Walgreens has agreed to pay $230 million to settle a case brought by the city of San Francisco over the opioid crisis.

The settlement, announced Wednesday, comes months after a bank ruling in the case against Walgreens. Attorneys for the city of San Francisco had asked US District Judge Charles Breyer of the Northern District of California for $8.1 billion in damages – an amount that Walgreens called “completely excessive” – ​​but both sides held back initiate a compensation process settlement talks.

Prosecutor David Chiu said at a news conference Wednesday that San Francisco received more than $350 million from opioid defendants including the Walgreens settlement.

“They were more concerned with profit than compliance with their legal obligations,” Chiu said. “There is no amount of money that can bring back the lives we have lost to this epidemic. But the only thing we can do as lawyers is fight for justice and make sure those who do harm are held accountable.”

Other opioid companies that have reached an agreement with the City of San Francisco include manufacturing companies Teva Pharmaceutical Industries Ltd. and Allergan of AbbVie Inc., both of whom walked out of the San Francisco trial for $54 million, and Endo Health Solutions, which paid $10 million in the previous trial.

In a statement, Walgreens denied liability and said there was no fault as against.

“We have not manufactured or marketed opioids, nor have we distributed them to ‘pill factories’ and internet pharmacies,” the statement said. “The comparison allows us to focus on our mission to transform healthcare and the well-being of our patients, customers and communities.”

“Above the Waterline”

Attorneys for the San Francisco Attorney’s Office hired seven outside law firms in the case, including Assistant Trial Attorney Richard Heimann of Lieff Cabraser Heimann & Bernstein in San Francisco; Aelish Baig, San Francisco partner at Robbins Geller Rudman & Dowd; Jayne Conroy from Simmons Hanly Conroy of New York; and Peter Mougey of Levin Papantonio Rafferty Proctor Buchanan O’Brien Barr Mougey in Pensacola, Florida.

“You were the outstanding face of this case,” Lieff Cabraser’s Elizabeth Cabraser said of the outside legal team at Wednesday’s news conference. “We won a litigation victory, the first of its kind, in opioid litigation nationally, and it enabled us to negotiate a settlement that will bring much-needed funds and resources to San Francisco faster and faster than the national settlements.”

Elizabeth Cabraser, Lieff, Cabraser, Heimann & Bernstein (Photo: Jason Doiy/ALM)

Last year, Walgreens agreed to pay around $5 billion to several states and Native American tribes that had opioid lawsuits.

Walgreens is one of several dispensaries targeted for their role in providing excessive amounts of opioids, which are prescription pain relievers, in communities. Breyer, of the Northern County of California, found in his Aug. 10 court ruling that Walgreens had failed federal opioid prescription due diligence requirements for 15 years, leading to illegal drug use in San Francisco.

The lawsuit is one of many for Walgreens. In one of the first landmark lawsuits, a Cleveland jury returned verdicts in 2021 against Walgreens, Walmart and CVS and for two counties in Ohio, Trumbull County and Lake County. Last year, the three pharmacies appealed a $650 million damages claim that, if extrapolated across all opioid cases, would cost them nearly $500 billion in public health costs. The US Circuit Court of Appeals for the Sixth Circuit has not yet scheduled hearings in this case.

Last year, Walgreens settled a case against the state of New Mexico and paid $683 million to settle a lawsuit brought by the state of Florida.

Minnesota: “A Clear Message”

Separately, Attorney General Keith Ellison on Wednesday announced the value of Minnesota’s previously announced settlement with Juul and Altria: $60.5 million.

Minnesota Attorney General Keith Ellison speaks at the University of Miami School of Law. Photo: Jenny Abreu

The settlement, which includes $8.6 million in legal fees and attorney fees, including for outside attorneys Robins Kaplan and Zimmerman Reed, is the largest per capita of any of the 48 states and U.S. territories that make up the Minnesota Attorney General, according to the Minnesota Attorney General have agreed with Juul office. Under the terms of the agreement, both companies will make payments over a period of eight years, starting at $22.75 million over 30 days.

Juul last year paid an estimated $1.7 billion to settle thousands of lawsuits brought by cities, counties, Native American tribes, school districts and states over its electronic cigarettes. Juul also agreed last month to pay $462 million to six states and the District of Columbia.

Altria, which owns a 35% stake in Juul, settled $235 million in a lawsuit against the San Francisco Unified School District this month. The comparison excludes cases from the states of Hawaii, Alaska and New Mexico.

The state of Minnesota began the state’s first trial over Juul’s e-cigarettes on March 28, but settled a confidential sum just before jury deliberations began last month.

“As we did in the Big Tobacco litigation 25 years ago, Minnesotans have again demonstrated their leadership by being the first and so far only state in the country to bring Juul and Altria to justice,” Ellison said. “This settlement, which is the largest of its kind in the country, also sends a clear message: We will not tolerate the marketing of nicotine products to children and adolescents in Minnesota and will hold you accountable if you do so.”

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The overdose-reversal drug, naloxone, should be available as an over-the-counter drug to help the national response to the opioid crisis, U.S. health advisers said Wednesday.

The Food and Drug Administration panel of experts voted 19-0 in favor after a full day of presentations and discussions addressing whether untrained users would be able to use the drug, formulated as a nasal spray, safely and effectively in emergency situations the change.

The positive vote, which is non-binding, came despite concerns from some panel members about the drug’s directions and packaging, which caused confusion among some people in a company study.

The manufacturer, Emergent Biosolutions, said it will revise the packaging and labeling to address these concerns. The FDA will make a final decision on the drug in the coming weeks.

Panel members urged the FDA to act quickly instead of waiting for Emergent to conduct a follow-up study with the easier-to-understand label.

Ninety-one people in the US die from opioid-related overdoses every day, but there is a tool that can reverse the effects of an overdose that more law enforcement and paramedics are carrying as part of their ongoing surgical protocol. It’s called Narcan, and here’s what you need to know about what it is, how it works, and how to use it.

“Given the climate of this crisis and its devastating consequences, there may be a much greater risk of delaying product availability,” said Maria Coyle, a pharmacy professor at Ohio State University who chaired the meeting.

The Narcan pre-filled nasal device is the leading version of the drug in the US, which is also available as an injection. If approved by the FDA, Narcan would be the first opioid treatment to make the regulatory switch to an over-the-counter drug.

The potential move represents the government’s recent effort to increase use of a drug that is a key tool in the fight against the US overdose epidemic, which kills more than 100,000 people annually. The decades-old drug can reverse the effects of an opioid overdose in minutes.

Narcan is already available without a prescription in all 50 states, where state leaders have issued standing orders for pharmacists to sell the drug to anyone who asks for it. But not all pharmacies carry it and those that do have to keep it behind the counter. The stigma attached to opioids can also deter people from asking about the drug.

“We believe that over-the-counter naloxone can help break down these barriers,” said Dr. Jody Green of the FDA, noting that the switch would allow the drug to be sold in vending machines, convenience stores and supermarkets.

Emergent presented results from a study of 70 people to show that people of different ages and backgrounds could quickly and correctly understand how to use the device in an emergency. About a third of the study participants had low reading ability, a group that the FDA says should have been larger.

FDA staffers also warned that a number of participants had difficulty following the directions, in part because of the way the multi-step directions were laid out on two sides of the box, the FDA noted.

“Where’s step one?” asked one participant, according to interview transcripts from the study provided by the FDA.

Emergent said it plans to move all directions to a single panel and add pictograms, per the FDA’s proposal.

Government officials are hoping that moving naloxone beyond the pharmacy counter will boost sales, with the potential to reduce costs. Currently, the drug can cost $50 for a two-pack if not covered by insurance.

Community advocates and organizations that support distribution of the drug welcomed the possible approval of an over-the-counter version.

“It’s going to have a tremendous impact on how people view the drug,” said Sheila Vakharia, associate director of research and academic engagement at the Drug Policy Alliance. “It will help destigmatize it and show people that it’s safe and easy to use.”

But Maya Doe-Simkins, a co-director of Remedy Alliance/For The People, worried that an over-the-counter version of narcan could also lead to a perception that it’s better than other forms of naloxone.

“We’re concerned that companies that have over-the-counter products may misrepresent injectable products,” said Doe-Simkins, who has long advocated for an over-the-counter version.

In the 1990s, death rates in the United States from painkillers began to rise steadily. Waves of death followed, led by other opioids such as heroin and, most recently, illicit fentanyl. Nearly 107,000 Americans died from a drug overdose in 2021, an all-time high, although recent data suggest deaths could be plateauing.

Based in Gaithersburg, Maryland, Emergent Biosolutions makes most of its money from medical products purchased by the federal government for the Strategic National Stockpile, including anthrax drugs and vaccines.

In 2021, the company caught public attention for its disastrous handling of COVID-19 vaccine production for Johnson & Johnson and AstraZeneca. Contamination problems at the company’s Baltimore facility eventually forced drugmakers to scrap the equivalent of hundreds of millions of vaccine doses.

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Associated Press writer Geoff Mulvihill of Cherry Hill, New Jersey contributed to this story.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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“I say this as a very strong supporter of safe injection sites: [The veto] can’t be used as a reason to not do everything that we possibly can right now,” he said.

“Some of my colleagues have said [safe injection sites are] not going to solve the problem, that we need to stop these drugs, we need to stop the drug dealing, we need to get people into treatment,” he added. “And what I said to them about that is, ‘Yes, yes and yes. So we had a small setback around the safe injection sites, but we need the yes, yes and yes to everything else in the meantime.”

Haney should expect the committee’s GOP lawmakers to push some of those other conversations, said Assemblymember Laurie Davies, a Republican who represents southern Orange County. She successfully pushed legislation this year that will make it easier to distribute fentanyl tests, which allow people to detect the presence of the deadly opioid in other drugs.

“There’s a lot of other things that we need to work on. But I’m just grateful that eyes are opening and they realize this is a crisis and we can do something to stop it,” she said, adding that one part of the conversation needs to be around prosecuting people who sell deadly fentanyl.

“This isn’t just an inner-city problem. It’s affecting every parent, it’s affecting every race and every color,” Davies said. “We’re losing men, women, children, no matter what the races, what their religion is, what their party affiliation is. This is something that affects every single Californian.”

One of those Californians who has been devastated by the impact of opioids is San Francisco resident Amy Cooper. She lost her son, John, to an overdose in 2014 — and then watched the dentist who had prescribed him the drugs without ever meeting him get acquitted at trial.

Cooper said since John’s death, she’s dedicated herself to advocating for solutions and educating people about the fentanyl problem. She said lawmakers need to focus on both education and accountability, including holding both doctors and pharmaceutical companies responsible.

“I can just tell you, 100%, we were uneducated and unaware. We had no idea that this was happening and that it was happening for our son. And then the results are just catastrophic,” she said.

Another aspect of the crisis that some hope to shed light on is the number of young people mistakenly buying drugs — often online — that turn out to be fentanyl. Lee Trope, a pediatric doctor at Santa Clara Valley Medical Center, said many of her patients seem to be experimenting with different substances and wind up becoming addicted to fentanyl or overdosing on it.

“They don’t realize what they’re buying, oftentimes on apps like Snapchat,” she said. “They think what they’re buying — they all call it ‘percs’ — they think they’re buying Percocet, which is a … less-potent opioid. And it’s pure fentanyl.”

Jayme Congdon, a pediatrician and researcher at UC San Francisco, said the new select committee will be raising awareness as it does its work — and she also believes shedding light on the issue is the first step toward change.

Congdon said 250 teens are dying in California each year from opioids. That’s seven times the number of pediatric COVID-19 deaths the state has witnessed.

“Because substance use and addiction are stigmatized issues, it’s just one of these topics that I think, you know, people think it’s not going to affect them or their families until it does,” she said. “We’re so pleased to see Assemblymember Haney is taking the lead on this issue so this crisis is hopefully going to start getting the attention that is warranted.”

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The opioid epidemic has been linked to more than 500,000 deaths in the US over the past two decades, counting those from prescription painkillers such as OxyContin and generic oxycodone as well as illicit drugs such as heroin and illegally produced fentanyl.

The surge in deaths has led to more than 3,000 lawsuits filed by state and local governments, Native American tribes, unions, hospitals and other entities in state and federal courts over the toll of opioids. In San Francisco, Mayor London Breed declared a state of emergency last year in the Tenderloin neighborhood, saying something had to be done about the high concentration of drug dealers and people consuming drugs in public.

The city attorney’s office says San Francisco saw a nearly 500% increase in opioid-related overdose deaths between 2015 and 2020 and that on a typical day, roughly a quarter of visits at the Zuckerberg San Francisco General Hospital Emergency Department are opioid-related.

In 2020, 712 people died of drug overdoses, compared with 257 people who died of COVID-19, according to the city health department.

A high percentage of an estimated 7,800 homeless people in San Francisco — many of whom pitch tents in the Tenderloin — are struggling with chronic addiction or severe mental illness, often both. Some people rant in the streets, nude and in need of medical help.

Pharmacy chains have been south less often than opioid makers or wholesalers that distribute pharmaceuticals more broadly. In one groundbreaking case, a federal jury in Ohio last year found CVS, Walgreens and Walmart recklessly distributed massive amounts of pain pills in two Ohio counties.

In May, Walgreens reached a $683 million settlement with the state of Florida in a lawsuit accusing the company of improperly dispensing millions of painkillers that contributed to the opioid crisis. Walgreens did not admit wrongdoing in its agreement with Florida and will make payments to the state over 18 years.

The company also faces litigation in Alabama, Michigan and New Mexico, among other states.

Deerfield, Illinois-based Walgreens Boots Alliance Inc. runs a network of around 9,000 drugstores in the United States. Walgreens and other prescription drug distributors have faced a slew of lawsuits over the opioid crisis.

This article was first published in the Associated Press, with contributions from Associated Press writer Tom Murphy in Indianapolis.

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The federal trial will examine the role of opioid manufacturers Allergan and Teva, distributor Anda, and Walgreens pharmacy in fueling the opioid epidemic in the City and County of san francisco

SAN FRANCISCO, April 25, 2022 /PRNewswire/ — Today, trial begins with the People of the State of Californiaacting by and through san francisco City Attorney David Chiu, against opioid manufacturers Allergan and Teva, distributor Anda, and Walgreens pharmacy. The bench trial will take place before the US District Court for the Northern District of California with Judge Charles R Breyer presiding

Brought on behalf of the people of the State of California, the lawsuit alleges that opioid manufacturers Allergan and Teva engaged in deceptive marketing practices that misrepresented the dangers of their pills and that all defendants, including Anda and Walgreens, failed to identify, divert, and report suspicious orders as required by law. Walgreens pharmacy is also accused of over-dispensing opioids without proper due diligence against fraud and diversion.

The people allege that these corporate practices fueled a widespread surge of opioid-related addiction and overdose in san francisco, thereby creating an ongoing public nuisance in the region. From 2006 to 2014, San Francisco County saw 163,645,704 opioids distributed, enough for 22 pills per person per year. Between 2015 and 2020, san francisco saw a 478% increase in opioid-related overdose deaths, and in a typical day at the Zuckerberg San Francisco General Hospital (ZSFG) Emergency Department, approximately 25 percent of visits are opioid-related. The lawsuit seeks funds to abate the public nuisance, as well as injunctive relief and civil penalties to repair the damage caused from the opioid epidemic and prevent such practices in the future.

“This trial will give voice to the tragic experiences and ongoing needs of our community on the front lines of the opioid epidemic,” said san francisco City Attorney David Chiu. “For too long, the people of san francisco have had to shoulder the burden of the opioid epidemic. It’s time for these companies to pay for the crisis they created. We look forward to presenting our case and securing the funds we need to heal.”

This trial is the fourth bellwether case in the federal opioid litigation proceeding involving more than 3,000 American cities, towns, and counties, bringing opioid manufacturers, distributors, and pharmacy chains to court for fueling the opioid epidemic. This case will serve as a test trial to help reach resolutions and seek accountability for the destruction these companies caused. for san francisco and communities around the country decimated by the opioid epidemic, litigation is a vital tool to secure the resources they need now to implement specific programs required at the local level and sustain the costly, decades-long recovery process ahead.

In a joint statement, National Prescription Opiate Litigation MDL Plaintiffs’ Executive Committee co-leads Paul T Farrell Jr of Farrell & Fuller Law LLC, Jayne Conroy of Simmons Hanley Conroyand joe rice of Motley Rice LLC, said:

“The manufacturers’ false marketing campaigns and Walgreens’ failure to report and prevent suspicious opioid orders has led to an unprecedented, unyielding public health crisis in san francisco and across the United States. The federal opioid litigation exists to facilitate the long overdue process of corporate accountability we have seen occur in courts across the country over the past several months. We look forward to seeing the same process unfold in san francisco in the days to come. This trial serves as an opportunity to provide financial relief to support local recovery efforts while shedding light on the defendants’ concerted efforts to sidestep their obligations under law.”

This trial follows a jury verdict from November 23, 2021 in the federal trial in the Northern District of Ohio that found CVS, Walgreens, and Walmart liable for fueling the opioid crisis in Lake County other Trumbull County of Ohio. A judge will determine the value of the opioid epidemic abatement funds owed by pharmacy chains to these communities in May of 2022.

The general public and members of the media can find information about how to listen to the proceedings here.

The case is City and County of san francisco, et al., v. Purdue Pharma LP, et al., Defendants (Case No. 3:18-cv-07591-CRB).

Contact: [email protected]

SOURCE National Prescription Opiate Litigation

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The San Francisco Chronicle says the city “wants to hold the prescription drug industry responsible” for the opioid crisis, with companies like Walgreens allegedly trivializing the risk of long-term use to customers. Also: the military fuel leak in Hawaii, efforts to block Alabama’s anti-trans law, and more.

San Francisco Chronicle: San Francisco Wants To Hold The Prescription Drug Industry Responsible For The Opioid Crisis. Here Are 3 Ways The Trial Underway Is Unique

With billions of dollars at stake, San Francisco opened a federal court trial Monday against Walgreens pharmacy and three companies that manufacture or distribute opioids. The companies regularly “overstated the benefits and trivialized the risks of the long-term use of opioids” to their customers, City Attorney David Chiu’s office said in a filing with US District Judge Charles Breyer of San Francisco, who is presiding over the non- jury trial. (Egelko, 4/25)

In other health news from across the US —

AP: US Military Drops Appeal Of Hawaii Order To Drain Fuel Tanks

The US government on Friday dropped its appeals of a Hawaii order requiring it to remove fuel from a massive military fuel storage facility that leaked petroleum into the Navy’s water system at Pearl Harbor last year. Attorneys for the US Department of Defense notified the state and federal courts of its decision. The move comes more than a month after Defense Secretary Lloyd Austin said the military would permanently shut down the tanks and drain all of their fuel. (McAvoy, 4/24)

AP: Hearing Set In Effort To Block Alabama Transgender Law

A federal judge will hear arguments next month on whether to block enforcement of an Alabama law outlawing the use of gender-affirming medications to treat transgender people under age 19. The May 5 hearing is scheduled just days before the law is set to take effect on May 8. US District Judge Liles Burke set the evidentiary hearing, scheduled to last up to two days, on a request for a temporary restraining order or preliminary injunction to stop Alabama officials from enforcing the law while a court challenge goes forward. (4/25)

Philadelphia Inquirer: Advocates For The Elderly Want State Regulators To Take A Harder Look At Nursing Home Sales

In the most complete revision of its nursing home rules in at least 25 years, the Pennsylvania Department of Health last month proposed new regulations that would require more scrutiny of homes’ prospective owners. For the first time, regulators would analyze the financial strength and past performance of owners — including individuals, not just legal entities — and related companies that seek to take over nursing homes in the state. Historically, officials have effectively rubber-stamped license applications, critics said. (Brubaker, 4/26)

Detroit Free Press: Michigan Schools Missing Students’ Signs Of Dyslexia

In the first grade, Lynn Gaskell’s daughter was behind in reading. When Rileigh, now 13, tried to read aloud, she added extra syllables to words and stumbled through pages. Rileigh’s school evaluated her and came back to her parents with a recommendation: Evaluate Rileigh for ADHD, which Rileigh did have. Her reading problems persisted all through elementary school, landing her extra time with reading teachers with little progress. Gaskell brought up dyslexia, but she said school officials brushed her off. “Not one single person approached me about dyslexia, not one time,” Gaskell said. (Altavena, 4/25)

Anchorage Daily News: Private Donors Put $7M Toward Anchorage’s Homelessness Plan

A group of private organizations is donating $7 million toward Anchorage’s plan to fast-track several homelessness services projects as part of an effort to close the city’s pandemic-era emergency mass care operations by June 30. The Anchorage Assembly has already allocated $6 million toward the projects, bringing the total so far to $13 million. Private donors include the Alaska Mental Health Trust Authority, Calista Corp., Chugach Alaska Corp., Doyon Ltd., Premera Blue Cross Blue Shield of Alaska, Providence Alaska, the Rasmuson Foundation and Weidner Apartment Homes. (Goodykoontz, 4/25)

AP: Indiana Town South By Government, Didn’t Hire Man With HIV

The federal government is accusing a southern Indiana town of discriminating against a man with HIV who applied to become a police officer. The Justice Department said it filed a lawsuit Monday against Clarksville, Indiana. Clarksville police had offered a job to a man who was already working as a volunteer reserve officer but then dropped the offer in 2015 based on his HIV status, the Justice Department said. (4/26)

KHN: Shopping For Space, Health Systems Make Over Malls

The hulking Hickory Hollow Mall — a full 1.1 million square feet of retail space in southeastern Nashville — was once the largest shopping center in Tennessee. But like many malls, it’s been in a downward death spiral for more than a decade. Now the mammoth complex surrounded by acres of parking is on track to join the ranks of malls making a transition into a booming economic sector: medicine. Vanderbilt University Medical Center has had such success reviving a different mall that its health system, Vanderbilt Health, plans to add medical clinics at the former Hickory Hollow Mall, rebranded a decade ago as the Global Mall at the Crossings. (Farmers, 4/26)

KHN: Tech Titans Want The Richest Californians To Pay For Pandemic Preparedness

Gabe Bankman-Fried, a former Wall Street trader, has raised $12 million from a cryptocurrency trading firm founded by his brother, Sam Bankman-Fried. Dustin Moskovitz, a billionaire who roomed with Mark Zuckerberg in college and helped found Facebook in 2004, funds a nonprofit with his wife that has ponied up $6.5 million. And Max Henderson, a startup investor and former Google executive, is using that money to spearhead, a campaign for a statewide ballot initiative that would tax California’s wealthiest residents and fund public health initiatives, with the ambitious goal of preventing another pandemic from ripping across the country . (Hard, 4/26)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

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