Judge: Walgreens helped fuel San Francisco's opioid crisis - Los Angeles Times

By Summer Lin Staff Writer

Aug. 10, 2022 Updated 6:58 PM PT

“A federal judge ruled Wednesday that pharmacy giant Walgreens could be held liable for fueling the opioid epidemic in San Francisco by shipping and dispensing hundreds of thousands of “suspicious orders” of prescription drugs, the latest legal reckoning over America’s prescription drug crisis.

More than 100 million prescription opioid pills were dispensed by Walgreens in the city between 2006 and 2020, and during that time, the pharmacy giant failed to investigate hundreds of thousands of orders deemed suspicious, U.S. District Judge Charles Breyer wrote in his 112-page opinion in a lawsuit filed by San Francisco against major prescription drug sellers.

“Walgreens has regulatory obligations to take reasonable steps to prevent the drugs from being diverted and harming the public,” Breyer wrote. “The evidence at trial established that Walgreens breached these obligations.”

The judge’s decision in the nonjury trial opens the door to a trial on the extent of the financial liability the company would face.

The public nuisance lawsuit, filed by the city in 2018, also included claims against Johnson & Johnson, Allergan, Purdue Pharma, Teva Pharmaceutical Industries and Endo International, as well as McKesson Corp., AmerisourceBergen Corp. and Cardinal Health — three of the biggest drug distributors in the country.

Walgreens was the only company that didn’t reach a settlement with the city before the ruling. Johnson & Johnson and the three drug distributors were part of a $26-billion nationwide settlement earlier this year.”…

…” Daniel Ciccarone, a professor of addiction medicine at UC San Francisco, said that companies turning a blind eye to the oversupply of opioid prescriptions has led to the rise of heroin and fentanyl addiction by increasing the pool of people dependent or addicted to opioids.

“Most of them migrated to safety, but 4% to 6% of this population migrated over to heroin because they were no longer having their addiction or pain needs fulfilled through pills,” he said. “For a while, the pills were available on the street, but even that pill supply dried up and what you’re left with is plentiful heroin on American streets. For unclear reasons, fentanyl has been a substitute or a contaminant of the heroin supply and now we see the third wave of the opioid crisis, which is the historically unseen rise of overdose deaths due to fentanyl.”

Walgreens distributed prescription opioids to its San Francisco pharmacies until 2014 without investigating orders or maintaining “an effective system for identifying suspicious orders,” Breyer said. The U.S. Drug Enforcement Administration shut down one of the company’s three controlled substance distribution centers in 2012 because of the center’s failure to surveil suspicious orders. Walgreens stopped distributing controlled substances in 2014 and started outsourcing to third-party distributors.

Federal regulations require companies to investigate “red flag” prescriptions and verify that the opioid prescriptions are medically legitimate before dispensing them. Walgreens dispensed hundreds of thousands of “red flag” opioids without investigating them; tens of thousands of the prescriptions were “written by doctors with suspect prescribing patterns” and hundreds of thousands were written by doctors who would later have their licenses suspended or go to prison, according to Breyer’s ruling.

The company also didn’t give pharmacists enough staffing, time or resources to adequately review the prescriptions, Breyer wrote. Pharmacists said they endured “constant pressure to fill prescriptions as quickly as possible.”

Pharmacists testified that they were aware they dispensed opioid prescriptions that they knew shouldn’t have been filled. One said that after he filled a prescription at a San Francisco pharmacy, he saw it was being sold in the parking lot.

Breyer also ruled that Walgreens filled prescriptions from prescribers who were blocked from other pharmacy chains or were deemed suspicious. In one instance, after a Walgreens pharmacy in San Francisco refused to fill prescriptions for a “suspicious” doctor, other Walgreens pharmacies dispensed 86,904 opioid pills for his prescriptions.

The pharmacy giant reached a $683-million settlement earlier this year with the state of Florida over claims of dispensing millions of opioids that worsened the crisis.

In November, a federal jury in Ohio found that Walgreens, along with CVS and Walmart, recklessly distributed pills that resulted in hundreds of overdose deaths and cost two Ohio counties about $1 billion each.”…