A Supreme Court ruling in the opioid pill mill case may have major implications in Long Island's battle against the drug crisis.

The court ruled in a unanimous decision that doctors who are accused of running so-called pill mills can only be criminally convicted if they "knowingly or intentionally acted in an unauthorized manner."

Dr. Jeffrey Reynolds, with the Family and Children's Association, says the ruling sends a dangerous message to potential wrongdoers. He says the ruling comes as Long Island grapples with skyrocketing overdose rates.

"The notion that doctors can once again go back to operating with immunity and run pill mills almost unchecked is really a major step backwards."

Teri Kroll, who has been on the front lines of Long Island's opioid crises since losing her son to an overdose in 2009, also is not happy with the ruling. Her son's doctor was convicted of over prescribing painkillers. She says similar convictions might be more difficult to secure now.

"We just turned around and took three steps back. Big steps back," says Kroll.

Defense attorney Nancy Bartling, however, says the court got this one right. Bartling says doctors have been criminally punished for medical mistakes and this ruling will prevent that.

"Now the law is going to be looking at the actual intent of the doctor," says Bartling. "And I think it will absolutely change the outcome."

New York state has some safeguards in place, including a prescription database meant to prevent doctor shopping. Advocates say that's not fool proof because it relies on doctors and pharmacists taking the time to access that data.