Linder v. United States

Summary

Charles O. Linder was a licensed physician in Spokane, Washington, registered under the Harrison Narcotic Act of 1914. In April 1922 he gave a woman named Ida Casey, whom he knew to be addicted to morphine and cocaine, one tablet of morphine and three of cocaine to take herself over a period of time. A federal grand jury indicted him on several counts; the jury acquitted him on all but one, and the Circuit Court of Appeals for the Ninth Circuit affirmed his conviction on that count, which charged a sale without the official order form required by section 2 of the act. The question was whether a registered physician who, in good faith, gave a known addict a small quantity of drugs to relieve the conditions of her addiction had committed a federal crime. The government relied on Webb v. United States (1919), Jin Fuey Moy v. United States (1920) and especially United States v. Behrman (1922), which it read as holding that any prescription to satisfy an addict's craving fell outside professional practice. Linder answered that the count did not allege bad faith or improper medicine and that the facts alleged did not amount to an offense against a revenue law. On 13 April 1925 a unanimous Court reversed. Justice McReynolds began from the premise that the Harrison Act was a revenue measure and could be sustained only as one. Citing McCulloch v. Maryland, he wrote that direct control of medical practice in the states is beyond federal power and that Congress could regulate it only as far as reasonably appropriate to collecting the tax. The act said nothing about addicts and did not prescribe their treatment; addicts, he wrote, are diseased and proper subjects for medical care. He then confined the earlier precedents to their facts: Webb involved thousands of orders sold for fifty cents, Jin Fuey Moy a doctor who charged by the dram, and Behrman an order for some three thousand doses. None of them, he held, meant that a physician acting in good faith and by fair medical standards could never give an addict moderate amounts for self-administration. Whether conduct was bona fide medical practice had to be decided on the evidence, and mere pretense would not shelter illegal sales. The library text gives McReynolds's opinion, including the grand jury's count, long extracts from the statute and the passages quoted from earlier cases, with notes left out. The decision did not end the debate. The Treasury's narcotics officers continued to treat maintenance prescribing as suspect, and later physicians and historians described Linder as a statement of principle that changed enforcement less than its words suggested. The Harrison Act remained in force until the Controlled Substances Act of 1970 replaced it, and the Court returned to the legal status of addiction in Robinson v. California (1962).

Top Lessons

• Enumerated powers and the practice of medicine

  McReynolds rests the decision on the structure of the Constitution: the national government has delegated powers only, and regulating the practice of medicine belongs to the states. A tax law may touch medicine only as needed to collect the tax. The lesson is that how a law is justified determines how far it can reach.

• Addiction as a condition for medical care

  The opinion describes addicts as diseased and proper subjects for treatment, and it treats a doctor's good-faith effort to relieve conditions incident to addiction as medicine rather than commerce. This was a significant statement at a time when enforcement officials regarded most such prescribing as unlawful.

• Reading precedents by their facts

  Rather than overrule Webb, Jin Fuey Moy or Behrman, McReynolds limits each to its circumstances: fifty-cent orders by the thousand, fees charged by the dram, three thousand doses at once. Students can see here how a court narrows broad language in earlier opinions by asking what those cases actually decided.

• Good faith and evidence

  The Court insists that whether a physician acted in bona fide medical practice must be determined from evidence and circumstances, not presumed from the bare fact that the patient was addicted. At the same time it warns that pretense cannot legalize forbidden sales.

Verified Quotes

Medical Lens

Linder is the Court's clearest early statement that addiction is a disease within the proper sphere of medical treatment, and that a physician's good-faith provision of moderate doses to relieve an addicted patient's condition is medical practice rather than an illicit sale. It is a key document in the history of opiate maintenance, the closing of the post-1919 narcotic clinics and the long dispute between physicians and federal enforcement over who defines legitimate treatment.

• Opinion of the Court, paragraph beginning: Obviously, direct control of medical practice in the states is beyond the power of the federal government.

  Justice McReynolds holds that the act does not prescribe methods of treating addicts, calls them diseased and proper subjects for treatment, and declines to treat four small tablets as improper medicine.

• Opinion of the Court, discussion of Behrman: The opinion cannot be accepted as authority for holding that a physician

  The Court confines the 1922 Behrman decision so that physicians acting by fair medical standards may give moderate amounts for self-administration to relieve conditions incident to addiction.

• Opinion of the Court, the trial judge's charge beginning: If you are satisfied beyond a reasonable doubt that defendant knew that this woman was addicted

  The jury instruction distinguishes catering to an addicted person's craving from relieving pain the physician believed in good faith arose from another illness, showing how the line was drawn at trial.