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Walgreens’ negligence contributed to flood of opioids in San Francisco, judge rules following landmark trial

A federal judge found Walgreens “substantially contributed” to the opioid crisis in San Francisco in a sweeping ruling Wednesday following an 11-week bench trial.

SAN FRANCISCO (CN) — Retail pharmacy giant Walgreens “substantially contributed” to San Francisco’s opioid crisis by ignoring red flags and continuing to fill prescriptions for drugs that later flooded the city’s streets, a federal judge ruled Wednesday.

“The evidence at trial established that from 2006 to 2020, Walgreens pharmacies in San Francisco dispensed hundreds of thousands of red-flag opioid prescriptions without performing adequate due diligence,” U.S. District Judge Charles Breyer wrote in a 112-page ruling, the culmination of a bench trial that unfolded over several months in federal court.

Tens of thousands of these prescriptions were ordered by doctors whose prescribing patterns were suspect, Breyer found, yet Walgreens did not sufficiently staff or train its pharmacies to investigate these suspicious orders. Rather, he said pharmacists were under “constant pressure to fill prescriptions as quickly as possible.”

"A subsequent trial will be held to determine the extent to which Walgreens must abate the public nuisance that it helped to create,” the judge ordered.

Walgreens was the last remaining defendant in the city and county of San Francisco’s 2018 lawsuit seeking to hold the opioid industry accountable for fueling the drug epidemic, as demand for their prescription pain pills laid the groundwork for black-market distribution of the potent narcotic fentanyl.

The city had reached settlements with Johnson & Johnson, Malinkrodt, Insys, McKesson, and Endo Pharmaceuticals by the time the trial opened in Breyer’s courtroom on April 25.

Oxycontin inventor Purdue Pharma skirted inclusion in the trial when it declared bankruptcy in 2020, and California received $486 million from a $6 billion multistate settlement, paid out over 18 years, to fund drug addiction treatment.

City Attorney David Chiu announced a $54 million settlement with drugmakers Allergan and Teva on July 12, just as closing arguments commenced. The settlement also resolved San Francisco's claims against the drug distributor Anda Inc., which was purchased by Teva in 2016. AbbVie, the parent company of Allergan, agreed to pay $13 million for its role in perpetuating the opioid crisis.

Breyer found the city had proven at trial that Walgreens's negligence caused "widespread harm across the city and interfered with public peace, comfort and convenience," as San Francisco's hospitals were overwhelmed with patients suffering from overdoses and drug-related conditions and its parks and public spaces infested with syringes and human waste.

"City staff have been stuck with syringes, encountered opioid users overdosing, confronted opioid-related violence, and found dead bodies. The effects of the opioid epidemic on San Francisco have been catastrophic," Breyer wrote. "The city has fought hard and continues to do so, but the opioid epidemic, which Walgreens helped fuel, continues to substantially interfere with
public rights in San Francisco."

Breyer's ruling notes that Walgreens, the dominant retail pharmacy chain in San Francisco, received 58.7% of the opioid prescriptions and dispensed 155,763,131 opioid pills in the city from 2006 to 2020. He quoted from declarations by Walgreens pharmacists, who said they were under intense pressure to fill prescriptions quickly reflexively.

He also cited testimony from Rebecca Gayle, a pharmacist at six different Walgreens stores in San Francisco’s Mission neighborhood from October 2012 to January 2016, who said she “constantly felt like there was a pressure to fill, fill, fill and that was what the company cared about most." She also testified that she faced retaliation from her managers if she "spent too long doing things that didn’t result in dispensing of a prescription."

Speaking to reporters Wednesday, Chiu said it was ironic that Walgreens would blame its recent rash of shuttered San Francisco stores on the street conditions it helped create. “It's like an arsonist complaining about the fire they started," he said.

The city was represented by staff attorneys from Chiu's office, along with lawyers from San Francisco-based firm Lieff Cabraser Heimann and Robbins Geller Rudman.

Fraser Engerman, a senior spokesperson for Walgreens, said in an email that the company would appeal the ruling.

"We are disappointed with this outcome. The facts and the law do not support the court’s decision. 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. We stand behind the professionalism and integrity of our pharmacists, dedicated healthcare professionals who live in the communities they serve," Engerman said. "The plaintiff’s attempt to resolve the opioid crisis with an unprecedented expansion of public nuisance law is misguided and unsustainable. We look forward to the opportunity to address these issues on appeal."

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