Document: 423 U.S. 122 96 S.Ct. 335 46 L.Ed.2d 333 UNITED STATES, Petitioner,v.Thomas W. MOORE, Jr. No. 74-759. Argued Oct. 7, 1975. Decided Dec. 9, Syllabus Respondent, a licensed physician registered under the Controlled Substances Act (CSA), 21 U.S.C. § 801 et seq., was convicted of knowing and unlawful distribution dispensation methadone (a controlled substance or addictive drug used in treatment heroin addicts) violation 841(a)(1), which makes it for "any person" knowingly intentionally to distribute dispense substance, except as authorized by CSA. The evidence disclosed that respondent prescribed large quantities patients without giving them adequate physical examinations specific instructions its use charged fees according quantity rather than medical services rendered. Court Appeals, however, reversed conviction on grounds exempted from prosecution 841 virtue his status registrant can be prosecuted only §§ 842 843, prescribe less severe penalties 841. Held: Registered physicians when, here, their activities fall outside usual course professional practice. Pp. 131-145. (a) Only lawful acts registrants CSA are That section terms reaches does not exempt (as could have) "all registrants" persons Act." language qualified authorization 822(b), authorizes possess, distribute, substances extent registration conformity with other provisions, added merely ensure engaged prosecuted, cannot fairly read support view all beyond reach simply because status. 131-133. (b) There is no indication operative 841-843 Congress intended establish two mutually exclusive penalty systems, nonregistrants punished fact term "registrants" some subsections 843 but being limited significance. Moreover, legislative history indicates concerned nature transaction, defendant's 133-135. (c) It immaterial whether also have been relatively minor offense violating 829 respect issuing prescriptions, since there nothing statutory scheme justifies conclusion who may thereby significantly greater acting "pusher." 135-138. (d) CSA, viewed against background history, reveals an intent limit physician's dispensing authority "professional practice." 138-143. (e) laws impede legitimate research allowed reasonable discretion treating patients, did intend serious criminal those go limits approved 143-145. (f) Where purpose clear, canon strict construction statutes favoring accused will satisfied if words statute "given fair meaning accord manifest lawmakers." United States v. Brown, 18, 25-26, 68 376, 379-380, 92 L.Ed. 442. P. 145. 164 U.S.App.D.C. 319, 505 F.2d 426, remanded. Paul L. Friedman, Washington, D. C., petitioner. Raymond Bergan, respondent. Mr. Justice POWELL delivered opinion Court. 1 issue this case (CSA Act), 84 Stat. 1242, distributing substances. Appeals District Columbia Circuit respondent, Act, ground he registrant. We reverse hold when 2 * Dr. Moore charged, 639-count indictment, (Dolophine), Schedule II substance,1 841(a)(1). subsection provides: 3 "Except subchapter, shall any person 4 "(1) manufacture, dispense, possess . ." 5 indictment covered 51/2 month period late August 1971 early February 1972. reduced before trial 40 counts, jury 22 counts. He sentenced concurrent five 15 years' imprisonment 14 10 30 years remaining eight second set sentences consecutive first. Fines totaling $150,000 were imposed.2 6 Methadone addicts. If taken controls can, like heroin, create euphoric "highs," properly administered eliminates addict's craving providing "high." principal methods addicts "detoxification" "maintenance." Under maintenance program, addict given fixed dose once day indefinite keep him using heroin. In detoxification during first few days free withdrawal symptoms. Then gradually until total abstinence reached. 7 Maintenance more controversial method treatment. During 822, itself, entitle conduct program. addition 822 registration, wished such program required obtain Food Drug Administration investigation new drug. Moore's FDA revoked summer 1971, claim conducting Instead, defense at had devised based work British practitioner. testified achieve "blockade" condition, so saturated would effect, instill strong psychological desire detoxification. Government's position established inconsistent accepted addicts, operated 8 Respondent concedes brief observe generally practices. conducted large-scale operation. Between September mid-February 1972 three pharmacies filled 11,169 prescriptions written Moore. These 800,000 tablets. On 54 wrote over 100 day. billing "sliding-fee scale" pegged solely prescribed, performed. ranged $15 50-pill prescription $50 150 pills. one-half months receipts totaled least $260,000. 9 When patient entered office most perfunctory examination. Typically included request see patient's needle marks (which one instance simulated) unsupervised urinalysis (the results regularly ignored). A then amount requested patient. return visits appointments never scheduled examination performed again received whatever requested. Accurate records kept, cases recorded. supervision administration consisted entirely label drugs reading: "Take directed detoxification." Some tablets get "high"; others sold gave friends relatives. Several increased dramatically while they respondent's care.3 judge dissenting, assumed acted wrongfully, held 841.4 App.D.C. 426 (1974). court found subject 843,5 841.6 reasoned: 11 " deal primarily through system administrative controls, relying modest provisions enforce reserving provided seeking avoid regulation registering." U.S.App.D.C., 323, F.2d, 430. 12 said, further, enacted scheme, reserved "legitimate chain." Persons "authorized (the) subchapter" within thus thought immunized section.7 13 advances basic arguments, contending each requires affirmance Appeals: (i) held, 843; (ii) event, question. now consider these arguments. Section 841(a)(1) "(e) xcept subchapter Relying language, per se take different exempted. By person." relied "Persons subchapter." This certain activities, blanket persons. limitation emphasized subsection's heading "Authorized activities," parallels headings "Unlawful acts." think 16 822(b) construed authorize exempting constraints, constitute sharp departure prior laws. But intent. Physicians stepped bounds practice Harrison (Narcotics) 1914, 38 785, predecessor Jin Fuey Moy States, 254 189, 41 98, 65 214 (1920), affirmed facts remarkably similar us (e. g., examination, directions use, graduated prescribed). upheld Behrman, 258 280, 42 303, 66 619 (1922), where defendant-doctor morphine, cocaine whom knew addict. 17 enacting attempted devise flexible structure Act. H.R.Rep.No.91-1444, Pt. 1, pp. (1970), U.S.Code Cong. & Admin.News 1970, p. 4566.8 Penalties geared violation, including character involved. "strengthen," weaken, "existing law enforcement field abuse." 1236 (1970) (preamble). See 1. 18 original bill date9 "make clear title handle substances." 38, 4606. unlikely seek, oblique way, carve out major exemption, registrants. Rather, prosecuted. B 19 nonetheless contends must interpreted light congressional up separate distinct systems: 841, sanctions 843. latter sections, argument goes, sole 20 sections provides real proposition systems. true All provide "(i)t (to commit proscribed acts)." Two 842(a), 843(a), 842(b) further qualify "who registrant." limited. context, "registrant" limiting term, indicating "persons" "registrants."10 means "nonregistrants" introducing subsections. indications do discrete 843(b), example, communication facility committing felony provision subchapter. violations both lead convictions; misdemeanors.11 ss 842(c)(2)(A), 802(13); And counsel agreed oral 841(a)(2), prohibits creation, distribution, dispensing, possession "counterfeit substance." defendant. embodied originated 501-503 Dangerous 1969. Report Senate Judiciary Committee described 501 counterpart 841) applying "traffickers." S.Rep.No.91-613, (1969). 502 "(a) dditional involved trade," "(f)urther specified 503. 9. House become explains: "The control problems related abuse manufacturers, wholesalers, retailers, chain, transactions chain illegal." 3, 4569. Although ambiguous, sensible interpretation imposed turn "transaction" falls channels. engage "(m)ore technical violations." 10. "severe penalties" those, drugs, purposes, "primarily profits derived therefrom." Ibid. C 23 particularly diversion channels illegitimate Id., 6; 4; 116 Cong.Rec. 996 (remarks Sen. Dodd). aware registrants, greatest access therefore opportunity diversion, responsible part illegal traffic. id., 1663 Hruska); 998 Griffin). 24 Recognizing concern suggested (a)(1) having violated prescriptions.12 Whether Court.13 note, hardly deemed appropriate sanction trafficking physician. Indeed, lighter than, applicable suspended number.14 traffic threat could, basis prosecution, directly formality prescription. Direct reached s long requirements complied with. 25 we relating procedures. "pusher."15 III 26 argues even prosecutions express exemption section. 27 instructed find 28 "beyond doubt physician, intentionally, (methadone) prescription, good faith accordance standard recognized States." App. 123. 29 address concluded circumstances. "usual 322 n. 11, 429 11. departed same street pushers legitimacy. register deliver federal order forms. requirement apply "the aforesaid only." 786. As noted above, strengthen weaken eliminate existing doctors.16 difficulty arises unlike spell unambiguous terms. 31 Instead expressly removing protection operate practice, uses concept "registration." defines scope circular terms: substances) statute, 32 Registration practitioners17 mandatory applicant State practices.18 823(f). contemplates medicine connection practice.19 follows automatically, extends further. chain" illegal. 3. Implicit understanding act "as physician." 33 made explicit 802(20), "practitioner" "registered jurisdiction practices research, to, administer, teaching chemical analysis, research." purposes describes type contemplated "in 34 Other throughout reflect confine limits. 812(b)(2) includes definition "(t)he (have) currently restrictions." I defined "no States," 812(b)(1)(B), follow automatically state Schedules V, use. record reporting 827 inapplicable narcotic V "by practitioner 827(c)(1) (A). 828(a) unless pursuant forms; 828(e) forms "for business 844(a) obtained "from practitioner, otherwise 885(a)(2). 35 presented sufficient exceeded practice."20 detailed inadequate none all. ignored tests make. give clinic took precautions misuse diversion. regulate dosage all, prescribing much frequently demanded. charge rendered, fee number desired. practical "pusher" IV 36 contended experimenting theory believe him. understandably testing theories. far authorizing experimentation physicians. compel "registrants," pharmacists 37 Comprehensive Abuse Prevention Control 1236, Title faced problem directly. Because potential decided necessary. expressed Prettyman Commission: "(A) controversy has existed fifty 39 practicing confused Out fear many refuse narcotics occasionally regimen lasting longer weeks. instances shun patients."21 Congress' solution 1970 257a. Secretary Health, Education, Welfare, after consultation Attorney General national organizations, "determine addiction designed "to clarify profession safely patients." 14, 4580. pointed "criminal prosecutions" past turned opinions prosecutors. "(t)hose comply recommendations jeopardize careers 15, 4581. negative implication remain penalties. clear. admitted trial,22 purposes. His revoked. Nor unfamiliar procedures Charges arising 1969 combination "long term" "short detoxification, dropped grand abide future programs. obtaining patient, reasonably thorough abiding urine tests, recording times amounts dosages, either administering daily dosage.23 At failed procedures.24 finally sufficiently ambiguous favor despite Congress. "when choice between readings what crime, appropriate, choose harsher alternative, require should spoken definite." Universal C.I.T. Credit Corp., 344 218, 221-222, 73 227, 229, 97 260 (1952). case, principle forth 380, 442 (1948), appropriately followed: 43 (of statutes) inexorable command override common sense evident purpose. demand 'narrowest meaning'; judgment reversed. disposition question 845, higher age. remand considering improperly 44 So ordered. 45 Judgment listed "a high abuse," restrictions," "may dependence." 812(b)(2). 812(c), (b)(11). addition, license D.C.Code Ann. 2-131 (1973), revocation upon felony." An appeal supersedeas revoking One taking approximately pills started visiting end Id. 43. Another intake almost 70. 53-54. third addict, seven 100. Tr. 310. 841(a) provides, full: substance; "(2) create, counterfeit "Dispense" 802(10) mean ultimate user by, of, 802(11) "distribute" (other dispensing) "Administer" refers direct application body 802(2). relevant Unlawful acts. "It title; another manufacture registration; "(3) 825 "(4) remove, alter, obliterate symbol "(5) fail make, keep, furnish record, report, notification, declaration, form, statement, invoice, information chapter; "(6) entry into premises inspection "(7) break, injure, deface seal placed 824(f) 881 remove dispose seal; "(8) own advantage, reveal, duly officers employees courts judicial proceeding chapter, acquired concerning process trade secret entitled protection. "(b) Manufacture. quota assigned 826 excess title." classified schedule II, business, form 828 fictitious, revoked, suspended, issued person; acquire misrepresentation, fraud, forgery, deception, subterfuge; false fraudulent material in, omit from, application, document made, filed punch, die, plate, stone, thing print, imprint, reproduce trademark, name, identifying mark, device likeness foregoing container labeling thereof render substance. Communication facility. causing facilitating commission constituting chapter. Each subsection. For subsection, 'communication facility' public private instrumentalities useful transmission writing, signs, signals, pictures, sounds kinds mail, telephone, wire, radio, communication." Violations convicted, carry years, fines $25,000, both. 841(b). Knowing violators year, fine civil $25,000 842. 842(c). four $30,000, 843(c). impose conviction. decision below stands alone. time conflicted rulings Circuits. Courts First, Fifth, Tenth Circuits squarely Badia, 490 296 (CA1 1973); Collier, 478 268 (CA5 Leigh, 487 206 Bartee, 479 484 (CA10 Jobe, 1973). Ninth Larson, 507 385 Since ruling decisions considered rejected analysis Circuit. Rosenberg, 515 190 (CA9 1975); Green, 511 1062 (CA7 1975). Sixth implicitly agreed. remanded instruct regular Carroll, 518 187 (6 Cir. To categories abuse, promise treatment, effects. 812. Interstate Foreign Commerce. No comparable passed January 28, 1970. represents commonsense recognition "not registration," 842(a)(2); registration" (his) quota." 842(b)(1), (2). reason complying order-form 842(a)(3), 843(a)(1), barred making distributions whatsoever. sensibly 842(a)(1), C." Part 821-829, covers applies "(e)very manufactures, distributes, dispenses proposes" so. 822(a). Presumably, 842(a)(1) phrased part: dispensed pharmacist, user, determined Federal Food, Drug, Cosmetic emergency situations, General, 353(b) title. Prescriptions retained refilled. "(b)Schedule IV, Such refilled six date renewed "(c) "No distributed purpose." General's regulations that: "A effective individual responsibility proper corresponding rests pharmacist fills purporting 309 (21 829) filling purported well it, CFR 306.04(a) (1973) (redesignated 1306.04(a) (1975)). "medical purpose" something "written prescription" 829. dissent, rely regulations. inherent "prescription" valid face addresses take. 829(a). Either IV. 829(b). 829(c). implicit (b). Regulation 306.04 explicit. doctor severely financial profit nonregistrants. 842(a)(2). deregistration refusal reregister. But, neither engaged. practitioners licenses, 823(f), "materially falsified" drug-related felony. 824(a). Conviction misdemeanor insufficient revocation. Narcotic Addict Treatment 1974 (NATA), 88 124, 802, 823, 824 (1970 ed., Supp. IV), modified facilitate "more expeditious" easier. doctors escape altogether pre-NATA law. sought "cure present intricate nearly impossible burden establishing 'the practice' speciously claims ethical humanitarian nature." S.Rep.No.93-192, (1973). cited illustrate successful actions brought aggravated circumstances prolonged effort make undercover penetrations." 13. "Practitioner" dentist, veterinarian, scientific investigator, pharmacy, hospital, licensed, registered, permitted, 802(20). manufacturers nonpractitioner distributors (such suppliers) discretionary General. finding consistent (in drugs) III-V distributors) interest. evaluating interest consider, "maintenance diversion," compliance local law, charges, experience, manufacturers) promotion manufacturing development Practitioners II-V "if rationale behind 823(f) follows: "Practitioners matter right firm involving permitted 4590 (emphasis added). "an honest effort" 124. President's Advisory Commission 56-57 (1963), quoted 14-15. 101. 97-100, 116, 136-138. 97-100.

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