prevent a criminal conviction for malpractice under the CSA?