NOT RECOMMENDED FOR PUBLICATION File Name: 25a0503n.06
Case No. 24-5430
UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT FILED Oct 28, 2025 KELLY L. STEPHENS, Clerk ) UNITED STATES OF AMERICA, ) Plaintiff-Appellee, ) ON APPEAL FROM THE ) UNITED STATES DISTRICT v. ) ) COURT FOR THE WESTERN ) DISTRICT OF TENNESSEE JEFFREY W. YOUNG, JR., ) Defendant-Appellant. ) OPINION )
Before: STRANCH, BUSH, and DAVIS, Circuit Judges.
DAVIS, Circuit Judge. Jeffrey Young, Jr. owned and operated a medical clinic that
illegally distributed controlled substances to hundreds of patients. This appeal involves his
prescribing activities to one of those patients: a woman to whom Young prescribed controlled
substances six times during her pregnancy. A jury convicted Young of fifteen counts related to
his prescription-drug scheme. Young filed a Rule 29 motion for acquittal on all counts and a
motion to dismiss the verdict for lack of subject-matter jurisdiction. Young appeals the district
court’s decision to deny both motions. Specifically, he claims that the government did not
sufficiently prove the six counts of distributing controlled substances to a pregnant woman and
that the indictment did not allege a violation of 21 U.S.C. § 841(a) because Young was authorized
within the meaning of the statute. We AFFIRM the district court’s denial of both motions. No. 24-5430, United States v. Young
I.
A. Facts
Young opened Preventagenix in North Jackson, Tennessee, in 2014. At the time, he was a
licensed nurse practitioner and was authorized by the Drug Enforcement Administration (“DEA”)
to prescribe Category II–V controlled substances. Young initially marketed Preventagenix as a
family medicine and preventive care clinic. Over the next year, however, Preventagenix devolved
into a pain management and addiction clinic. Following this shift, its clientele ballooned nearly
threefold. Around eighty percent of patients—including those who failed drug tests and had
histories of addiction—received controlled substance prescriptions.
Hope Rogers1 became Young’s patient in November 2014. She sought treatment and pain
relief for carpal tunnel syndrome, among other things. Rogers had a history of substance abuse
but did not consider herself to have an active addiction when she began seeing Young. By the
time she learned she was pregnant in February 2015, she had an active addiction as a result of
Young increasingly prescribing controlled substances to her. During Rogers’s pregnancy, Young
prescribed her controlled substances six times. Rogers’s daughter, born in August 2015, had
opioids in her system and spent two weeks in the NICU.
B. Procedural History
A grand jury indicted Young on fifteen counts. Count 1 alleged that he conspired to
distribute and dispense controlled substances from July 2014 through January 2017, in violation
of 21 U.S.C. § 846. Counts 2–7 alleged that Young unlawfully distributed and dispensed
controlled substances to a pregnant woman on six occasions and aided and abetted others doing so
1 The parties refer to Hope Rogers as “Rogers,” although she stated at trial that she currently goes by Hope Arment. The government acknowledged this distinction in its brief, noting that it followed Young’s naming convention. We follow the parties’ lead.
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on specified dates from March to July 2015, in violation of 21 U.S.C. §§ 841(a), 861(f), and 18
U.S.C. § 2. Counts 8–14 alleged that he unlawfully distributed and dispensed controlled
substances on specified dates from June to November 2016 and aided and abetted others doing so,
in violation of 21 U.S.C. § 841(a)(1) and 18 U.S.C. § 2. Count 15 alleged that Young maintained
a drug-involved premises and aided and abetted others doing so from July 2014 to January 2017,
in violation of 21 U.S.C. § 856(a)(1) and 18 U.S.C. § 2. Young pleaded not guilty on all counts,
and trial commenced.
At trial, the government called twelve witnesses: three former Preventagenix employees,
two former patients, Young’s former supervising physician, two undercover officers, two
investigators, and two expert witnesses. Young did not call any witnesses. Relevant to Counts 2–
7, the government called Rogers and Tricia Aultman, M.D., an expert witness and internal
medicine physician from Mississippi.
Rogers testified that her addiction worsened while she was in Young’s care such that she
was actively addicted to controlled substances when she discovered she was pregnant in February
2015. When Rogers requested an additional prescription or an increased dosage, Young repeatedly
accommodated the requests. For example, Young prescribed a thirty-day supply of Percocet to
Rogers on March 5, 2015. Twenty days later, he wrote her another prescription for Lortab at her
request. Even as Young increased the dosages of her prescriptions, Rogers did not recall Young
ever advising her of the risks associated with consuming opiates while pregnant. Rogers testified
that a medical assistant at Preventagenix told her she was fired as a patient because a drug screen
showed that her prescribed medications were not metabolized. Rogers explained that the
medication failed to metabolize because she often tried to pass drug tests by adding medication to
her urine in the bathroom. Despite this aberrant test result, Young declined to fire Rogers as a
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patient and continued to write her prescriptions. During Rogers’s pregnancy, Young wrote Rogers
six prescriptions for hydrocodone and oxycodone.
Based on her expertise as an internal medicine physician, Aultman testified that each of the
six prescriptions were without a legitimate medical purpose and not in the ordinary course of
professional practice. She noted that the diagnoses in Rogers’s chart were unlikely to provide a
legitimate medical reason for the prescriptions because Young added the diagnoses with “no
investigation.” (Trial Tr. Day 4 (PM), R. 282, PageID 3905). She also explained that opioids “are
not a drug of choice in pregnancy in any way” and should be used “only if absolutely necessary.”
(Id. at 3911). Aultman informed jurors that Young’s prescriptions would have been
“contraindicated” because of Rogers’s pregnancy. (Id. at 3912). According to Aultman, the
appropriate standard of care would have been to switch Rogers to methadone or Suboxone. She
described Young’s prescribing decisions as “not just bad medicine” but “harmful” because they
put both Rogers and her unborn child at risk. (Id. at 3921).
The government questioned Aultman about a drug screen from April 29, 2015, which
showed both hydrocodone and oxycodone in Rogers’s system at a time when Rogers was not
prescribed oxycodone. Aultman opined that Rogers was “clearly abusing, diverting, selling, doing
something with her medicine” and that she was “not taking it in the prescribed manner.” (Id. at
3924–25).
At the close of the government’s case-in-chief, Young moved for judgment of acquittal on
all counts. The district court denied the motion, and the jury found Young guilty of all fifteen
counts. Young then filed a post-verdict motion to dismiss, arguing that the district court lacked
subject-matter jurisdiction because Young was authorized to prescribe controlled substances under
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§ 841(a). The district court also denied this motion and sentenced Young to 240 months in prison
followed by six years of supervised release. Young timely appealed.
II.
On appeal, Young raises two claims: (1) the district court erred by denying his Rule 29
motion regarding the sufficiency of the evidence for Counts 2-7; and (2) the district court lacked
subject-matter jurisdiction. We address each in turn.
A. Sufficiency of the Evidence
Young’s sufficiency-of-the-evidence challenge is premised on his contention that the
government failed to prove that his prescriptions to Rogers lacked a legitimate medical purpose
and were issued outside the course of professional practice. We disagree.
We review de novo a Rule 29 challenge to the sufficiency of the evidence. United States
v. Robinson, 99 F.4th 344, 353 (6th Cir. 2024). The key inquiry is whether “any rational trier of
fact could have found the elements of the crime beyond a reasonable doubt.” United States v.
Baggett, 251 F.3d 1087, 1095 (6th Cir. 2001) (quoting United States v. King, 169 F.3d 1035, 1038–
39 (6th Cir. 1999)). “[V]iewing the evidence in the light most favorable to the government,” id.,
we “draw all available inferences and resolve all issues of credibility in favor of the jury’s verdict,”
United States v. Jackson, 470 F.3d 299, 309 (6th Cir. 2006) (quoting United States v. Salgado, 250
F.3d 438, 446 (6th Cir. 2001)). We will not “weigh the evidence presented, consider the credibility
of witnesses, or substitute our judgment for that of the jury.” Id. (quoting United States v. Davis,
177 F.3d 552, 558 (6th Cir. 1999)). A defendant challenging the sufficiency of the prosecution’s
evidence “bears a very heavy burden.” United States v. Emmons, 8 F.4th 454, 478 (6th Cir. 2021)
(quoting United States v. Abboud, 438 F.3d 554, 589 (6th Cir. 2006)).
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To convict a defendant under § 841(a)(1), “the government must show: ‘(1) That defendant
distributed a controlled substance; (2) That he acted intentionally or knowingly; and (3) That
defendant prescribed the drug without a legitimate medical purpose and outside the course of
professional practice.’” United States v. Anderson, 67 F.4th 755, 769 (6th Cir. 2023) (quoting
United States v. Johnson, 71 F.3d 539, 542 (6th Cir. 1995)); see also United States v. Zayas, 32
F.4th 211, 224 (3d Cir. 2022) (concluding that § 861(f) requires the government to prove “the
defendant’s knowledge of an individual’s pregnancy”).
The government presented ample evidence at trial that Young unlawfully distributed
controlled substances to Rogers during her pregnancy. The bulk of Young’s challenge pertains to
the third prong in the analysis, but we briefly address the first two prongs.
Distributed Controlled Substances. The parties do not dispute that Young distributed
controlled substances to Rogers. Both agree that Rogers was pregnant until August 2015, and that
Young prescribed controlled substances to her six times throughout March, April, May, June, and
July 2015.
Acted Intentionally or Knowingly. The parties also agree that Young knew Rogers was
pregnant, as evidenced by a follow-up note in her chart that Young had learned Rogers was
pregnant in February 2015. But Young contends that the government’s evidence that he knowingly
prescribed to Rogers without authorization was insufficient to support his conviction because he
did not know the prescriptions “were for an illegal purpose.” (ECF 47, Appellant’s Br., 25). In
the context of medical practitioners, when the evidence shows that a defendant dispensed
controlled substances by issuing prescriptions, the government must prove that the defendant knew
the prescriptions were unauthorized. See Ruan v. United States, 597 U.S. 450, 467 (2022). We
rejected the notion that a practitioner’s unreasonable subjective belief that he is “prescribing in an
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‘authorized’ manner” is sufficient to establish that the practitioner lacks knowledge of
authorization and therefore did not distribute controlled substances knowingly. United States v.
Suetholz, No. 23-5613, 2024 WL 4182903, at *3 (6th Cir. Sep. 13, 2024). Applying Ruan and
United States v. Bauer, 82 F.4th 522 (6th Cir. 2023), we explained that “[c]ircumstantial evidence
of knowledge of lack of authorization can also include expert testimony describing how far the
defendant’s practices deviated from the mainstream.” Suetholz, 2024 WL 4182903, at *3–4.
Here, the government presented circumstantial evidence that Young knowingly lacked
authorization to prescribe controlled substances to Rogers. Specifically, Aultman testified as an
expert witness that Young’s prescriptions to Rogers were “[a]bsolutely not” within the ordinary
course of professional practice for a legitimate medical purpose. (Trial Tr. Day 4 (PM), R. 282,
PageID 3922). Aultman explained that Young departed from the standard of care for pregnant
patients by failing to switch Rogers to methadone or Suboxone. See Suetholz, 2024 WL 4182903,
at *3 (affirming a § 841(a) conviction where the expert’s testimony that Suetholz “frequently and
sharply departed” from the standards of professional practice helped show that Suetholz “knew
that his prescribing practices deviated from professional norms”). And text messages from Young
to a friend, whose wife was also a patient, revealed Young stating that Xanax during pregnancy
was a “definite no” because “[i]t would harm the baby.” (Trial Tr. Day 4 (AM), R. 281, PageID
3839). This evidence further demonstrated that Young knew his conduct was outside the ordinary
course of professional practice and therefore was unauthorized.
Legitimate Medical Purpose and Course of Professional Practice. At the core of his
appeal, Young disputes that his prescriptions to Rogers had no legitimate medical purpose and
were outside the course of professional practice. Instead, he insists that he was “free to treat his
patients in the manner he fe[lt] [was] best for that individual patient.” (ECF 47, Appellant’s Br.,
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26). But practitioners must mind the guardrails erected to avoid running afoul of § 841(a). And
working within “‘accepted limits’ on prescribing” is one such guardrail. Suetholz, 2024 WL
4182903, at *3 (quoting Ruan, 597 U.S. at 467).
Based on Aultman’s expert testimony combined with Young’s own acknowledgment of the
command against prescribing opioids to pregnant patients, a rational juror could conclude that
Young did not prescribe hydrocodone and oxycodone to Rogers for a legitimate medical purpose
and within the course of professional practice. See United States v. Elliott, 876 F.3d 855, 864 (6th
Cir. 2017) (finding that the expert witness’s testimony “offered additional evidence to distinguish
[the physician’s] actions from those of an ordinary doctor”). Aultman expressly stated that Young’s
six prescriptions to Rogers were not for a legitimate medical purpose and were outside the course
of professional practice. She reviewed Rogers’s chart and determined that several diagnoses were
unlikely to provide a legitimate medical basis for Young’s prescriptions because Young performed
“no investigation” before listing the diagnoses. (Trial Tr. Day 4 (PM), R. 282, PageID 3905).
Aultman further opined that opioids “are not a drug of choice in pregnancy in any way” and should
be used “only if absolutely necessary.” (Id. at 3911). She noted that a prescription for opioids
would have been “contraindicated” and classified Young’s decisions as “not just bad medicine”
but “harmful.” (Id. at 3912; 3921). Jurors were free to accept Aultman’s opinion as proof that
Young’s prescribing activities lacked any legitimate medical purpose.
A rational juror also could find that Young disregarded signs that Rogers was abusing
her prescriptions and therefore acted outside the course of professional practice by continuing
to issue new prescriptions without adhering to compliance protocols. See Anderson, 67 F.4th at
769 (sustaining a § 841(a) conviction where an expert witness examined patient files and
found that, among other shortcomings, the physician failed to enforce compliance measures).
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Aultman testified that Rogers was “clearly abusing, diverting, selling, doing something with her
medicine” and that she was “not taking it in the prescribed manner.” (Trial Tr. Day 4 (PM), R.
282, PageID 3924–25). On this topic, Aultman discussed the import of Rogers’s April 29, 2015,
positive drug screen for hydrocodone and oxycodone. Aultman explained that because Young had
not prescribed oxycodone to Rogers at that time, he should have known that this was an aberrant
result. Yet, rather than probing Rogers as to the reasons for the result, he wrote her more
prescriptions in May, June, and July 2015. Rogers recalled one instance in which a medical
assistant attempted to fire Rogers as a patient because Rogers had inconsistent test results. But
Young retained Rogers as a patient, wrote her additional prescriptions, and increased the dosages.
See United States v. Chaney, 921 F.3d 572, 591 (6th Cir. 2019) (affirming a § 841(a) conviction
where a physician increased his patient’s prescription after a drug screen was negative for the
prescribed medications).
Another clue that Young acted outside the course of professional practice in prescribing to
Rogers was the fact that Rogers suffered from active addiction. See United States v. Romano, No.
24-3463, 2025 WL 2061204, at *4 (6th Cir. July 23, 2025) (rejecting a sufficiency-of-the-evidence
challenge because Romano prescribed high doses of opioids to patients with “signs of addiction”).
Rogers testified that she was actively addicted to controlled substances while she was Young’s
patient, and this addiction worsened as Young increased her dosages. For example, Young wrote
Rogers a thirty-day prescription for Percocet on March 5, 2015, and, 20 days later, wrote her
another prescription for Lortab when she requested additional medication. And these increases in
her dosages were not accompanied by any advice from Young about the risks associated with
taking opiates while pregnant, including that infants can be addicted to opiates at birth. See id.
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(upholding a § 841(a) conviction where a physician did not “adequately warn his patients about
the serious risks of the drugs”).
The crux of Young’s counterarguments—that his prescriptions to Rogers were “monitored
and accepted by independent third-party physicians”—is unavailing. (ECF 47, Appellant’s Br.,
19). The jury was free to find that another practitioner’s knowledge and acceptance of Young’s
prescription-writing practices to Rogers did not outweigh the substantial evidence that he
meaningfully veered away from professional standards of care. Moreover, the facts underlying
Young’s counterarguments are unfounded. First, he suggests that he merely continued dispensing
medications that Rogers’s previous physician had prescribed. But Aultman testified that her
review of the records revealed that at Rogers’s first visit, Young discontinued a low-level opioid,
started Rogers on hydrocodone, and increased the Klonopin dosage. And he did so “with no clear
reason[.]” (Trial Tr. Day 4 (PM), R. 282, PageID 3908).
Next, Young claims that Rogers’s obstetrician was aware of the medications that Young
prescribed to her. Young points to Rogers’s testimony that she could not recall any physician
informing her of the risks associated with the medications. Nevertheless, as Young acknowledges,
Rogers also testified that her obstetrician advised her to stop taking prescription medications. And
this point buttresses the jury’s conclusion that prescribing these opiates during pregnancy falls
outside the ordinary course.
Based on the foregoing, the district court did not err in denying Young’s Rule 29 motion.
B. Subject-Matter Jurisdiction
Young also challenges the district court’s exercise of subject-matter jurisdiction over his
case. The district court denied his motion to dismiss, reasoning that United States v. Moore,
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423 U.S. 122 (1975), and Gonzales v. Oregon, 546 U.S. 243 (2006), established that Young could
be prosecuted under § 841(a). We agree.
On appeal, Young appears to advance a four-part argument: (1) Young was “authorized”
to prescribe controlled substances pursuant to § 841(a) because he was registered with the DEA;
(2) the Attorney General must rely on Chevron, U.S.A., Inc. v. Natural Resources Defense Council,
Inc., 467 U.S. 837 (1984), or Auer v. Robbins, 519 U.S. 452 (1997), to apply the conditions of
“legitimate medical purpose” and “usual course of his professional practice” in 21 C.F.R.
§ 1306.04 to § 841(a); (3) the Attorney General failed to follow the Administrative Procedure Act
in promulgating § 1306.04; and (4) Loper Bright Enterprises v. Raimondo, 603 U.S. 369 (2024),
overturned Chevron thereby eliminating the government’s ability to indict Young under § 841(a).
Because Young’s status as a registrant does not exempt his conduct from the purview of § 841(a),
we need not reach his remaining arguments.
We review de novo questions of subject-matter jurisdiction. United States v. Bacon, 884
F.3d 605, 608 (6th Cir. 2018). Challenges to subject-matter jurisdiction “involve[] a court’s power
to hear a case, [and] can never be forfeited or waived.” United States v. Cotton, 535 U.S. 625, 630
(2002). A district court lacks subject-matter jurisdiction if “the face of the indictment failed to
charge the elements of a federal offense.” Bacon, 885 F.3d at 609 (quoting United States v. Martin,
526 F.3d 926, 934 (6th Cir. 2008)). “[A]n indictment is sufficient if it . . . contains the elements
of the offense charged and fairly informs a defendant of the charge against which he must
defend[.]” United States v. Anderson, 605 F.3d 404, 411 (6th Cir. 2010) (first alteration in original)
(quoting Hamling v. United States, 418 U.S. 87, 117 (1974)). “[I]n a prosecution under the
Controlled Substances Act, the Government need not refer to a lack of authorization . . . in the
criminal indictment.” Ruan, 597 U.S. at 462 (holding that a defendant first must meet his burden
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of demonstrating that his conduct was “authorized” before the burden shifts to the government to
prove mens rea).
Section 841(a) Permits the Government to Prosecute Young. The government argues that
Moore forecloses Young’s appeal. Young does not address Moore. If Young desired to argue that
Moore is abrogated or inapplicable to his case, he “presumably would have briefed the issue in
[his] reply,” after he received the government’s response relying on Moore. L.D. Mgmt. Co. v.
Gray, 988 F.3d 836, 841 (6th Cir. 2021).
Moore squarely governs this case. In Moore, the Supreme Court held that “only the lawful
acts of registrants are exempted” from prosecution under § 841. 423 U.S. at 131. The Court
rejected the possibility that a physician registered under the Controlled Substances Act (“CSA”)
was “per se exempted from prosecution under § 841 because of his status as a registrant.” Id.
Consistent with Moore, Young’s conduct is punishable under § 841(a) because he “exceeded the
bounds of ‘professional practice.’” Id. at 142–43 (highlighting Moore’s failure to perform physical
examinations, administer methadone, prevent abuse of prescriptions, regulate dosages, and charge
based on services provided instead of the number of drugs requested).
Chevron and Auer Deference are Inapplicable. Though the district court lacked the
foresight of Loper Bright when it denied Young’s motion to dismiss, we need not address Young’s
argument that Chevron or Auer deference are required to rely on § 1306.04. The Court in Moore
did not depend on 21 C.F.R. § 306.04 (1973) to determine the bounds of § 841. Instead, the Court
held that both the “scheme” of the CSA and its legislative history “reveal[] an intent to limit a
registered physician’s dispensing authority to the course of his ‘professional practice.’” Moore,
423 U.S. at 140. Similarly, in Gonzales, the Court rejected the government’s attempts to rely on
Auer deference to interpret § 1306.04. 546 U.S. at 257. The Court reasoned that § 1306.04 “just
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repeats two statutory phrases and attempts to summarize the others” included in the CSA. Id. “An
agency does not acquire special authority to interpret its own words when, instead of using its
expertise and experience to formulate a regulation, it has elected merely to paraphrase the statutory
language.” Id. Here, regardless of the validity and applicability of § 1306.04 to § 841(a), the
district court had subject-matter jurisdiction to decide Young’s case. The government’s indictment
sufficiently alleged that his conduct fell outside the usual course of professional practice under
Moore.
Given the foregoing, the district court did not err in denying Young’s motion to dismiss.
III.
For the reasons discussed, we AFFIRM.
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