Petition for Rehearing — John L. Stanton, Petitioner v. United States

NO. 24-525

In the

Supreme Court of the United States

JOHN L. STANTON, M.D.,

Petitioner,

v.

UNITED STATES OF AMERICA,

Respondent.

__________________________

On Petition for a Writ of Certiorari to the

United States Court of Appeals for the Sixth Circuit

PETITION FOR REHEARING

Matthew J. Pelcowitz

CHAPMAN LAW GROUP

701 Waterford Way, Ste. 340

Miami, FL 33126

(305) 712-7177

Ronald W. Chapman II

Counsel of Record

CHAPMAN LAW GROUP

1441 W. Long Lake Rd., Ste. 310

Troy, MI 48098

(248) 644-6326

rwchapman@chapmanlawgroup.com

February 7, 2025

SUPREME COURT PRESS

Counsel for Petitioner

♦

(888) 958-5705

♦

BOSTON, MASSACHUSETTS

i

TABLE OF CONTENTS

Page

TABLE OF AUTHORITIES ....................................... ii

PETITION FOR REHEARING .................................. 1

REASONS FOR GRANTING REHEARING ............. 1

CONCLUSION............................................................ 3

RULE 44.2 CERTIFICATE ........................................ 4

REHEARING APPENDIX

TABLE OF CONTENTS

American Society of Addiction Medicine

Public Policy Statement ..................................... 1a

ii

TABLE OF AUTHORITIES

Page

TABLE OF AUTHORITIES

CASES

United States v. Moore,

423 U.S. 122 (1975) ............................................. 1

STATUTES

21 U.S.C. § 841(a) ............................................... 1, 2, 3

JUDICIAL RULES

Sup. Ct. R. 44.2............................................................. 1

OTHER AUTHORITIES

American Society of Addiction Medicine,

Reducing Risk of Federal Investigation or

Prosecution for Prescribing Controlled

Addiction Medications for Legitimate

Medical Purposes (Jan. 31, 2025), https://

www.asam.org/advocacy/public-policystatements/details/public-policystatements/2025/01/03/reducing-risk-offederal-investigation-or-prosecution-forprescribing-controlled-addictionmedications-for-legitimate-medicalpurposes. .............................................................. 2

1

PETITION FOR REHEARING

Petitioner, John L. Stanton, respectfully petitions

for rehearing of this Court’s January 13, 2025, Order

denying his petition for a writ of certiorari.

REASONS FOR GRANTING REHEARING

Rule 44.2 authorizes a petition for rehearing based

on <intervening circumstances of a substantial . . . effect.=

Dr. Stanton’s petition explained why this Court’s review

was warranted in this first instance4namely that the

government has broadened the scope of enforcement

under 21 U.S.C. § 841(a) past simply drug trafficking

to convict physicians even where their prescriptions

were for a legitimate medical purpose. This is significant

given that such enforcement directly contradicts this

Court’s holding in United States v. Moore, 423 U.S.

122 (1975) that the harsh penalties under Section

841(a) are reserved only for drug trafficking. Id. at

137.

The American Society of Addiction Medicine

(ASAM) is now specifically calling for this Court to rein

in the government’s enforcement of Title 21. In its

recent public policy statement on December 12, 2024,

which was not provided to the Court in Dr. Stanton’s

prior pleadings, the ASAM presses for the adoption of

a conjunctive standard under Section 841(a).1 That

1 American Society of Addiction Medicine, Reducing Risk of Federal

Investigation or Prosecution for Prescribing Controlled Addiction

Medications for Legitimate Medical Purposes (Jan. 31, 2025),

2

public policy statement is provided in the appendix

accompanying this petition and it reminds the government that Congress’ intent in passing the Controlled

Substance Act (CSA) <was to prevent the trafficking

or dealing of drugs, not to ensure good quality medical

treatment.=2 The statement then closes by recommending, inter alia, that this Court decide that the

CSA and its regulations require a conjunctive standard.

https://www.asam.org/advocacy/public-policy-statements/details/

public-policy-statements/2025/01/03/reducing-risk-of-federalinvestigation-or-prosecution-for-prescribing-controlled-addictionmedications-for-legitimate-medical-purposes.

2 Id.

3

CONCLUSION

Accordingly, Dr. Stanton respectfully submits

that the Court should grant his petition for rehearing

to clarify that 21 U.S.C. § 841(a) requires that the

government prosecute a physician under a conjunctive

standard.

Respectfully submitted,

Ronald W. Chapman II

Counsel of Record

CHAPMAN LAW GROUP

1441 W. Long Lake Rd., Ste. 310

Troy, MI 48098

(248) 644-6326

rwchapman@chapmanlawgroup.com

Matthew J. Pelcowitz

CHAPMAN LAW GROUP

701 Waterford Way, Ste. 340

Miami, FL 33126

(305) 712-7177

Counsel for Petitioner

February 7, 2025

4

RULE 44.2 CERTIFICATE

I hereby certify that that this Petition for Rehearing

is presented in good faith and not for delay. In addition,

the grounds of this petition are limited to intervening

circumstances of a substantial or controlling effect or

to other substantial grounds not previously presented.

/s/ Ronald W. Chapman II

Ronald W. Chapman II

Counsel of Record

CHAPMAN LAW GROUP

1441 W. Long Lake Rd., Ste. 310

Troy, MI 48098

(248) 644-6326

rwchapman@chapmanlawgroup.com

February 7, 2025

REHEARING APPENDIX

TABLE OF CONTENTS

American Society of Addiction Medicine

Public Policy Statement ..................................... 1a

Reh.App.1a

AMERICAN SOCIETY OF ADDICTION

MEDICINE PUBLIC POLICY STATEMENT

ASAM – American Society of

Addiction Medicine

Public Policy Statement on Reducing Risk

of Federal Investigation or Prosecution for

Prescribing Controlled Addiction Medications

for Legitimate Medical Purposes

Background

Addiction medications, such as medications for

opioid use disorder (MOUD), are lifesaving treatments

for addiction. Methadone and buprenorphine (i.e.,

agonist MOUD) are the current gold standard for

treating opioid use disorder (OUD),1 decreasing morta-

 Addiction medications are medications that are specifically

indicated for and prescribed to treat substance use disorders as an

initial lifesaving measure, as a motivational engagement strategy

(i.e., withdrawal management), and as part of a long-term treatment plan similar to medications used to treat other chronic conditions, such as bipolar disorder, hypertension, or diabetes.

1 Klimas J, Hamilton MA, Gorfinkel L, Adam A, Cullen W, Wood

E. Retention in opioid agonist treatment: a rapid review and metaanalysis comparing observational studies and randomized controlled trials. Syst Rev. Aug 6 2021;10(1):216. doi:10.1186/s13643021-01764-9

Reh.App.2a

lity risks by 50% among people with OUD. 2 Unfortunately, in 2023 fewer than 20% of people with OUD

in the US received MOUD.3 Several reasons exist for the

underutilization of MOUD, including the limited

number of practitioners who offer buprenorphine and

the limited supply of opioid treatment programs. For

example, an estimated 30% of counties lack buprenorphine prescribers, with particularly low rates in rural

counties.4 Despite the elimination of the federal waiver

requirement, buprenorphine prescribing remains low.5

Fear of intrusion into clinical practice by the Department of Justice (DOJ), including the Drug Enforcement

Administration (DEA), is a key buprenorphine prescribing

2 Santo T, Jr., Clark B, Hickman M, et al. Association of Opioid

Agonist Treatment With All-Cause Mortality and Specific Causes

of Death Among People With Opioid Dependence: A Systematic

Review and Meta-analysis. JAMA Psychiatry. 2021;78(9):979-993.

doi:10.1001/jamapsychiatry.2021.0976

3 Substance Abuse and Mental Health Services Administration.

Key substance use and mental health indicators in the United

States: Results from the 2023 National Survey on Drug Use and

Health (HHS Publication No. PEP24-07-021, NSDUH Series H59). Center for Behavioral Health Statistics and Quality, Substance

Abuse and Mental Health Services Administration 2024.

4 Corry B, Underwood N, Cremer LJ, Rooks-Peck CR, Jones C.

County-level sociodemographic differences in availability of two

medications for opioid use disorder: United States, 2019. Drug

Alcohol Depend. Jul 1 2022;236:109495. doi:10.1016/j.drugalcdep.

2022.109495

5 Ali MM, Chen J, Novak PJ. Utilization of Buprenorphine for

Opioid Use Disorder After the Practitioner Waiver Removal. Am

J Prev Med. Sep 18 2024;doi:10.1016/j.amepre.2024.09.013

Reh.App.3a

barrier.6 7 8 9 10 11 12 Practitioners fear they will be

investigated or prosecuted for well-intentioned actions

that violate ambiguous federal law. Nevertheless, as

compared to other known barriers to buprenorphine

prescribing (e.g., prior authorization requirements

6 Mendoza S, Rivera-Cabrero AS, Hansen H. Shifting blame:

Buprenorphine prescribers, addiction treatment, and prescription

monitoring in middle-class America. Transcultural Psychiatry.

2016;53:465-487. doi:10.1177/1363461516660884

7 Nyaku AN, Zerbo EA, Chen C, et al. A survey of barriers and

facilitators to the adoption of buprenorphine prescribing after

implementation of a New Jersey-wide incentivized DATA-2000

waiver training program. BMC Health Serv Res. Feb 8 2024;

24(1):179. doi:10.1186/s12913-024-10648-2

8 Andraka-Christou B, Capone MJ. A qualitative study comparing

physician-reported barriers to treating addiction using buprenorphine and extended-release naltrexone in U.S. office-based practices. International Journal of Drug Policy. 2018;54:9-17. doi:10.

1016/j.drugpo.2017.11.021

9 Andrilla CHA, Coulthard C, Larson EH. Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder.

Ann Fam Med. Jul 2017;15(4):359-362. doi:10.1370/afm.2099

10 Fenstemaker C, Abrams EA, Obringer B, King K, Dhanani LY,

Franz B. Primary care professionals9 perspectives on tailoring

buprenorphine training for rural practice. J Rural Health. Mar

14 2024;doi:10.1111/jrh.12832

11 Albright J, Ciaverelli R, Essex A, Tkacz J, Ruetsch C.

Psychiatrist Characteristics That Influence Use of Buprenorphine

Medication-Assisted Treatment. Journal of Addiction Medicine.

2010;4:197-203. doi:10.1097/ADM.0b013e3181c816f3

12 Jones CM, McCance-Katz EF. Characteristics and prescribing

practices of clinicians recently waivered to prescribe buprenorphine

for the treatment of opioid use disorder. Addiction. 2019;114:471482. doi:10.1111/add.14436

Reh.App.4a

and lack of OUD treatment knowledge), advocates

and policymakers have paid little attention to fear of

DOJ or DEA intrusion as an important deterrent to

practitioners9 willingness to offer this MOUD.

Regardless of whether buprenorphine prescribing

actually increases the risk of DOJ investigation/

prosecution, the perception that buprenorphine prescribing could increase risks of investigation/prosecution is a prescribing barrier. Even if a DOJ investigation or prosecution does not result in a conviction, the

costs (personal, professional, and financial) of responding

to an investigation/prosecution could prevent practitioners from initiating and/or continuing to offer

MOUD. The perceived risk of investigation/prosecution can be particularly powerful when combined with

other barriers to prescribing, such as prior authorization burdens, inadequate reimbursement,13 state

law requirements for buprenorphine prescribing,14,15

low self-confidence in treating OUD,16 and stigma

against patients with OUD, potentially contributing

to the belief that buprenorphine treatment is more

complicated and <risky= than treatment for other

13 Huhn AS, Dunn KE. Why aren9t physicians prescribing more

buprenorphine? Journal of Substance Abuse Treatment. 2017;78:17. doi:10.1016/j.jsat.2017.04.005

14 Andraka-Christou B, Golan OK, Williams M, Buksbaum S,

Gordon AJ, Stein BD. A Systematic Review of State Office-Based

Buprenorphine Treatment Laws Effective During 2022: Counseling,

Dosage, and Visit Frequency Requirements. Substance Use &

Addiction Journal 2024;In pressdoi:10.1177/29767342231223721

15 Andraka-Christou B, Gordon AJ, Bouskill K, et al. Toward a

Typology of Office-based Buprenorphine Treatment Laws: Themes

from a Review of State Laws. J Addict Med. May 18 2021;16(2):192207. doi:10.1097/ADM.0000000000000863

Reh.App.5a

comparable chronic conditions.16,17 Given the high

mortality rate of untreated OUD,18 the effectiveness

of buprenorphine for treating OUD and reducing the

risk of death, and the limited supply of buprenorphine

prescribers, it is imperative that policymakers and

regulators take actions to encourage practitioners to

enter and stay in the OUD treatment field.

Federal regulations implementing the CSA grant

authority for prescribing controlled substances, like

buprenorphine, for <a legitimate medical purpose by

an individual practitioner acting in the usual course

of his professional practice.=19 However, neither the

CSA nor implementing federal regulations define <a

legitimate medical purpose by an individual practitioner

acting in the usual course of his professional practice.=

Furthermore, federal circuit courts have been inconsistent in determining whether a CSA violation requires proof of both (a) violation of legitimate medical

purposes and (b) deviation from the usual course of

16 Louie DL, Assefa MT, McGovern MP. Attitudes of primary

care physicians toward prescribing buprenorphine: a narrative

review. BMC Family Practice. 2019;20(1)doi:10.1186/s12875019-1047-z

17 Herman T, Hasgul Z, Lim TY, Jalali MS, Stringfellow EJ.

Dynamics of prescribing and accessing medications for opioid use

disorder: a community-based systems analysis. Addiction

Research & Theory. 2024:1-12. doi:10.1080/16066359.2024.2420087

18 Larney S, Tran LT, Leung J, et al. All-Cause and Cause-Specific

Mortality Among People Using Extramedical Opioids: A Systematic

Review and Meta-analysis. JAMA Psychiatry. 2020;77(5):493502. doi:10.1001/jamapsychiatry.2019.4170

19 21 C.F.R. § 1306.04(a).

Reh.App.6a

professional practice,20,21 or whether proof of only one

of these conditions is sufficient.22 23 24 25 26 27 28

Jurisdictions that require proof of both conditions are

said to use a conjunctive standard, whereas those requiring proof of only one condition are said to have a

disjunctive standard. Courts have been increasingly

using the disjunctive standard.29

The conjunctive standard does not separate

<legitimate medical purpose= from <by an individual

practitioner acting in the usual course of his professional

practice.= Importantly, a conjunctive standard is better

20 United States v. Feingold, 454 F.3d 1001, 1012 (9th Cir. 2006).

21 United States v. Smith, 573 F.3d 639 (8th Cir. 2009).

22 United States v. Ruan, 966 F.3d 1101 (11th Cir. 2020), vacated

and remanded, 597 U.S. 450, 142 S.Ct. 2370, 213 L.Ed.2d 706

(2022), and cert. granted, judgment vacated sub nom. Couch v.

United States, 142 S.Ct. 2895, 213 L.Ed.2d 1109 (2022), and

adhered to in part, 56 F.4th 1291 (11th Cir. 2023).

23 United States v. Abovyan, 988 F.3d 1288 (11th Cir. 2021).

24 United States v. Heaton, 59 F.4th 1226, n17 (11th Cir. 2023).

25 United States v. Duldulao, 87 F.4th 1239 (11th Cir. 2023).

26 United States v. Armstrong, 550 F.3d 382 (5th Cir. 2008).

27 United States v. Nelson, 383 F.3d 1227 (10th Cir. 2004).

28 United States v. Naum, 832 F. App9x 137 (4th Cir. 2020), cert.

granted, judgment vacated, 142 S.Ct. 2893, 213 L.Ed.2d 1108

(2022).

29 Oliva JD, Dineen KK. Brief of Amici Curiae Professors of

Health Law and Policy in Support of Ruan, Ruan v. United

States, 597 U.S. 450, 142 S.Ct. 2370, 213 L.Ed.2d 706 (2022).

2022.

Reh.App.7a

aligned with the original purposes of the CSA to

prevent drug trafficking,30 addresses concerns about

the amorphous meaning of <the usual course of professional practice,= and could decrease practitioners9

fears about DOJ intrusion that serve as a prescribing

barrier.

A disjunctive standard allows for prosecution

with only proof of violation of the <usual course of professional practice.= This standard has led to fear, because the <usual course of professional practice= is

amorphous and ambiguous. The <usual course of professional practice= may vary among well-intentioned

practitioners due to the heterogeneity of state regulations governing the practice of addiction medicine,

as well as the heterogeneity of patients with substance

use disorder (SUD), practitioners who treat SUD, and

practice settings. Patients have a wide range of

potential complexity. A practitioner may need to

spend more time treating a patient with complex

clinical problems than a patient with fewer healthrelated conditions or whose conditions have stabilized;

therefore, the usual course of practice may differ

significantly between practitioners who tend to treat

more complex cases versus practitioners who tend to

treat less complex cases. Similarly, a practitioner who

is the only buprenorphine prescriber in a high-need

community may have a significantly higher patient

volume than a practitioner in a lower-need community

with more prescribers per capita. Practitioners treating

a higher proportion of patients with OUD involving

fentanyl may need to use higher doses, on average,

than practitioners treating OUD involving heroin or

30 United States v. Rosenberg, 515 F.2d 190 (9th Cir. 1975).

Reh.App.8a

prescription opioids like oxycodone or hydrocodone,

because OUD involving fentanyl is more effectively

managed at higher doses.31 Furthermore, practitioners

serving vulnerable populations, including patients

experiencing homelessness, patients living in remote

and indigenous communities, pregnant and parenting

individuals, or justice-involved individuals may need

to utilize patient centered treatment plans that vary

widely from typical practice, including low-threshold,

flexible approaches, or off-label use of medications.

The DEA has explicitly described <red flags= of

prescribing practices.32 DOJ personnel, however, do

not typically have the requisite medical expertise to

accurately evaluate the totality of the circumstances33

that may explain reasonable differences in prescribing

practices across practitioners. In addition, rigidly

comparing practitioner practices to guidelines or recommendations found in documents from medical professional organizations is inappropriate. Every patient is

unique; practitioners must have the flexibility to exercise their professional judgment, and the pace of change

in scientific knowledge and clinical practice often

31 Chambers LC, Hallowell BD, Zullo AR, et al. Buprenorphine

Dose and Time to Discontinuation Among Patients With Opioid

Use Disorder in the Era of Fentanyl. JAMA Network Open.

2023;6(9):e2334540-e2334540. doi:10.1001/jamanetworkopen.2023.

34540

32 Drug Enforcement Administration. Preventing diversion.

Department of Justice. https://www.deadiversion.usdoj.gov/GDP/

(DEA-DC-13)%20Preventing%20Diversion.pdf.

33 United States v. Parasmo, No. 19-CR-1 (JMA), 2023 WL

1109649 (E.D.N.Y. Jan. 30, 2023).

Reh.App.9a

exceeds the speed of updates to these documents,34

which involve a time-consuming and rigorous development process. For example, an April 2023 study

found almost 90% of addiction medicine practitioners

surveyed had substantially changed their MOUD

prescribing practices over the last five years in response

to the recent fentanyl crisis,35 yet the ASAM clinical

document directly addressing buprenorphine treatment for high-potency synthetic opioids like fentanyl,

describing the need for high doses of buprenorphine,

was not released until July 2023.36 Additionally, while

some practitioners have been prescribing psychostimulant medications off-label to treat stimulant use

disorder for years, ASAM did not release a clinical practice guideline on the management of stimulant use

disorder until 2024, noting that off-label prescribing

of psychostimulant medications for stimulant use

disorder may be appropriate for some patients.37

34 Center for Substance Abuse Treatment. Clinical Guidelines

for the Use of Buprenorphine in the Treatment of Opioid

Addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS

Publication No. (SMA) 04-3939. Rockville, MD: Substance Abuse

and Mental Health Services Administration. 2024.

35 Weleff J, Christian NJ, Wang JX, et al. Navigating new

norms: Addiction specialists9 perspectives on opioid use disorder

treatments and policy challenges in the fentanyl era. The American Journal on Addictions. 2024;doi:10.1111/ajad.13653

36 Weimer MB, Herring AA, Kawasaki SS, Meyer M, Kleykamp

BA, Ramsey KS. ASAM Clinical Considerations: Buprenorphine

Treatment of Opioid Use Disorder for Individuals Using Highpotency Synthetic Opioids. Journal of Addiction Medicine.

2023;17(6):632-639. doi:10.1097/adm.0000000000001202

37 The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder. J Addict Med. May-Jun 01

Reh.App.10a

It is important for regulatory agencies and the

DOJ to consider Congress9 intent in passing the CSA,

which was to prevent the trafficking or dealing of

drugs, not to ensure good quality medical treatment.

Patients already have an alternative recourse – civil

malpractice lawsuits – if they are harmed following

deviation from the standard of care. Problematically,

a disjunctive standard of the CSA allows for more severe

punishment (including imprisonment) of a practitioner

than civil malpractice lawsuits, without the need to

prove patient harm.

The DOJ9s expertise would best be utilized by

focusing on practitioners prescribing for improper

reasons – in other words, without a legitimate medical

purpose. Although the CSA and its regulations do not

define <legitimate medical purpose,= case law suggests

it means having the intention to improve a patient9s

health-related condition.38 39 40 41 Practitioners may be

unsure whether they are following the <usual course

of professional practice,= but they know whether they

have the intention to improve a patient9s healthrelated condition. Therefore, practitioners are far

2024;18(1S Suppl 1):1-56. doi:10.1097/adm.0000000000001299

38 City & Cnty. of San Francisco v. Purdue Pharma L.P., 620 F.

Supp. 3d 936 (N.D. Cal. 2022). United States District Court, N.D.

California.

39 United States v. Moore, 423 U.S. 122, 126, 96 S.Ct. 335, 46

L.Ed.2d 333 (1975).

40 United States v. Tran Trong Cuong, 18 F.3d 1132 (4th Cir.

1994).

41 Ruan v. United States, 597 U.S. 450, 142 S.Ct. 2370, 213

L.Ed.2d 706 (2022) (Alito, Thomas, & Barret, concurring).

Reh.App.11a

less likely to fear DOJ intrusion if the DOJ focuses on

violations of <legitimate medical purpose= rather than

on violations of the <usual course of professional practice.= An amicus brief in the recent US Supreme Court

Case, Ruan v. United States (2022), argued that a

conjunctive standard would address the problem: <Because the standard of care is increasingly used as a

proxy for the 8usual course9 standard, a mistaken or

even somewhat careless prescriber could only be saved

from criminal sanction because of her legitimate medical purpose.=

A practitioner prescribing without a legitimate

medical purpose inherently differs from a wellintentioned practitioner providing atypical or even

low-quality care. Criminal sanctions should be reserved

for practitioners without a legitimate medical purpose.

Citing Supreme Court precedent, the 9th Circuit in

Feingold said juries in CSA cases should <determine

whether a practitioner has acted not as a doctor, or

even as a bad doctor, but as a <pusher= whose conduct

is without a legitimate medical justification.=

Potential indicators of legitimate medical purpose

– i.e., intention to prevent, treat, or manage a healthrelated condition – include but are not limited to

assessing a patient, and weighing the risks and benefits

of clinical options before treatment. For example,

using a person-centered approach, practitioners may

weigh the relative risks and benefits of continued

buprenorphine prescribing to patients who sometimes

misuse their medication and decide that treatment

Reh.App.12a

cessation would pose a greater risk of harm (e.g.,

overdose) to the patient than continued treatment.42

Recommendations

1.

The US Attorney General should address relevant

federal regulations to clarify that <legitimate

medical purpose by an individual practitioner

acting in the usual course of his professional

practice= is a conjunctive standard.

2.

To avoid confusion about the definition of <legitimate medical purpose,= the US Attorney General

should address relevant federal regulations to

clarify that <legitimate medical purpose= means

<for the purpose of preventing, treating, or

managing a patient9s health-related condition.=

3.

When enforcing controlled substance prescribing

requirements under the CSA, the DOJ and DEA

should focus their efforts on practitioners who are

not prescribing controlled substances for legitimate medical purposes.

4.

Federal circuit courts should adopt a conjunctive

standard rather than a disjunctive standard.

5.

The US Supreme Court should decide that the

CSA and its regulations require a conjunctive

standard. The US Supreme Court could base

their rationale on the following: a) the original

purpose of the CSA was to stop drug trafficking

rather than to regulate the practice of medicine;

b) the DOJ violates bedrock principles of federalism

42 Jakubowski A, Fox A. Defining Low-threshold Buprenorphine

Treatment. J Addict Med. Mar/Apr 2020;14(2):95-98. doi:10.1097/

ADM.0000000000000555

Reh.App.13a

when it prosecutes practitioners merely for veering

from the usual course of professional practice;

and c) the plain text of the existing relevant federal

regulation does not separate <legitimate medical

purpose= from <by an individual practitioner

acting in the usual course of his professional

practice.=

Adopted by the ASAM Board of Directors on

December 12, 2024.