Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1410_1an2.pdf
Page Number: 33.0

Cite as:  597 U. S. ____ (2022) 

13 

ALITO, J., concurring
ALITO, J., concurring in judgment 

be said, however, when a doctor knowingly or purposefully 
issues  a  prescription  to  facilitate  “addiction  and  recrea-
tional abuse,” Gonzales v. Oregon, 546 U. S. 243, 274 (2006).
Objectives of that kind are alien to medical practice, and a 
doctor who prescribes drugs for those purposes is not “act-
ing as a physician” in any meaningful sense.

I  would  thus  hold  that  a  doctor  who  acts  in  subjective 
good  faith  in  prescribing  drugs  is  entitled  to  invoke  the 
CSA’s  authorization  defense.  Under  the  correct  under-
standing of that defense, a doctor acts “in the course of pro-
fessional practice” in issuing a prescription under the CSA 
if—but only if—he or she believes in good faith that the pre-
scription is a valid means of pursuing a medical purpose.  A 
doctor who knows that he or she is acting for a purpose for-
eign to medicine—such as facilitating addiction or recrea-
tional drug abuse—is not protected by the CSA’s authoriza-
tion  to  distribute  controlled  substances  by  prescription.
Such doctors may be convicted of unlawfully distributing or 
dispensing a controlled substance under §841(a)(1).

Based  on  this  holding,  I  would  vacate  the  judgments  of 
the Courts of Appeals below.  And like the Court, I would 
leave it to those courts to determine on remand whether the 
instructions  provided  in  petitioners’  respective  trials  ade-
quately described the good-faith defense and whether any 
errors in the instructions were harmless.