[268 U.S. 5, 6] Mr. George Turner, of Spokane, Wash., for petitioner.
[268 U.S. 5, 9] The Attorney General, Solicitor General Beck, of Washington, D. C., Assistant Attorney General Donovan, and Mr. Harry S. Ridgely, of Washington, D. C., for the United States. [268 U.S. 5, 10]
Mr. Justice McREYNOLDS delivered the opinion of the Court.
The court below affirmed the conviction of petitioner by the District Court, Eastern District of Washington, under the following count of an indictment returned therein June 26, 1922. As to all other counts the jury found him not guilty.
Count II. And the grand jurors aforesaid upon their oaths do further present: That Charles O. Linder, whose other or true name is to the grand jurors unknown, hereinafter in this indictment called the defendant, late of [268 U.S. 5, 11] the County of Spokane, state of Washington, heretofore, to wit, on or about the 1st day of April, 1922, at Spokane, in the Northern division of the Eastern district of Washington, and within the jurisdiction of this court, did then and there violate the Act of December 17, 1914, entitled 'An act to provide for the registration of, with collectors of internal revenue, and to impose a special tax upon all persons who produce, import, manufacture, compound, deal in, dispense, sell, distribute, or give away opium or coca leaves, their salts, derivatives, or preparations, and for other purposes,' as amended February 24, 1919, in that he did then and there knowingly, willfully and unlawfully sell, barter and give to Ida Casey a compound, manufacture, and derivative of opium, to wit, one (1) tablet of morphine and a compound, manufacture, and derivative of coca leaves, to wit, three (3) tablets of cocaine, not in pursuance of any written order of Ida Casey on a form issued for that purpose by the Commissioner of Internal Revenue of the United States; that the defendant was a duly licensed physician and registered under the act; that Ida Casey was a person addicted to the habitual use of morphine and cocaine and known by the defendant to be so addicted; that Ida Casey did not require the administration of either morphine or cocaine by reason of any disease other than such addiction; that the defendant did not dispense any of the drugs for the purpose of treating any disease or condition other than such addiction; that none of the drugs so dispensed by the defendant was administered to or intended by the defendant to be administered to Ida Casey by the defendant or any nurse, or person acting under the direction of the defendant, nor were any of the drugs consumed or intended to be consumed by Ida Casey in the presence of the defendant, but that all of the drugs were put in the possession or control of Ida Casey with the intention on the part of the defendant that Ida Casey [268 U.S. 5, 12] would use the same by self-administration in divided doses over a period of time, the amount of each of said drugs dispensed being more than sufficient or necessary to satisfy the cravings of Ida Casey therefor if consumed by her all at one time; that Ida Casey was not in any way restrained or prevented from disposing of the drugs in any manner she saw fit and that the drugs so dispensed by the defendant were in the form in which said drugs are usually consumed by persons addicted to the habitual use thereof to satisfy their craving therefor and were adapted for consumption-contrary to the form of the statute in such case made and provided and against the peace and dignity of the United States.
The Harrison Narcotic Law, approved December 17, 1914 (38 Stat. 785, c. 1 [Comp. St. 6287g-6287q])-12 sections-is entitled:
Section 1 provides:
Sec. 2 provides:
Section 1 was amended by the Act of February 24, 1919, c. 18, 40 Stat. 1057, 1130 (Comp. St. Ann. Supp. 1919, 6287g). This increased the special annual tax to $24 on importers, manufacturers, producers and compounders, $12 on wholesale dealers, $6 on retail dealers, and $3 [268 U.S. 5, 15] on 'physicians, dentists, veterinary surgeons, and other practitioners lawfully entitled to distribute, dispense, give away, or administer any of the aforesaid drugs to patients upon whom they in the course of their professional practice are in attendance.' It also added a provision requiring that stamps-one cent for each ounce-should be affixed to every package of opium, coca leaves, any compound, salt, derivative or preparation thereof, produced in or imported into the United States and sold or removed for consumption or sale, and then the following paragraph:
Manifestly, the purpose of the indictment was to accuse petitioner of violating section 2 of the Narcotic Law, and the trial court so declared. Shortly given the alleged facts follow. Petitioner, a duly licensed and registered physician, without an official written order therefor, knowingly, [268 U.S. 5, 16] willfully and unlawfully did sell, barter and give to Ida Casey one tablet of morphine and three tablets of cocaine; he knew she was addicted to habitual use of these drugs and did not require administration of either because of any disease other than such addiction, and he did not dispense them for the treatment of any other disease or condition; they were not administered by him or by any nurse or other person acting under his direction, nor were they consumed or intended for consumption in his presence; the amount was more than sufficient to satisfy the recipient's cravings if wholly consumed at one time; petitioner put the drugs into her possession expecting that she would administer them to herself in divided doses over a period of time; they were in the form in which addicts usually consume them to satisfy their cravings; the recipient was in no way prevented or restrained from disposing of them.
Petitioner maintains that the facts stated are not sufficient to constitute an offense. The United States submit that, considering United States v. Behrman, 258 U.S. 280 , 42 S. Ct. 303, the sufficiency of the indictment is clear.
The trial court charged:
In effect, the indictment alleges that the accused, a duly registered physician, violated the statute by giving [268 U.S. 5, 17] to a known addict four tablets containing morphine and cocaine with the expectation that she would administer them to herself in divided doses, while unrestrained and beyond his presence or control, for the sole purpose of relieving conditions incident to addiction and keeping herself comfortable. It does not question the doctor's good faith nor the wisdom or propriety of his action according to medical standards. It does not allege that he dispensed the drugs otherwise than to a patient in the course of his professional practice or for other than medical purposes. The facts disclosed indicate no conscious design to violate the law, no cause to suspect that the recipient intended to sell or otherwise dispose of the drugs, and no real probability that she would not consume them.
The declared object of the Narcotic Law is to provide revenue, and this court has held that whatever additional moral end it may have in view must 'be reached only through a revenue measure and within the limits of a revenue measure.' United States v. Jin Fuey Moy, 241 U.S. 394, 402 , 36 S. Ct. 658, Ann. Cas. 1917D, 854. Congress cannot, under the pretext of executing delegated power, pass laws for the accomplishment of objects not intrusted to the federal government. And we accept as established doctrine that any provision of an act of Congress ostensibly enacted under power granted by the Constitution, not naturally and reasonably adapted to the effective exercise of such power, but solely to the achievement of something plainly within power reserved to the states, is invalid and cannot be enforced. McCulloch v. Maryland, 4 Wheat, 316 423; License Tax Cases, 5 Wall. 462; United States v. De Witt, 9 Wall. 41; Keller v. United States, 213 U.S. 138 , 29 S. Ct. 470, 16 Ann. Cas. 1066; Hammer v. Dagenhart, 247 U.S. 251 , 38 S. Ct. 529, 3 A. L. R. 649, Ann. Cas. 1918E, 724; Child Labor Tax Case, 259 U.S. 20 , 42 S. Ct. 449. In the light of these principles, and not forgetting the familiar rule that 'a statute must be construed, if fairly possible, so as to avoid, not only the conclusion that it is [268 U.S. 5, 18] unconstitutional, but also grave doubts upon that score,' the provisions of this statute must be interpreted and applied.
Obviously, direct control of medical practice in the states is beyond the power of the federal government. Incidental regulation of such practice by Congress through a taxing act cannot extend to matters plainly inappropriate and unnecessary to reasonable enforcement of a revenue measure. The enactment under consideration levies a tax, upheld by this court, upon every person who imports, manufactures, produces, compounds, sells, deals in, dispenses or gives away opium or coca leaves or derivatives therefrom, and may regulate medical practice in the states only so far as reasonably appropriate for or merely incidental to its enforcement. It says nothing of 'addicts' and does not undertake to prescribe methods for their medical treatment. They are diseased and proper subjects for such treatment, and we cannot possibly conclude that a physician acted improperly or unwisely or for other than medical purposes solely because he has dispensed to one of them in the ordinary course and in good faith, four small tablets of morphine or cocaine for relief of conditions incident to addiction. What constitutes bona fide medical practice must be determined upon consideration of evidence and attending circumstances. Mere pretense of such practice, of course, cannot legalize forbidden sales, or otherwise nullify valid provisions of the statute, or defeat such regulations as may be fairly appropriate to its enforcement within the proper limitations of a revenue measure.
United States v. Jin Fuey Moy, supra, points out that the Narcotic Law can be upheld only as a revenue measure. It must be interpreted and applied accordingly. Further, grave constitutional doubts concerning section 8 cannot be avoided unless limited to persons who are required to register by section 1. Mere possession of the drug creates no presumption of guilt as against any other person. [268 U.S. 5, 19] In United States v. Doremus, 249 U.S. 86, 93 , 95 S., 39 S. Ct. 214, a registered physician was accused of unlawfully selling, giving away and distributing 500 one-sixth grain tablets of heroin without official written order. Another count charged selling, dispensing and distributing 500 such tablets not in the course of regular professional practice. The trial court held section 2 invalid because it invaded the police power of the state. This court declared:
The sharp division of the court in this cause and the opinion in Jin Fuey Moy's Case clearly indicated that the statute must be strictly construed and not extended beyond the proper limits of a revenue measure.
Webb v. United States, 249 U.S. 96, 99 , 39 S. Ct. 217, came here on certified questions. Two were answered upon authority of Doremus' Case. The third inquired whether a regular physician's order for morphine issued to an addict, not in the course or professional treatment with design to cure the habit, but in order to provide enough of the drug to keep him comfortable by maintaining his customary use, is a 'physicians prescription.' The answer was that 'to call such an order for the use of morphine a physician's prescription would be so plain a pervision of meaning that no discussion of the subject is required.' The lower [268 U.S. 5, 20] court had sought instruction in order that it might decide the particular cause. The question specified no definite quantity of drugs, nor the time intended for their use. The narrated facts show, plainly enough, that physician and druggist conspired to sell large quantities of morphine to addicts under the guise of issuing and filling orders. The so-called prescriptions were issued without consideration of individual cases and for the quantities of the drugs which applicants desired for the continuation of customary use. The answer thus given must not be construed as forbidding every prescription for drugs, irrespective of quantity, when designed temporarily to alleviate an addict's pains, although it may have been issued in good faith and without design to defeat the revenues. This limitation of the reply is confirmed by Behrman's Case, 258 U.S. 280 , 42 S. Ct. 303, infra, decided three years later, which suggests at least that the accused doctor might have lawfully dispensed some doses.
In Jin Fuey Moy v. United States, 254 U.S. 189, 194 , 41 S. Ct. 98, doctor and druggist conspired to sell opiates. The prescriptions were not issued in the course of professional practice. The doctor became party to prohibited sales.
The quoted language must be confined to circumstances like those presented by the cause. In reality, the doctor became party to sales of drugs. He received a [268 U.S. 5, 21] fixed sum per dram under guise of issuing prescriptions. The quoted words are repeated in Behrman's Case, which recognizes the possible propriety of prescribing small quantities.
United States v. Balint, 258 U.S. 250, 253 , 254 S., 42 S. Ct. 301, holds:
United States v. Behrman, 258 U.S. 280, 287 , 42 S. Ct. 303, came up under the Criminal Appeals Act (Comp. St. 1704). The indictment charged that Behrman, a registered physician, did unlawfully sell, barter, and give to one King, an 'addict,' 150 grains of heroin, 360 grains of morphine, and 210 grains of cocaine, by issuing three prescriptions. Further, that the drugs were not intended or required for treatment of any disease or condition other than such addiction, but for self-administration over a period of several days. The question was:
And, replying, this court said:
This opinion related to definitely alleged facts and must be so understood. The enormous quantity of drugs ordered, considered in connection with the recipient's character, without explanation, seemed enough to show prohibited sales and to exclude the idea of bona fide professional action in the ordinary course. The opinion cannot be accepted as authority for holding that a physician, who acts bona fide and according to fair medical standards, may never give an addict moderate amounts of drugs for self-administration in order to relieve conditions incident to addiction. Enforcement of the tax demands no such drastic rule, and if the act had such scope it would certainly encounter grave constitutional difficulties.
The Narcotic Law is essentially a revenue measure and its provisions must be reasonably applied with the primary view of enforcing the special tax. We find no facts alleged in the indictment sufficient to show that petitioner had done anything falling within definite inhibitions or sufficient materially to imperil orderly collection of revenue from sales. Federal power is delegated, and its prescribed limits must not be transcended even though the end seems desirable. The unfortunate condition of the recipient certainly created no reasonable probability that she would sell or otherwise dispose of the few tablets intrusted to her; and we cannot say that by so dispensing [268 U.S. 5, 23] them the doctor necessarily transcended the limits of that professional conduct with which Congress never intended to interfere.
The judgment below must be reversed. The cause will be remanded to the District Court for further proceedings in harmony with this opinion.