As state governments nationwide have begun to take aim at the companies that they believe played key roles in driving the opioid crisis, the state of Florida has extended the fight to include Walgreens and CVS. At the center of these lawsuits are accusations regarding efforts to popularize the drug OxyContin along with other widely prescribed painkillers. Walgreens and CVS are firms that operate pharmacies throughout the U.S., including ones in Florida, and the crux of the argument is that they had a role in making OxyContin too easily accessible to too many people, ultimately adding fuel to the larger opioid crisis. The two companies are the two largest pharmacy chains in the country.
Origins of the Lawsuits
It’s important to understand that CVS and Walgreens are secondary players in the business of selling prescription OxyContin. The main figure in these lawsuits is Purdue Pharma, a firm based in Connecticut and the holder of the main patents that allow it to sell OxyContin. Both the federal government and individual states have been pursuing criminal and civil legal actions against Purdue Pharma going back at least as early as 2007 when the company ended up paying more than $600 million in a combination of fines and other payments arising from its role in creating, marketing and pushing the painkiller to doctors and patients throughout the country.
OxyContin, often known by the street name oxy, was the centerpiece of the campaign. It was brought to market in 1996 and advertised as something close to a wonder opioid. Purdue’s marketing pitch included telling doctors and patients that the drug utilized a time-release formula, meaning it was less likely to be abused than some of its most known predecessors, especially Percocet and Vicodin, and led to nothing resembling the high that’s commonly associated with other opioids.
A particular problem became evident early on, however. Both prescription patients and street-drug users rapidly figured out that crushing the tablets of oxy allowed them to chew, crush, snort or inject the drug and obtain a high that was just as strong as would be expected when shooting heroin. Making the situation radically worse was that pharmaceutical representatives were encouraged to market the drug directly to medical practitioners and pharmacists who frequently had very little training in recognizing the signs of substance abuse or knowing what to do when confronted with a person who had a drug problem.
By the year 2000, Purdue Pharma was making more than $1 billion annually selling OxyContin. Even as it became clear from police reports throughout the nation that street-level users and dealers were breaking into pharmacies and raiding them to obtain oxy, Purdue Pharma largely treated the developments as a non-issue.
The Current Florida Lawsuit
At first blush, the operators of pharmacies look like additional victims of the opioid crisis. Unfortunately, pharmaceutical marketing often plays a role in how businesses like Walgreens and CVS present the products they sell to their customers. The Florida lawsuit argues that these companies had a habit of keeping poor records, making it harder to intervene when a patient developed a drug problem.
The complaint also alleges that Walgreens overlooked activity levels that obviously indicated problem behavior. In one instance involving just a single Walgreens in Pasco County, FL, the companies distribution center sent 2.2 million tablets of OxyContin to an area that was only home to 12,000 residents total. That amount is enough to provide a half-year supply to all 12,000 of those people. Florida also notes in its lawsuit that the company had previously paid a settlement of $80 million to the DEA as a result of its inadequate tracking of the emerging opioid crisis and the role it played in selling drugs under questionable circumstances.
Both Walgreens and CVS are alleged to have shipped billions of tablets to Florida, displaying little regard for why there was so much demand for such a strong painkiller. Notably, the Florida lawsuit also targets Endo Pharmaceuticals and Teva Pharmaceutical, generic manufacturers of the older painkiller Percocet.
One of the statements made by the suit is that “defendants knew or should have known that the quantity of opioids being distributed in Florida far exceeds the medical need of Florida residents.” CVS has said the suit is without merit, and Walgreens has offered no comment.
Forming the core of the case is the claim made by Pam Bondi, Florida’s attorney general, that the companies made little effort to take note of or stop suspicious purchasing of painkillers. It also includes claims that a company named Insys Therapeutics provided kickbacks to doctors who prescribed opioid drugs to their patients. The state also declares that the lack of reliable information regarding the rising opioid crisis likely delayed its ability to respond by several years, giving time for an already troubling situation to compound itself.
The Scale of the Opioid Crisis in Florida
Given that the state of Florida has one of the largest elderly populations in the U.S. and is also the home of more than 20 million people, the state represents a market that virtually any company wants to get into. The aging population of the state tracks closely with trends related to the opioid crisis as the population with substance use disorders arising from it tends to be older. Nationwide, it’s estimated that about 130 people per day die from opioid-related overdoses, and 11.4 million people misused opioids that they had been prescribed.
In the Sunshine State, the trend in opioid overdose deaths has gone from fewer than 500 in 1999 to nearly 2,800 in 2016. Factoring in significant population growth during the same period, that works out to a rise from 2.6 overdose deaths per 100,000 residents in 1999 to 14.4 such deaths per 100,000 in 2016. For reference, the national average in 2016 was 13.3 opioid overdose deaths per 100,000 people.
In 2013, Florida had 69.6 opioid prescriptions written for every 100 people who lived there. The state has also earned a reputation for being home to a number of pain mills, medical practices that exist largely to ensure people can get prescriptions virtually on demand. At the peak of the pain mill trend, 90 out of 100 of the top opioid prescribing practices were located in the state.
Related social problems have risen, too, such as neonatal abstinence syndrome where babies are born with withdrawal symptoms arising from drug use by their mothers during pregnancy. In 1999, the state saw 0.4 such births per 1,000. By 2013, that figure had risen to 6.3 births per 1,000.
A unique factor that positions Florida to have more trouble than other states is that it has a long history with organized criminal syndicates selling and transshipping drugs through the state. By the early 1970s, the state had become a noted hub in the international drug trafficking system. The U.S. Department of Justice notes that there are several sources of the state’s appeal to dealers and traffickers, including:
- 14 large seaports
- Proximity to drug-producing regions in Latin American and the Caribbean
- 13 international airports
- Several national street gangs
- Extensive and unpoliced rural areas that permit the dealing, packing and shipping of drugs
While much of the Florida lawsuit centers on the pharmacies that sold prescription drugs to customers, there remain serious concerns about how many of those sales were legitimate and how many were being diverted toward criminal operations. As the suit contends, the lack of good data being kept by companies like Walgreens and CVS makes it challenging to answer such a question. It has been established that OxyContin was being sold in the state as a street drug at the time.
Demographic trends and improvements in medicine collided to make pain management an industry that was seen as ripe for economic exploitation by companies like Purdue Pharma, Walgreens and CVS in the 1990s. Notable factors that drove the opioid crisis include:
- More people surviving cancer and serious workplace injuries
- An aging population
- Pain management issues arising from the obesity epidemic
- The rise of complex surgical techniques
- Growing public demand for pain management options in general
How Florida Has Responded
The state has focused on two particular tracks to try to reduce the overprescribing of drugs and the flow of legal opioids into the illegal market. These are:
- Increased monitoring
- Cracking down on pill mills
Following from both these efforts, the Florida lawsuit against companies like Walgreens and CVS is about ensuring that the state has a clearer picture of the challenges it faces by actually enforcing reporting requirements and seeing that companies that turn a blind eye to what’s going on will pay a price for their omissions.
To date, however, it remains questionable whether these types of pushes have been enough. While the prescription opioid crisis appears to finally be abating, law enforcement officials have also noticed a massive spike in deaths from synthetic opioids, particularly forms of fentanyl that are manufactured in laboratories. It’s very possible that since a market for opioid use has been established, criminal enterprises will come in to fill the void as legal sources of the drugs become the subjects of crackdowns.
The state is also committing money to a range of potential solutions, and it’s backed in its efforts by a $54 million grant from the federal government. One of the goals of the Florida lawsuit against CVS and Walgreens is to recover some of the money that it will need in order to build treatment programs for its citizens.
Florida will commit more than $20 million to be spent on drugs that treat addiction or block the effects of opioids in the human body. A further $1.7 million was directed to purchase naloxone kits that are used to treat individuals who are in the midst of full-on drug overdoses. The state has also directed $14 million to providing beds at residential treatment centers, delivering outpatient treatment options and funding emergency room expenses related to overdoses. It has backed laws requiring doctors to check patients’ names against an established database of those who already have prescriptions in order to deter people doubling up.
It remains to be seen what Florida’s future holds when it comes to solving the opioid crisis. Many people in the medical and law enforcement communities are worried that the proverbial genie is already out of the bottle and that overdoses will not return to pre-crisis levels. Taking steps to encourage treatment and diversion programs, however, is seen as a positive development, and efforts to hold responsible parties accountable may also help curb use of opioids.