Walgreens helped fuel the opioid epidemic in San Francisco by shipping hundreds of thousands of "suspicious orders" of prescription drugs to its pharmacies, a federal judge ruled Wednesday.
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.
How much the company will have to pay will be determined at a later trial date.
"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 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 court ruling. Johnson & Johnson and the three drug distributors were part of a $26-billion nationwide settlement earlier this year.
The company expressed its disappointment with the court ruling and said it's planning to appeal, according to Walgreens spokesperson Fraser Engerman.
"As we have said throughout this process, we never manufactured or marketed opioids, nor did we distribute them to the 'pill mills' and internet pharmacies that fueled this crisis," he said in a statement. "We stand behind the professionalism and integrity of our pharmacists, dedicated healthcare professionals who live in the communities they serve."
Peter Mougey, one of the attorneys representing the city, said the verdict sheds a light on the negligence Walgreens displayed in failing to stop the opioid epidemic in San Francisco.
"The sun has set on Walgreens' attempt to hide the evidence of its nonexistent opioid compliance program while it instead focused on profits by flooding San Francisco with a tsunami of pills," he said. "Judge Breyer's 100-page order meticulously covers the two months of evidence presented at trial. San Francisco can now take meaningful steps cleaning up the mess Walgreens created."
The opioid crisis has ravaged San Francisco in recent years. Emergency visits because of opioids have spiked from 886 in 2015 to 2,998 in 2020, according to court filings. In 2019, about 40,958 city residents out of about 860,000 San Franciscans suffered from opioid addiction. In 2019, about 1,939 city residents overdosed on opioids, averaging to about 5.3 overdoses a day.
Walgreen 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," 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."
Walgreens likely "dispensed large volumes of medically illegitimate opioid prescriptions that were diverted for illicit use and that substantially contributed to the opioid epidemic in San Francisco," Breyer wrote.
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. The trial marked the first time the pharmaceutical companies had to defend themselves in the country's reckoning of the opioid crisis.
———
