A jury trial began Monday in a lawsuit launched by former Florida Attorney General Pam Bondi in 2018 against Walgreens pharmacies, accusing the company of flooding the state with opioid pills and creating an epidemic of addiction.
Current Attorney General Ashley Moody now directs the lawsuit.
“This is a simple case,” Jim Webster, the state’s attorney told a jury during opening remarks. “Nobody denies there’s an opioid crisis. Walgreens knowingly profited off the opioid crisis and was fueling it. Their conduct was unconscionable.”
Florida has been called the “epicenter” of the country’s prescription opioid crisis. The most commonly shipped opioid drugs include OxyContin, Hydrocodone, methadone and fentanyl.
The trial in the Sixth Judicial Circuit Court of Florida in Pinellas County in Clearwater is being streamed live courtesy of Courtroom View Network.
Walgreens, the country's largest pharmacy, is accused of creating a public nuisance and for violations of the Florida Deceptive Practices Act.
Florida's case is the latest of state-led lawsuits against opioid manufacturers, distributors and dispensers, to proceed to trial.
Opening arguments in West Virginia's case were held last week, and this week, Washington State's case will conclude with closing arguments.
Defense attorneys for Walgreens are contending that others caused the epidemic - pharmaceutical companies like Purdue Pharma, distributors like McKesson Corp. and AmerisourceBergen, internet pharmacies and irresponsible clinics known as “pill mills.”
Purdue Pharma has been the subject of lawsuits and settlement agreements. In 2020, the company owned by the Sackler family reached an $8.3 billion settlement agreement after admitting company officials had knowingly conspired to aid doctors dispensing the drugs without a legitimate medical purpose.
The original Florida lawsuit included as defendants opioid distributors CVS Pharmacy, Teva Pharmaceutical, Allergan and Endo International. Those companies settled with the state for more than $878 million last month.
Attorneys for the state of Florida will ask for millions more from Walgreens to fund abatement programs for drug treatment programs.
They said it will take 30 years to recover from the epidemic.
Webster, of the Washington D.C.-based firm Kellogg, Hansen, Todd, Figel & Frederick, told the jury evidence would show Walgreens had sold billions of (opioid) pills that never should have been sold.
“Walgreens should have investigated suspicious orders and did not,” Webster said. “It put opioids in the hands of addicted people and criminals.”
Webster said opioids had killed through overdose or suicide 39,417 Floridians over a 20-year period.
“That’s more than one (death) per day,” he noted. “Walgreens ignored its duty, ignored suspicious prescriptions. One of every four opioids (in Florida) was sold by Walgreens.”
Webster said the damage from the opioid crisis had been immense, including thousands of babies born addicted from addict mothers, and 700,000 drug-related arrests over 20 years. The state had spent $14 billion attempting to deal with the crisis, he added.
“Deliberate efforts by Walgreens flooded the state with opioids that are the same as heroin,” Webster said.
Webster presented a chart that said the opioid epidemic accelerated in 2006. The worst year was 2011, when 400 million pills from red-flagged suspicious orders were dispensed to the public. He added that top officials of Walgreens ignored the dangers of the drugs they were providing in order to grow profits.
“They handed them (opioids) out like they were Tylenol,” Webster said. “Walgreens has been consistent. It was a massive betrayal of trust that we place in pharmacies, an explosion of opioids misuse.”
Webster said victims were often not criminals, but simply people experiencing pain who got addicted through no fault of their own.
“They were not trying to get high,” he said.
Webster said others were involved in creating the crisis such as greedy doctors (over-prescribing), loosely dispensing to clinics called pill mills, drug manufacturers and distributors. He predicted Walgreens would fail to take its share of responsibility and blame everyone else.
“This is about Walgreens and its duty,” Webster said. “Walgreens ignored suspicious prescriptions. You can’t just hand out an opioid to a person with a piece of paper who looks like he came from a doctor.”
Webster said officials of Walgreens conspired to deceive the public about the dangers of opioids and to overcome the historical drug conservatism of the past.
“They (Walgreens) said it was to protect pain patients and it was just a coincidence they made money,” Webster said. “When (opioid) sales went down they said (to Walgreens pharmacies), your sales are too low. This was a business opportunity.”
Webster said drug conservatism started to change in the 1980’s.
“Why?” he asked. “Greed, manufacturers like Purdue started to make new opioids, and wanted to sell them to a much larger market than terminal (end-of-life) pain. The pharmacies were the last line of defense.”
Webster said 4.3 billion pills were dispensed in Florida between 2006 and 2021, with 55 percent of the orders red-flagged as suspicious.
The U.S. Drug Enforcement Administration (DEA) shut down six Walgreens outlets selling the highest volumes in the towns of Oviedo, Fort Pierce, Fort Meyers and Port Richey.
Webster said the company had realized net sales of $2.1 billion.
He added that Walgreens stores became illegal drug use and abuse havens with employees stealing stocks of pills to illegally sell. People were overdosing in store parking lots, he said.
One Florida resident for every 50 had an opioid disorder.
“There are 900 (Walgreens) pharmacies in Florida,” Webster said. “They saw an opportunity to make a fortune.”
Walgreens defense attorney Steve Derringer, of Bartlit Beck in Chicago, said there is no disagreement the opioid crisis is real.
“It’s not new,” he said. “The state knew about it for a long time. I want you to pay attention to the difference between what (plaintiff) attorneys say, and what the Attorney General’s Office has said outside this court.”
The reference may relate to AG Moody's public statements that illegal fentanyl from conspirators in Mexico and China was a major cause of opioid addiction and overdose deaths. In a pre-trial ruling last month, Moody lost a bid to prevent those statements from being introduced at trial.
Formerly, Walgreens had been a distributor, distributing drugs to its own pharmacies.
“They knew their customers,” Derringer said.
Derringer said the majority of pharmacies had done their best to follow the laws such as those of the U.S. Drug Enforcement Administration (DEA) and doctors-prescribed opioid drugs.
“We’re the pharmacy,” Derringer said. “We take the prescription, review it and make the decision whether to dispense it. A pharmacy is not a doctor. We’re not there to second-guess the doctor.”
Derringer said pharmacies have worked hard to make certain drug dispensing is conducted responsibly.
“These are judgements pharmacies make every day from behind the counter,” he said. “It’s good-faith dispensing. That’s company policy.”
He disputed plaintiff lawyer Webster's statement that opioid drugs were handed out like over-the-counter Tylenol, adding that if a red-flagged suspicious order could not be satisfactorily resolved, the drug would not be dispensed.
Before 1980, opioid pain pills had been mainly prescribed for end-of-life patients and those with cancer. Derringer displayed a chart that read, “Why are there so many pills?”
“In the 1980s and '90s there was a change,” he said. “It used to be if you had chronic pain, there wasn’t much could be done about it. There was an increasing recognition that people with pain should be treated, not ignored.”
In 1995, the Food & Drug Administration approved the drug OxyContin for treating moderate to severe pain. Its delayed absorption rate in the body, Derringer said, led to the claim its abuse level would be reduced.
An added product claim was that when used legitimately in the management of pain, addiction to such a drug was rare.
“The use of opioids has increased a lot,” Derringer said. “The Attorney General’s Office in 2018 put on their website statements about the cause of the crisis, that said the companies that make opioids used a campaign of misinformation to increase opioid prescriptions and use among the general public. The Purdues of the world caused it (the epidemic). They misrepresented to pharmacies.”
Derringer said a plaintiff attorney suggestion there was an inappropriate conspiracy between Purdue and Walgreens, or that Walgreens went along with Purdue as an accomplice, was false.
He said the abundance of irresponsible drug dispensing clinics, some operated by convicted felons, was one of the principle causes of the epidemic. Little had been done by the state to curb the abuses until 2009 with the authorization of the Prescription Drug Monitoring Program and the “Pill Mill” law of 2011, that prohibited clinics from both prescribing and dispensing drugs.
The law closed 839 pill mills, Derringer said.
“Why would you go to a Walgreens if you’re a pill mill and risk a pharmacist saying no?” Derringer asked.
Derringer said his client was placed in a difficult situation, trying to deal with a flood of prescriptions written by doctors and to make sure that patients with chronic pain could get the relief they needed.
“Walgreens' policy has been to comply with state law,” Derringer said. “If an order is red-flagged you do not dispense (drug). The state’s dispensing standard and Walgreen’s are the same. The burden of proof is on the Attorney General’s Office.”
Circuit Judge Kimberly Byrd is presiding.