As Justice Thomas expressly states in his majority opinion: "Finally, the Cooperative contends that we should construe the Controlled Substances Act to include a medical necessity defense in order to avoid what it considers to be difficult constitutional questions.
In particular, the Cooperative asserts that, shorn of a medical necessity defense, the statute exceeds Congress’ Commerce Clause powers, violates the substantive due process rights of patients, and offends the fundamental liberties of the people under the Fifth, Ninth, and Tenth Amendments.
"[5] As such, the question of the constitutionality of the Controlled Substances Act under the doctrine of substantive due process remains an open one, undecided by the Supreme Court, and debated by the citizens of the United States.
Even some opponents of the substantive due process argument who support the War on Drugs have noted that the doctrine could potentially lead to the invalidation of anti-drug laws.
[6] It is argued that the reverse burden of proof in drug-possession cases is incompatible with the rule of law in that the power to convict is effectively taken from the courts and given to those who are willing to plant evidence.