A BBC investigation revealed a plethora of online pharmacies in the U.K. appear to be selling medication without doctor approval. 

The BBC said they bought over 1,600 prescription-only pills from 20 online pharmacies without general practitioner approval or any scrutiny other than an online questionnaire. The names of the pharmacies were withheld for obvious reasons, but they managed to purchase anti-anxiety medications, painkillers and sleeping pills as easily as one might purchase a sandwich at Subway. 

This problem has been increasing in frequency for years but especially since certain restrictions for online prescribing were eased during the COVID-19 pandemic. This created what Thorrun Govind, a pharmacist, health lawyer and former chair of the Royal Pharmaceutical Society referred to as a “wild west” of online prescribing. 

“The current guidance basically tells pharmacies to be robust, but do that in your own way, and we know that under this current system, patients have died,” Govind said to BBC.

Of the 20 online pharmacies BBC attempted to purchase dangerous medications from:

• Nine were selling a prescription-only anti-anxiety drug BBC chose not to name 

• Three of those nine pharmacies sold that drug to BBC investigators based on their falsely-given answers to an online questionnaire without any further scrutiny

• Nine pharmacies sold them prescription-only painkillers 

• 14 pharmacies sold them prescription-only sleeping medication

The problem isn’t universal across the board for every online pharmacy. According to BBC, a select few of the pharmacies they investigated followed up with them and asked for medical records or contact information for a general practitioner. One of these pharmacies, however, went so far as to send follow-up marketing emails regarding an addictive painkiller telling the investigators they had “something fabulous” in their cart and to “buy before time runs out.”

Govind told BBC that pharmacies are able to get away with this because the language used to write these laws was written too vaguely. To be clear, she’s referring to laws in the U.K., but the same problem also exists in America too and abroad. The laws allow too much interpretation for the individual pharmacies to determine their own ways of verification, which has no doubt allowed unscrupulous pill peddlers to distribute dangerous medications without proper checks.

“This has led to such a variation, with some online pharmacies asking for checks like video consultations, while others seem to let you simply click on the drug you want and go forward to pay,” Govind told BBC. 

This has led to verifiable deaths in people who were able to abuse the online pharmacy system. Katie Corrigan, 38, from St Erth in Cornwall died after developing an addiction to prescription painkillers after she was prescribed them for neck pain. Her doctor opted to cut her off, but she was able to obtain the painkillers as well as an anti-anxiety medication from online pharmacies. Her parents told the BBC that stricter regulations are needed to prevent more deaths. 

“Katie needed help, she didn’t need more medication,” Katie’s mom, Christine Taylor, told BBC. 

Another woman who chose to remain anonymous told BBC she was able to purchase a weight loss drug intended for people about twice her actual weight without any difficulty. 

“After taking it for a few days, I felt really bad – I couldn’t eat, I was exhausted and basically stopped functioning,” the woman told BBC. 

“If I’d had to send a picture, or any proof of my weight, I don’t think I would have been prescribed it.”

The problem is not limited to online pharmacies, either. Something the BBC investigation did not mention was the ease in which people are able to circumvent their country’s pharmaceutical laws by ordering whatever drug they seek from online marketplaces in countries with less regulation or oversight. I personally know at least a couple people who have ordered hundreds if not thousands of Xanax pills and painkillers from websites like IndiaMart. One of them was years before COVID happened too.

It’s definitely sketchy, super illegal, and there’s no way to verify if the pills are real or pressed, so I would recommend avoiding this method like the plague and just getting what you need from a doctor, but if you’re savvy enough to be able to google what different brands of Xanax are called in other countries, and if you’re willing to roll the dice that U.S. Customs won’t look through your package, it’s as easy as shopping on Amazon. Whether you’re driving to Tijuana to buy Mexican Farmapram or ordering through middlemen in the Middle East, patients and dealers seem to find new and improved ways to avoid going through doctors for prescription medication almost daily.

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Federal law enforcement agents sent a warning letter dated Nov. 27 to pharmacies across Georgia, warning them that dispensing and selling cannabis oil is illegal under federal law. The letter arrived a month into Georgia’s medical cannabis program.

Last June, Georgia’s Board of Pharmacy released a set of regulations that enable the state’s independent pharmacies to dispense cannabis oil to eligible patients enrolled in a registry maintained by the state Department of Public Health. Beginning last Oct. 27, Georgia is the first state in the U.S. to permit independent pharmacies to sell low-THC oil. The move made it legal for over 400 independent pharmacies in Georgia to apply for the program and dispense cannabis oil. Over 100 have applied for the program so far.

The Drug Enforcement Administration (DEA) warned them that dispensing THC is illegal because it remains a Schedule I drug. 

“All DEA registrants, including DEA-registered pharmacies, are required to abide by all relevant federal laws and regulations,” reads a letter sent to a Georgia pharmacy by Matthew J. Strait, a DEA deputy assistant administrator in the agency’s Diversion Control Division. “A DEA-registered pharmacy may only dispense controlled substances in Schedules II-V of the Controlled Substances Act. Neither marijuana nor THC can lawfully be possessed, handled, or dispensed by any DEA-registered pharmacy.”

Keep in mind that things could change soon on the federal level: The Department of Health and Human Services (HHS) sent an Aug. 19 letter, recommending to the DEA that cannabis be rescheduled and moved to the Schedule III drug category, making the substance legally accessible through a prescription at the federal level, which would make it legal in Georgia pharmacies. Last October, President Joe Biden requested that the HHS secretary and attorney general conduct a review of the classification of cannabis under federal law, and they did so.

“No one should be in jail just for using or possessing marijuana,” Biden said Oct. 6.

Since Georgia only allows low-THC and CBD cannabis products, it’s unlikely people seeking a high are going to go through its medical program.

Anti-Cannabis Reform Orgs Rejoice

Smart Approaches to Marijuana (SAM) celebrated the blow to medical cannabis patients in a news release, posting the memo on their website. Opponents said Georgia’s program that supplies low-THC cannabis oil to patients “flies in the face of the position of every major medical association.”

NORML explains that Georgia’s low-THC medical cannabis law only allows for cannabis oils containing not more than 5% THC and an amount of CBD equal to or greater than the amount of THC. Today strains of cannabis in other states can exceed 30% THC. And then in Georgia, it has to be stored in a pharmaceutical container labeled by the manufacturer indicating the percentage of THC.

“The Georgia Pharmacy Board’s move to allow the sale of THC oils over the counter in drugstores is a disaster for public health because it implies an FDA endorsement of these dangerous, psychoactive products that can have very serious consequences for users, especially young people,” said SAM President Kevin Sabet. “The DEA’s repudiation of this policy is good news for consumers, and I applaud their affirming the federal government’s position that marijuana is not medicine. 

“As we’ve stated clearly throughout this debate, THC drugs are not medicine and federal law makes clear sales of marijuana and non-prescription THC drugs are illegal.The Board’s decision to allow pharmacies to dispense unregulated THC oils flies in the face of the position of every major medical association, Surgeons General appointed by both parties, the FDA, and the DEA. 

“Unlike with prescription medications, there is no legitimate dosing regimen or other quality control mechanism in place for these drugs. THC oils are often so high in potency that any level of consumption could be dangerous to physical and mental health. Pharmacies found to be violating federal law should be shut down immediately and face the harshest penalties under the law.”

Georgia’s own anti-cannabis reform organization, Georgians for Responsible Marijuana Policy, also responded. 

“I imagine, in the short term, the pharmacies who started dispensing medical marijuana would have to stop or risk a confrontation with the DEA,” Michael Mumper of Georgians for Responsible Marijuana Policy told 11Alive. “You know, there’s always been that tension between marijuana being illegal at the national level, while 38 states have approved it for medical reasons and 24 now for recreational reasons. There was always that tension about where is the federal government going to draw the line. Where Georgia went the furthest is that they were the first state in the country to have pharmacies dispense medical marijuana. And so I think they just pushed the DEA to a certain point.”

But Georgia’s pharmacies supply patients, often who have run out of options.

“We believe that this is an important thing,” Ira Katz of Little Five Points Pharmacy in Atlanta told 11Alive a month ago, “because who better than your independent pharmacist, who knows your history and knows your medical history, is able to best dispense medical marijuana?”

It’s unlikely Georgia pharmacies will be able to continue dispensing cannabis oil as-is.

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Friday, Oct. 27 was a historic day for cannabis in Georgia and throughout the country, as it was the first day that pharmacists were legally allowed to sell cannabis at the pharmacy counter.

Dr. Ankit Patel was the first pharmacist to begin selling cannabis at his pharmacy, Robins Pharmacy. “It’s awesome. It’s historic,” Patel told CNN. “I’ve been following the laws in Georgia about passing it, and I’ve been excited about this possibility for about four years now. When they finally said independent pharmacies will be able to carry it, I filled out the license form immediately. I knew I had to get this.”

So far, Robins Pharmacy (located in the city of Warner Robins) as well as Omega Pharmacy and Allen Pharmacy Group, were among the first to receive a state license for selling low-THC medical cannabis products, which is defined as less than 5% THC. According to People, there are more than 400 independent pharmacies in Georgia that could apply to be a part of the program.

In order to obtain approval from the state, pharmacies must receive an inspection from the Georgia Drugs and Narcotics Agency, where they examine the pharmacy’s security and interview staff about proper product knowledge and handling.

State law dictates that cannabis products must be kept on shelves along with other prescription medicines, according to Allen Pharmacy Group owner Bill Posey. “Just like all other ‘dangerous’ drugs,” Posey said. “Blood pressure medicine is also considered a ‘dangerous’ drug in this circumstance. Everyday we sell drugs that I would consider more dangerous than medical cannabis.”

Posey’s pharmacy began selling cannabis as of Monday, Oct. 30. “We have already had someone calling, wanting to know when they can come in and make a purchase, so I know there’s a need,” Posey said ahead of the starting sale date.

Posey told CNN that cannabis is a useful replacement for opioids, but the state allows a total of 18 conditions that qualify patients for medical cannabis. This includes patients with severe, terminal, or end stage conditions associated with cancer, Amyotrophic lateral sclerosis, seizure disorders or trauma head injuries, multiple sclerosis, Crohn’s disease, mitochondrial disease, Parkinson’s disease, sickle cell disease, Tourette’s syndrome, autism spectrum disorder, epidermolysis bullosa, Alzheimer’s disease, AIDS, peripheral neuropathy, hospice patients, intractable pain, and post-traumatic stress disorder.

Omega Pharmacy owner Dr. Jordan Day told CNN that her pharmacy will begin selling medical cannabis sometime this week. She also spoke about cannabis as a way to wean patients off of opioids. “We’ll be able to show them the products, hopefully give them a little bit of information, find out what they are wanting to use it for,” Day said, adding that medical cannabis could be useful for replacing general pain, sleep, and anxiety medication. “With the pharmacist and the doctor involved, that really is the best thing that the patient could have,” Day said.

Posey also explained that pharmacies like his own are independent, and he’s able to spend more time with patients that he’s served regularly for many years. “We don’t just give people medication and say, ‘OK, you’re done.’ We like to make sure that we always treat everyone who walks in like family,” Posey said.

Patel informed all of his pain patients the benefits of medical cannabis. “Right now, we’re going through an opioid shortage, and I talked to all my pain medicine patients about it, and I let them know that if this is something that they’re interested in, it’s legal in the state of Georgia,” Patel said. “You know, it’s much more natural, [a] less addicting option than opioids.” 

On Oct. 20, one week prior to the official launch date, Georgia Access to Medical Cannabis Oil Commission chair Andrew Turnage said that this will increase accessibility for medical cannabis like never before. “It’s just a 15-to-20-minute drive from where patients are located across the state. That’s going to be so much easier for them to get access,” Turnage said.

Gov. Brian P. Kemp signed House Bill 324, also called “Georgia’s Hope Act,” in April 2019, and it took effect starting in July 2019. “Over the years, I’ve met with children who are battling chronic, debilitating diseases. I’ve heard from parents who are struggling with access and losing hope,” Kemp said in April 2019. “This compromise legislation is carefully crafted to provide access to medical cannabis oil to those in need. This is simply the right thing to do.”

The law directs control of cannabis license regulation, cultivation, production, manufacturing, and sales of low-THC oil to the Georgia Access to Medical Cannabis Commission. In November of 2019, seven members of the commission were appointed. However, it wasn’t until July 2021 when the state revamped its original medical cannabis program and the commission approved six companies to sell cannabis.

Earlier this month, Georgia officials reported that its medical cannabis patient number has been updated and is much less than previously thought. Originally, they believed there were more than 50,000 patients, when in reality there are roughly 14,000, which was due to “anomalies” such as the system not updating when patient cards expired or patients passed away after 2015.

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Built-in structures to incentivize jacking up drug prices in pharmacies, and prey on seniors, could soon be whittled down.

Sens. Maggie Hassan (D-NH) and Bob Menendez (D-N.J.) were among those who voted Wednesday to advance a bipartisan bill she personally helped develop to reduce the rocketing cost of prescription drugs and the way pharmacy managers benefit from rising drug prices. 

The Modernizing and Ensuring PBM Accountability (MEPA) Act, which passed the Finance Committee July 26 on a bipartisan basis, reduces the cost incentive for pharmacy benefit managers (PBMs) to prioritize more expensive drugs because they receive higher payouts for higher priced drugs.

Drugmakers say that the rising rebates they must pay PBMs are forcing them to jack up prescription drug prices. According to a recent analysis, drugmaker rebates to PBMs increased from $39.7 billion in 2012 to $89.5 billion in 2016, partially offsetting list prescription drug price increases. PBMs say, however, that they have been passing along a larger share of the money to insurers.

“Last year, we took on Big Pharma by giving Medicare the ability to negotiate drug prices, and we must continue to stand up to the health care industry and help people afford the medications that they need,” said Senator Hassan. “This bipartisan legislation will ensure that pharmacy benefit managers don’t push people to more expensive drugs just so that they can get a larger payout, saving seniors their hard-earned money while also saving taxpayer dollars.”

HIV drugmaker Gilead Sciences was slammed for its PBM Express Scripts because it jacked up the prices of its lifesaving hepatitis C cures Sovaldi and Harvoni. But Gilead later changed its tune and joined a chorus of drugmakers—turning on PBMs. “I have never met, in this entire experience, a PBM or a payer outside of the Medicaid segment that preferred a price of $50,000 over $75,000 and a rebate back to them,” Jim Meyers, executive VP of worldwide commercial operations for Gilead told Bloomberg in 2017. “We have a system that’s incentivized upon rebate revenue.”

What Would Change Under The Modernizing and Ensuring PBM Accountability Act

The bill would lower prescription drug costs and is estimated to save $1.7 billion in taxpayer dollars. It makes a few adjustments to common PBM practices and transparency requirements under Medicare Part D, which the Senator outlined as follows:

• PBMs often prioritize coverage of more expensive drugs because part of their compensation is calculated through the list prices of drugs. This legislation will break the link between drug prices and how much pharmacy benefit managers are paid, so there is no longer a financial incentive for these companies to push patients to buy more expensive medication.
• This legislation will ban the practice of “spread pricing” in Medicaid, in which pharmacy benefit managers negotiate a lower price with a pharmacy but charge a higher price to the health plan, pocketing the difference.
• The legislation also includes a bipartisan measure that Senator Hassan led to ensure that pharmacy benefit managers report transparently on how they price low-cost generics and biosimilar medications, allowing more visibility into whether people can easily access these generics.

Sen. Menendez (D-N.J.), a senior member of the U.S. Senate Committee on Finance, said the Modernizing and Ensuring PBM Accountability (MEPA) Act includes his own inclusion, the Patients Before Middlemen (PBM) Act, joined by Marsha Blackburn (R-TN), alongside Senate Finance Chairman Ron Wyden (D-OR), Senate Finance Ranking Member Mike Crapo (R-ID), Sen. Jon Tester (D-MN), and Sen. Roger Marshall (R-KS).

“For too long, PBMs have held a vise grip over the prescription drug supply chain—price gouging hardworking families and seniors alike. Through the current incentive structure, whereby they turn a profit as a percentage of the list price of a prescription, PBMs wield their influence to have health insurers cover more and more expensive drugs—even when cheaper options are available,” said Sen. Menendez. “My Patients Before Middlemen Act, which I’ve introduced alongside Senators Blackburn, Wyden, Crapo, Marshall, and Tester, would replace the complicated scheme of opaque rebates and administrative charges with a flat fee—one that is negotiated before entering into a contract. By delinking PBM compensation from drug prices, we help lower prescription drug costs for Medicare Part D beneficiaries and better align incentives in the market. Our bipartisan Patients Before Middlemen (“PBM”) Act would curb the biggest abuses in the PBM industry today.”

Multiple factors impact skyrocketing drug prices—and when it’s a lifesaving drug, people will pay anything. Between 2007 and 2018, the cost of some insulin products increased by over 200%, according to a study published in 2022 in The Lancet. Most famously, “Pharma Bro” Martin Shkreli jacked up the price of lifesaving antiparasitic medication Daraprim, for people with HIV, in 2015 by 4000%. He also allegedly created an elaborate scheme to deny the entry of generic drug competition from getting a piece of the pie.

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Regulators in Georgia have opened the door for medical cannabis patients in the state to have far greater access to treatment. 

The state Board of Pharmacy “has released a set of regulations that will allow Georgia’s independent pharmacies to dispense cannabis oil to eligible patients enrolled in a registry maintained by the state Department of Public Health,” according to Northwest Georgia News.

The outlet reports that state regulators have “granted manufacturing licenses thus far to two companies.” 

“Trulieve Georgia and Botanical Sciences LLC have begun producing cannabis oil and have opened dispensaries in Marietta and Macon, with more to come,” according to the outlet. “Separate from those dispensaries, the 2019 law also authorizes independent pharmacies to sell cannabis oil to eligible patients.”

“This gives an opportunity for virtually every community to have access,” said Andrew Turnage, executive director of the Georgia Access to Medical Cannabis Commission, which oversees the medical cannabis program, as quoted by Northwest Georgia News. 

“They set a pathway for independent pharmacies to apply and subject these pharmacies to inspection and regulation for this medicine,” he added.

Lawmakers in the Peach State first legalized medical cannabis treatment with the passage of Haleigh’s Hope Act in 2015, which granted eligible patients access to low-THC cannabis oil. 

The state General Assembly followed that up with “Georgia’s Hope Act” in 2019, “which authorizes the Georgia Access to Medical Cannabis Commission to oversee the regulated licensing of limited, in-state cultivation, production, manufacturing, and sale of low-THC oil as well as dispensing to registered patients on the state’s Low-THC Oil Registry,” according to the state Access to Medical Cannabis Commission’s official website. 

After Republican Gov. Brian Kemp signed the bill into law that spring, the commission was “administratively attached for budget, procurement, and human resources support…to the Office of the Georgia Secretary of State,” the government website says.

According to the website, patients with the following conditions are eligible for cannabis oil prescriptions: “Cancer, when such diagnosis is end stage or the treatment produces related wasting illness or recalcitrant nausea and vomiting; Amyotrophic lateral sclerosis, when such diagnosis is severe or end stage; Seizure disorders related to diagnosis of epilepsy or trauma related head injuries; Multiple sclerosis, when such diagnosis is severe or end stage; Crohn’s disease; Mitochondrial disease; Parkinson’s disease, when such diagnosis is severe or end stage; Sickle cell disease, when such diagnosis is severe or end stage; Tourette’s syndrome, when such syndrome is diagnosed as severe; Autism spectrum disorder, when (a) patient is 18 years of age or more, or (b) patient is less than 18 years of age and diagnosed with severe autism; Epidermolysis bullosa; Alzheimer’s disease, when such disease is severe or end stage; AIDS when such syndrome is severe or end stage; Peripheral neuropathy, when symptoms are severe or end stage; Patient is in hospice program, either as inpatient or outpatient; Intractable pain; [and] Post-traumatic stress disorder resulting from direct exposure to or witnessing of a trauma for a patient who is at least 18 years of age.”

But the state’s thousands of eligible patients were unable to obtain the cannabis oil until earlier this year, when the first two medical cannabis dispensaries opened for business last month. 

Trulieve, a medical cannabis company, operates both of those dispensaries, which are located in the towns of Macon and Marietta.

“We believe that access to medical cannabis improves lives, and Trulieve is proud to be the first to provide that access to the state of Georgia,” said Trulieve CEO Kim Rivers in a press release at the time of the opening. “We look forward to providing high quality products and an elite experience.”

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In Utah, dispensaries are referred to as pharmacies, and the method of which patients must apply for and obtain cannabis medicine differs. While the state of Utah is home to over three million people, only 15 pharmacies and eight cultivators are allowed to legally operate there.

Pharmacists are essential to the structure of Utah’s medical cannabis program, as they are legally the only way that medical cannabis patients can obtain cannabis products. Beehive Farmacy’s Pharmacist in Charge, Mindy Madeo, has been a pharmacist for over 20 years, but found a new calling to enter the cannabis industry after the state of Utah legalized medical cannabis. Madeo attended the University of Maryland School of Pharmacy’s cannabis program, which she will soon be graduating with a Masters of Science in Medical Cannabis Science and Therapeutics. It’s currently the only pharmacy school in the U.S. to offer such a degree, and furthermore, Madeo is one of the only people in Utah to have earned such a distinction.

Madeo took time to chat with High Times about what sets Utah apart from other states’ medical cannabis programs, the influence of the Church of Jesus Christ of Latter-day Saints (LDS), and what the future holds for patients.

The Essential Pharmacist

When Madeo began her entrance into the cannabis industry, she helped one of the pharmacies, called Wholesome, open up shop. While that pharmacy was a bit more business-focused, Madeo then moved on to Beehive Farmacy where she currently works as Pharmacist in Charge. Beehive Farmacy has two locations out of the total 15 that are allowed statewide, one in Salt Lake City and another in Brigham City. “It’s been really amazing,” Madeo said of her role. “The work I do every day is really like my dream. I’ve been doing it for two years and I still say I would do it even if I wasn’t getting paid.”

Madeo explained how Utah’s medical cannabis program works for patients. Similarly to other states, patients must go to a doctor and obtain a recommendation for a cannabis card—but new patients can’t just go to a pharmacy to pick up their medicine right away. “It is required by law that every single patient that’s new to the cannabis program, has to sit down and have a consultation with the pharmacist. And that’s the unique thing. That’s the thing that no other state does,” Madeo explained. “And it’s expensive to run as a business to do that, but the results are just phenomenal.”

These consultations only take an average of 30 minutes, during which pharmacists like Madeo will ask their patient which medications they currently take. “I’ve noticed as I was doing this that it’s not just the pain pills,” she shared. “It’s stimulants, like the Adderall and Ritalin in the morning that people can come off of. It’s the sleeping pills at night. It’s the antidepressants. It’s the stomach meds. I’ve even had I’ve even had quite a few patients come off of blood pressure medications.” After identifying their patient’s needs, pharmacists recommend various cannabinoid combination products, or different cultivars or terpene profiles, to use as a treatment.

Madeo also notes the importance of teaching new patients how to control their dosage, what to do if they consumed a bit too much, and for regular consumers, how to reset tolerance or reassess their current medication. “So I think giving patients control of their pain, control of their health, where they’re able to increase or decrease or try different products is very empowering for people. And I wish more medicine would be like that.”

The LDS Church

Aside from regular curious customers, Madeo has also witnessed the shift in perspective by the Church of Jesus Christ of Latter-day Saints (LDS) and its members. “In Utah, it’s amazing because the LDS church, at first was not on board. There was a lot of controversy,” she said of the church’s initial stance on cannabis. “And then they changed some policy saying like ‘You can’t have cannabis.’ And then they changed it again and saying ‘It’s fine if it’s with a doctor.’ So currently, it’s 100% fine as long as the doctor recommends it. And I am seeing so many old people, so many people that come in [and] you can tell [that] they’re Mormon, they’re wearing CTR rings. Their minds are changing. And to me, that in itself is just an amazing thing to watch.”

Expanding Legislation in Utah

Utah initially passed its medical cannabis legislation when former Gov. Gary Hubert signed House Bill 195 into law in March 2018, which allows patients the “right to try” cannabis as a treatment if they are terminally ill. Later in November 2018, Utah voters approved Proposition 2, which created the foundation for the state’s current medical cannabis program. The state’s program launched in March 2020, and now there are an estimated 41,000 medical cannabis patients in the state, as of January 2022.

Cannabis isn’t the only medical treatment that legislators are contemplating when it comes to access. In the 2022 legislative session, Utah legislators passed House Bill 167, also called the Mental Illness Psychotherapy Drug Task Force, which will review studies about psychedelic substances being used as a treatment for medical patients. Substances such as psilocybin therapy, or even the use of MDMA, are being used to treat certain medical conditions.

Ultimately, Madeo sees a bright future for the medical patients of Utah, and those who aren’t currently patients but are becoming curious about how cannabis can help. However, there are still many hurdles to overcome. “In Utah, and probably in the whole country is, right now we sit and we differentiate between medical use and recreation[al] use, right? That word ‘recreation’ is a terrible word. We should be calling it ‘adult-use.’ But we still use “rec.” To me, that’s such a judgment call, and I don’t think there’s much of a difference between the two.”

Madeo commented on the judgmental attitude of laws in Utah, from limitations on advertisements or restriction on anything that is Rastafarian inspired, such as colors or designs. “To me, they’re trying to whitewash the plant that we’ve been using forever,” she said.

But this judgement also extends to consumers as well. “We’re somehow like targeting this culture that we think we’re judging them and we’re saying, ‘You have dreadlocks, you are using concentrate … you’re using too high of a dose, so you’re a rec patient.’ That person could have anxiety, they could have cancer. Give me five minutes with someone who you say is rec and I’ll find a medical reason why they’re using it.”

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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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