No Chevron Needed: DEA Registration Does Not Immunize Practitioners from § 841(a); Sixth Circuit Affirms Ruan Knowledge Can Be Proven Circumstantially in Pregnant-Patient Prescribing

Case: United States v. Jeffrey W. Young, Jr., No. 24-5430 (6th Cir. Oct. 28, 2025) (not recommended for publication)

Panel: Stranch, Bush, and Davis, JJ. (opinion by Davis, J.)

Court: U.S. Court of Appeals for the Sixth Circuit

Introduction

This appeal arises from the prosecution of a nurse practitioner, Jeffrey Young, Jr., who operated a clinic (Preventagenix) in Jackson, Tennessee that evolved into a high-volume pain and addiction practice. The government charged Young with a 15-count indictment stemming from his prescription of controlled substances to hundreds of patients. The centerpiece of the appeal is a subset of six counts involving prescriptions of opioids to a pregnant patient, Hope Rogers (now Arment), between March and July 2015.

After a jury convicted Young on all counts, he moved under Rule 29 for a judgment of acquittal (arguing the evidence was insufficient on the six “pregnant patient” counts) and separately moved to dismiss for lack of subject-matter jurisdiction (arguing, among other things, that as a DEA registrant he was “authorized” under 21 U.S.C. § 841(a) and that post–Loper Bright the government could not rely on the regulation at 21 C.F.R. § 1306.04). The district court denied both motions, and Young appealed.

The Sixth Circuit affirmed. It held that a rational jury could find beyond a reasonable doubt that Young knowingly issued unauthorized prescriptions lacking a legitimate medical purpose and outside the usual course of professional practice, satisfying § 841(a)(1) (as incorporated in the pregnancy counts with § 861(f) and aiding-and-abetting). On jurisdiction, the court reaffirmed that DEA registration does not immunize a practitioner from § 841(a) (United States v. Moore) and that the indictment’s allegations were sufficient without invoking deference doctrines, rendering the Loper Bright/Chevron issues immaterial.

Summary of the Opinion

Sufficiency of the evidence (Counts 2–7): Viewing the record in the light most favorable to the government, the court held that a rational jury could find all elements under § 841(a)(1) as charged with § 861(f): Young knowingly distributed controlled substances to a patient he knew was pregnant; his prescriptions lacked a legitimate medical purpose and were outside the ordinary course of professional practice. The court emphasized expert testimony detailing stark deviations from accepted standards—particularly for pregnant patients with opioid dependence—and circumstantial evidence (including Young’s text messages acknowledging risks in pregnancy and his ignoring aberrant drug-screen results) to support the Ruan knowledge requirement.
Subject-matter jurisdiction: The court rejected Young’s argument that his DEA registration deprived the district court of subject-matter jurisdiction or defeated the indictment. Relying on United States v. Moore and Gonzales v. Oregon, the court held that only lawful acts of registrants are exempt from § 841(a) and that § 1306.04’s validity or interpretive deference (Chevron/Auer) need not be resolved to sustain jurisdiction. The indictment sufficiently alleged conduct outside professional practice, satisfying the elements. Ruan confirms the government need not plead lack of authorization in the indictment.
Disposition: Affirmed in all respects.

Analysis

Precedents Cited and Their Influence

United States v. Moore, 423 U.S. 122 (1975): Foundational CSA precedent holding that registered practitioners are not per se exempt from § 841(a). Only lawful prescribing “in the course of professional practice” is authorized. The Sixth Circuit treats Moore as dispositive of Young’s “I was registered, so I’m authorized” theory. Because Moore rests on the CSA’s text and structure rather than on deference to regulation, it forecloses jurisdictional arguments premised on DEA registration.
Gonzales v. Oregon, 546 U.S. 243 (2006): The Court declined to defer under Auer to § 1306.04 when the regulation merely paraphrased statutory language. Gonzales underscores that courts determine the CSA’s scope by statutory interpretation, not agency say-so. The Sixth Circuit leverages Gonzales to show that deference doctrines are unnecessary here, especially post–Loper Bright.
Ruan v. United States, 597 U.S. 450 (2022): Clarifies mens rea for practitioner prosecutions: once the defendant meets the burden of production that his conduct was “authorized,” the government must prove beyond a reasonable doubt that the practitioner knowingly or intentionally acted without authorization (i.e., without legitimate medical purpose and outside the usual course). The panel uses Ruan to frame the knowledge inquiry and to confirm that the indictment need not plead “lack of authorization.”
United States v. Suetholz, No. 23-5613, 2024 WL 4182903 (6th Cir. Sept. 13, 2024): Applying Ruan, the Sixth Circuit recognized that the government may prove knowledge circumstantially, including through expert testimony demonstrating sharp deviations from professional norms. The court here follows Suetholz, treating expert testimony about departures from standard-of-care as powerful circumstantial proof of knowing lack of authorization.
United States v. Bauer, 82 F.4th 522 (6th Cir. 2023): Post-Ruan guidance in the Sixth Circuit on proving knowledge. Together with Suetholz, Bauer reinforces that objective deviations—when stark—can support an inference of subjective knowledge.
United States v. Anderson, 67 F.4th 755 (6th Cir. 2023): Restates § 841(a)(1) elements in practitioner cases and endorses reliance on expert review of patient files to show lack of legitimate purpose and practice outside the ordinary course, including non-enforcement of compliance measures. This provided a template for the evidentiary showing against Young.
United States v. Elliott, 876 F.3d 855 (6th Cir. 2017): Confirms that expert testimony can distinguish a physician’s actions from ordinary practice and support § 841(a) liability.
United States v. Chaney, 921 F.3d 572 (6th Cir. 2019): Upholds conviction where the physician increased opioid prescriptions after incongruent drug screen results, a fact pattern mirrored in Young’s treatment of Rogers.
United States v. Romano, No. 24-3463, 2025 WL 2061204 (6th Cir. July 23, 2025): Rejects sufficiency challenges where high-dose opioids were prescribed despite evident addiction and inadequate warnings—again echoing features in this record.
United States v. Zayas, 32 F.4th 211 (3d Cir. 2022): On § 861(f), the Third Circuit concluded the government must prove knowledge of the patient’s pregnancy. The Sixth Circuit cites Zayas as persuasive authority; the parties here did not dispute knowledge of pregnancy.
Indictment/Jurisdiction Authorities: United States v. Bacon, 884 F.3d 605 (6th Cir. 2018) (de novo review of jurisdiction); United States v. Cotton, 535 U.S. 625 (2002) (subject-matter jurisdiction cannot be waived and concerns court’s power); United States v. Anderson, 605 F.3d 404 (6th Cir. 2010) and Hamling v. United States, 418 U.S. 87 (1974) (indictment sufficiency standard); Ruan, 597 U.S. at 462 (indictment need not allege lack of authorization).

Legal Reasoning

1) Sufficiency of the evidence under § 841(a)(1) (Counts 2–7): The court conducts de novo review under the familiar “any rational trier of fact” standard, drawing all reasonable inferences in the government’s favor and eschewing credibility reassessments. The first two elements were uncontested: Young distributed controlled substances by prescription during Rogers’s pregnancy, and he knew of the pregnancy (as reflected in his chart).

Mens rea after Ruan: The dispute centered on whether Young knowingly issued unauthorized prescriptions. Post-Ruan, the government must prove the defendant knew his prescriptions were outside authorization. The panel drew on Suetholz and Bauer to emphasize that this knowledge can be proven circumstantially. Here, the government offered:

Expert testimony (Dr. Tricia Aultman): She opined unequivocally that each of the six prescriptions was not for a legitimate medical purpose and was outside professional practice, highlighting that opioids are “not a drug of choice in pregnancy” and are “contraindicated” absent extraordinary necessity. She identified failures in diagnosis (“no investigation”), monitoring, and adherence to accepted treatment for pregnant patients with opioid dependence (i.e., transitioning to methadone or buprenorphine-based therapy).
Evidence of conscious disregard: Young ignored an aberrant drug screen (positive for oxycodone when not prescribed) and escalating signs of misuse/diversion yet continued and increased prescriptions. He failed to counsel the patient on risks, and resisted clinic efforts to discharge her after noncompliance. Under Anderson and Chaney, such conduct supports findings of noncompliance with professional standards and awareness thereof.
Text messages acknowledging risk: Young wrote that “Xanax” in pregnancy is a “definite no” because it would harm the baby, supporting the inference he appreciated the risk profile of controlled substances in pregnancy and, by extension, that his departures from the standard-of-care were not inadvertent.

In combination, this evidence permitted a rational jury to find both lack of legitimate medical purpose and prescribing outside the ordinary course—and, crucially post-Ruan, that Young knew as much when he wrote the scripts.

2) Subject-matter jurisdiction and indictment sufficiency: Young’s jurisdictional attack had multiple layers: he was a DEA registrant (hence “authorized”); § 1306.04’s “legitimate medical purpose” and “usual course” gloss needed Chevron or Auer deference; the APA allegedly was not followed; and Loper Bright’s abrogation of Chevron undermined the government’s theory. The panel held it need not reach the deference/APA/Loper Bright questions because Moore controls the threshold issue: registration does not per se authorize all prescribing. Only lawful acts are exempt; practitioners who exceed professional bounds can be prosecuted under § 841(a).

Further, relying on Gonzales v. Oregon, the court explained that § 1306.04 merely paraphrases statutory standards and does not require interpretive deference to uphold prosecutions under § 841(a). On pleading, Ruan confirms the government need not allege lack of authorization in the indictment; the indictment is sufficient if it contains the offense elements and fairly informs the defendant—which this indictment did by alleging prescriptions outside the professional course. Consequently, the district court had subject-matter jurisdiction.

Impact

Practitioner prosecutions post-Ruan: This decision reinforces that prosecutors can meet Ruan’s knowledge requirement with circumstantial evidence, especially robust expert testimony mapping stark deviations from mainstream practice. Documentary proof (charts, drug screens), patient compliance failures, and even offhand communications (texts, emails) can round out the inference of knowing lack of authorization.
DEA registration offers no shield: The court’s reliance on Moore and Gonzales—independent of any deference to § 1306.04—means that Loper Bright’s curtailment of Chevron is a non-issue for § 841(a) prosecutions against registrants. Expect future challenges that hinge on deference to falter where the statute itself contains the operative “authorization” limits.
Pregnancy-specific enhancements (§ 861(f)): Although the parties did not dispute knowledge of pregnancy, the court’s citation to Zayas highlights the knowledge-of-pregnancy element. Expect focused litigation on what evidence establishes a practitioner’s knowledge (or deliberate ignorance) of pregnancy when § 861(f) is charged.
Clinical compliance and standard-of-care: The opinion emphasizes the importance of adherence to compliance protocols (responding to aberrant screens, managing addiction risks, and providing risk counseling), particularly during pregnancy. Inconsistent drug screens and failure to transition dependent pregnant patients to evidence-based therapies (methadone or buprenorphine) are markers juries may view as outside the “usual course.”
Indictment sufficiency and jurisdiction: Defendants are unlikely to succeed in dismissing CSA indictments as jurisdictionally defective merely because they are registrants or because the indictment does not plead lack of authorization. Ruan and classic indictment sufficiency rules (Hamling/Anderson) foreclose that path.
Unpublished but persuasive: While not precedential in the Sixth Circuit, the opinion is citable for its application of Moore and Ruan, and for its treatment of post–Loper Bright arguments as irrelevant to the CSA’s authorization analysis.

Complex Concepts Simplified

21 U.S.C. § 841(a)(1): Makes it a crime to distribute or dispense controlled substances “except as authorized.” For practitioners, a prescription is “authorized” only if it is for a legitimate medical purpose and within the usual course of professional practice.
“Legitimate medical purpose” and “usual course of professional practice”: These are statutory touchstones, long recognized in Moore. They are informed by accepted medical standards, clinical guidelines, and compliance protocols. Expert testimony often frames the boundaries.
Ruan’s knowledge requirement: In practitioner cases, the government must prove the defendant knew or intended that the prescriptions were unauthorized. This can be shown with circumstantial evidence—gross deviations from norms, ignored red flags, and internal acknowledgments of risk.
21 U.S.C. § 861(f) (pregnancy): Adds a pregnancy-specific dimension, requiring the government to prove the defendant knew the patient was pregnant. Courts look to chart notes, test results, and communications. Here, both sides agreed Young knew.
DEA registration: A license to prescribe controlled substances within legal limits. It does not immunize unlawful prescribing. Moore squarely rejects any per se exemption for registrants.
Chevron/Auer/Loper Bright: Chevron and Auer are deference doctrines to agency interpretations. Loper Bright curtailed Chevron, but here, deference is unnecessary because the CSA’s authorization limits come from the statute itself, as construed in Moore and Gonzales.
Rule 29 motion (sufficiency of the evidence): A request for acquittal on the ground that no rational jury could find guilt beyond a reasonable doubt. Courts view the evidence in the government’s favor and do not reweigh credibility.
Subject-matter jurisdiction vs. merits: Jurisdiction concerns the court’s power to hear a criminal case; indictment sufficiency asks whether it alleges a federal offense. Merits issues (e.g., whether conduct was authorized) are typically for trial, not jurisdiction.
Aberrant drug screen and compliance protocols: In pain management, incongruent screens are red flags. The standard-of-care requires investigation, possible tapering or termination, and documented risk counseling. Ignoring such red flags can evidence prescribing outside the usual course.
Methadone or buprenorphine (Suboxone) in pregnancy: Evidence-based treatments for pregnant patients with opioid use disorder; failure to consider or transition to these modalities may show deviation from accepted practice.

Conclusion

United States v. Young offers a clear, if unpublished, reaffirmation of two pillars of practitioner liability under the Controlled Substances Act. First, under Moore, DEA registration is no bar to prosecution; only lawful, professionally grounded prescribing is “authorized.” This conclusion stands independently of any agency deference, rendering post–Loper Bright arguments beside the point. Second, under Ruan, the Sixth Circuit confirms that knowledge of unauthorized prescribing can be proven with circumstantial evidence, and that expert testimony demonstrating stark departures from the standard-of-care—especially in sensitive contexts like pregnancy—can carry the government’s burden alongside documentary and contextual proof.

On these facts, the government’s case was more than sufficient: expert testimony, ignored compliance red flags, and Young’s own statements amply supported the jury’s findings that his six pregnancy-era prescriptions lacked a legitimate medical purpose and were written outside the course of professional practice, and that he knew as much. The indictment’s allegations were likewise sufficient to confer jurisdiction. The decision thus fortifies the Moore–Ruan framework and signals that, in the Sixth Circuit, registrant status and deference skirmishes will not derail § 841(a) prosecutions where the trial record demonstrates glaring deviations from accepted medical practice.