United States Court of Appeals 

for the Fifth Circuit _____________ 

No.19-20662 

consolidated with 

No.21-20120 

Summary Calendar 

_____________ 

United States of America, 

Plaintiff—Appellee, 

versus

Muhammad Arif, 

Defendant—Appellant. 

Appeals from the United States District Court 

for the Southern District of Texas 

USDC No. 4:17-CR-388-3 

Before Smith, Stewart, and Graves, Circuit Judges. 

Per Curiam:*

Muhammad Arif was convicted by a jury of conspiring to unlawfully 

distribute controlled substances, including Hydrocodone (also known as 

Norco) and Carisoprodol (also known as Soma), not for a legitimate medical 

*

 Pursuant to 5th Circuit Rule 47.5, the court has determined that this 

opinion should not be published and is not precedent except under the limited 

circumstances set forth in 5th Circuit Rule 47.5.4. 

United States Court of Appeals 

Fifth Circuit 

FILED 

December 30, 2021 

Lyle W. Cayce 

Clerk 

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purpose and outside the scope of professional practice. The jury also 

convicted him of three counts of distributing and dispensing Norco and Soma 

not for a legitimate medical purpose and outside the scope of professional 

practice, and aiding and abetting. The district court sentenced Arif to 

concurrent 96-month terms of imprisonment on all counts, to be followed by 

a two-year term of supervised release. 

On appeal, Arif asserts that the evidence is insufficient to support his 

convictions. Although Arif moved for a judgment of acquittal at the 

conclusion of the Government’s case-in-chief, he did not renew his motion 

at the close of all the evidence; this results in plain error review on appeal. 

See United States v. Smith, 878 F.3d 498, 502-03 (5th Cir. 2017). 

Under the plain error standard, Arif must show an error that is clear 

or obvious—rather than subject to reasonable dispute—and affects his 

substantial rights. See Puckett v. United States, 556 U.S. 129, 135 (2009). If 

he makes that showing, this court has the discretion to correct the error only 

if it “seriously affects the fairness, integrity or public reputation of judicial 

proceedings.” Id. (internal quotation marks and citation omitted). 

For insufficient evidence to rise to the level of plain error, there must 

have been a “manifest miscarriage of justice.” United States v. Phillips, 477 

F.3d 215, 219 (5th Cir. 2007) (internal quotations marks and citation 

omitted); see Smith, 878 F.3d at 503. A manifest miscarriage of justice occurs 

when “the record is devoid of evidence pointing to guilt or contains evidence 

on a key element of the offense that is so tenuous that a conviction would be 

shocking.” United States v. Vasquez, 766 F.3d 373, 377 (5th Cir. 2014) 

(internal quotation marks and citation omitted); see Smith, 878 F.3d at 503. 

The elements of the offense of conspiring to distribute and dispense 

controlled substances outside the scope of professional practice are: “(1) an 

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agreement by two or more persons to unlawfully distribute or dispense a 

controlled substance outside the scope of professional practice and without a 

legitimate medical purpose; (2) the defendant's knowledge of the unlawful 

purpose of the agreement; and (3) the defendant's willful participation in the 

agreement.” United States v. Oti, 872 F.3d 678, 687 (5th Cir. 2017). In order 

to convict Arif of the substantive offenses, the Government was required to 

prove that Arif (1) distributed or dispensed a controlled substance (or aided 

and abetted such acts), (2) acted knowingly or intentionally, and (3) did so 

other than for a legitimate medical purpose or outside the usual course of 

professional practice. See United States v. Evans, 892 F.3d 692, 703 (5th Cir. 

2018); 18 U.S.C. § 2(a). 

Arif argues that the evidence is insufficient to support his convictions 

because it fails to show that he knew that the prescriptions written for Norco 

and Soma lacked a legitimate purpose, or that the prescriptions were being 

provided outside the course of professional practice. Arif concedes that he 

received some medical training in Pakistan, but he argues that the record does 

not show that he was aware of customary pain management policies in the 

United States. He contends that the record shows that he operated at the 

direction of a doctor and that treating patients with Norco and Soma was the 

standard practice of doctors at the clinic where he was employed. As to the 

three substantive counts, Arif raises the argument that, because he was a nonregistrant who was not authorized to dispense controlled substances, he 

could be convicted only on an aiding and abetting theory, not as a principal. 

At trial, there was testimony that Arif filled out prescription forms 

that had been pre-signed by a doctor who worked at the same clinic, that Arif 

filled out the forms after seeing patients for five to ten minutes, that he did 

not have a medical license in Texas (although he claimed to have been a 

doctor in Pakistan), and that he consistently prescribed both Norco and 

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Soma. There was also evidence that Arif had telephone contact with the 

drivers who brought patients to the clinic, and that he knew that the drivers 

ultimately received the prescriptions written for the patients. Additionally, 

the Government’s medical expert opined that there was no medical 

indication for the combination of Norco and Soma, because together these 

drugs are a dangerous combination that involves an increased risk of 

overdose. The medical expert also testified that prescriptions for Norco and 

Soma were outside the scope of professional practice and not for any 

legitimate medical purpose. Given the foregoing, far from being devoid of 

evidence, see Vasquez, 766 F.3d at 377, there is ample evidence showing that 

Arif knowingly and voluntarily joined in a conspiracy to unlawfully distribute 

and dispense controlled substances not for a legitimate purpose and outside 

the course of professional practice. See Oti, 872 F.3d at 686-89. 

As to the three substantive counts, we also conclude that the evidence 

is sufficient to establish Arif’s guilt.1

 “A conviction for aiding and abetting 

requires proof that the substantive offense occurred and that the defendant 

(1) associated with the criminal venture; (2) purposefully participated in the 

crime; and (3) sought by his actions for it to succeed.” United States 

v. Daniels, 930 F.3d 393, 403 (5th Cir. 2019) (internal quotation marks and 

citation omitted); see 18 U.S.C. § 2(a). “Typically, the same evidence will 

support both a conspiracy and an aiding and abetting conviction.” United 

States v. Scott, 892 F.3d 791, 799 (5th Cir. 2018) (internal quotation marks 

omitted). 

1

 Because we determine that the evidence is sufficient to establish Arif’s guilt on 

the three substantive counts under an aiding and abetting theory, we do not consider the 

sufficiency of the evidence as to these counts under other theories of criminal liability. 

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Here, there was evidence to establish that Arif, who was medically 

trained, filled out prescription forms for Norco and Soma on the dates in 

question, that those forms were signed by a doctor who worked at the same 

clinic, and that these prescriptions were not for a legitimate medical purpose 

and were issued outside the scope of professional practice. Because the 

record is not “devoid of evidence pointing to guilt” and does not “contain[] 

evidence on a key element of the offense that is so tenuous that a conviction 

would be shocking,” the evidence is sufficient under the applicable standard 

of review. See Vasquez, 766 F.3d at 377. 

AFFIRMED.

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