A federal jury in Ohio on Tuesday found that pharmacy giants Walgreens, CVS and Walmart contributed to the opioid crisis in that state, a verdict that could serve as a bellwether for thousands of similar cases pending from coast to coast. The decision is the first verdict returned by a jury that holds a pharmacy retailer responsible for its role in the devastating epidemic of opioid overdoses that has plagued the United States for decades.

In the lawsuit, Lake and Trumbell Counties in northeastern Ohio maintained that the pharmacy retailers had recklessly distributed more than 100 million opioid pain pills in the counties, leading to addiction, death and a strain on public services. Between 2012 and 2016, more than 80 million prescriptions painkillers were dispensed in Trumbull County alone, or about 400 pills for every resident. During the same period, approximately 61 million opioid painkillers were dispensed in Lake County.

“For decades, pharmacy chains have watched as the pills flowing out of their doors cause harm and failed to take action as required by law,” a committee of attorneys representing local governments in federal opioid lawsuits said in a statement. “Instead, these companies responded by opening up more locations, flooding communities with pills, and facilitating the flow of opioids into an illegal, secondary market.”

Counties Say Pharmacies Created a Public Nuisance

Attorneys for the plaintiffs argued that the actions of the pharmacies amounted to a public nuisance that cost the counties about $1 billion each to address. Mark Lanier, an attorney representing the counties, said that the pharmacies failed to hire or train enough employees and implement systems to prevent suspicious orders from being filled.

“The law requires pharmacies to be diligent in dealing drugs,” Lanier said. “This case should be a wake-up call that failure will not be accepted.” 

“The jury sounded a bell that should be heard through all pharmacies in America,” he added.

The suit originally also named pharmacy retailers Rite-Aid and Giant Eagle as plaintiffs in the case. Rite-Aid settled in August and agreed to pay Trumbull County $1.5 million in damages, while a settlement amount with Lake County has not been released. Giant Eagle agreed to settle late last month, although terms of that agreement were not disclosed.

The case, which was decided by a 12-person jury after a six-week trial, was returned in one of about 3,000 federal opioid lawsuits being supervised by U.S. District Judge Dan Polster in Cleveland. Adam Zimmerman, who teaches mass litigation at Loyola Law School in Los Angeles, said that the verdict could prompt other pharmaceutical retailers to settle their pending cases.

“It’s the first opioid trial against these major household names,” Zimmerman told the New York Times. “They have been the least willing group of defendants to settle, so this verdict is at least a small sign to them that these cases won’t necessarily play out well in front of juries.”

Pharmacy Chains Will Appeal Verdict

All three retailers have indicated that they will appeal the jury’s verdict. Walmart said in a statement that the plaintiffs’ attorneys sued “in search of deep pockets while ignoring the real causes of the opioid crisis—such as pill mill doctors, illegal drugs, and regulators asleep at the switch—and they wrongly claimed pharmacists must second-guess doctors in a way the law never intended and many federal and state health regulators say interferes with the doctor-patient relationship.”

Walgreens spokesperson Fraser Engerman characterized the case as an unsustainable effort “to resolve the opioid crisis with an unprecedented expansion of public nuisance law,” adding that the company “never manufactured or marketed opioids nor did we distribute them to the ‘pill mills’ and internet pharmacies that fueled this crisis.”

“As plaintiffs’ own experts testified, many factors have contributed to the opioid abuse issue, and solving this problem will require involvement from all stakeholders in our health care system and all members of our community,” CVS spokesperson Mike DeAngelis said in a statement after the verdict was announced.

The retail pharmacies are not alone in their criticism of the verdict. Dr. Ryan Marino, an assistant professor of the Departments of Emergency Medicine and Psychiatry at Cleveland’s Case Western Reserve University School of Medicine, says that focusing on blaming the pharmaceutical industry, prescribers, and pharmacies ignores the role that bad policies have played in the opioid crisis.

“If retail pharmacies are declared responsible, I ask that we also hold policymakers responsible for their role in driving people to foreseeable death and failing to act to prevent disordered substance use or addiction by failing to provide access to safety in addition to basic things like housing, education, employment, and income, which are well known to prevent addiction in the first place,” Marino wrote in an email to High Times. “The same old approaches have not helped this problem, and in fact, seem to be only making it worse.”

Some drug manufacturers and distributors including Johnson & Johnson have also opted to settle cases brought against them for their alleged contributions to the opioid crisis, which has killed more than 500,000 Americans over the past twenty years. Kevin Roy, chief public policy officer at addiction solutions advocacy group Shatterproof, said that Tuesday’s verdict could prompt other pharmacies to consider a settlement.

“It’s a signal that the public, at least in select places, feels that there’s been exposure and needs to be remedied,” Roy said.

Roy noted, however, that the different courts hearing opioid cases have not been consistent in their judgments and that the details of public nuisance laws vary from state to state. Earlier this month, a California judge ruled in favor of drug manufacturers in a case brought by the city of Oakland and three counties. And in Oklahoma on November 9, the state Supreme Court overturned a 2019 verdict for $465 million against Johnson & Johnson.

“There’s been a variety of different decisions lately that should give us reason to be cautious about what this really means in the grand scheme,” Roy said.

Just how much Walgreens, CVS and Walmart will have to pay Trumbull and Lake Counties remains to be seen. The judge is expected to issue a decision on damages to be awarded in the case in the spring.

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More than 100,000 people succumbed to overdose deaths in the United States in the span of a year, a record death toll that underscores the continuing failure of the War on Drugs to keep the nation safe.

During the 12-month period ending April 2021, 100,306 Americans died of drug overdoses, according to provisional data released by the U.S. Centers for Disease Control and Prevention on Wednesday. Federal officials point to the coronavirus pandemic and the proliferation of powerful synthetic opioids including fentanyl as major contributors to the spike in overdose deaths over the past two years.

“These are numbers we have never seen before,” Dr. Nora Volkow, director of the National Institute on Drug Abuse, told the New York Times. Commenting on the human toll behind the statistics, Volkow noted that a majority of the deaths occurred among people aged 25 to 55.

“They leave behind friends, family and children, if they have children, so there are a lot of downstream consequences,” Dr. Volkow said. “This is a major challenge to our society.”

Overdose Deaths Add to Covid-19’s Toll

During the same time period, approximately 509,000 died from Covid-19 in the United States, according to figures from Johns Hopkins University, while millions were left isolated due to quarantines and business closures. Volkow noted that the pandemic also led to border shutdowns that made powerful synthetic opioids including fentanyl easier to smuggle into the country than naturally produced but less potent and thus more bulky drugs including morphine and heroin.

“What we’re seeing are the effects of these patterns of crisis and the appearance of more dangerous drugs at much lower prices,” Volkow said to CNN. “In a crisis of this magnitude, those already taking drugs may take higher amounts and those in recovery may relapse. It’s a phenomenon we’ve seen and perhaps could have predicted.”

The new data, representing deaths from May 2020 through April 2021, reflects a 28.5 percent increase in the number of fatal overdoses in the United States compared to the same time period one year earlier and the first time deaths have exceeded 100,000 in one year. Synthetic opioids including fentanyl were up 49 percent over the year before, contributing to the vast majority (64 percent) of overdose deaths. Stimulants including methamphetamines were involved in about a quarter of overdose deaths, a jump of 48 percent over the previous year. The data also show more modest increases in the number of overdose deaths caused by natural opioids, cocaine and prescription medications.

Dr. Volkow said that while some drug users intentionally seek out fentanyl, others “may not have wanted to take it. But that is what is being sold, and the risk of overdose is very high.”

The pandemic also decreased the availability and access to treatment for substance use disorders. As the country reopens and life begins to return to normal, overdose deaths are likely to remain high if access to drug treatment and other interventions is not improved, experts says.

“Even if Covid went away tomorrow, we’d still have a problem. What will have an impact is dramatic improvement to access to treatment,” said Dr. Andrew Kolodny, medical director of opioid policy research at the Brandeis University Heller School for Social Policy and Management.

“These are deaths in people with a preventable, treatable condition. The United States continues to fail on both fronts, both on preventing opioid addiction and treating addiction,” he continued, adding that President Joe Biden should act on his campaign promises to address the continuing opioid crisis.

Access to Treatment Saves Lives

The White House Office of National Drug Control Policy on Wednesday released model legislation to serve as a guideline for states to pass laws that increase access to naloxone, a life-saving drug that can reverse opioid overdoses. Other medications including buprenorphine can be prescribed to help those with opioid use disorder, but access to the drugs is also often limited. In October, the U.S. Department of Health and Human Services issued a plan to combat drug overdoses, including federal support for harm reduction and recovery services and provisions that lessen barriers to substance abuse treatment.

“If we really want to turn the corner, we have to get to a point where treatment for opioid addiction is easier to access than fentanyl, heroin, or prescription opioids are,” Kolodny said.

Beth Connolly, director of the Pew Charitable Trusts substance use prevention and treatment initiative, said that improving access to drug treatment and emergency interventions can help bring down the spike in overdose deaths.

“The evidence is really clear that using medications to treat opioid addiction disorders saves lives,” said Connolly. “As we see more and more evidence that (medication) does save lives, that will hopefully reduce stigmatizing and categorizing in favor of supporting individuals.”

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Volunteer groups in Canada are providing relief to people struggling with addiction by giving away free marijuana and cannabis edibles as a substitution for opioids. Addiction experts, however, are wary that the unproven treatment might prevent people with opioid use disorder from seeking evidence-based therapies that have proven to be effective.

In London, Ontario, volunteers with the Cannabis Substitution Program set up a table outside a church each Tuesday to distribute packages of free cannabis and edibles to people who use drugs. Members of the group maintain that high doses of THC, as much as 100 milligrams baked into an edible, can serve as a substitute for opioids and other dangerous drugs while treating the symptoms of withdrawal. 

Since launching in April, the program has been popular, with up to 200 people showing up each week and forming a line that stretches down the block. Members of the group say that the cannabis it distributes is paid for and donated by private individuals.

Stefan Nichol, outreach director at Impact Church and a supporter of the substitution program, said that while cannabis is not a definitive treatment for opioid addiction and withdrawal, it can provide relief to those trying to break the cycle of drug abuse.

“To be honest, weed will never cure dope sickness,” Nichol told the CBC. “But it does help people sleep through a day of it.”

Cannabis Substitution Program volunteer Mary McCarty said that organizers began holding the weekly events to help address the city’s opioid epidemic after learning of similar initiatives in Vancouver, British Columbia and Halifax, Nova Scotia.

“I thought, ‘You know what? London needs one of these,’” McCarty said. “It’s ridiculous what’s going on.”

In Halifax, volunteers with the East Coast Cannabis Substitution Program put together packages of cannabis to be handed out to people who use drugs every Monday. When CBC News visited the group at the height of the coronavirus pandemic, each package included a roll-your-own joint kit, a cannabis gummy, THC capsules, and edibles including chocolate, cookies and a meatloaf slider.

Volunteer Chris Backer, who travels to the city’s north end each week to hand out the packages, says that he believes the donations can help people quit more dangerous drugs. 

“It’s breaking the cycle of addiction,” he said last year. “Cannabis has been documented to be very successful and is an adjunct to try to help beat addiction.”

Addiction Experts Skeptical of Weed and Edibles as Substitute

Addiction experts including Steven Laviolette, professor in the School of Medicine and Dentistry at Western University in London, however, are skeptical of using cannabis for those struggling with opioid abuse.

“I’m not aware of any evidence to suggest that would be effective as a substitute for opioid-related dependence and addiction,” he said.

But Laviolette acknowledged that cannabis may have a place in treating some forms of addiction. He has conducted research into the use of CBD as a treatment for amphetamine addiction.

“We were able to show that it quite literally blocked the activation of these drugs on the dopamine neurons, so the neurons would stop firing in the presence of CBD,” he said. “That has really strong implications for CBD as an anti-addiction treatment.”

Laviolette noted that researchers in the U.S. are also studying CBD’s potential as a treatment for opioid addiction. But he says that THC may pose a risk to some people with addiction disorders.

“THC has been shown to cause overactivation of addiction pathways in the brain,” he said. “It could make it even worse because THC would be ramping up the brain’s addiction pathways and could potentially make problems like relapse and withdrawal an even greater issue for people suffering with opioid dependence.”

Dr. Samuel Hickcox, the physician lead for addictions medicine at Nova Scotia Health, said that the cannabis substitution programs do not have “high-quality scientific evidence” to support their effectiveness. He fears that people will turn to cannabis instead of medications that have been proven to be an effective treatment for opioid addiction.

“That really worries me because we know that people who have an opioid addiction, if they are on medications like Suboxone or methadone, that their health will improve. They’re much less likely to have fatal overdoses,” he said. “If we take that away from people by offering an unproven alternative, we run the risk of actually causing more harm than benefit.”

McCarty, however, says that she has witnessed how the gifts of cannabis can positively impact those struggling with addiction.

“People come and thank us all the time,” she said.

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