Bexis gave us a splendid Christmas present when he handed us a case that is right in our wheelhouse: a criminal matter with (literally) crazy facts and some connection to prescription drug labels. United States v. Rainford, 2025 WL 3522333 (10th Cir. Dec. 9, 2025), is a relatively rare (something the opinion itself mentioned) published federal appellate decision on the effect of: (1) drug labeling, and (2) off-label, high dose prescriptions, on the availability of an involuntary intoxication defense in a criminal case.
The facts of Rainford are grim. The defendant killed a man he thought was molesting his daughter. He thought wrong. No such molestation occurred. The defendant was operating under a psychotic delusion. His defense in his criminal trial was that the delusion was caused by taking “exceedingly high doses” of Adderall.
The victim was a Native American and the murder took place in Oklahoma’s “Indian country.” Thus, there was federal jurisdiction over the case. The jury rejected the defendant’s defense of involuntary intoxication and found him guilty of first degree murder.
The defendant on appeal argued that the court improperly instructed the jury on involuntary intoxication. You probably remember from your first year law school class on criminal law that voluntary intoxication is not a defense. The concept is that someone knows when they drink ten beers or smoke three joints that they might start acting badly, so they are responsible for their deeds, even if they were drink- or drug-addled. They made a bad choice and must suffer the consequences of that bad choice. But involuntary intoxication is different. It can get a defendant off the hook. It is not the defendant’s fault if someone slipped LSD in his tea and he mistook someone’s head for a can that needed opening.
In Rainford, the defendant claimed that he did not know that the high doses (twice the recommended limit) of Adderall over time would prompt him to experience paranoid delusions. The government argued that the defendant had abused Adderall as a stimulant and bodybuilding aid. The government also suggested that the defendant was abusing methamphetamine the day of the shooting. The defendant contested all of that.
The legal issue on appeal concerned the jury instructions. The court listed a set of circumstances where involuntary intoxication could not be found. These included if the defendant was using Adderall along with illegal drugs such as methamphetamine and if the defendant “had knowledge or should have had knowledge based on warnings or prior experience of the possible intoxicating effect of Adderall.” The defendant also on appeal challenged the trial court’s refusal to instruct the jury “on involuntary manslaughter based on the imperfect defense of another.” The defendant’s theory was that he was in such a state of psychosis that he subjectively, though unreasonably, believed he shot the victim to protect his daughter from harm.
Jury instructions are reviewed de novo. At the same time, courts review for abuse of discretion a trial court’s decision whether to instruct on a lesser included defense.
Involuntary intoxication has received relatively little attention from federal courts. While involuntary intoxication has been codified as an affirmative defense by many states, as well as Model Penal Code section 2.08, it has not been incorporated into federal law by an act of Congress. We are in the little inhabited area of federal common law.
Luckily for the defendant, there is federal precedent for recognizing involuntary intoxication when unexpected intoxication results from a medically prescribed drug. But the trial court’s jury instructions made the defendant’s task in proving that up difficult. Was it too difficult? The answer, it turns out, is Yes.
The Tenth Circuit reversed the conviction based on erroneous jury inspections. It held that relatively anodyne labeling about a possible intoxicating effect was not enough to preclude a defendant’s ability to use an involuntary toxication defense that would have negated the necessary mens rea. The phrasing of the jury instruction could make the jury think that knowledge of Adderall’s “minor intoxicating effects was disqualifying even if [the defendant] had no knowledge of severe intoxicating effects.” The jury instruction made it seem as if any warning was dispositive. “It cannot be a defendant’s responsibility to anticipate an unusual reaction based on general warnings that a drug might affect one’s mental health.” The Tenth Circuit emphasized that “[a]ll prescription drugs come with some warnings, and to prevent a jury from finding involuntary intoxication whenever a medication warns of ‘possible intoxicating effects’ would effectively eliminate involuntary intoxication for prescription drugs as a legal defense.” The Tenth Circuit’s opinion also allows a doctor’s off-label prescription of high doses of the drug to be raised in support of that defense.
Similarly, the Tenth Circuit read the trial court’s jury instructions to be insufficiently nuanced about the use of illegal drugs. The instructions contained “no causal or temporal limit on illegal drugs as a disqualifier.” In short, by “incorrectly instructing that these factors categorically barred a finding of involuntary intoxication, the district court improperly took this decision away from the jury.”
The government argued, as it always does, that the case against the criminal defendant was so overwhelming that any instructional error was harmless. But the Tenth Circuit disagreed. The government pounded home the exclusionary factors in the closing, so at least the government thought they would be important to the jury. We learned long ago as a young prosecutor that if we managed to get into evidence something pretty iffy – such as 404(b) evidence of a prior similar crime – we might not need or want to use it in closing. Better to count on at least one of the jurors remembering the probative and prejudicial (there – we said it) bit and deploying it during deliberations.)
The Tenth Circuit also held that the trial court erred by not instructing on the lesser included offense of involuntary manslaughter based on the imperfect defense of another, specifically the defendant’s daughter. The Tenth Circuit held that such an imperfect defense would be valid even in an instance of voluntary intoxication. Whether a jury would buy that defense is by no means a certain thing, but at least the defendant would get the chance to try it out.
The Tenth Circuit reversed the conviction and remanded for a new trial with better jury instructions. For at least one guy in an orange jumpsuit, Christmas came early.