Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1410_1an2.pdf
Page Number: 1

(Slip Opinion) 

OCTOBER  TERM,  2021 

1 

Syllabus 

NOTE:  Where  it  is  feasible,  a  syllabus  (headnote)  will  be  released,  as  is 
being  done  in  connection  with  this  case,  at  the  time  the  opinion  is  issued. 
The  syllabus  constitutes  no  part  of  the  opinion  of  the  Court  but  has  been 
prepared  by  the  Reporter  of  Decisions  for  the  convenience  of  the  reader. 
See United States v. Detroit Timber & Lumber Co., 200 U. S. 321, 337. 

SUPREME COURT OF THE UNITED STATES 

Syllabus 

XIULU RUAN v. UNITED STATES 

CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR 
THE ELEVENTH CIRCUIT 

No. 20–1410.  Argued March 1, 2022—Decided June 27, 2022* 

Petitioners Xiulu Ruan and Shakeel Kahn are medical doctors licensed 
to  prescribe  controlled  substances.    Each  was  tried  for  violating  21 
U. S. C. §841, which makes it a federal crime, “[e]xcept as authorized[,] 
. . . for any person knowingly or intentionally . . . to manufacture, dis-
tribute, or dispense . . . a controlled substance.”  A federal regulation
authorizes  registered  doctors  to  dispense  controlled  substances  via 
prescription,  but  only  if  the  prescription  is  “issued  for  a  legitimate
medical  purpose  by  an  individual  practitioner  acting  in  the  usual 
course of his professional practice.”  21 CFR §1306.04(a).  At issue in 
Ruan’s and Kahn’s trials was the mens rea required to convict under
§841 for distributing controlled substances not “as authorized.”  Ruan 
and Kahn each contested the jury instructions pertaining to mens rea 
given at their trials, and each was ultimately convicted under §841 for
prescribing in an unauthorized manner.  Their convictions were sepa-
rately affirmed by the Courts of Appeals. 

Held: Section 841’s “knowingly or intentionally” mens rea applies to the 
statute’s “except as authorized” clause.  Once a defendant meets the 
burden of producing evidence that his or her conduct was “authorized,” 
the  Government  must  prove  beyond  a  reasonable  doubt  that  the  de-
fendant knowingly or intentionally acted in an unauthorized manner. 
Pp. 4–16.

(a) Criminal  law  generally  seeks  to  punish  conscious  wrongdoing. 
Thus, when interpreting criminal statutes, the Court “start[s] from a
longstanding presumption . . . that Congress intends to require a de-
fendant to possess a culpable mental state.”  Rehaif v. United States, 

—————— 

* Together with No. 21–5261, Kahn v. United States, on certiorari to 

the United States Court of Appeals for the Tenth Circuit.