The verdict of a federal jury in Ohio Tuesday held that Walgreens CVS, Walmart and Walgreens contributed to Ohio’s opioid crisis. It could also be used as a benchmark for other cases from coast to coast. It is the first time that a jury has held a pharmacy chain responsible for the opioid epidemic that has plagued America for over a decade.

The lawsuit was filed by Lake and Trumbell Counties of northeastern Ohio. They claimed that more than 100,000,000 opioid pain pills were being distributed in reckless ways in their counties. This led to abuse, death, and a strain upon public services. Trumbull County was home to more than 80,000,000 prescriptions for painkillers between 2012 and 2016. That’s about 400 pills per resident. In Lake County, around 61 million opioid painkillers have been dispensed during the same time period.

“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 Nuisance Public

Plaintiffs attorneys claimed that the actions taken by the pharmacies created a nuisance which cost each county approximately $1 billion. Mark Lanier, an attorney for the counties, stated that pharmacies had failed to properly train employees or implement security systems to stop suspicious orders being fulfilled.

“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.

In original lawsuit, Rite-Aid Pharmacy and Giant Eagle were also listed as plaintiffs. Rite-Aid agreed to settle in August with Trumbull County. Lake County was not informed of the settlement. Giant Eagle reached a settlement late last month. Terms of that agreement have not been disclosed.

Following a six-week trial and a twelve person jury, the case was remanded to the United States District Judge Dan Polster of Cleveland. Adam Zimmerman is a professor of mass litigation at Loyola Law School, Los Angeles. He said the verdict might encourage other pharmacies to resolve their 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.”

Appeal Verdict for Pharmacy Chains

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.

Retail pharmacies don’t have to be the only ones expressing their disapproval of this 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 Chronic News. “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 pointed out, however that different courts that hear opioid cases are not consistent in their decisions and that details regarding public nuisance laws differ from one state to the next. In a case brought in by three California counties and the city of Oakland, an California judge decided in favor of drug producers earlier this month. 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.

It remains to be determined how much Walgreens and CVS will pay Trumbull or Lake Counties. A decision is expected in spring by the judge on any damages.